Prevention of Endotracheal Tube-Induced Coughing During Emergence from General Anesthesia

Gonzalez, Rene M.; Bjerke, Richard J.; Drobycki, T.; Stapelfeldt, Wolf H.; GREEN, J. M.; Janowitz, M.; Clark, Melissa

doi:10.1097/00132586-199506000-00044

Cited by 20 publications

(30 citation statements)

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“…4,[10][11][12][13][14][15] Although intravenous anesthetics have been shown to be effective in reducing the incidence of cough at emergence, time can be delayed until the patient can respond to simple orders. 16 Thus, topical local anesthetics represent an attractive alternative to suppress cough while maintaining rapid awakening. Administration of 2-4% lidocaine to the glottic area before the end of surgery was associated with a 32-69% decrease in the incidence of cough.…”

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confidence: 99%

“…Administration of 2-4% lidocaine to the glottic area before the end of surgery was associated with a 32-69% decrease in the incidence of cough. 16,17 Minogue et al administered 4% lidocaine with a syringe fitted with a multi-orifice cannula before intubation, and this resulted in a significant decrease in the incidence of peri-extubation cough. 6 Other researchers have opted to lubricate the ETT cuff to decrease mucosal irritation.…”

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confidence: 99%

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The effects of lidocaine spray and intracuff alkalinized lidocaine on the occurrence of cough at extubation: a double-blind randomized controlled trial

D’Aragon

Beaudet

Gagnon

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Our study aimed to evaluate the effects of lidocaine sprayed onto the larynx and/or injected into the tracheal tube cuff to decrease the incidence of cough at extubation and postoperative sore throat. Methods One hundred twenty women scheduled for gynecological surgery \ 120 min in duration were enrolled in this randomized double-blind prospective study. Prior to tracheal intubation, 4% lidocaine or 0.9% saline was sprayed onto the patients' supra-and subglottic areas.After tracheal intubation, the tracheal tube cuff was filled with either an alkalinized 2% lidocaine solution or 0.9% saline. This resulted in four groups: spray-cuff, spray-saline, saline-cuff, and saline-saline. A logistic regression comprising the two factors was used for analysis. The primary outcome was the incidence of cough at extubation. The secondary outcome was the incidence and severity of sore throat reported by patients at 15 min, 60 min, and 24 hr after tracheal extubation. Results Cough occurred in 42%, 24%, 63%, and 69% of patients in the spray-cuff, spray-saline, saline-cuff, and saline-saline groups, respectively. The use of lidocaine spray decreased the incidence of cough at extubation (odds ratio = 0.256; 95% confidence interval 0.118 to 0.554; P \ 0.001); however, the use of intracuff alkalinized lidocaine had no impact on the occurrence of cough (P = 0.471). Severity of sore throat was clinically low (visual analog scale [VAS] B 3) in all groups. No significant difference was observed in hoarseness, dysphagia, nausea, or vomiting. Conclusion Sprayed lidocaine decreases the incidence of cough at tracheal extubation in surgeries of less than two hours. The use of alkalinized lidocaine into high-volume/ low-pressure endotracheal cuffs had no impact on decreasing the incidence of cough or pain.

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confidence: 99%

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confidence: 99%

The effects of lidocaine spray and intracuff alkalinized lidocaine on the occurrence of cough at extubation: a double-blind randomized controlled trial

D’Aragon

Beaudet

Gagnon

et al. 2013

Can J Anesth/J Can Anesth

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“…1~ A reliable technique for improving ETT tolerance while facilitating rapid and full emergence from general anesthesia would be desirable in many situations. "Deep" extubation (removal of the ETT while the patient is still in a deep plane of general anesthesia), administration of intravenous (iv) opioids or iv lidocaine, and local lidocaine spray prior to emergence have been used to diminish coughing.I, [3][4][5][6][7][8][9] Although some authors consider "deep" extubation to be an effective technique to prevent coughing during emergence from general anesthesia, 3,s loss of airway protection and aspiration is a major drawback. Intravenous lidocaine in doses of 1.0-2.0 mg.kg -1, producing a plasma lidocaine level (3 lag.m1-1) can transiently suppress coughing and other airway reflexes.…”

