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Xu J, Sun P, Ma JH, Wang DX. Multimodal prevention of emergence cough following nasal endoscopic surgery under general anesthesia: a double-blind randomized trial. Front Med (Lausanne) 2024; 11:1288978. [PMID: 38327707 PMCID: PMC10847355 DOI: 10.3389/fmed.2024.1288978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
Purpose Cough during emergence from anesthesia is a common problem and may cause adverse events. Monotherapy faces uncertainty in preventing emergence cough due to individual differences. We aimed to evaluate the efficacy and safety of multimodal intervention for preventing emergence cough in patients following nasal endoscopic surgery. Methods In this double-blind randomized trial, 150 adult patients undergoing nasal endoscopic surgery were randomly allocated into three groups. For the control group (n = 50), anesthesia was performed according to clinical routine, no intervention was provided. For the double intervention group (n = 50), normal saline 3 mL was sprayed endotracheally before intubation, 0.4 μg/kg dexmedetomidine was infused over 10 min after intubation, and target-controlled remifentanil infusion was maintained at an effect-site concentration of 1.5 ng/mL before extubation after surgery. For the multimodal intervention group (n = 50), 0.5% ropivacaine 3 mL was sprayed endotracheally before intubation, dexmedetomidine and remifentanil were administered as those in the double intervention group. The primary endpoint was the incidence of emergence cough, defined as single cough or more from end of surgery to 5 min after extubation. Results The incidences of emergence cough were 98% (49/50) in the control group, 90% (45/50) in the double group, and 70% (35/50) in the multimodal group, respectively. The incidence was significantly lower in the multimodal group than those in the control (relative risk 0.71; 95% CI 0.59 to 0.86; p < 0.001) and double (relative risk 0.78; 95% CI 0.63 to 0.95; p = 0.012) groups; the difference between the double and control groups was not statistically significant (relative risk 0.92; 95% CI 0.83 to 1.02; p = 0.20). The severity of sore throat was significantly lower in the multimodal group than that in the control group (median difference-1; 95% CI -2 to 0; p = 0.016). Adverse events did not differ among the three groups. Conclusion For adult patients undergoing endonasal surgery, multimodal intervention including ropivacaine topical anesthesia before intubation, dexmedetomidine administration after intubation, and remifentanil infusion before extubation after surgery significantly reduced emergence cough and was safe.
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Affiliation(s)
- Jing Xu
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Pei Sun
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Jia-Hui Ma
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
- Outcomes Research Consortium, Cleveland, OH, United States
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Ozden MG, Bakan N, Kocoglu H. The effect of extubation in prone position on emergence and recovery in lumbar spinal surgery. J Neurosurg Sci 2023; 67:185-190. [PMID: 32536118 DOI: 10.23736/s0390-5616.20.05007-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Extubation of patients in supine position after prone operations may lead to unwanted effects on hemodynamic and respiratory parameters during emergence and recovery period. We aimed to observe the effects of prone position on emergence and recovery periods after prone surgery. METHODS This randomized controlled trial was studied with sixty patients extubated either in prone position (30 patients) or in supine position (30 patients) after lumbar spinal surgery in tertiary educational hospitals. Heart rate, non-invasive arterial blood pressure, peripheral oxygen saturation and Bispectral Index values were measured, and recorded in all patients during operation, at the time an anesthetic agent was discontinued, before and after extubation. The number of the mouth suctioning, Aldrete recovery score, and Ricker agitation score were recorded together with the severity of cough during emergence and recovery. Incidents such as nausea, vomiting, respiratory failure, uncontrolled airway, and decreased saturation were also recorded. RESULTS Heart rate and mean arterial pressure values were significantly lower in the prone group during emergence and recovery period compared with the supine group (P<0.05). Aldrete Recovery Scores were higher in the prone group (P<0.001). The number of the mouth suctioning and the cough severity were lower in the prone group (P<0.001). CONCLUSIONS Extubation in the prone position provides a more comfortable emergence and recovery periods by less altering the hemodynamic and respiratory status with better recovery profile.
