Anesthesia, Cough
Conditions
Brief summary
This study is designed to compare the effects of alkalinized lidocaine in the endotracheal tube cuff to a bolus dose of remifentanil given prior to the emergence of anesthesia: * on the incidence of perioperative coughing * on the time needed for the emergence of a desflurane-based anesthesia * on the incidence of sore throat after extubation. The investigators hypothesis is that the use of alkalinized lidocaine in the endotracheal tube cuff will reduce the incidence of perioperative coughing after a desflurane-based anesthesia.
Detailed description
Emergence is an important period of general anesthesia during which several problems can occur. Coughing, hypertension, tachycardia and agitation have been observed during emergence of general anesthesia. Desflurane is a newer volatile agent allowing early recovery from anesthesia. This agent has led to earlier discharge and more rapid resumption of normal activities after surgery. However, an incidence of coughing around 70% has been reported after a desflurane-based anesthesia. Different techniques and drugs have been studied to reduce coughing during emergence. Among others, the role of lidocaine given intravenously, topically, or intracuff has been studied. The use of intracuff alkalinized lidocaine has been proven effective to reduce the incidence of coughing during emergence of anesthesia. Furthermore, there is some evidence supporting the administration of intravenous opioids prior to emergence of general anesthesia to reduce perioperative coughing, agitation and hemodynamic stimulation. However, depending on the type of opioids given, this may delay the emergence from anesthesia. The effect of a remifentanil infusion given in combination with isoflurane as the volatile agent has been shown to reduce the incidence of perioperative coughing without delaying the emergence of anesthesia. Bolus doses of remifentanil have also been proven effective to reduce the hemodynamic response to extubation. The effect of these two modalities (alkalinized lidocaine and remifentanil) have never been compared. This study will assess their efficacy to prevent perioperative coughing after a desflurane-based anesthesia.
Interventions
DRUGRemifentanil
Bolus dose of intravenous remifentanil 0.25 mcg/kg given once before emergence of general anesthesia
Administration of alkalinized lidocaine in the endotracheal tube cuff
Sponsors
Centre de Recherche du Centre Hospitalier de l'Université de Montréal
Centre hospitalier de l'Université de Montréal (CHUM)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patients aged 18-80 years * Physical status 1-3 * Patients undergoing elective surgery under general anesthesia requiring oral endotracheal intubation (excluding head and neck surgery) * Expected duration of surgery of at least 1.5 hour.
Exclusion criteria
* Current use of ACE inhibitor * Chronic cough * Asthma or severe pulmonary disease * Pulmonary tract infection * Anticipated difficult intubation * Current use of opioids * Current use of cough medicine * Contraindication to remifentanil, lidocaine * Pregnancy * Symptomatic cardiac, renal or hepatic disease
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Incidence of coughing during emergence and after extubation | From emergence until 10 minutes after extubation |
Secondary
| Measure | Time frame |
|---|---|
| Time to emergence | From the discontinuation of Desflurane until extubation |
| Incidence of sore throat one hour after extubation | Assessed one hour after extubation |
Countries
Canada
Outcome results
None listed