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A randomised controlled trial of intracuff lidocaine and alkalised lidocaine for sedation and analgesia requirements in mechanically ventilated patients. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2022; 38:10.7196/SAJCC.2022.v38i1.484. [PMID: 35634479 PMCID: PMC9132076 DOI: 10.7196/sajcc.2022.v38i1.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/08/2022] Open
Abstract
Background Airway irritation caused by prolonged inflation of endotracheal tube (ETT) cuff results in post-intubation morbidities. Objectives We aimed to study intracuff lidocaine and alkalised lidocaine on sedation or analgesia requirements of patients undergoing mechanical ventilation in the intensive care unit (ICU). The primary outcome was to calculate the total dose of propofol and fentanyl required to obtund the unwanted airway and circulatory reflexes. Secondary outcomes were to determine the frequency and severity of cough and haemodynamic parameters. Methods It was a double-blinded, randomised controlled study in the ICU after emergency laparotomy, in patients aged 20 - 55 years, and classified as American Society of Anesthesiologists (ASA) classes 1E and 2E with tube in situ. Exclusion criteria were patients with body mass index >30 kg/m² , haemodynamic instability, requiring positive end-expiratory pressure ≥7 cm H2O, and a history of chronic obstructive pulmonary disease. After ethics clearance and written consent, patients were randomly assigned into two groups (36 in each), Group L (ETT cuff inflated with lidocaine 2%) and Group AL (cuff inflated with a mixture of lidocaine 2% and sodium bicarbonate 1:1). Results Mean dose of propofol consumed in Group AL was significantly less than that in Group L (p<0.001). The mean standard deviation (SD) fentanyl utilisation in Group AL was 1 323.61 (187.27) µg, and that in Group L was 1433.09 (42.58) µg (p=0.040). Group L patients had a significantly higher incidence of cough than those in Group AL (p=0.01). There was no significant difference in the mean arterial pressure (p=0.22), although heart rate was significantly higher in Group L (p<0.001). Conclusion Alkalised lidocaine reduces the requirement of sedation, analgesia, and the incidence of cough in intubated patients maintaining haemodynamic stability when compared with lidocaine. Contributions of the study Alkalised lidocaine when used in endotracheal tube cuff inflation reduces the need for sedation and analgesia in mechanically-ventilated patients, and improves haemodynamic stability.
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Intracuff alkalinized lidocaine to prevent postoperative airway complications: A meta-analysis. World J Clin Cases 2021; 9:10626-10637. [PMID: 35004994 PMCID: PMC8686150 DOI: 10.12998/wjcc.v9.i34.10626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/13/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Post-extubation cough is a common phenomenon in surgical patients undergoing general anesthesia, which can lead to potentially dangerous complications. In this meta-analysis, we evaluated the efficacy and safety of intracuff alkalinized lidocaine in patients with tracheal intubation to prevent cough and other airway complications during the perioperative period.
AIM To perform a systematic review and meta-analysis of intracuff alkalinized lidocaine for the prevention of postoperative airway complications.
METHODS PubMed, Embase, Cochrane, and Web of Science were searched for randomized controlled trials (RCTs) that compared intracuff alkalinized lidocaine to placebo. We used risk-of-bias assessment to assess the RCTs, and the quality of evidence was assessed using the grading of recommendations, assessment, development, and evaluations.
RESULTS Twelve randomized trials (1175 patients) were analyzed. Meta-analysis showed that intracuff alkalinized lidocaine was associated with less cough compared to that produced by placebo [risk ratio (RR): 0.38; 95% confidence interval (CI): 0.23-0.63]. Similarly, intracuff alkalinized lidocaine was more effective than the control in reducing postoperative sore throat at 24 h (RR: 0.19; 95%CI: 0.09-0.41) and postoperative hoarseness (RR: 0.38; 95%CI: 0.21-0.69).
CONCLUSION Intracuff alkalinized lidocaine is an effective adjuvant that can decrease airway complications, such as coughing, hoarseness, and sore throat.
