Post adenotonsillectomy coughing and laryngospasm in children: preextubation mini-dose suxamethonium, lidocaine, and their combination prove prophylactic
DOI:
https://doi.org/10.18203/2320-6012.ijrms20223619Keywords:
Adenotonsillectomy, Coughing, Laryngospasm, Lidocaine, SuxamethoniumAbstract
Background: Post adenotonsillectomy coughing and laryngospasm in children entails deleterious sequelae, warranting continued search for effective prophylaxis. The aim was to determine the prophylactic efficacy of intravenous mini-dose (0.1 mg/kg) suxamethonium, 1.5 mg/kg lidocaine 1%, and their combination, against coughing and laryngospasm in children emerging from general anaesthesia after adenotonsillectomy.
Methods: Ethical approval and parental written consent secured, 69 children, aged 1-6 years, of American Society of Anesthesiologists (ASA) class I were randomized into groups A, B, and C, of 23 each. All patients had general anaesthesia induced with propofol 2 mg/kg plus fentanyl 2 µ/kg, maintained with isoflurane 1-1.5% in 100% oxygen, and tracheal intubation facilitated by pancuronium 0.075 mg/kg. Two minutes after reversal dose of neostigmine, groups A, B and C respectively received 1.5 mg/kg lidocaine 1%, suxamethonium 0.1 mg/kg, and 1.5 mg/kg lidocaine 1% plus suxamethonium 0.1 mg/kg, intravenously. Tracheal extubation was done 90 seconds after study drug administration, and coughing and laryngospasm were assessed for 10 minutes using modified Minogue and Likert 4-point scales respectively.
Results: All 69 subjects completed the study. The incidence of mild to moderate coughing was 22 (95.7%) in groups A and B, and 19 (82.6%) in group C, p=1.000. Laryngospasm occurred in none (0.0%) in group C, while in groups A and B its occurrence was 1(4.3%), p=1.000.
Conclusions: Mini-dose suxamethonium or lidocaine 1.5 mg/kg prevented grade 3 coughing and laryngospasm; furthermore, their combination prevented grade 3 coughing and achieved zero incidence of laryngospasm.
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References
Pak HJ, Lee WH, Ji SM, Choi YH. Effect of a small dose of propofol or ketamine to prevent coughing and laryngospasm in children awakening from general anesthesia. Korean J Anesthesiol. 2011;60(1):25-9.
Irwin RS. Complications of cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1):54-8.
Visvanathan T, Kluger MT, Webb RK, Westhorpe RN. Crisis management during anaesthesia: Laryngospasm. Qual Saf Health Care. 2005;14(3):3.
Alalami AA, Ayoub CM, Baraka AS. Laryngospasm: review of different prevention and treatment modalities. Paediatr Anaesth. 2008;18(4):281-8.
Gil G, Robert WM. Laryngospasm in anaesthesia. Contin Educ Anaesth Crit Care Pain. 2014;14(2):47-51.
Heidari SM, Rahimi M, Hashemi SJ, Fesahat B. A comparison between intravenous magnesium sulphate, lidocaine and propofol in prevention of respiratory complications after adenotonsillectomy. J Isfahan Med School. 2013;30(217):2178-88.
Hampson-Evans D, Morgan P, Farrar M. Pediatric laryngospasm. Paediatr Anaesth. 2008;18(4):303-7.
Chung DC, Rowbottom SJ. A very small dose of suxamethonium relieves laryngospasm. Anaesthesia. 1993;48(3):229-30.
Hobaika ABS, Lorentz MN. Laryngospasm. Rev Bras Anestesiol. 2009;59(4):487-95.
Katz DL, Jekel JF, Elmore JG, Wild DMG, Lucan SC. Sample size calculation for epidemiological studies. In: Jekel JF eds. Jekel’s Epidemiology, Biostatistics, Preventive Medicine and Public Health. 4th edition. Philadelphia: Saunders, Elsevier Inc.; 2014: 155.
