Effectiveness of lidocaine/prilocaine cream on cardiovascular reactions from endotracheal intubation and cough events during recovery period of older patients under general anesthesia: prospective, randomized placebo-controlled study

Abstract

Background Endotracheal intubation is known to pose significant physiological, pharmacokinetic, and dynamic changes and postoperative respiratory complications in patients under general anesthesia. Method An RCT trial was organized by the Third Affiliated Hospital at Sun Yat-sen University, China. Patients were eligible for inclusion in the trial if they were over 60 years old and had upper-abdominal surgery during the induction of anesthesia and had enrolled in endotracheal intubations. The primary end point included cardiovascular reactions during the induction of anesthesia and endotracheal intubations and cough events during the recovery period. In the test group, 2 g of lidocaine/prilocaine cream (and in the control group, 2 g of Vaseline) were laid over the surface of the tracheal tube cuff. Results The systolic blood pressure (F value = 62.271, p < 0.001), diastolic blood pressure (F value = 150.875, p < 0.001), and heart rate (F value = 75.627, p < 0.001) of the test group were significantly lower than the control group. Cough events during the recovery period in the test group were better (spontaneous cough, χ2 value = 10.591, p < 0.001; induced cough, χ2 value =10.806, p < 0.001). Conclusion In older patients, coughing and cardiovascular reactions under anesthesia and endotracheal intubations were reduced, as a result of using lidocaine/prilocaine cream on the surface of the tracheal tube cuff. Trial registration International Clinical Trials Network NCT02017392, 2013-12-16.

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

“…So far, the consensus among anesthesiologists is that compound Lidocaine cream can reduce the cough response caused by tracheal tube removal after general anesthesia. One study showed that compound Lidocaine cream signi cantly reduced the incident of cough caused by endotracheal extubation to 6.4% in old patients [5]. 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].…”

“…The anesthesiologist A treated the surface of the tip of the endotracheal tube according to the random number table by predetermined medication or saline, normal saline(2 ml)in group C, 2 g compound lidocaine cream in group L, 10% tetracaine 2 ml in group T and compound lidocaine cream 2 g combined 10% tetracaine injection (2 ml) in group F. The compound lidocaine cream was applied and the tetracaine injection or the NS was sprayed on the surface of the tracheal tube cuff. The method of applying compound Lidocaine cream (compound lidocaine cream, 10g, containing 25mg each of lidocaine and prilocaine, Tongfang Pharmaceutical Group Co., Ltd. Beijing China) to the surface of the tracheal tube cuff is according to the previous study [5], The method of spraying tetracaine (tetracaine Hydrochloride for Injection, 50 mg, Chengdu Zhengkang Pharmaceutical Co., Ltd. Chengdu, China) to the surface of the tracheal tube cuff is according to the previous clinical experience of our department. Moreover, we modi ed lidocaine cream to compound lidocaine cream in the manuscrip.…”

“…The irritation of the endotracheal tube to the epiglottis and airway mucosa is the anatomical cause of coughing and sore throat. Compound Lidocaine cream applying tracheal tube or tetracaine spraying on airway mucosa is the most commonly used method to prevent cough due to extubation from general anaesthesia [5,6]. However, in our clinical anesthesia work, there are still nearly 50% of patients with choking and coughing reactions.…”

Lidocaine-eluting endotracheal tube effectively attenuates intubation related airway response

“…Common clinical approaches to attenuate intubationinduced airway and hemodynamic responses include shortacting opioids, anti-arrhythmia agents, and intravenous or topical anesthetic agents (9,10). Among these, topical lidocaine (LDC) has been applied for decades by means of intratracheal spray, oxygen atomization, intracuff filling, or gel lubrication due to the advantage of its simple operation, direct absorption, and rapid anesthetic effect (3,(9)(10)(11)(12)(13)(14). However, the topical use of LDC does not provide a longterm anesthetic effect due to the relatively low doses used and short effective anesthetic duration (1 to 2 h, or less) (3,7,9,15).…”

Correction to: Effectiveness of lidocaine/prilocaine cream on cardiovascular reactions from endotracheal intubation and cough events during recovery period of older patients under general anesthesia: prospective, randomized placebo-controlled study

“…Following publication of the original article [ 1 ], we have been notified that there is a mistake in authors’ first and last names.…”