Effects of lignocaine administered intravenously or intratracheally on airway and hemodynamic responses during emergence and extubation in patients undergoing elective craniotomies in supine position

Abstract

Introduction:Sympathoadrenergic responses during emergence and extubation can lead to an increase in heart rate (HR) and blood pressure whereas increased airway responses may lead to coughing and laryngospasm. The aim of our study was to compare the effects of lignocaine administered intravenously (IV) or intratracheally on airway and hemodynamic responses during emergence and extubation in patients undergoing elective craniotomies.Methodology:Sixty patients with physical status American Society of Anaesthesiologists Classes I and II aged 18–70 years, scheduled to undergo elective craniotomies were included. The patients were randomly divided into three groups of twenty patients; Group 1 receiving IV lignocaine and intratracheal placebo (IV group), Group 2 receiving intratracheal lignocaine and IV placebo (I/T group), and Group 3 receiving IV and intratracheal placebo (placebo group). The tolerance to the endotracheal tube was monitored, and number of episodes of cough was recorded during emergence and at the time of extubation. Hemodynamic parameters such as HR and blood pressure (systolic, diastolic, mean arterial pressure) were also recorded.Results:There was a decrease of HR in both IV and intratracheal groups in comparison with placebo group (P < 0.005). Rise in blood pressure (systolic blood pressure, diastolic blood pressure and mean arterial pressure) was comparable in both Groups 1 and 2 but was lower in comparison with placebo group (P < 0.005). Cough suppression was comparable in all the three groups. Grade III cough (15%) was documented only in placebo group.Conclusion:Both IV and intratracheal lignocaine are effective in attenuation of hemodynamic response if given within 20 min from skull pin removal to extubation. There was comparable cough suppression through intratracheal route and IV routes than the placebo group.

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

“…Several studies have shown that lidocaine can reduce the incidence and severity of cough during anesthetic emergence through different methods, including intracuff, tube lubrication, intratracheal instillation and intravenous bolus infusions before an induction [17–20]. Shabnum et al [12]. found that both IV and intratracheal lidocaine are effective in the attenuation of cough.…”

“…Two studies showed that the administration of single-dose 0.5 mg/kg dexmedetomidine before the end of surgery effectively reduced cough during anesthetic emergence [10, 11]. Additionally, a previous report showed that an intravenous administration of lidocaine can inhibit cough during extubation [12]. Even though both of these treatments have been reported to effectively inhibit cough on the emergence from general anesthesia, but the differences between intravenous lidocaine and dexmedetomidine in inhibiting cough during the tracheal extubation period are unclear.…”

Role of pre–extubation fentanyl in mastectomy: a randomized, controlled, double–blind study

“…Both tracheal intubation and extubation are associated with hazardous consequences such as tachycardia, arrhythmias, myocardial ischemia, hypertension as well as elevation of intracranial and intra-abdominal pressure. 1 These potentially serious side effects during tracheal intubation can be solved and managed effectively and rapidly by administration of inhalational or intravenous (IV) anesthesia. 2 On contrary, during extubation, if hypertensive crises occur especially in hypertensive patients, anesthesiologist, if aware by such problem, may have less weapons to manage it.…”