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Lidocaine-eluting endotracheal tube effectively attenuates intubation related airway response. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:871. [PMID: 34164505 PMCID: PMC8184491 DOI: 10.21037/atm-21-1930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Lidocaine (LDC) is a local anesthetic widely used to relieve intubation-related airway responses. However, low drug concentration and short effective duration of LDC is inadequate to provide a satisfactory anesthetic effect on the surface of the airway. The present study sought to develop a LDC-delivery endotracheal tube (ETT) to achieve high local drug concentration and sustained drug release with the aim of attenuating an intubation-related airway response. Methods ETTs and polyvinyl chloride (PVC) discs were coated with different molecular weight (MW) poly lactic-co-glycolic acid (PLGA: 50/50; MW: 3,000, 6,000, and 10,000) loaded with LDC by airbrush spray. The morphology of LDC-eluting coatings was analyzed using scanning electron microscopy. In vitro drug release was determined by ultraviolet spectrophotometer. An in vivo study was performed to investigate the differences in plasma LDC concentration, intubation tolerance, and tracheal tissue injury in rabbits undergoing intubation of blank, LDC-spray, or LDC-coated ETTs. Results Approximate 5 mg/cm2 coatings (containing 2.5 mg/cm2 LDC) were deposited onto the PVC discs and ETTs. While even distribution and smooth surfaces were generated in PLGA3000 + LDC and PLGA6000 + LDC coatings, PLGA10000 + LDC formed uneven and gullied coatings. Burst release within the first 4 h and sustained release for at least 5 days was achieved in vitro in PLGA + LDC coatings and the in vivo study demonstrated higher plasma LDC concentration and longer drug release duration in LDC-coated ETTs compared with LDC-spray. LDC-coated ETTs significantly improved intubation tolerance in rabbits, as measured by less general anesthetic consumption and longer tube tolerance duration in contrast to blank ETTs with or without LDC spray. Histology assessment showed less mucosal edema area in the PLGA3000 + LDC and PLGA6000 + LDC groups compared to the control, LDC-spray, and PLGA10000 + LDC groups. Among the different MW PLGAs, PLGA6000 presented optimal morphological characteristics, drug release, and anesthetic effect. Conclusions ETTs coated with PLGA + LDC effectively attenuate an intubation-related airway response via increasing local drug concentration and extending drug action duration, which demonstrates a potential therapeutic benefit for patients undergoing intubation.
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Efficacy of intracuff lidocaine in reducing coughing on tube: a systematic review and meta-analysis. J Int Med Res 2020; 48:300060520901872. [PMID: 32046552 PMCID: PMC7111121 DOI: 10.1177/0300060520901872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective Method Results Conclusion
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Efficacy of 8 mg lidocaine and 2 mg cetylpyridinium chloride (CPC) fixed-combination lozenges on sore throat pain intensity compared with 1 mg lidocaine and 2 mg CPC fixed-combination lozenges in subjects with sore throat due to upper respiratory tract infection: a randomized double-blind parallel-group single-dose study. Trials 2018; 19:679. [PMID: 30541606 PMCID: PMC6292119 DOI: 10.1186/s13063-018-3077-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 11/24/2018] [Indexed: 11/23/2022] Open
Abstract
