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 h 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 the time to awareness when compared with lidocaine and normal saline. Trial registration ChiCTR1800017482 . (Prospective registered). Initial registration date was 01/08/2018.

Effects of dexmedetomidine on intraoperative hemodynamics, recovery profile and postoperative pain in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial

“…This study showed that the spontaneous respiratory recovery time and extubation time increased more significantly in the experimental groups compared with NS group. The dexmedetomidine 0.8μg/kg group had the greatest effect on the spontaneous breathing time and extubation time, which was similar to previous studies [ 4 , 6 – 8 , 10 , 11 , 14 , 15 , 17 ]. The higher the dose of dexmedetomidine, the greater the effect on the spontaneous breathing time and extubation time of patients.…”

“…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 fluctuation, arrhythmia, wound dehiscence and bleeding. Many drugs such as propofol, ketamine, remifentanil and lidocaine have been used to reduce the cough reflex during extubation [ 1 – 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.…”

“…Studies have found that administration of dexmedetomidine during surgery or at the end of surgery can attenuate stress and cough response, reduce postoperative pain and postoperative nausea and vomiting (PONV). However, with a high dose or administrated at the end of surgery, dexmedetomidine delays awakening and caused bradycardia and other complications [ 4 – 8 ]. For short surgery or day-surgery like laparoscopic cholecystectomy (LC), whether the rational loading dose of dexmedetomidine before induction can attenuate stress and cough response, alleviate postoperative pain and reduce PONV, meanwhile minimize the influence on recovery time and heart rates (HR).…”

Smooth Extubation and Smooth Emergence Techniques: A Narrative Review

“…IV lidocaine has long been studied as an agent to suppress laryngospasm and the cardiovascular response to extubation [ 13 , 34 , 35 ]. However, it should be noted that evidence from other studies has not always supported the efficacy of lidocaine to attenuate or prevent these changes [ 2 ].…”