Comparison of the effectiveness of lidocaine sprayed at the laryngeal inlet and the endotracheal tube cuff versus intravenous lidocaine for reducing cough during extubation: A prospective randomized controlled trial

Abstract

Background & objective: Coughing during extubation of the endotracheal tube (ETT) may lead to poor surgical results. The aim of this study was to investigate the efficacy of a simple lidocaine application route to reduce coughing during ETT extubation.

Methodology: A prospective, randomized control trial was conducted. The topical group received four puffs of 10% lidocaine sprayed at the cuff of the ETT and four puffs at the laryngeal inlet, whereas the intravenous (IV) group received a 1.5 mg/kg intravenous injection of 2% lidocaine prior to extubation. The incidences of coughing during extubation, 24-h postoperative adverse events, and hemodynamic responses after extubation were analyzed.

Results: One hundred forty-eight patients met the criteria for analysis. The incidence of coughing during extubation between the topical group (44.6%) and the IV group (50.0%) was not significantly different (p = 0.51). However, the incidence of having a cough with a severity grade of 3 was significantly less likely to occur in the topical group (1.4%) compared to the IV group (9.5%) (p = 0.02). The incidence of having a sore throat was similar in both groups (p > 0.99), whereas hoarseness and dysphagia events were not found in the topical group. There was no statistically significant difference in the hemodynamic response between groups.

Conclusion: The combination of topical lidocaine spray on the laryngeal inlet and cuff of the ETT seems similarly effective in reducing cough during extubation compared to systemic IV lidocaine. However, the combined topical lidocaine application showed benefit outcomes, including reduced incidence of grade 3 cough severity and no dysphagia or hoarseness events.

Key words: Lidocaine; Endotracheal tube; Cough; Sore throat

Citation: Thongrong C, Kasemsiri p, Thamburanawit W, poomsawat S. Comparison of the effectiveness of lidocaine sprayed at the laryngeal inlet and the endotracheal tube cuff versus intravenous lidocaine for reducing cough during extubation: A prospective randomized controlled trial. Anaesth. Pain Intensive Care 2020;24(4):403-410.

Received: 5 December 2019, Reviewed: 3 January 2020, Revised: 18 May 2020, Accepted: 20 May 2020