Background Lozenges containing lidocaine and cetylpyridinium chloride (CPC) are commonly used for the treatment of sore throat. The lidocaine acts locally to provide pain relief and the CPC has an antiseptic effect. Mebucaine CL, a well-established fixed-combination sore throat lozenge, contains 1 mg lidocaine and 2 mg CPC. Single-agent lozenges containing 8 mg lidocaine have also been demonstrated to be significantly superior to placebo in confirmatory pain intensity assessments. This study compared a new lozenge formulation, containing 8 mg lidocaine and 2 mg CPC, with the currently marketed lozenge for the treatment and relief of sore throat symptoms in subjects diagnosed with a sore throat due to an upper respiratory tract infection (URTI). Methods In this double-blind parallel-group study, 250 adults with a sore throat due to an URTI were randomized to receive a single lozenge containing either 8 mg lidocaine + 2 mg CPC (n = 125) or 1 mg lidocaine + 2 mg CPC (n = 125). The primary efficacy endpoint of the study was the change in sore throat pain intensity (STPI) between baseline (immediately pre-treatment) and the 2-h post-dose assessment, measured on a 100 mm visual analog scale. STPI was measured at baseline and regular intervals up to 240 min after the lozenge was administered (evaluated in clinic). Any difficulty in swallowing and time to onset and duration of the analgesic effect were also assessed. Results No increase in efficacy was demonstrated with the higher dose of lidocaine. The difference in the 2-h post-dose change in STPI was not statistically significant between the treatments. There was only one statistically significant difference between the treatments in all of the efficacy outcomes assessed: pain relief scores at 4 h post-dose were higher with 1 mg lidocaine + 2 mg CPC than with 8 mg lidocaine + 2 mg CPC (P = 0.0461). The most commonly reported adverse event (AE) was a headache; the only other AE experienced by more than one subject was throat irritation. No severe adverse events were reported during the assessment period. Conclusions The modest difference in the pattern of effectiveness between the two treatments observed in this study does not support use of the 8 mg lidocaine + 2 mg CPC lozenge. Trial registration ClinicalTrials.gov, NCT01265446. Registered on 20 December 2010.
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Staggering the dose of sugammadex lowers risks for severe emergence cough: a randomized control trial. BMC Anesthesiol 2017; 17:137. [PMID: 29020936 PMCID: PMC5637258 DOI: 10.1186/s12871-017-0430-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/02/2017] [Indexed: 12/18/2022] Open
Abstract
Background Cough on emergence has been reported as a common adverse reaction with sugammadex reversal. We investigated if staggering the dose of sugammadex will reduce emergence cough in a single-center, randomized, double-blinded study. Methods A hundred and twenty ASA 1–3 adults were randomly reversed with 1 mg/kg sugammadex prior to extubation followed by another 1 mg/kg immediately after extubation (staggered group), single dose of 2 mg/kg sugammadex (single bolus group) or neostigmine 0.02 mg/kg with glycopyrrolate (neostigmine group). Results We found 70% of patients (n = 28) reversed with single boluses of sugammadex had Grade 3 emergence cough compared to 12.5% (n = 5) in the staggered sugammadex group and 17.5% (n = 7) in the neostigmine group (p < 0.001). Besides cough, emergence agitation also appeared highest in the single bolus sugammadex group (n = 14, 35%, p = 0.005). On the other hand, staggering sugammadex lowered risks of developing severe cough (RR 0.2, p < 0.001) and agitation (RR 0.43, p = 0.010) on emergence in addition to cough (RR 0.25, p = 0.039) and early sore throat (RR 0.70, p = 0.036) in the post-anesthetic care unit. The risks for severe emergence cough (RR 0.86, p = 0.762), severe cough in the post-anesthetic care unit (RR 1.0, p = 1.000) and sore throat (RR 1.17, p = 0.502) were also not different between the staggered sugammadex group and control given neostigmine. In terms of timing, there was no delay in time taken from discontinuing anesthetic agents to reversal and extubation if sugammadex was staggered (emergence time 6.0 ± 3.2 s, p = 0.625 and reversal time 6.5 ± 3.5, p = 0.809). Conclusions Staggering the dose of sugammadex for reversal will effectively decrease common emergence and early postoperative complications. Trial registration ANZCTR Number ACTRN12616000116426. Retrospectively registered on 2nd February 2016.
