Lidocaine to Prevent Cough and Hemodynamic Changes in Tracheal Extubation
Status:
Recruiting
Trial end date:
2020-11-01
Target enrollment:
Participant gender:
Summary
Coughing during tracheal extubation can be associated to adverse effects like tachycardia,
arterial hypertension (AHT), increase of intracranial pressure (ICP) and intraocular pressure
(IOP), and the dehiscence of surgical wounds. In ophthalmic, head and neck, and abdominal
surgery, and in several other neurosurgical interventions it is vital to prevent these
effects. The incidence of laryngeal irritation due to orotracheal intubation hinders patient
comfort in the immediate postoperative (POP) period and no pharmacological intervention has
been yet proven to prevent it.
At the end of the surgical procedure, the depth of the anesthetic plane decreases with the
concomitant suspension of the anesthetic agents. However, the patient still requires
ventilatory support through the endotracheal tube (EDT). The physical stimulation of the
trachea created by this foreign body leads to the activation of the sympathetic nervous
system, expressed in AHT, tachycardia, and ICP. To tolerate the EDT and prevent these
effects, different maneuvers have been tested such as extubating the patient in a deep
anesthetic plane or administering intravenous (IV) narcotics with the entailed complications:
airway (AW) obstruction and hypercapnia, and the aspiration of an unprotected AW. Progress
has been made with the introduction of ultrashort acting opioids, with significant
statistical results. Moreover, beta-blockers, calcium channel blockers, angiotensin
converting enzyme inhibitors and dexmedetomidine have been used to decrease the hemodynamic
impact associated to tracheal extubation. The use of both IV and intratracheal lidocaine in
doses ranging from 1 mg/kg to 3 mg/kg, has been studied with controversial results.
In view of the above, and as lidocaine is the most commonly used low-cost drug in all
operating rooms with a good safety profile when used at low doses, the purpose of this study
is twofold: to assess its effects at reducing coughing and to evaluate its hemodynamic impact
when administering IV 1 mg/kg prior to extubation. Then, the efficiency of reducing the
incidence of sore throats after the immediate POP shall be investigated.