Comparison of the Effects of Magnesium Sulfate and Remifentanil on Hemodynamic Responses During Tracheal Extubation After Laparotomy: A Randomized Double-blinded Trial

Comparing the effects of magnesium sulfate and lidocaine spray on hemodynamic changes caused by laryngoscopy and tracheal intubation: a randomized clinical trial

AIM

This study aims at comparing the impact of Magnesium Sulfate and Lidocaine sprays on hemodynamic changes after laryngoscopy and tracheal intubation.

DESIGN

This double-blind clinical trial (code IRCT20230719058846N1) was conducted on the patients undergoing elective surgery in the city of Karaj.

METHODS

A total of 100 patients, aged 18 to 40 years and classified as ASA I or II, who were candidates for elective surgery, were randomly assigned to two equal groups. Prior to intubation, patients received lidocaine spray (5 puffs of Lidocaine 10%) in one group, and magnesium sulfate spray (5 puffs of Magnesium 20%) in the other. Induction of anesthesia was the same in both groups. Patients' hemodynamic statuses were measured and compared once before the intubation and also 1, 3, 5, 7 and 10 min after it.

RESULTS

Before the intervention, there was no statistically significant difference between the two groups in terms of demographic and hemodynamic variables (P < 0.05). The results showed that the systolic blood pressure at minutes 3, 5, and 7 was significantly lower among the patients receiving magnesium than those receiving lidocaine (P < 0.05). Other hemodynamic variables were not statistically different between the two groups (P < 0.05).

CONCLUSION

Based on the findings of the present study, magnesium sulfate spray is more effective than lidocaine in controlling hemodynamic complications. Therefore, it can be used to reduce hemodynamic complications following intubation. However, it may be associated with tachycardia, which needs to be taken into account.

Extubation and the Risks of Coughing and Laryngospasm in the Era of Coronavirus Disease-19 (COVID-19)

The coronavirus disease-19 (COVID-19) pandemic has prompted new interest among anesthesiologists and intensivists in controlling coughing and expectoration of potentially infectious aerosolized secretions during intubation and extubation. However, the fear of provoking laryngospasm may cause avoidance of deep or sedated extubation techniques which could reduce coughing and infection risk. This fear may be alleviated with clear understanding of the mechanisms and effective management of post-extubation airway obstruction including laryngospasm. We review the dynamic function of the larynx from the vantage point of head-and-neck surgery, highlighting two key concepts:

1. The larynx is a complex organ that may occlude reflexively at levels other than the true vocal folds;

2. The widely held belief that positive-pressure ventilation by mask can “break” laryngospasm is not supported by the otorhinolaryngology literature.

We review the differential diagnosis of acute airway obstruction after extubation, discuss techniques for achieving smooth extubation with avoidance of coughing and expectoration of secretions, and recommend, on the basis of this review, a clinical pathway for optimal management of upper airway obstruction including laryngospasm to avoid adverse outcomes.