Comparison Between Lidocaine Inhalation and Intravenous Dexamethasone in Reducing Postoperative Sore Throat Frequency After Laryngeal Mask Insertion

Evaluation of the Effect of Intranasal Lidocaine in the Treatment of Spasticity in Patients with Traumatic Brain Injury

Background

Spasticity following traumatic brain injury (TBI) is one of the most significant barriers of returning patients to their normal life. Spasticity caused by TBI does not have a specific or definitive treatment, and the clinical effect of pharmacologic treatments has not been significant.

Methods

In this single-arm study, we evaluated 15 patients. For each patient with spasticity, treatment with oral baclofen 25 mg was started three times a day as a part of standard therapy. After 48 hours, if the spasticity did not decrease by at least one score in the Modified Tardieu or Ashworth scales, lidocaine 0.5% was administered as a continuous intranasal infusion. The initial dose of lidocaine was 1 mg/min, which was gradually increased to 2 mg/min. Spasticity and the frequency of spasms were assessed by Ashworth and modified tardieu scales (MTS) and Spasm Frequency Score (SFS), respectively. Heart rate (HR), respiratory rate (RR), mean arterial blood pressure (MAP), Richmond Agitation-Sedation Scale (RASS), Glasgow Coma Scale (GCS), and arterial oxygen saturation (SP_o2) of patients were recorded during nine days of treatment. All data were analyzed by SPSS version 21. P-value less than 0.05 was considered as statistically significant.

Results

Out of 15 participants in this study, 13 (86.7%) were male, and 2 (13.3%) were female (mean age: 29.26 ± 12.5 years). There were no significant differences in Ashworth Scale, Modified Tradieu Scale, RASS Score, GCS Score, MAP, SP_o2 percentage, HR, RR, and the number of spasms per day between the time of initiation of treatment and the second day of baclofen treatment (P > 0.05). Evaluation of spasticity using Ashworth scale on the first and last days of lidocaine treatment showed a significant decrease in the mean spasticity (3.46 ± 0.51 and 1.46 ± 0.91, respectively; P < 0.001). Spasticity assessment using the MTS showed a significant reduction in the mean of the last day of treatment compared to the mean of the first day of treatment (3.6 ± 0.5 and 1.26 ± 0.51, respectively; P < 0.001). This decrease was also seen in the mean of the last day of treatment compared to the first day in SFS (13.3 ± 3.88 and 3.8 ± 0.51, respectively; P < 0.001). Comparison of HR, RR, MAP, RASS, GCS, and SP_o2 on the first and last days of treatment did not show any statistical differences.

Conclusions

Although continuous intranasal treatment with lidocaine can be effective in spasm reduction of patients with TBI, further studies with larger sample sizes and longer follow-up periods are required.

The median effective dose (ED50) of cis-Atracurium for laryngeal mask airway insertion during general Anaesthesia for patients undergoing urinary surgery

Background

In clinical practice, the laryngeal mask airway is an easy-to-use supraglottic airway device. However, the cis-atracurium dosage for laryngeal mask insertion has not been standardised. We aimed to determine the optimal dose of cis-atracurium using a sequential method for successful laryngeal mask insertion.

Methods

The cohort study protocol is registered at clinicaltrial.gov (NCT-03668262). Twenty-three patients undergoing elective urinary surgery were sequentially administered cis-atracurium doses as follows: 150, 100, 70, 50, 30, and 20 μg·kg^− 1. The main outcome involved the determination of the response to laryngeal mask airway insertion: ≥16 points and < 16 points indicated “satisfactory” and “unsatisfactory” responses, respectively. The median effective dose was estimated using the mean of the seven crossovers from “satisfactory” and “unsatisfactory” responses. The primary outcome involved the determination of the median effective dose (ED50) of cis-atracurium for laryngeal mask airway insertion.

Results

The median effective dose of cis-atracurium was 26.5 μg·kg^− 1 (95% CI 23.6–29.8) using the sequential method. Heart rate was decreased in the 50 μg·kg^− 1 group compared to that in the 30 μg·kg^− 1 group at timepoints T7, T8, and T10 (P = 0.0482, P = 0.0460, and P = 0.0236, respectively), but no difference was observed in the 20 μg·kg^− 1 group. Systolic blood pressure was decreased in the 50 μg·kg^− 1 group compared to that in the 20 μg·kg^− 1 group at timepoints T2, T3, and T4 (P = 0.0159, P = 0.0233, and P = 0.0428, respectively). The train-of-four value was significantly lower in the 50 μg·kg^− 1 group than in the 30 μg·kg^− 1 group at timepoint T3 (P = 0.0326).

Conclusions

The ED50 of cis-atracurium was 26.5 μg·kg^− 1 for laryngeal mask airway insertion.

Trial registration

Clinicaltrial.gov Registry, NCT03668262, Registered on 11 September 2018.