Lidocaine versus propofol administration on the attenuation of hemodynamic responses during extubation in the adult elective surgical patient: A prospective cohort

Abstract

Background Tracheal extubation is the process of removing a tube from the trachea. It is associated with an increase in heart rate, blood pressure, intracranial pressure, intraocular pressure, coughing, bronchospasm, laryngospasm, and bleeding. Many techniques, as well as drugs, have been attempted for attenuation of the airway and cardiovascular responses. Propofol and lidocaine are widely available drugs in resource-limited settings even though their relative effectiveness for smooth extubation is not well established. Objectives To assess the effectiveness of intravenous lidocaine and propofol on the attenuation of extubation-induced hemodynamic responses in the adult elective surgical patient from November 01, 2019, to February 30, 2020, at Asella teaching and referral hospital, Ethiopia. Methods Institutional-based prospective observational cohort study design was conducted on 72 ASA I patients who underwent elective surgery. The study participants were allocated into three groups equally based on anesthetists' extubation plan; Group P, 0.5 mg/kg propofol, group L, 1.5 mg/kg lidocaine administered 2 min before extubation and group C was a control group. Data were analyzed by SPSS version 20 after the normality of the data was checked by the Shapiro Wilk test. One-way ANOVA followed by a Tukey posthoc test has been employed to find the pair-wise significance and a p-value of <0.05 was considered as statistically significant. Results A demographic status and clinical characteristics of the patient were comparable between groups with p-values of >0.05. After extubation; heart rate, systolic, diastolic, and mean arterial blood pressure were decreased significantly in groups of propofol and lidocaine within 10 min. Propofol shows better results in maintaining stable systolic blood pressure up to 3 min, while heart rate, diastolic, and mean arterial pressure were maintained stable up to 5 min after extubation (p = 0.001). Conclusions 0.5 mg/kg propofol or 1.5 mg/kg lidocaine might help to attenuate extubation induced hemodynamic responses.

Compound lidocaine/prilocaine cream combined with tetracaine prevents cough caused by extubation after general anaesthesia: a randomised controlled trial

“…Data are expressed as median + up-interquartile range/down up-interquartile range. *** P < 0.001 vs. group C; # # P < 0.01, ### P < 0.001 vs. group F, respectively myocardial ischaemia, and intracranial pressure elevation [17][18][19].…”

“…Therefore, it is very important to prevent coughing caused by the endotracheal tube. The endotracheal tube-induced airway response (especially during intubation and extubation) also increases the risk of adverse cardiovascular events, including arrhythmias, hypertension, myocardial ischaemia, and intracranial pressure elevation [ 17 – 19 ].…”

Effect of low-dose lidocaine on MEPs in patients undergoing intracranial tumor resection with propofol anesthesia: A randomized controlled trial

“…Moreover, it also inhibits the release of adrenaline and catecholamine and alleviates the stress response caused by a surgical operation. [ 11 , 12 ] Studies have shown that intravenous application of 1.5 mg/kg lidocaine reduces hemodynamic changes during endotracheal intubation, extubation, and operation. [ 13 ] Our results showed that MAP decreased at T1 in both groups; however, it was significantly decreased in group L but not in group C. HR decreased at T1 in group L. These results indicate that low-dose lidocaine reduces the stress response caused by endotracheal intubation.…”

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

“…Therefore, it is very important to prevent the choking reaction caused by the endotracheal tube. Furthermore, the endotracheal tube induced airway response (especially during endotracheal intubation and extubation) is prone to increase the risk of adverse cardiovascular events including arrhythmias, hypertension, myocardial ischemia, and intracranial pressure elevation [17][18][19]. During the recovery period of general anesthesia, sputum aspiration and tracheal tube extraction are the strongest stimulation to tracheal mucosa and most likely to induce cough reaction.…”