Effects of 10% lidocaine spray on arterial pressure increase due to suspension laryngoscopy and cough during extubation
Deok Hee Lee, Sang-Jin Park, Deok Hee Lee, Sang-Jin Park
Abstract
Background: It is well known that suspension laryngoscopy (SL) produces marked hemodynamic changes. Coughing during extubation sometimes causes adverse clinical problems. We investigated whether 10% lidocaine spray could attenuate hemodynamic stress responses due to SL and reduce coughing incidence during extubation.
Methods: Sixty patients undergoing SL were randomly divided into two groups and intubated without 10% lidocaine spray (control group) or given 1.5 mg/kg of 10% lidocaine, sprayed onto laryngeal and intratracheal sites 2 min prior to intubation (10% lidocaine group). Mean arterial pressure (MAP) and heart rates (HR) during SL and coughing incidence during extubation were recorded.
Results: MAP at 2.5 and 5 min (P < 0.05) and HR at 2.5 min after SL (P < 0.01) were greater in the control group than in the 10% lidocaine group. The number of coughs decreased in the 10% lidocaine group compared to the control group during pre- (6.8 ± 3.2 vs 10.3 ± 4.4, P < 0.01) and post-extubation period of 5 min (4.0 ± 2.3 vs 6.2 ± 4.2, P < 0.05) and during the entire study period (10.8 ± 3.9 vs 16.5 ± 5.6, P < 0.001).
Conclusions: Preoperative laryngeal and intratracheal spraying with 1.5 mg/kg of 10% lidocaine spray is effective for attenuation of arterial pressure increase to SL and suppression of coughing during extubation.
Keywords: Cough; Laryngoscopy; Lidocaine; Pressure.
References
- Wenig BL, Raphael N, Stern JR, Shikowitz MJ, Abramson AL. Cardiac complications of suspension laryngoscopy. Fact or fiction? Arch Otolaryngol Head Neck Surg. 1986;112:860–862.
- Mustola ST, Baer GA, Metsä-Ketelä T, Laippala P. Haemodynamic and plasma catecholamine responses during total intravenous anaesthesia for laryngomicroscopy. Thiopentone compared with propofol. Anaesthesia. 1995;50:108–113.
- Strong MS, Vaughan CW, Mahler DL, Jaffe DR, Sullivan RC. Cardiac complications of microsurgery of the larynx: etiology, incidence and prevention. Laryngoscope. 1974;84:908–920.
- Bidwai AV, Bidwai VA, Rogers CR, Stanley TH. Blood-pressure and pulse-rate responses to endotracheal extubation with and without prior injection of lidocaine. Anesthesiology. 1979;51:171–173.
- Leech P, Barker J, Fitch W. Proceedings: Changes in intracranial pressure and systemic arterial pressure during the termination of anaesthesia. Br J Anaesth. 1974;46:315–316.
- Takita K, Morimoto Y, Kemmotsu O. Tracheal lidocaine attenuates the cardiovascular response to endotracheal intubation. Can J Anaesth. 2001;48:732–736.
- Park YO, Bang KS, Choi EM, Hong SJ, Kim IS, Shin KM, et al. Plasma Lidocaine Concentration and Hemodynamic Effect after 10% Lidocaine Spray on Laryngopharyngeal and Intratracheal Site during the Endotracheal Intubation. Korean J Anesthesiol. 2005;49:152–156.
- Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg. 2004;99:1253–1257.
- Hamaya Y, Dohi S. Differences in cardiovascular response to airway stimulation at different sites and blockade of the responses by lidocaine. Anesthesiology. 2000;93:95–103.
- Pandazi AK, Louizos AA, Davilis DJ, Stivaktakis JM, Georgiou LG. Inhalational anesthetic technique in microlaryngeal surgery: a comparison between sevoflurane-remifentanil and sevoflurane-alfentanil anesthesia. Ann Otol Rhinol Laryngol. 2003;112:373–378.
- Ayuso A, Luis M, Sala X, Sánchez J, Traserra J. Effects of anesthetic technique on the hemodynamic response to microlaryngeal surgery. Ann Otol Rhinol Laryngol. 1997;106:863–868.
- Matot I, Sichel JY, Yofe V, Gozal Y. The effect of clonidine premedication on hemodynamic responses to microlaryngoscopy and rigid bronchoscopy. Anesth Analg. 2000;91:828–833.
- Denlinger JK, Ellison N, Ominsky AJ. Effects of intratracheal lidocaine on circulatory responses to tracheal intubation. Anesthesiology. 1974;41:409–412.
- Hamill JF, Bedford RF, Weaver DC, Colohan AR. Lidocaine before endotracheal intubation: intravenous or laryngotracheal? Anesthesiology. 1981;55:578–581.
- Gonzalez RM, Bjerke RJ, Drobycki T, Stapelfeldt WH, Green JM, Janowitz MJ, et al. Prevention of endotracheal tube-induced coughing during emergence from general anesthesia. Anesth Analg. 1994;79:792–795.
- Diachun CA, Tunink BP, Brock-Utne JG. Suppression of cough during emergence from general anesthesia: laryngotracheal lidocaine through a modified endotracheal tube. J Clin Anesth. 2001;13:447–451.
- Jee D, Park SY. Lidocaine sprayed down the endotracheal tube attenuates the airway-circulatory reflexes by local anesthesia during emergence and extubation. Anesth Analg. 2003;96:293–297.
- Soltani HA, Aghadavoudi O. The effect of different lidocaine application methods on postoperative cough and sore throat. J Clin Anesth. 2002;14:15–18.
- Yukioka H, Yoshimoto N, Nishimura K, Fujimori M. Intravenous lidocaine as a suppressant of coughing during tracheal intubation. Anesth Analg. 1985;64:1189–1192.
- Nishino T, Hiraga K, Sugimori K. Effects of i.v. lignocaine on airway reflexes elicited by irritation of the tracheal mucosa in humans anaesthetized with enflurane. Br J Anaesth. 1990;64:682–687.
- Prengel AW, Lindner KH, Hähnel J, Ahnefeld FW. Endotracheal and endobronchial lidocaine administration: effects on plasma lidocaine concentration and blood gases. Crit Care Med. 1991;19:911–915.
- Groeben H, Silvanus MT, Beste M, Peters J. Both intravenous and inhaled lidocaine attenuate reflex bronchoconstriction but at different plasma concentrations. Am J Respir Crit Care Med. 1999;159:530–535.
- Yusa T, Taira Y, Sasara T, Yoza K. Effects of intratracheal lidocaine spray on circulatory responses to endotracheal intubation. Masui. 1990;39:1325–1332.
- Maruyama K, Sakai H, Miyazawa H, Iijima K, Toda N, Kawahara S, et al. Laryngotracheal application of lidocaine spray increases the incidence of postoperative sore throat after total intravenous anesthesia. J Anesth. 2004;18:237–240.
- Herlevsen P, Bredahl C, Hindsholm K, Kruhøffer PK. Prophylactic laryngo-tracheal aerosolized lidocaine against postoperative sore throat. Acta Anaesthesiol Scand. 1992;36:505–507.
- Klemola UM, Saarnivaara L, Yrjölä H. Post-operative sore throat: effect of lignocaine jelly and spray with endotracheal intubation. Eur J Anaesthesiol. 1988;5:391–399.
- Oh YJ, Kim HK, Park DH. The Effect of 10% Lidocaine Spray on Hemodynamics and Postoperative Sore Throat Accompanied by Endotracheal Intubation. Korean J Anesthesiol. 1996;30:663–667.
Source: PubMed