Before intubation in pediatric patients, which intervention helps blunt the rise in intracranial pressure?

• A. Administer Succinylcholine Before Intubation
• B. Give Lidocaine prior to intubation to blunt increase in ICP
• C. Delay intubation to allow ICP to normalize
• D. Use High-Dose Fentanyl Alone

Answer: (B)

During airway management, laryngoscopy can trigger a sympathetic surge that raises blood pressure and cerebral blood flow, leading to a transient increase in intracranial pressure. Administering lidocaine intravenously just before intubation dampens that reflex response, preventing or reducing the spike in ICP and helping protect cerebral perfusion during the procedure. In children, a typical approach is IV lidocaine about 1 mg/kg given shortly before laryngoscopy.

Succinylcholine before intubation can transiently raise ICP due to fasciculations and other reflex effects, delaying intubation to let ICP normalize isn’t appropriate when airway protection is needed, and high-dose fentanyl alone carries risks like respiratory depression and hypotension without addressing the immediate ICP rise as directly.