Sanikop CS, Bhat S. Efficacy of intravenous lidocaine in prevention of post extubation laryngospasm in children undergoing cleft palate surgeries. Indian J Anaesth. 2010;54(2):132-6.
Tung A, Fergusson NA, Ng N, Hu V, Dormuth C, Griesdale DGE. Pharmacological methods for reducing coughing on emergence from elective surgery after general anaesthesia with endotracheal intubation: protocol for a systematic review of common medications and network meta-analysis. Syst Rev. 2019;8(1):32.
Leicht P, Wisborg T, Chraemmer-Jørgensen B. Does intravenous lidocaine prevent laryngospasm after extubation in children? Anesth Analg. 1985;64:1193-6.
Gefke K, Andersen LW, Friesel E. Lidocaine given intravenously as a suppressant of cough and laryngospasm in connection with extubation after tonsillectomy. Acta Anaesthesiol Scand. 1983;27(2):111-2.
Olsson GL, Hallen B. Laryngospasm during anaesthesia. A computer incidence study in 136,929 patients. Acta Anaesthesiologica Scandinavica. 1984; 28:567-75.
Mihara T, Uchimoto K, Morita S, Goto T. The efficacy of lidocaine to prevent laryngospasm in children: a systematic review and meta-analysis. Anaesthesia. 2014;69(12):1388-96.
Panchal AR, Berg KM, Kudenchuk PJ, Rios MD, Hirsch KG, Link MS, et al. 2018 American heart association focused update on advanced cardiovascular life support use of antiarrhythmic drugs during and immediately after cardiac arrest: an update to the American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2018;138:740-9.
Manouchehrian N, Jiryaee N, Moheb FA. Propofol versus lidocaine on prevention of laryngospasm in tonsillectomy: a randomized clinical trial. Eur J Translation Myol. 2022;32(3).
Erb TO, Ungern-Sternberg BS, Keller K, Frei FJ. The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetized children. Anaesthesia. 2012;68(1):13-20.
Electronic Medicines Compendum. Lidocaine Hydrochloride 2% w/v solution for injection Monograph. Available at: https://www.medicines.org.uk/emc/product/6281/smpc#gref. Accessed on 16 October 2022.
Walker RW, Sutton RS. Which port in a storm? Use of suxamethonium without intravenous access for severe laryngospasm. Anaesthesia. 2007;62(8):757-9.
Isono S. Developmental changes of pharyngeal airway patency: implications for pediatric anesthesia. Pediatr Anesth. 2006;16:109-22.
Harteveld LM, Nederend I, Harkel ADJ, Schutte NM, Rooij SR, Vrilkotte TJM, et al. Maturation of the cardiac autonomic nervous system activity in children and adolescents. J Am Heart Assoc. 2021;10:017405.
Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of The Difficult Airway. A Closed Claims Analysis. Anesthesiology 2005;103:33-39
Roy WL, Lerman J. Laryngospasm in paediatric anaesthesia. Can J Anaesth. 1988;35:93-8.
Gulhas N, Durmus M, Demirbilek S, Togal T, Ozturk E, Ersoy MO. The use of magnesium to prevent laryngospasm after tonsillectomy and adenoidectomy; a preliminary study. Paediatr Anaesth. 2003;13(1):43-7.
Wang Z, Li N, Jiang M, Dear K, Hsieh CR. Records of medical malpractice litigation: a potential indicator of health-care quality in China. Bull World Health Organ. 2017;95(6):430-6.
Yadav RK, Majhi PC, Tiwari D. A clinical comparison of high dose and low dose of suxamethonium. J Coll Med Sci Nepal. 2013;9(2):1-8.
Oliveira CMB, Issy AM, Sakata RK. Intraoperative intravenous lidocaine. Rev Bras Anestesiol. 2010;60(3):325-33.
Appiah-Ankam J, Hunter JM. Pharmacology of neuromuscular blocking drugs. Contin Educat Anaesth Crit Care Pain. 2004;4(1):2-7.
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