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Incidence and risk factors of postoperative sore throat after endotracheal intubation in Korean patients. J Int Med Res 2017; 45:744-752. [PMID: 28173712 PMCID: PMC5536682 DOI: 10.1177/0300060516687227] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To investigate the incidence of postoperative sore throat (POST) in Korean patients undergoing general anaesthesia with endotracheal intubation and to assess potential risk factors. Methods This prospective study enrolled patients who underwent all types of elective surgical procedures with endotracheal intubation and general anaesthesia. The patients were categorized into group S (those with a POST) or group N (those without a POST). The demographic, clinical and anaesthetic characteristics of each group were compared. Results This study enrolled 207 patients and the overall incidence of POST was 57.5% (n = 119). Univariate analysis revealed that significantly more patients in group S had a cough at emergence and hoarseness in the postanaesthetic care unit compared with group N. Receiver operating characteristic curve analysis showed that an intracuff pressure ≥17 cmH2O was associated with POST. Multivariate analysis identified an intracuff pressure ≥17 cmH2O and cough at emergence as risk factors for POST. At emergence, as the intracuff pressure over ≥17 cmH2O increased, the incidence of hoarseness increased. Conclusions An intracuff pressure ≥17 cmH2O and a cough at emergence were risk factors for POST in Korean patients. Intracuff monitoring during anaesthesia and a smooth emergence are needed to prevent POST.
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Efficacy and Safety of Using Air Versus Alkalinized 2% Lignocaine for Inflating Endotracheal Tube Cuff and Its Pressure Effects on Incidence of Postoperative Coughing and Sore Throat. Anesth Essays Res 2017; 11:1057-1063. [PMID: 29284875 PMCID: PMC5735450 DOI: 10.4103/aer.aer_85_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and Objective: We wished to compare the endotracheal tube (ETT) cuff pressure inflated with air or alkalinized lignocaine during anesthesia and evaluate clinical symptoms such as coughing and sore throat (postoperative sore throat [POST]) following tracheal extubation. Materials and Methods: This was a prospective randomized controlled study conducted in a tertiary care set up over a period of 1 year. We included 100 patients in age group of 18–65 years posted for elective surgeries of duration more than 90 min under general anesthesia with N2O-O2 mixture. Patients were randomized using computer-generated randomization table into air and lignocaine group. The ETT cuff was inflated with air or alkalinized lignocaine (2% lignocaine with 7.5% sodium bicarbonate, in the proportions of 19.0:1.0 ml) to the volume that prevented air leak using cuff pressure manometer. After extubation, an independent observer blinded to study group recorded the presence or absence of coughing and POST at immediately, 1 h and 24 h postoperatively. Results: Demographic data, baseline characteristics (American Society of Anesthesiologists grade, intracuff volume/cuff pressure at start of surgery), and duration of anesthesia were comparable among study groups (P > 0.05). Cuff pressure and volume achieved in the end of surgery were much higher in air group as compared to lignocaine group (P < 0.05). Incidence of coughing and POST at immediately, 1 h and 24 h postoperatively was significantly higher in air group compared to lignocaine group. Impact of duration of anesthesia on rise in cuff pressure was significantly higher in air group and its effect on cuff-induced laryngotracheal morbidity was significant in both air and lignocaine group. Conclusion: This study showed the significance of use of alkalinized 2% lignocaine in prevention of rise of cuff pressure and incidence of coughing and POST. Duration of anesthesia has also a significant effect on incidence of postoperative trachea-laryngeal morbidity.
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Prophylactic Administration of Corticosteroids for Preventing Postoperative Complications Related to Tracheal Intubation: A Systematic Review and Meta-Analysis of 18 Randomized Controlled Trials. Clin Drug Investig 2016; 36:255-65. [PMID: 26715108 DOI: 10.1007/s40261-015-0369-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Sore throat, cough, and hoarseness are the common and severe complications after general anesthesia with tracheal intubation. The efficacy of prophylactic administration of corticosteroids in reducing the incidence of postoperative complications is controversial. Thus, we conducted a meta-analysis to assess the effects of corticosteroids in the prevention of postoperative complications. METHODS A comprehensive literature search of Pubmed, Embase, and Web of Science was conducted to identify relative trials. Eligible studies were randomized controlled trials (RCTs) that assessed the effect of corticosteroids for preventing postoperative complications. The outcomes included the prevalence of postoperative sore throat, cough, hoarseness, laryngeal edema, and reintubation. A random-effects or fixed-effects model was used to pool the estimates, according to the heterogeneity among the included studies. RESULTS Eighteen RCTs with a total of 2685 patients were included in this meta-analysis. Pooled estimates showed that corticosteroids significantly reduced the incidence of postoperative sore throat, hoarseness, and cough. Moreover, corticosteroids had a positive effect on the incidence of laryngeal edema and reintubation. Subgroup analysis showed that corticosteroids significantly decreased the incidence of severe sore throat and hoarseness, but not cough. CONCLUSION Evidence from this meta-analysis of 18 RCTs indicated that prophylactic administration of corticosteroids is not only effective in reducing the incidence and severity of postoperative sore throat and hoarseness, but also the incidence of laryngeal edema and reintubation.