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Affiliation(s)
- Mesure G Ozden
- Anesthesiology and Reanimation Clinic, Goztepe Education and Research Hospital, Istanbul Medeniyet University, Istanbul, Türkiye -
| | - Nurten Bakan
- Anesthesiology and Reanimation Clinic, Sancaktepe Education and Research Hospital, Sancaktepe, Türkiye
| | - Hasan Kocoglu
- Anesthesiology and Reanimation Clinic, Goztepe Education and Research Hospital, Istanbul Medeniyet University, Istanbul, Türkiye
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Wasinwong W, Thongkhachok S, Kitsiripant C, Nimmaanrat S, Suwannachot A, Thinkan N. Comparison of 40 and 100 mg of laryngotracheal lidocaine instillation to prevent cough during emergence from general anesthesia: A randomized controlled trial. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2023. [DOI: 10.1016/j.tacc.2023.101235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Afonso AM, McCormick PJ, Assel MJ, Rieth E, Barnett K, Tokita HK, Masson G, Laudone V, Simon BA, Twersky RS. Enhanced Recovery Programs in an Ambulatory Surgical Oncology Center. Anesth Analg 2021; 133:1391-1401. [PMID: 34784326 PMCID: PMC8568332 DOI: 10.1213/ane.0000000000005356] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND We describe the implementation of enhanced recovery after surgery (ERAS) programs designed to minimize postoperative nausea and vomiting (PONV) and pain and reduce opioid use in patients undergoing selected procedures at an ambulatory cancer surgery center. Key components of the ERAS included preoperative patient education regarding the postoperative course, liberal preoperative hydration, standardized PONV prophylaxis, appropriate intraoperative fluid management, and multimodal analgesia at all stages. METHODS We retrospectively reviewed data on patients who underwent mastectomy with or without immediate reconstruction, minimally invasive hysterectomy, thyroidectomy, or minimally invasive prostatectomy from the opening of our institution on January 2016 to December 2018. Data collected included use of total intravenous anesthesia (TIVA), rate of PONV rescue, time to first oral opioid, and total intraoperative and postoperative opioid consumption. Compliance with ERAS elements was determined for each service. Quality outcomes included time to first ambulation, postoperative length of stay (LOS), rate of reoperation, rate of transfer to acute care hospital, 30-day readmission, and urgent care visits ≤30 days. RESULTS We analyzed 6781 ambulatory surgery cases (2965 mastectomies, 1099 hysterectomies, 680 thyroidectomies, and 1976 prostatectomies). PONV rescue decreased most appreciably for mastectomy (28% decrease; 95% confidence interval [CI], -36 to -22). TIVA use increased for both mastectomies (28%; 95% CI, 20-40) and hysterectomies (58%; 95% CI, 46-76). Total intraoperative opioid administration decreased over time across all procedures. Time to first oral opioid decreased for all surgeries; decreases ranged from 0.96 hours (95% CI, 2.1-1.4) for thyroidectomies to 3.3 hours (95% CI, 4.5 to -1.7) for hysterectomies. Total postoperative opioid consumption did not change by a clinically meaningful degree for any surgery. Compliance with ERAS measures was generally high but varied among surgeries. CONCLUSIONS This quality improvement study demonstrates the feasibility of implementing ERAS at an ambulatory surgery center. However, the study did not include either a concurrent or preintervention control so that further studies are needed to assess whether there is an association between implementation of ERAS components and improvements in outcomes. Nevertheless, we provide benchmarking data on postoperative outcomes during the first 3 years of ERAS implementation. Our findings reflect progressive improvement achieved through continuous feedback and education of staff.