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confidence: 99%

In vitro diffusion of lidocaine across endotracheal tube cuffs

Huang

Tsai

Chen

et al. 1999

Can J Anesth/J Can Anesth

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Purposc: Lidocaine diffuses across endotracheal tube cuffs, which may serve as a reservoir for local anesthetic to assist in the prevention of E-l-l--induced cough while emerging from general anesthesia. However, the rate of diffusion is slow. Two techniques, alkalization and warming, may increase the proportion of uncharged drug available for diffusion. The purpose of this study is to determine the effectiveness of warming alkalization or warming with alkalization on diffusion. Methods: Four preparations of lidocaine 4% were studied. Group (Gr) L -lidocaine (24~ Gr WL -warmed lidocaine (38~ Gr AL -alkalized lidocaine (24~ Gr WAL -warmed, alkalized lidocaine (38~ Twenty-four Mallinckrodt 8.0 ID (Mallinckrodt Critical Care Division of Mallinckrodt, Inc., Glens Falls, New York) endotracheal tube cults were filled with 6 ml of one of the four preparations. They were then placed in a 20 ml water bath at 38~ and samples were drawn from the water bath at intervals for up to 360 rain. The lidocaine concentration in each sample was determined by gas chromatography. Results: The highest lidocaine concentration was reached in Gr WAL (410.98 ---8.53/Jg'ml -i) after 300 min and then decreased to 376.18 ___ 4.59/Jg'ml -~ after 360 rain. In Gr AL the highest concentration (235.05 _-_ 2.99 Hg.ml -I) was reached after 360 rain. Lidocaine concentrations in Gr L and WL after 360 min were 3.19 __-I. 16 Hg-ml -I and 4.32 +-2.02/lg'ml -I respectively. Condition: Alkalization with or without warming, but not warming alone, promotes lidocaine diffusion from endotracheal tube cuff.Obje~df : La lidocaine diffuse, lentement toutefois, au travers des ballonnets des tubes endotrach~aux. Les balIonnets peuvent servir de r&ervoir ~ ranesth&ique local et participer ~ la prevention de la toux induite par le TET pendant la r&up&ation de I'anesth~sie g6n&ale. I'alcalinisation et le r&hauffement peuvent accro~tre la proportion de m~dicament susceptible de diffuser. I'objectif de la pr&ente &ude est de d&erminer I'eflicacit~ du r&hauffement, seul ou avec alcalinisation, sur la diffusion. M&hode : On a &udi~ quatre preparations de lidocaine. Le groupe (Gr) L -lidoca'ine (24 ~ Gr LR -lidoca'ine r&hauff& (38 ~ Gr LA -lidoca/ne alcalinis& (24 ~ Gr LRA -lidocaine r&hauff&, alcalinis& (38 ~ Vingtquatre tubes endotrach6aux ~ ballonnets Mallinckrodt de DI 8,0 (Mallinckrodt Critical Care Division of Mallinckrodt, Inc., Glens Falls, New York) ont fitfi remplis de 6 ml de rune des preparations. Plac& ensuite dans un bain d'eau de 20 ml ~ 38 ~ on en a ensuite retir~ des &hantillons ~ des intervalles pouvant aller jusqu'~ 360 min. La concentration de lidoca'ine a ~t~ d6termin6e par chromatographie en phase gazeuse. R&ultats : La plus forte concentration de lidocaine a ~t~ atteinte dans le Gr LRA, 410,98 ---8,53 Hg'ml-', apr~s 300 rain, puis elle a baiss~ ~ 376, 18 ---4,59 ~/g-ml-' apr& 360 rain. Dans le Gr LA, la concentration maximale &ait de 235,05 ___ 2,99/ag.ml-' apt& 360 rain. Dans les Gr Let LR, la lidoca'l'ne ~tait, apr& 360 rain de 3, 19 _ I, 16/ag.ml-...

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“…8 This study found significant increase in cough incidence among smokers without intervention than nonsmokers Table 2. This finding goes with findings of other studies that state smoking exaggerate coughing reflex and could be explained by chronic smoking affect respiratory epithelia ranging from inflammation to dysplasia and this render respiratory epithelia to be more reactive to endotracheal tube insertion which cause stretch stimuli in the trachea.…”

Section: Discussionmentioning

confidence: 58%

Effect of endotracheal tube lidocaine instillation in prevention of smokers emergence coughing: sample of Iraqi patients undergoing emergency appendectomy

Jawad¹,

Alsaady

2016

Int J Res Med Sci

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Prevention of Endotracheal Tube-Induced Coughing During Emergence from General Anesthesia

Cited by 20 publications

References 0 publications

The effects of lidocaine spray and intracuff alkalinized lidocaine on the occurrence of cough at extubation: a double-blind randomized controlled trial

The effects of lidocaine spray and intracuff alkalinized lidocaine on the occurrence of cough at extubation: a double-blind randomized controlled trial

In vitro diffusion of lidocaine across endotracheal tube cuffs

Effect of endotracheal tube lidocaine instillation in prevention of smokers emergence coughing: sample of Iraqi patients undergoing emergency appendectomy

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