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The prophylactic effect of dexamethasone on postoperative sore throat in prone position surgery. Korean J Anesthesiol 2016; 69:255-61. [PMID: 27274371 PMCID: PMC4891538 DOI: 10.4097/kjae.2016.69.3.255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 02/01/2016] [Accepted: 02/05/2016] [Indexed: 02/08/2023] Open
Abstract
Background Sore throat and hoarseness are common complications after general anesthesia with tracheal intubation. The position for patients can affect the incidence of postoperative sore throat (POST) by causing displacement of the endotracheal tube. This study investigated the prophylactic effect of dexamethasone in prone position surgeries. Methods One hundred-fifty patients undergoing lumbar spine surgery (18-75 yr) were randomly allocated into the normal saline group (group P, n = 50), dexamethasone 0.1 mg/kg group (group D1, n = 50) or dexamethasone 0.2 mg/kg group (group D2, n = 50). The incidence and severity of POST, hoarseness, and cough were measured using direct interview at 1, 6, and 24 h after tracheal extubation. The severity of POST, hoarseness, and cough were graded using a 4-point scale. Results At 1, 6, and 24 h after extubation, the incidence of sore throat was significantly lower in group D1 (1 h; P = 0.015, 6 h; P < 0.001, 24 h; P = 0.038) and group D2 (1 h; P < 0.001, 6 h; P < 0.001, 24 h; P = 0.017) compared to group P. There were less number of patients in the groups D1 and D2 than group P suffering from moderate grade of POST at 1, 24 h after extubation. The incidence of hoarseness at 1, 6, and 24 h after extubation was significantly lower in groups D2 than group P (P < 0.001). There were no significant differences in the incidence of cough among the three groups. Conclusions The prophylactic use of dexamethasone 0.1 mg/kg and 0.2 mg/kg in prone surgery reduces the incidence of postoperative sore throat and dexamethasone 0.2 mg/kg decreases the incidence of hoarseness.
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The effects of propofol, ketamine and combination of them in prevention of coughing and laryngospasm in patients awakening from general anesthesia: A randomized, placebo-controlled, double blind clinical trial. Adv Biomed Res 2016; 5:64. [PMID: 27135033 PMCID: PMC4832885 DOI: 10.4103/2277-9175.179186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 06/11/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Coughing and laryngospasm are undesirable outcomes occurring during emergence from general anesthesia. We compared the effect of small doses of propofol, ketamine and a combination of them on the occurrence and severity of coughing and laryngospasm in patients awakening from general anesthesia. MATERIALS AND METHODS 160 patients who were scheduled to undergo operations under general anesthesia were randomly assigned to one of the following groups, 40 in each group: propofol group (0.25 mg/kg intravenous (IV) propofol), ketamine group (0.25 mg/kg IV ketamine), combination group (0.25 mg/kg IV propofol, and 0.25 mg/kg IV ketamine) and control (0.1 ml/kg IV saline). Drugs were administered before extubation at previously defined time. Presence and severity of coughing and laryngospasm were recorded within twominutes after extubation. RESULTS The presence of coughing in the combination group (27.5%) was less than that in other groups; also it was less frequent in the propofol group (57.5%) than the control (82.5%) (all P < 0.05). But the incidence did not differ between the propofol and the ketamine (70%) group; nor did it differ between the ketamine and control groups (P = 0.356 and P = 0.121, respectively). The cases with severe coughing (grade 3) in the combination group (none) were significantly less than in the propofol (four) and the control groups (seven) (P = 0.040 and P = 0.006 respectively). There was no significant difference between the groups in frequency of laryngospasm. CONCLUSION Administration of propofol or combination of propofol and ketamine decreases the incidence of post extubation coughing. This combination can also decrease severe cases.