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Affiliation(s)
- Anoushka M. Afonso
- From the Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - Patrick J. McCormick
- From the Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | | | - Elizabeth Rieth
- From the Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - Kara Barnett
- From the Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - Hanae K. Tokita
- From the Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Geema Masson
- From the Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vincent Laudone
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Brett A. Simon
- From the Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - Rebecca S. Twersky
- From the Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
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Hasanein R, El-Sayed W. The effect of nebulized lidocaine hydrochloride on emergence from sevoflurane anesthesia in children undergoing Tonsillectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2013.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Superior laryngeal nerve block as an adjuvant to General Anesthesia during endoscopic laryngeal surgeries. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2015.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hu S, Li Y, Wang S, Xu S, Ju X, Ma L. Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgery. BMC Anesthesiol 2019; 19:66. [PMID: 31054568 PMCID: PMC6500031 DOI: 10.1186/s12871-019-0739-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/18/2019] [Indexed: 12/27/2022] Open
Abstract
Background Intravenous lidocaine and dexmedetomidine treatments have been proposed as methods for inhibiting cough. We compared the efficacy of intravenous lidocaine and dexmedetomidine treatments on inhibiting cough during the tracheal extubation period after thyroid surgery. Methods One hundred eighty patients undergoing thyroid surgeries were randomly allocated to the LIDO group (received lidocaine 1.5 mg/kg loading, 1.5 mg/kg/h infusion), the DEX group (received dexmedetomidine 0.5 μg/kg loading, 0.4 μg/kg/h infusion) and the CON group (received saline), with 60 cases in each group. The primary outcomes of cough were recorded. Secondary outcomes included hemodynamic variables, awareness time, volume of drainage, the postoperative visual analogue scale and adverse effects were recorded. Results The incidence of cough were significantly lower in the LIDO group (28.3%) and the DEX group (31.7%) than that in the CON group (66.7%) (P = 0.000). Additionally, both moderate and severe cough were significantly lower in the LIDO group (13.3%) and the DEX group (13.4%) than these in the CON group (43.4%) (P < 0.05). Compared with the two treatment groups, both mean arterial blood pressure and heart rate were significantly increased in the CON group during tracheal extubation (P < 0.05). Compared with the CON group, the volume of drainage was significantly reduced in the two treatment groups within 48 h after surgery (P < 0.05). compared with the CON group, the postoperative visual analogue scale was significantly lower in groups LIDO and DEX after surgery(P < 0.05). Compared with the LIDO group and the CON group, the time to awareness was longer in the DEX group (P < 0.05). In the DEX group, bradycardia was noted in 35 patients, while no bradycardia was noted in LIDO group and CON group. Conclusion Compared with intravenous infusions of normal saline, both lidocaine and dexmedetomidine had equal effectiveness in attenuating cough and hemodynamic changes during the tracheal extubation period after thyroid surgery, and both of these treatments were able to reduce the volume of postoperative bleeding and provide better analgesic effect after surgery. But intravenous infusions of dexmedetomidine resulted in bradycardia and delayed the time to awareness when compared with lidocaine and normal saline. Trial registration ChiCTR1800017482. (Prospective registered). Initial registration date was 01/08/2018.
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Affiliation(s)
- Shenghong Hu
- Department of Anesthesiology, The First Affiliated Hospital, Anhui Medical University, Hefei, 230022, China.,Department of Anesthesiology, The Anqing Affiliated Hospital, Anhui Medical University, Anqing, 246003, China
| | - Yuanhai Li
- Department of Anesthesiology, The First Affiliated Hospital, Anhui Medical University, Hefei, 230022, China.
| | - Shengbin Wang
- Department of Anesthesiology, The Anqing Affiliated Hospital, Anhui Medical University, Anqing, 246003, China
| | - Siqi Xu
- Department of Anesthesiology, The Anqing Affiliated Hospital, Anhui Medical University, Anqing, 246003, China
| | - Xia Ju
- Department of Anesthesiology, The Anqing Affiliated Hospital, Anhui Medical University, Anqing, 246003, China
| | - Li Ma
- Department of Thyroid and Breast Surgery, The Anqing Affiliated Hospital, Anhui Medical University, Anqing, 246003, China
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Hong SM, Ji SM, Lee JG, Kwon MA, Park JH, Kim S, Lee GW. The effect of endotracheal 1% lidocaine administration to reduce emergence phenomenon after general anesthesia. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.2.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sung-Man Hong
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Sung-Mi Ji
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Jeong-Gug Lee
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Min-A Kwon
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Jeong-Heon Park
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Seokkon Kim
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Gwan-Woo Lee
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
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Roberts MH, Gildersleve CD. Lignocaine topicalization of the pediatric airway. Paediatr Anaesth 2016; 26:337-44. [PMID: 26919822 DOI: 10.1111/pan.12868] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 11/28/2022]
Abstract
The application of topical laryngeal lignocaine is a technique used frequently in pediatric anesthesia. It is often used to facilitate open airway procedures, tracheal intubation, or to reduce the incidence of perioperative adverse respiratory events such as coughing and laryngospasm. A number of studies have shown that applying topical lignocaine to the larynx reduces perioperative respiratory adverse events, while others have shown an increased incidence of respiratory complications with lignocaine administration. There is a lack of evidence on the effect of topical lignocaine on the sensitivity of upper airway reflexes and swallowing, the duration of time that airway reflexes are obtunded, and the optimum and safe maximum dose of lignocaine when used by this route. We review the current literature relating to the use of lignocaine to topicalize the pediatric airway. This review concentrates on the indications for use, the maximum safe dose, the effect on swallowing, and risk of aspiration and the complications of the technique.
