Reducing Cough During Extubation
Conditions
Brief summary
Coughing during extubation of endotracheal tube (ETT) is a common problem that leads to poor surgical results including hemodynamic change, rebleeding at the surgical wound and wound dehiscence. Recently, lidocaine has been introduced for reducing coughing during extubation. However, data comparing routes of lidocaine application are lacking, thus, this study compared the combination of lidocaine sprayed on laryngeal inlet and cuff of ETT versus intravenous lidocaine injection for efficacy in reducing coughing
Detailed description
A prospective randomized control trial was conduct with 164 patients. They were randomly allocated into Gr. A and B. Group A received four puffs of 10% lidocaine sprayed at the cuff of ETT and four puffs at laryngeal inlet whereas Gr. B received 15 mg/kg of 2% lidocaine intravenous injection prior to extubation. The same general anesthesia protocol was applied in all of the patients. Incidence and severity of cough during extubation was evaluated. Furthermore, incidence of 24-hour postoperative adverse events (including sore throat, dysphagia, and hoarseness) and hemodynamic response after extubation were analyzed.
Interventions
DRUG10% lidocaine sprayed
four puffs of 10% lidocaine sprayed at the cuff of ETT and four puffs at laryngeal inlet
DRUG2% lidocaine intravenous
15 mg/kg of 2% lidocaine intravenous injection prior to extubation
Sponsors
Khon Kaen University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
The study based on a sequentially numbered list were prepared in the same way. Participant and outcome assessor were blined to the computer generated lists
Intervention model description
The randomized controled trial was conducted. the investigator allocated patient into two arms. Group A received four puffs of 10% lidocaine sprayed at the cuff of ETT and four puffs at laryngeal inlet whereas Gr. B received 15 mg/kg of 2% lidocaine intravenous injection prior to extubation
Eligibility
Sex/Gender
ALL
Age
19 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* patients who underwent elective surgery with American Society of Anesthesiologists physical status classifications of I and III
Exclusion criteria
* patients having body mass index more than 35 kg/m2, high risk of aspiration, chronic smokers more than ten pack-years, chronic cough or recent upper respiratory infection, suspected difficult airway, retained ETT prior surgery, surgery at oral cavity, neck and thoracic region, operative time more than 120 minutes or less than 30 minutes, and history of lidocaine allergy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in incidence of coughing | the incidence was recorded during extubation and immediatly extubation | Coughing event was recorded by blinded anesthesiologist |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Severity of coughing | the severity was recorded during extubation and immediatly extubation | the severity of cough was recorded by blinded anesthesiologist. Coughing level severity (16) was evaluated as 0 = no cough; 1 = slight cough, cough without obvious contraction of abdomen; 2 = moderate cough, strong and sudden contraction of the abdomen lasting less than 5 seconds; 3 = severe cough, strong and sudden contraction of the abdomen sustained more than 5 seconds |
| Incidence of postoperative sore throat | the incidence was recorded within 24 hr after extubation | Incidence of postoperative sore throat was recorded by two blinded anesthetist nurses . The numeric rating scale (0 = no, 10 = extreme) was used for evaluation of sore throat. If the numeric rating scale was more than 3, it was considered as a significant adverse event. |
| Incidence of dysphonia | the incidence was recorded within 24 hr after extubation | Incidence of dysphonia was recorded by two blinded anesthetist nurses . |
| Incidence of dysphagia | the incidence was recorded within 24 hr after extubation | Incidence of dysphagia was recorded by two blinded anesthetist nurses . |
Countries
Thailand
Outcome results
None listed