Effect of endotracheal tube lidocaine instillation in prevention of smokers emergence coughing: sample of Iraqi patients undergoing emergency appendectomy
Keywords:Anesthesia, Cough, Lidocaine, Smokers
Background:Cough reflex is normal protective reflex but cause various complication during emergence from general anesthesia especially to smokers
Methods: 300 patients of both sex enrolled in this study to have open emergency appendectomy. Patients divided into 4 groups. 50 non-smoker patients as control group. 50 smokers patient received no per operative efforts to reduce the incidence of postoperative cough, 100 smokers patient received 20 ml of 0.5% lidocaine dropped slowly into the endotracheal tube throughout the procedure, and 100 smoker patient received 20 ml normal saline dropped slowly into the endotracheal tube throughout the procedure. At the end of surgery, after extubation, the patient was considered to have cough if develops irritating cough or have 3 or more bucking.
Results: Incidence of cough significantly decreased (p≤0.05) among smoking patients treated with lidocaine in relation to patients treated with normal saline, smokers without intervention.
Conclusions: Instillation of lidocaine to endotracheal tube is effective method in reduction of smokers cough during emergence from general anesthesia.
Sumathi PA, Shenoy T, Ambareesha M, Krishna HM. Controlled comparison between betamethasone gel and lidocainee jelly applied over tracheal tube to reduce postoperative sore throat, cough, and hoarseness of voice. Br J Anaesth. 2008;100(2):215-8.
Aouad MT, Al-Alami AA, Nasr VG, Souki FG, Zbeidy RA, SiddikSayyid SM. The effect of low-dose remifentanil on responses to the endotracheal tube during emergence from general anesthesia. Anesth Analg. 2009;108:1157-60.
Lee JY, Lim BG, Park HY, Kim NS. Sufentanil infusion before extubation suppresses coughing on emergence without delaying extubation time and reduces postoperative analgesic requirement without increasing nausea and vomiting after desflurane anesthesia. Korean J Anesthesiol. 2012;62(6):512-7.
Schwilk B, Bothner U, Schraag S, Georgieff M. Perioperative respiratory events in smokers and non-smokers undergoing general anaesthesia. Acta Anaesthesiol Scand. 1997;41:348-55.
Bousselmi R, Lebbi MA, Bargaoui A, Romdhane MB, Messaoudi A, Gabsia AB, Ferjani M. Lidocainee reduces endotracheal tube associated side effects when instilled over the glottis but not when used to inflate the cuff: a double blind, placebo-controlled, randomized trial. La tunisie medicale. 2014;92 (n°01):29-33.
Nishino T, Hiraga K, Sugimori K. Effects of i.v. lignocaine on airway reflexes elicited by irritation of the tracheal mucosa in humans anesthetized with enflurane. Br J Anaesth. 1990;64682-7.
Kothari D, Tandon N, Singh M, Kumar A. Attenuation of circulatory and airway responses to endotracheal extubation in craniotomies for intracerebral space occupying lesions: dexmedetomidine versus lignocaine. Anesthesia: essays and researches. 2014;8(1).
Gonzalez RM, Bjerke RJ, Drobycki T, Stap elfeldt WH, Green JM, Janowitz MJ, et al. Prevention of endotracheal tube-induced coughing during emergence from general anesthesia. Anesth Analg. 1994;79:792-5.
Erskine RJ, Murphy PJ, Langton JA. Effect of stopping smoking on upper airway reflexes. Br J Anaesth. 1993;70:478.
Bergren DR. Chronic tobacco smoke exposure increases cough to capsaicin in awake guinea pigs. Respir Physiol. 2001;126:127-40.
Navarro L, Lima R, Aguiar A, Braz J, Carness J, Módolo N. The effect of intracuff alkalinized 2% lidocainee on emergence coughing, sore throat, and hoarseness in smokers. Rev Assoc Med Bras. 2012;58(2):248-53.
Caranza R, Raphael JH, Nandwani N, Langton JA. Effect of nebulized lidocainee on the quality of induction of anaesthesia in cigarette smokers. Anaesthesia. 1997;52:849-52.
George SE, Singh G, Mathew BS, Fleming D, Korula G. Comparison of the effect of lignocaine instilled through the endotracheal tube and intravenous lignocaine on the extubation response in patients undergoing craniotomy with skull pins: a randomized double blind clinical trial. J. Anaesthesiol Clin Pharmacol. 2013;29:2.