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Affiliation(s)
- Mari H Roberts
- Department of Anaesthesia, University Hospital of Wales, Cardiff, UK
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10
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Tan PY, Poopalalingam R. Anaesthetic Concerns for Functional Endoscopic Sinus Surgery. PROCEEDINGS OF SINGAPORE HEALTHCARE 2014. [DOI: 10.1177/201010581402300310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Functional endoscopic sinus surgery (FESS) is the primary approach used today for the surgical treatment of chronic sinusitis. The aim of our review is to look at the increasing body of literature highlighting the various anaesthetic techniques that can be employed in the optimisation of surgical conditions and safety of a surgical procedure with significant potential risk.
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Affiliation(s)
- Pei Yu Tan
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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Meng YF, Cui GX, Gao W, Li ZW. Local airway anesthesia attenuates hemodynamic responses to intubation and extubation in hypertensive surgical patients. Med Sci Monit 2014; 20:1518-24. [PMID: 25175842 PMCID: PMC4156342 DOI: 10.12659/msm.890703] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effects of topical ropivacaine anesthesia on hemodynamic responses during intubation and extubation of hypertensive patients. MATERIAL AND METHODS One hundred fifty patients with hypertension ASA II-III were scheduled for noncardiac operations. Patients were divided into 3 groups: a control group receiving 5 ml saline, and 2 groups receiving topical anesthesia with 100 mg lidocaine or 37.5 mg ropivacaine. Hemodynamic responses, including blood pressure and heart rate (HR), were recorded at baseline (T0), before intubation (T1), during tracheal intubation (T2), 2 min after intubation (T3), upon eye opening on verbal commands (T4), during tracheal extubation (T5), and 2 min after extubation (T6). Patients were injected with urapidil 5 mg during intubation and extubation if their systolic blood pressure (SBP) was ≥160 mmHg or diastolic blood pressure (DBP) was ³90 mmHg, and esmolol 10 mg when HR was ≥90 bpm. RESULTS During extubation, the total dosages of urapidil and esmolol were significantly higher in the saline than in the lidocaine or ropivacaine groups, and were significantly lower in the ropivacaine than in the lidocaine group. At T2, SBP, SBP, MAP, and HR were lower in the lidocaine and ropivacaine groups than in the saline group, but the differences were not significant. From T4 to T6, SBP, DBP, MAP, and HR were significantly lower in the ropivacaine group than in the other 2 groups (P<0.05 each). CONCLUSIONS Topical lidocaine and ropivacaine anesthesia can effectively reduce hemodynamic responses during intubation, with ropivacaine better at inhibiting hemodynamic changes at emergence in hypertensive patients.
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Affiliation(s)
- You-Fan Meng
- Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China (mainland)
| | - Guang-Xiao Cui
- Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China (mainland)
| | - Wei Gao
- Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China (mainland)
| | - Zhi-Wen Li
- Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China (mainland)
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Mihara T, Uchimoto K, Morita S, Goto T. The efficacy of lidocaine to prevent laryngospasm in children: a systematic review and meta-analysis. Anaesthesia 2014; 69:1388-96. [PMID: 24992191 DOI: 10.1111/anae.12788] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2014] [Indexed: 11/28/2022]
Abstract
The purpose of this meta-analysis was to determine the efficacy of lidocaine in preventing laryngospasm during general anaesthesia in children. An electronic search of six databases was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were adhered to. We included randomised controlled trials reporting the effects of intravenous and/or topical lidocaine on the incidence of laryngospasm during general anaesthesia. Nine studies including 787 patients were analysed. The combined results demonstrated that lidocaine is effective in preventing laryngospasm (risk ratio (RR) 0.39, 95% CI 0.24-0.66; I(2) = 0). Subgroup analysis revealed that both intravenous lidocaine (RR 0.34, 95% CI 0.14-0.82) and topical lidocaine (RR 0.42, 95% CI 0.22-0.80) lidocaine are effective in preventing laryngospasm. The results were not affected by studies with a high risk of bias. We conclude that, both topical and intravenous lidocaine are effective for preventing laryngospasm in children.