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Effect of Intracuff Lidocaine on Postoperative Sore Throat and the Emergence Phenomenon: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One 2015; 10:e0136184. [PMID: 26288276 PMCID: PMC4544846 DOI: 10.1371/journal.pone.0136184] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 07/30/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Postoperative sore throat and other airway morbidities are common and troublesome after endotracheal tube intubation general anesthesia (ETGA). We propose lidocaine as endotracheal tube (ETT) cuff inflation media to reduce the postintubation-related emergence phenomenon. METHODS We searched PubMed, EMBASE, and Cochrane databases systematically for randomized controlled trials (RCTs) that have investigated the outcome of intracuff lidocaine versus air or saline in patients receiving ETGA. Using a random-effects model, we conducted a meta-analysis to assess the relative risks (RRs) and mean difference (MD) of the incidence and intensity of relevant adverse outcomes. RESULTS We reviewed nineteen trials, which comprised 1566 patients. The incidence of early- and late-phase postoperative sore throat (POST), coughing, agitation, hoarseness, and dysphonia decreased significantly in lidocaine groups, with RRs of 0.46 (95% confidence interval [CI]: 0.31 to 0.68), 0.41 (95% CI: 0.25 to 0.66), 0.43 (95% CI: 0.31 to 0.62), 0.37 (95% CI: 0.25 to 0.55), 0.43 (95% CI: 0.29 to 0.63), and 0.19 (95% CI: 0.08 to 0.5), respectively, when compared with the control groups. The severity of POST also reduced significantly (mean difference [MD] -16.43 mm, 95% CI: -21.48 to -11.38) at 1 h and (MD -10.22 mm, 95% CI: -13.5 to -6.94) at 24 h. Both alkalinized and non-alkalinized lidocaine in the subgroup analyses showed significant benefits in emergence phenomena prevention compared with the control. CONCLUSION Our results indicate that both alkalinized and non-alkalinized intracuff lidocaine may prevent and alleviate POST and postintubation-related emergence phenomena.
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Abstract
BACKGROUND Sore throat is a common side-effect of general anaesthesia and is reported by between 30% and 70% of patients after tracheal intubation. The likelihood of a sore throat varies with the type, diameter, and cuff pressure of the endotracheal tube used. If intubation is essential, it may be helpful to give drugs prophylactically to alleviate postoperative sore throat. Local anaesthetics and steroids have been used for this purpose. This review was originally published in 2009 and was updated in 2015. OBJECTIVES The objective of this review was to evaluate the efficacy and any harm caused by topical and systemic lidocaine used prophylactically to prevent postoperative sore throat in adults undergoing general anaesthesia with endotracheal intubation. SEARCH METHODS We searched CENTRAL (The Cochrane Library 2013, Issue 9), MEDLINE (January 1966 to October 2013), and EMBASE (1980 to October 2013). We also contacted manufacturers and researchers in the field. The original search was undertaken in June 2007. We reran the search in February 2015 and found four studies of interest. We will deal with those studies when we next update the review. SELECTION CRITERIA We included randomized controlled trials (RCTs) of topical and systemic prophylactic lidocaine therapy versus control (using air or saline) that reported on the risk and severity of postoperative sore throat as an outcome. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information, such as the risk of any adverse effects. MAIN RESULTS We included 19 studies involving 1940 participants in this updated review. Of those 1940 participants, 952 received topical or systemic lidocaine therapy and 795 were allocated to the control groups. Topical and systemic lidocaine therapy appeared to reduce the risk of postoperative sore throat (16 studies, 1774 participants, risk ratio (RR) was 0.64 (95% confidence interval (CI) 0.48 to 0.85), the quality of the evidence was low), although when only high-quality trials were included (eight studies, 814 participants) the effect was no longer significant (RR 0.71, 95% CI 0.47 to 1.09). Lidocaine given systemically in two studies (320 participants) did not reveal evidence of an effect (RR 0.44, 95% CI 0.19 to 1.05 ). The severity of sore throat as measured on a visual-analogue scale (VAS) was reduced by lidocaine therapy (six trials, 611 participants, (mean difference (MD) -10.80, 95% CI -14.63 to -6.98). The adverse effects of lidocaine were not reported in these studies, though toxicity is generally rare. AUTHORS' CONCLUSIONS In our revised systematic review, although the results of included studies show generally positive results, they should be interpreted carefully. The effect size of lidocaine appeared to be affected by study quality; drug concentration; route of administration; management of cuff pressure during anaesthesia; the included population; and the type of outcome measured.
