Impact of topical airway anesthesia on immediate postoperative cough/bucking: a systematic review and meta-analysis

Sakae, Thiago Mamôru; Souza, Renato Lucas Passos de; Brandão, Julio Cézar Mendes

doi:10.1016/j.bjane.2021.03.016

Cited by 5 publications

(4 citation statements)

References 43 publications

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“…These medications can also be used to decrease pain or discomfort due to skin irritation, sunburns, and several other causes of minimal discomfort on the body surface. Topical anesthesia is widely used on mucous membranes, such as the nose, throat, rectum, and vagina, to minimize the pain of some medical procedures, such as the insertion of tubes or a speculum [ 5 ]. In addition, topical anesthesia is widely used in invasive airway procedures such as endoscopy, intubation, and bronchoscopy [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Using Chitosan-Coated Polymeric Nanoparticles-Thermosensitive Hydrogels in association with Limonene as Skin Drug Delivery Strategy

Campos

Proença

Costa

et al. 2022

BioMed Research International

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Topical delivery of local anesthetics (LAs) is commonly used to decrease painful sensations, block pain throughout procedures, and alleviate pain after surgery. Dermal and/or transdermal delivery of LAs has other advantages, such as sustained drug delivery and decreased systemic adverse effects. This study reports the development of poly(D,L-lactide-co-glycolide) (PLGA) nanoparticles coated with chitosan for the sustained release and topicality of benzocaine (BZC) and topical delivery. BZC PLGA nanoparticles or nonencapsulated drugs were further incorporated into Poloxamer hydrogels (Pluronic™ F-127). The nanoparticles showed a mean diameter of 380 ± 4 nm, positive zeta potential after coating with chitosan ( 23.3 ± 1.7 mV), and high encapsulation efficiency ( 96.7 ± 0.02 % ). Cellular viability greater than 70% for both fibroblasts and keratinocytes was observed after treatment with nanoparticles, which is in accordance with the preconized guidelines for biomedical devices and delivery systems. Both the nanoparticles and hydrogels were able to modulate BZC delivery and increase drug permeation when compared to the nonencapsulated drug. Furthermore, the incorporation of limonene into hydrogels containing BZC-loaded nanoparticles increased the BZC permeation rates. Non-Newtonian and pseudoplastic behaviors were observed for all hydrogel nanoformulations with or without nanoparticles. These results demonstrate that the hydrogel-nanoparticle hybrids could be a promising delivery system for prolonged local anesthetic therapy.

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Section: Introductionmentioning

confidence: 99%

Using Chitosan-Coated Polymeric Nanoparticles-Thermosensitive Hydrogels in association with Limonene as Skin Drug Delivery Strategy

Campos

Proença

Costa

et al. 2022

BioMed Research International

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“…Our study showed that the compound Lidocaine cream also can signi cantly reduce the incident of cough caused by endotracheal extubation about 35% compared NS control group, but there are still 61% patients who have a cough response, perhaps this is because younger patients were more responsive to tracheal tube stimulation of the airway mucosa than older patients [20]. A review study also showed that local anesthetics did not attenuate cough associated with extubation [21], but another eta-study showed that topical airway anesthesia demonstrated better than placebo or no medication in reducing immediate post-extubation cough/bucking [22]. It is well known that tetracaine has a very strong mucosal penetration and can play a better mucosal surface anesthesia [7].…”

Section: Discussionmentioning

confidence: 99%

Compound Lidocaine cream combined with tetracaine prevents cough reaction of patients with general anesthesia caused by extubation: a randomised controlled trial

