Consensus recommendations for paediatric airway topicalisation using lidocaine

INTRODUCTION: Lidocaine is commonly used to provide airway topicalisation in children. However, there is a paucity of evidence and no guidance available on safe dosing practices. METHODS: An international expert multidisciplinary, multi-society working group conducted a systematic review of the literature, followed by a three-round Delphi process to produce consensus recommendations. These recommendations aim to improve the safety of children having their airways topicalised with lidocaine. RESULTS: The systematic review identified 26 articles, with 21 recommendations agreed across five domains of practice: dosing; recovery; adverse reactions; institutional responsibilities; and learning from events. Evidence was limited and mainly grades C and D but the strength of the recommendations, based on the expert consensus, was mainly moderate (65-79% consensus) and strong (≥ 80% consensus). DISCUSSION: It is hoped these consensus recommendations will promote safe practice when lidocaine is used for airway topicalisation in children.