Effect of intravenous versus intratracheal lidocaine on airway and hemodynamic responses during extubation after thyroid surgery. A prospective cohort study

Abstract

Introduction: Coughing during extubation after thyroid surgery can increase venous pressure and release the vessel ligation which leads to active bleeding, and form hematoma which can be a life threatening due to airway obstruction. Lidocaine before extubation may reduce cough and hemodynamic instability. The aim of this study was to compare effect of intra-tracheal and intravenous lidocaine on airway and hemodynamic responses during extubation. Method: A hospital based prospective cohort study was conducted on 74 patients who underwent thyroid surgery. A Systematic random sampling technique was employed. Data recording was made after Anesthetists gave 1.5 mg/kg 2% lidocaine either intravenous (control group) or intra-tracheal (exposed group) before extubation. The episode and grade of coughs were recorded. Heart rate and blood pressure were also recorded at the time of lidocaine administration, and at 1,2,3,4 and 5 minutes post extubation. Independent two sample t-test and chi-square were computed. P-value < 0.05 considered as statistically significant. Result: The two groups were comparable with respect to socio -demographic and clinical characteristics. The incidence of coughing after intravenous and intratracheal lidocaine was 11% and 15%, p-value, 0.425, respectively. The sedation score after extubation also was comparable between the two groups. Even though the difference between the two groups was statistically insignificant, the mean heart rates and blood pressure after lidocaine in intravenous and intratracheal lidocaine groups were higher at 1 min post extubation and then decline to baseline mean heart rate at 5 munities post extubation. Conclusion: Intravenous and intratracheal lidocaine have comparable effects on airway and hemodynamic response during extubation after thyroid surgery. The sedation score after lidocaine was also similar among the two groups. Therefore lidocaine can be used either intra tracheal or intravenously before extubation. Highlights