Intravenous Lidocaine Prior to Extubation Reduces Emergence Agitation and Cough in Pediatric Adenotonsillectomy under Sevoflurane Anesthesia

Lee, Ji Yeon; Kim, Chong Hoon; Kim, Soo Hwan; Kim, Joon Sik; Lee, Ki Young

doi:10.4097/kjae.2007.53.4.458

Cited by 3 publications

(10 citation statements)

References 28 publications

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“…A total of 571 records were identified through database searching and other sources, the full texts of 50 articles were examined in detail. And finally we included 12 RCTs 3 4 5 9 10 11 12 13 14 15 16 17 with a total of 1416 participants. Searching process was shown in the flowchart ( Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Anesthetists have been administering lidocaine intravenously or topically to prevent perioperative events during pediatric general anesthesia for many years. However, some studies have proposed that lidocaine prevents perioperative events such as cough and agitation but not laryngospasm 3 4 5 6 . Given that most studies are underpowered due to low incidence of laryngospasm or small-sized candidates, we decided to conduct a network meta-analysis of randomized controlled trials that evaluated the effect of intravenous or topical lidocaine in preventing laryngospasm during pediatric general anesthesia.…”

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confidence: 99%

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The Efficacy of Lidocaine in Laryngospasm Prevention in Pediatric Surgery: a Network Meta-analysis

Lai

et al. 2016

Sci Rep

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Higher incidence and worse outcomes of laryngospasm during general anesthesia in children than adults have been reported for many years, but few prevention measures are put forward. Efficacy of lidocaine in laryngospasm prevention has been argued for many years and we decided to design this network meta-analysis to assess the efficacy of lidocaine. We conducted an electronic search of six sources and finally included 12 Randomized Controlled Trials including 1416 patients. A direct comparison between lidocaine and placebo revealed lidocaine had the effect on preventing laryngospasm in pediatric surgery (RR = 0.46, 95% CI = [0.30, 0.70], P = 0.0002, I2 = 0%). Both subgroup analysis and network analysis demonstrated that both intravenous lidocaine (subgroup: RR = 0.39, 95% CI = [0.18, 0.86], P = 0.02, I2 = 38%; network: RR = 0.25, 95% CI = [0.04, 0.86]) and topical lidocaine (subgroup: RR = 0.37, 95% CI = [0.19, 0.72], P = 0.003, I2 = 0%; network: RR = 0.14, 95% CI = [0.02, 0.55]) was effective in laryngospasm prevention, while no statistical difference was found in a comparison between intravenous and topical lidocaine. In conclusion, both intravenous and topical lidocaine are effective in laryngospasm prevention in pediatric surgery, while a comparison between them needs more evidences.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

The Efficacy of Lidocaine in Laryngospasm Prevention in Pediatric Surgery: a Network Meta-analysis

Lai

et al. 2016

Sci Rep

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“…Although intravenous infusion of lidocaine may delay recovery, postoperative sore throat is reduced, possibly lessening agitation. [7,8] The mechanism by which lidocaine relieves sore throat and cough remains unclear, but it is known that the drug reduces secretion of neuropeptides in the brainstem and airway by inhibiting stimulation of sensory C fibers in the airway and reducing stimulation of the mucosa in the airway by the tracheal tube. [26] One study found that lidocaine reduced agitation by lessening airway stimulation [8] and another found that the drug had no effect on agitation.…”

Section: Discussionmentioning

confidence: 99%

“…[7,8] The mechanism by which lidocaine relieves sore throat and cough remains unclear, but it is known that the drug reduces secretion of neuropeptides in the brainstem and airway by inhibiting stimulation of sensory C fibers in the airway and reducing stimulation of the mucosa in the airway by the tracheal tube. [26] One study found that lidocaine reduced agitation by lessening airway stimulation [8] and another found that the drug had no effect on agitation. [27] In the former study, 1 mg/kg of 1% lidocaine or 2 mg/kg of 2% lidocaine was administered after return of spontaneous breathing; in the latter study, lidocaine 1.5 mg/kg was administered at the end of anesthesia.…”

Section: Discussionmentioning

confidence: 99%

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Effect of esmolol and lidocaine on agitation in awake phase of anesthesia among children