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Attenuation of circulatory and airway responses to endotracheal extubation in craniotomies for intracerebral space occupying lesions: Dexmedetomidine versus lignocaine. Anesth Essays Res 2015; 8:78-82. [PMID: 25886109 PMCID: PMC4173576 DOI: 10.4103/0259-1162.128916] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The objective of the study is to compare the effect of dexmedetomidine versus lignocaine in attenuation of circulatory and airway responses during endotracheal extubation in craniotomies for intracerebral space occupying lesions (ICSOL). MATERIALS AND METHODS A total of 50 patients of American Society of Anesthesiologists Grade I and II of either sex, aged 18-50 years undergoing craniotomies for non-vascular ICSOL under general anesthesia were divided into two groups according to drug received. Group D (n = 25) received dexmedetomidine (0.5 mcg/kg) whereas group L (n = 25) received lignocaine (1.5 mg/kg). Both the drugs were given 5 min before the extubation over a period of 60 s. Values for heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), were recorded just before (A0) and 1, 3, 5 (A1, A3, A5) min after the study drug administration, at extubation (E) and 1, 3, 5, 10, 15 min after extubation (E1, E3, E5, E10 and E15). Respiratory rate, oxygen saturation and airway responses like coughing, breath-holding, laryngospasm/bronchospasm were recorded only at extubation (E) and 1, 3, 5, 10, 15 min after extubation (E1, E3, E5, E10, E15). Quality of extubation was recorded with four point scale. After extubation all these patients were also observed for sedation by Ramsey sedation score. RESULTS Both groups showed a statistically significant increase (D < L) in HR, SBP and DBP during (E) and immediately after extubation (E1) (P < 0.05). Dexmedetomidine (72%) produced a higher degree of sedation (Grade 3) as compare with lignocaine (0%) and with no incidence of coughing or breath holding (P < 0.05). CONCLUSION Single dose of dexmedetomidine (0.5 mcg/kg) given 5 min before extubation produced significant attenuation of circulatory and airway responses produced during extubation as compared to Lignocaine (1.5 mg/kg) in ICSOL.
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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: 7] [Impact Index Per Article: 0.7] [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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Intracuff buffered lidocaine versus saline or air—A comparative study for smooth extubation in patients with hyperactive airways undergoing eye surgery. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2009.10872600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Dexamethasone for preventing postoperative sore throat: a meta-analysis of randomized controlled trials. Ir J Med Sci 2013; 183:593-600. [PMID: 24357270 DOI: 10.1007/s11845-013-1057-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 12/08/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Postoperative sore throat (POST) is a common complication following tracheal intubation. The effectiveness of prophylactic dexamethasone on POST needs further elucidation. AIMS To evaluate the effectiveness and safety of intravenous dexamethasone for the prevention of POST in patients undergoing endotracheal intubation. METHODS Studies were identified by literature searches of PubMed, Embase, and the Cochrane database. Systematic review was performed by two independent investigators. RESULTS We summarized 7 RCTs including 727 participants. Intravenous dexamethasone significantly reduced the risk of POST at 24 h [pooled risk ratio (RR) = 0.676; 95 % confidence interval (CI) 0.494-0.925; P = 0.014; heterogeneity test, I (2) = 45.8 %], as well as alleviating its severity [standardized mean difference (SMD) = -1.15; 95 % CI -1.86 to -0.45; P = 0.002; heterogeneity test, I (2) = 91.7 %]. Further sub-group analysis indicated a significant relationship between dexamethasone and reduced risk of POST when its dose was over 0.1 mg/kg. No severe adverse effects were reported. CONCLUSIONS Our results suggest that intravenous dexamethasone reduces the risk and severity of POST from intubation at 24 h. The effective dosage of dexamethasone for preventing the risk of POST appeared to be over 0.1 mg/kg.
