Post adenotonsillectomy coughing and laryngospasm in children: preextubation mini-dose suxamethonium, lidocaine, and their combination prove prophylactic

Abstract

Background: Post adenotonsillectomy coughing and laryngospasm in children entails deleterious sequelae, warranting continued search for effective prophylaxis. The aim was to determine the prophylactic efficacy of intravenous mini-dose (0.1 mg/kg) suxamethonium, 1.5 mg/kg lidocaine 1%, and their combination, against coughing and laryngospasm in children emerging from general anaesthesia after adenotonsillectomy.Methods: Ethical approval and parental written consent secured, 69 children, aged 1-6 years, of American Society of Anesthesiologists (ASA) class I were randomized into groups A, B, and C, of 23 each. All patients had general anaesthesia induced with propofol 2 mg/kg plus fentanyl 2 µ/kg, maintained with isoflurane 1-1.5% in 100% oxygen, and tracheal intubation facilitated by pancuronium 0.075 mg/kg. Two minutes after reversal dose of neostigmine, groups A, B and C respectively received 1.5 mg/kg lidocaine 1%, suxamethonium 0.1 mg/kg, and 1.5 mg/kg lidocaine 1% plus suxamethonium 0.1 mg/kg, intravenously. Tracheal extubation was done 90 seconds after study drug administration, and coughing and laryngospasm were assessed for 10 minutes using modified Minogue and Likert 4-point scales respectively.Results: All 69 subjects completed the study. The incidence of mild to moderate coughing was 22 (95.7%) in groups A and B, and 19 (82.6%) in group C, p=1.000. Laryngospasm occurred in none (0.0%) in group C, while in groups A and B its occurrence was 1(4.3%), p=1.000.Conclusions: Mini-dose suxamethonium or lidocaine 1.5 mg/kg prevented grade 3 coughing and laryngospasm; furthermore, their combination prevented grade 3 coughing and achieved zero incidence of laryngospasm.