Park

Kim

et al. 2019

Chinese Medical Journal

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Background: Sevoflurane is widely used to anesthetize children because of its rapid action with minimal irritation of the airways. However, there is a high risk of agitation after emergence from anesthesia. Strabismus surgery, in particular, can trigger agitation because patients have their eyes covered in the postoperative period. The aim of this study was to determine whether or not esmolol and lidocaine could decrease emergence agitation in children. Methods: Eighty-four patients aged 3 to 9 years undergoing strabismus surgery were randomly assigned to a control group (saline only), a group that received intravenous lidocaine 1.5 mg/kg, and a group that received intravenous esmolol 0.5 mg/kg and lidocaine 1.5 mg/kg. Agitation was measured using the objective pain score, Cole 5-point score, and Richmond Agitation Sedation Scale score at the end of surgery, on arrival in the recovery room, and 10 and 30 min after arrival. Results: The group that received the combination of esmolol and lidocaine showed lower OPS and RASS scores than the other two groups when patients awoke from anesthesia (OPS = 0 (0–4), RASS = –4 [(–5)–1]) and were transferred to the recovery room (OPS = 0 (0–8), RASS = –1 [(–5)–3]) ( P < 0.05). There was no significant difference in the severity of agitation among the three groups at other time points ( P > 0.05). Conclusions: When pediatric strabismus surgery is accompanied by sevoflurane anesthesia, an intravenous injection of esmolol and lidocaine could alleviate agitation until arrival in the recovery room. Trial registration: Clinical Research Information Service, No. KCT0002925; https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=11532

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Comparison of the Agitation-Reducing Effects of Esmolol and Lidocaine in Pediatric Strabismus Surgery: A Double-Blind, Randomized Clinical Study

Ji,

Kang,

Seo

et al. 2023

Soonchunhyang Med Sci

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Objective: Agitation is a common symptom in children undergoing surgery, especially when surgeries are performed under sevoflurane and when patients undergo strabismus surgery. Because agitation can increase the risk of falls and lacerations on surgical sites and can delay discharge from the recovery room, adopting measures to reduce the incidence of agitation is essential. This study aimed to compare the agitation-reducing effects of lidocaine and esmolol administered individually or as a combination.Methods: We included 80 patients scheduled to undergo strabismus surgery. Thiopental and sevoflurane were administered to induce general anesthesia. Group EL received lidocaine (2 mg/kg) right after the end of surgery and esmolol (0.5 mg/kg) immediately after recovery from anesthesia after turning the anesthetic gas off; group L received lidocaine at 2 mg/kg right after the end of surgery and did not receive esmolol, group E did not receive lidocaine at the end of the surgery but received esmolol at 0.5 mg/kg right after recovery from anesthesia, and group C received neither esmolol nor lidocaine. Agitation severity was assessed using the objective pain score, Pediatric Anesthesia Emergence Delirium Scale immediately after recovery from anesthesia and until discharge from the recovery room.Results: Groups L and EL showed significantly lower agitation than groups E and C right after recovery from anesthesia, right after arrival to the recovery room, and 10 minutes after arrival to the recovery room (P < 0.05). Groups L and EL showed no differences in the reduction of the severity of agitation (P > 0.05).Conclusion: Compared to the groups without lidocaine administration, groups L and EL, which received 2 mg/kg lidocaine, showed a higher level of reduction in agitation immediately after recovery from anesthesia and right after arrival to the recovery room (P < 0.05).

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Intravenous Lidocaine Prior to Extubation Reduces Emergence Agitation and Cough in Pediatric Adenotonsillectomy under Sevoflurane Anesthesia

Cited by 3 publications

References 28 publications

The Efficacy of Lidocaine in Laryngospasm Prevention in Pediatric Surgery: a Network Meta-analysis

The Efficacy of Lidocaine in Laryngospasm Prevention in Pediatric Surgery: a Network Meta-analysis

Effect of esmolol and lidocaine on agitation in awake phase of anesthesia among children

Comparison of the Agitation-Reducing Effects of Esmolol and Lidocaine in Pediatric Strabismus Surgery: A Double-Blind, Randomized Clinical Study

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