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Effect of a small dose of propofol or ketamine to prevent coughing and laryngospasm in children awakening from general anesthesia. Korean J Anesthesiol 2011; 60:25-9. [PMID: 21359077 PMCID: PMC3040427 DOI: 10.4097/kjae.2011.60.1.25] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 08/18/2010] [Accepted: 08/19/2010] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Coughing during emergence from general anesthesia may be detrimental in children. We compared the effect of a small dose of propofol or ketamine administered at the end of sevoflurane anesthesia on the incidence or severity of coughing in children undergoing a minimal invasive operation. METHODS One hundred and eighteen children aged between 3 and 15 years, American Society of Anesthesiologists (ASA) status I, were enrolled in this randomized double blind study. Anesthesia was induced with propofol or ketamine and maintained with sevoflurane in N(2)O/O(2). Each group received propofol 0.25 mg/kg or ketamine 0.25 mg/kg and the control group received saline 0.1 ml/kg. The decision to perform tracheal extubation was based on specified criteria, including the resumption of spontaneous respiration. During emergence from anesthesia and extubation, coughing was observed and graded at predefined times. RESULTS The incidence of emergence without coughing was higher in the propofol group than in the ketamine and control group (19%, 11% and 6%, respectively), whereas the incidence of severe coughing was higher in the control group than in propofol and ketamine group (17.14%, 10.0% and 6.98%, respectively). CONCLUSIONS The addition of propofol 0.25 mg/kg decreased the incidence of coughing after sevoflurane general anesthesia in children undergoing non-painful procedures.
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Airway management in obstructive sleep apnea: local solutions. Can J Anaesth 2010; 58:228; author reply 229. [PMID: 21136311 DOI: 10.1007/s12630-010-9427-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 11/15/2010] [Indexed: 12/29/2022] Open
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Comparison in Effect of Intravenous Alfentanil and Lidocaine on Airway-Circulatory Reflexes during Extubation. INT J PHARMACOL 2008. [DOI: 10.3923/ijp.2008.223.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
UNLABELLED The use of cuffed tracheal tubes in children younger than 8 yr of age has recently increased, although cuff hyperinflation may cause tracheal mucosal damage. In this study, we sought to measure the cuff pressure (P(cuff)) after initial free air inflation (iP(cuff)) and to follow its evolution throughout the duration of 50% nitrous oxide (N(2)O) anesthesia. One-hundred-seventy-four children, aged 0 to 9 yr, fulfilling the following criteria, were studied: 1). weight of 3-35 kg; 2). ASA physical status I or II; 3). elective surgery; 4). anesthesia with tracheal intubation using a cuffed tube and lasting at least 45 min; and 5). gas mixture containing 50% N(2)O. Free air inflation results in variable iP(cuff), with hyperinflation in 39% of cases. Numerous gas removals were required to maintain P(cuff) less than 25 cm H(2)O in 85% of the patients. The number of deflations decreased with the duration of mechanical ventilation and was small after 105 min. No difference was observed among the different cuffed tube sizes. We conclude that iP(cuff) is unpredictable after free air inflation and that numerous gas removals are required to maintain P(cuff) less than 25 cm H(2)O during N(2)O anesthesia in children. IMPLICATIONS Free inflation of the tracheal tube cuff, controlled only by the palpation of the pilot balloon, is not reliable and results in extremely variable (and sometimes very high) initial cuff pressures in children. In addition, nitrous oxide anesthesia may result in cuff hyperinflation requiring numerous gas removals.
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