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Affiliation(s)
- T Mihara
- Department of Anaesthesiology, Kanagawa Children's Medical Centre, Yokohama, Japan
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Arslan IB, Kose I, Ciger E, Demirhan E, Gumussoy M, Cukurova I. Does topical anesthesia using aerosolized lidocaine inhibit the superior laryngeal nerve reflex? Otolaryngol Head Neck Surg 2013; 149:466-72. [PMID: 23818488 DOI: 10.1177/0194599813495372] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study was designed to evaluate the effectiveness of topical lidocaine in attenuating the laryngeal reflex and blunting hemodynamic response by inhibition of the superior laryngeal nerve in laryngeal microsurgery, which would be helpful in preventing potential complications. STUDY DESIGN A prospective, randomized, double-blind study. SETTING Tertiary medical center. SUBJECTS AND METHODS Fifty-four patients requiring glottic and supraglottic laryngeal microsurgery were randomly assigned to 1 of 2 groups, with equal numbers. Before surgery, 10% lidocaine was topically applied to the laryngeal surface of the epiglottis and vocal folds under direct vision in the study group and saline aerosol was applied in the control group. Heart rates, arterial blood pressure, and SPO2 were recorded at baseline, after induction, immediately before and after intubation, during the surgery, and upon extubation. Laryngospasm, agitation, and coughing were recorded during the recovery period. RESULTS Heart rates, arterial pressure, and SPO2 did not differ significantly from baseline to postintubation period among the groups. SPO2 values measured similar in the remaining study. Heart rates and blood pressures were slightly decreased in the study group after lidocaine administration, but only blood pressure at pre- and post-extubation was significantly decreased in the study group (P < .05). Also laryngospasm and coughing were not statistically different between the 2 groups. There was an obvious gap between the 2 groups for agitation. Study group agitation was noted significantly lower (P < .05). CONCLUSION These findings indicate that preoperative topical lidocaine application may be helpful in attenuating airway-circulatory reflexes in laryngeal microscopic surgery.
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Affiliation(s)
- Ilker Burak Arslan
- Tepecik Training and Research Hospital, ENT and Head & Neck Surgery Clinic, Izmir/Turkey.
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14
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Aerosolized lidocaine during invasive mechanical ventilation: in vitro characterization and clinical efficiency to prevent systemic and cerebral hemodynamic changes induced by endotracheal suctioning in head-injured patients. J Neurosurg Anesthesiol 2013; 25:8-15. [PMID: 22990390 DOI: 10.1097/ana.0b013e31826a75b1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients with severe brain injury, endotracheal suctioning (ETS) can increase intracranial pressure (ICP) and reduce cerebral perfusion pressure (CPP). The aim of this prospective, blinded clinical trial was to assess the effectiveness of aerosolized lidocaine to prevent increase of ICP induced by ETS in mechanically ventilated head-injured patients. METHODS First, we measured the particle size of aerosolized lidocaine produced by a vibrating plate nebulizer. Second, we measured the cerebral hemodynamic response to tracheal suctioning in patients in a neurosurgical intensive care unit with and without pretreatment of aerosolized lidocaine. RESULTS Particle size distribution of aerosolized lidocaine was suitable to reach the bronchotracheal target during mechanical ventilation. In 15 patients included in this study, aerosolized lidocaine by itself did not induce significant changes in ICP. ETS caused an increase in ICP (variation: 6±2 mm Hg, P<0.05) with a concomitant decrease in CPP (variation: 2±2 mm Hg, P<0.05) that was maximal at 1 minute after NaCl aerosolization. This was prevented by aerosolization of lidocaine (variation of ICP: 1±1 mm Hg, and CPP: -1±1 mm Hg, P<0.05). CONCLUSIONS Aerosolized lidocaine (2 mg/kg) can prevent ETS-induced increases in ICP, without modifying systemic and cerebral hemodynamics in deeply sedated patients.
