Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgery

Abstract

Background：Intravenous lidocaine and dexmedetomidine treatments have been proposed as methods for inhibiting cough. We compared the efficacy of intravenous lidocaine and dexmedetomidine treatments on inhibiting cough during the tracheal extubation period after thyroid surgery. Methods：One hundred eighty patients undergoing thyroid surgeries were randomly allocated to the LIDO group (received lidocaine 1.5 mg/kg loading, 1.5 mg/kg/h infusion), the DEX group (received dexmedetomidine 0.5 µg/kg loading, 0.4 µg/kg/h infusion) and the CON group (received saline), with 60 cases in each group. The primary outcomes of cough were recorded. Secondary outcomes included hemodynamic variables, awareness time, volume of drainage, the postoperative visual analogue scale and adverse effects were recorded. Results: The incidence of cough were significantly lower in the LIDO group (28.3%) and the DEX group (31.7%) than that in the CON group (66.7%) (P=0.000). Additionally, both moderate and severe cough were significantly lower in the LIDO group (13.3%) and the DEX group (13.4%) than these in the CON group (43.4%) (P<0.05). Compared with the two treatment groups, both mean arterial blood pressure and heart rate were significantly increased in the CON group during tracheal extubation (P<0.05). Compared with the CON group, the volume of drainage was significantly reduced in the two treatment groups within 48 hours after surgery (P<0.05). compared with the CON group, the postoperative visual analogue scale was significantly lower in groups LIDO and DEX after surgery(P<0.05). Compared with the LIDO group and the CON group, the time to awareness was longer in the DEX group (P<0.05). In the DEX group, bradycardia was noted in 35 patients, while no bradycardia was noted in LIDO group and CON group. Conclusion: Compared with intravenous infusions of normal saline, both lidocaine and dexmedetomidine had equal effectiveness in attenuating cough and hemodynamic changes during the tracheal extubation period after thyroid surgery, and both of these treatments were able to reduce the volume of postoperative bleeding and provide better analgesic effect after surgery. But intravenous infusions of dexmedetomidine resulted in bradycardia and delayed time to awareness when compared with lidocaine and normal saline.

Effects of Dexmedetomidine on Intraoperative Hemodynamics, Recovery Profile and Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Trial

“…A Previous study has shown that the incidence of cough is 66.7% during the tracheal extubation period in the CON group [4] . We hypothesized that dexmedetomidine infusion before induction could reduce the incidence of cough during emergence by 50% (a power of 80% and α of 0.05), 30 patients required in each group.…”

“…Cough during the recovery period of general anesthesia is a more concerned problem, mainly caused by the stimulation of endotracheal tube, secretions and volatile anesthetics, which not only brings unpleasant feelings to patients, but also accompanies with complications such as laryngospasm, circulation uctuation, arrhythmia, wound dehiscence and bleeding. Many drugs such as propofol, ketamine, remifentanil and lidocaine have been used to reduce the cough re ex during extubation [1][2][3][4] . Dexmedetomidine is a α 2 adrenergic receptor agonist that can produce sedative and anti-anxiety effects through receptors in the locus coeruleus without respiratory depression [12,17] .…”

“…Dexmedetomidine is a α 2 adrenergic receptor agonist that can produce sedative and anti-anxiety effects through receptors in the locus coeruleus without respiratory depression [12,17] . Moreover, it is often used to reduce cough during the emergence of general anesthesia due to its unique sedative effect [2,4,5] . However, the dose-effect relationship is still controversial.…”

Supine versus semi-Fowler’s positions for tracheal extubation in abdominal surgery-a randomized clinical trial

“…Although expectoration is comparable between the two groups, the semi-Fowler’s position still provides better expectoration than the supine position without increasing unfavorable severe coughing and passive bucking. Some studies have shown that intravenous lidocaine or dexmedetomidine can reduce post-extubation coughing [ 18 , 19 ]. In our study, there was no significant difference in the percentage of patients using lidocaine cream or intravenous dexmedetomidine.…”

Extubation and the Risks of Coughing and Laryngospasm in the Era of Coronavirus Disease-19 (COVID-19)

“…Even when a patient does not react with a significant heart rate increase or cough during extubation, a moment of breath-holding or transient upper airway obstruction may follow, which must be managed with close observation and appropriate upper airway support until quiet, regular breathing resumes. The administration of intravenous lidocaine prior to extubation has been demonstrated to decrease airway irritability without depressing respiration or delaying emergence [30][31][32]. The selective use of propofol, fentanyl, remifentanil, hydromorphone, tramadol, ketamine, dexmedetomidine, or magnesium may smooth the course of extubation, whether the intent is to extubate the trachea with the patient awake, sedated, or deeply anesthetized [13,28,29,33,34].…”