Zhang

Zhao

et al. 2022

Preprint

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Background: Coughing response caused by tracheal extubation is the most common in general anesthesia patients with tracheal intubation during recovery from anesthesia. However, high aerosol production by coughing during recovery from general anesthesia in patients with respiratory infections (especially COVID-19) is one of the highest risk factors for infection among healthcare workers. Application of local anesthetics to the endotracheal tube is an effective method to reduce the choking reaction. The most commonly used anaesthetics are compound Lidocaine cream and tetracaine injection. However, there is still a certain number of choking reactions in the clinic when the two anaesthetics are used alone. We speculate that the combined application of compound Lidocaine cream and tetracaine will play a better role in prevent coughing response caused by tracheal extubation.Methods: A total of 211 patients, who had undergone laparoscopic cholecystectomy or cholecystectomy combined with common bile duct exploration under general anesthesia, were randomly assigned to Group C (saline injection, 53 cases), Group L(compound lidocaine cream, 52 cases), Group T (tetracaine, 52 cases) and Group F (compound lidocaine cream combined tetracaine, 54 cases). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), levels of epinephrine and levels of norepinephrine were recorded or measured immediately before extubation and one minute after extubation. In addition, endotracheal tube tolerance, the incidence of bucking, the incidence of agitation, the active extubation rate, the incidence of postoperative pharyngeal pain and the incidence of postoperative cough were analyzed. Results: Blood pressure and heart rate as well as blood concentrations of epinephrine and norepinephrine were significantly higher in the group C compared with the every other group at the time of extubation as well as 1 min after extubation (P < 0.001). And group F significantly reduced the Blood pressure and heart rate as well as blood concentrations of epinephrine and norepinephrine compared group L or group T (P < 0.05, P < 0.01 or P < 0.001). When the patients emerged from general anesthesia, 96% of the group C had cough caused by sputum aspiration and extubation, which was significantly reduced by group L (61.5%, P < 0.001), group T (75%, P < 0.05) and group F (22.2%, P < 0.001), furthermore, group F significantly reduced the incidence of cough compared group L or group T (P < 0.01). Assessment of endotracheal tube tolerance, the score in the group C ((1, 3) 4, P < 0.001) is higher than group L ((0, 1) 2), group T ((0, 1.25) 3) and group F ((0, 0) 1), furthermore, group F significantly reduced the score compared group L or group T (P < 0.05, P < 0.01, respectively). The incidence of agitation and the active extubation rate were also higher in group C (96.2%, 71.7%, respectively, P < 0.001) than group L (48.1%, 15.4%, respectively), group T (61.5%, 26.9%，respectively) and group F (17.3%, 7.7%，respectively), furthermore，group F significantly reduced the incidence of cough compared group L or group T (P < 0.05 or P < 0.01). In addition, the incidence of postoperative pharyngeal pain and the incidence of postoperative cough were no statistical difference between every groupConclusions: Compound Lidocaine cream combined tetracaine may be a more advantageous approach for preventing choking and stabilizing circulation during extubation in emergence from general anesthesia, which may play an important role in preventing medical staff from contracting respiratory infectious diseases. Trial registration: Chinese Clinical Trial Registry: ChiCTR2200058429 (registration date: 09-04-2020) “retrospectively registered”.

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“…Various strategies aimed at reducing cough reflex caused by endotracheal tube cuff have been studied, such as applying local anaesthetics to the endotracheal tube cuff, inhaling steroid preoperatively, opioid or lidocaine administration during emergence and extubation, or extubation under deep anesthesia [7][8][9]. No trial on cough reflex caused by sudden pressure reduction of the endotracheal tube cuff during extubation has been conducted.…”

Section: Introductionmentioning

confidence: 99%

Effects of continuous and slow tracheal tube cuff deflation on cough reflex during extubation in noncardiac surgery patients: a randomised clinical trial

et al. 2023

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Background The incidence of cough reflex during extubation is 76%. Cough reflex causes severe hemodynamic fluctuations and airway complications. This prospective trial investigated the potential effects of tracheal tube cuff deflation on cough reflex during extubation. Methods One hundred and twenty-six patients scheduled for operations within 3 h under general anaesthesia with orotracheal intubation were randomly assigned to one of three groups: control (C), experimental (E) or syringe (S) groups. Patients in group C underwent tracheal tube cuff deflation using a 10-ml syringe in 1 s, patients in group E underwent tracheal tube cuff deflation continuously and slowly in 5 s using a cuff pressure gauge until the pressure was zero and patients in group S underwent tracheal tube cuff deflation using a 10-ml syringe at a speed of 1 ml s−1. The incidence and severity of cough reflexs during extubation and the incidence of postoperative airway complications within 48 h were assessed. Results Compared with group C (60.0%), the incidence of cough reflex in group E was 9.8% (p < 0.001) and in group S was 12.5% (p < 0.001). The severity of cough reflex was graded as 2 (1–2) in group C, 1 (1–1) in group E and 1 (1–1) in group S (p < 0.001 for group comparisons). The incidence of hoarseness in group C was 0.0%, in group E was 19.5% and in group S was 5.0% (p < 0.05 for all groups, p = 0.009 between group C and E). Conclusions Compared with deflating a trachal tube cuff with a 10-ml syringe in 1 s, the use of a 10-ml syringe at a speed of 1 ml s−1 or a cuff pressure guage within 5 s can both reduce the incidence of cough reflex, but deflating with a cuff pressure guage can increase the incidence of postoperative hoarseness. Trial registration Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

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Impact of topical airway anesthesia on immediate postoperative cough/bucking: a systematic review and meta-analysis

Cited by 5 publications

References 43 publications

Using Chitosan-Coated Polymeric Nanoparticles-Thermosensitive Hydrogels in association with Limonene as Skin Drug Delivery Strategy

Using Chitosan-Coated Polymeric Nanoparticles-Thermosensitive Hydrogels in association with Limonene as Skin Drug Delivery Strategy

Compound Lidocaine cream combined with tetracaine prevents cough reaction of patients with general anesthesia caused by extubation: a randomised controlled trial

Effects of continuous and slow tracheal tube cuff deflation on cough reflex during extubation in noncardiac surgery patients: a randomised clinical trial

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