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Lee DH, Park SJ. Effects of 10% lidocaine spray on arterial pressure increase due to suspension laryngoscopy and cough during extubation. Korean J Anesthesiol 2011; 60:422-7. [PMID: 21738845 PMCID: PMC3121089 DOI: 10.4097/kjae.2011.60.6.422] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 12/08/2010] [Accepted: 12/10/2010] [Indexed: 12/12/2022] Open
Abstract
Background It is well known that suspension laryngoscopy (SL) produces marked hemodynamic changes. Coughing during extubation sometimes causes adverse clinical problems. We investigated whether 10% lidocaine spray could attenuate hemodynamic stress responses due to SL and reduce coughing incidence during extubation. Methods Sixty patients undergoing SL were randomly divided into two groups and intubated without 10% lidocaine spray (control group) or given 1.5 mg/kg of 10% lidocaine, sprayed onto laryngeal and intratracheal sites 2 min prior to intubation (10% lidocaine group). Mean arterial pressure (MAP) and heart rates (HR) during SL and coughing incidence during extubation were recorded. Results MAP at 2.5 and 5 min (P < 0.05) and HR at 2.5 min after SL (P < 0.01) were greater in the control group than in the 10% lidocaine group. The number of coughs decreased in the 10% lidocaine group compared to the control group during pre- (6.8 ± 3.2 vs 10.3 ± 4.4, P < 0.01) and post-extubation period of 5 min (4.0 ± 2.3 vs 6.2 ± 4.2, P < 0.05) and during the entire study period (10.8 ± 3.9 vs 16.5 ± 5.6, P < 0.001). Conclusions Preoperative laryngeal and intratracheal spraying with 1.5 mg/kg of 10% lidocaine spray is effective for attenuation of arterial pressure increase to SL and suppression of coughing during extubation.
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Affiliation(s)
- Deok Hee Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Korea
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Kundra P, Kumar V, Srinivasan K, Gopalakrishnan S, Krishnappa S. Laryngoscopic techniques to assess vocal cord mobility following thyroid surgery. ANZ J Surg 2010; 80:817-21. [PMID: 20969690 DOI: 10.1111/j.1445-2197.2010.05441.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Assessment of vocal cord mobility using Macintosh laryngoscope is frequently performed after extubation following thyroid surgery to rule out laryngeal nerve palsy. This study compared patient comfort and assessment accuracy of post-operative vocal fold mobility with Macintosh laryngoscope and fibreoptic endoscope. METHODS One hundred four physically fit patients undergoing thyroid surgery were included for the study. Tele-laryngoscopy was done to rule out pre-existing vocal cord palsy. Direct laryngoscopy (DL) was performed to each patient after extubation, followed by nasal fibreoptic endoscopy (NFE) to assess the vocal cord mobility. Tele-laryngoscopic assessment was repeated after 1 week to compare the DL and NFE findings. Patient reactivity score (PRS) and haemodynamic parameters were recorded with each technique. RESULTS Macintosh laryngoscope could pick up 4 (50% sensitivity and 88% specificity) and fibreoptic endoscope 7 (87.9% sensitivity and 98.9% specificity) out of the 8 vocal cord palsies identified by tele-laryngoscopy. Patients had significant discomfort during DL (PRS median 3) when compared with NFE and tele-laryngoscopy (PRS median 2), P<0.05. Grade 1 view of larynx in 92.1% patients during intubation worsened to grade 2 (76.3%) and grade 3 (15.8%) during extubation with DL, and a significant rise in mean arterial pressure and heart rate was observed from the baseline value till 5 min and when compared with NFE (P<0.05). CONCLUSION NFE provides accurate assessment of vocal fold mobility with reasonable patient comfort in the immediate post-operative period. Macintosh laryngoscope fails to give optimum visualization and predisposes the patient to significant discomfort and stress.
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Affiliation(s)
- Pankaj Kundra
- Department of Anaesthesiology and Critical Care Surgery ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India.
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Cho HR, Kim HK, Baek SH, Jung KY. The effect of remifentanil infusion on coughing during emergence from general anesthesia with desflurane. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.6.670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hyeok-rae Cho
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hae-kyu Kim
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seung-hoon Baek
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Kyu-youn Jung
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea
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