The effect of intracuff alkalinized lidocaine combining with dexamethasone on post-extubation morbidity in smoker patients undergoing laparoscopic surgery under general anesthesia. A randomized double-blind study
Publication Type
Conference Paper
Authors

The effect of intracuff alkalinized lidocaine combining with dexamethasone on post-extubation morbidity in smoker patients undergoing laparoscopic surgery under general anesthesia. A randomized double-blind study

 

Aidah Alkaissi¹, PhD,  Islam Zagharneh, MS¹, Noualdin Almasri², MD

¹An-Najah National University, Nablus, Palestine

²Rafidia Hospital, Ministry of Health, Nablus, Palestine

 

Background: endotracheal intubation has been known to cause post-intubation airway related adverse effects, which include post-operative coughing, hoarseness and sore throat. Coughing in post extubation phase after general anesthesia is a seriously problem, with an incidence of 15% to 94%, that may result in possibility dangerous problems. Smoking is one of the most common risk factors that predisposes patients to perioperative complications (Beckers et al., 1991, Moller, et al 2002).

Objective: to compare between the effect of combination of [alkalinized 2% lidocaine plus dexamethason] , alkalinized 2% lidocaine alone, dexamethason alone, and air on post extubation reaction  that are cough, sore throat and hoarsness when inflated in endotrackeal tube  cuff.

Methods: A prospective, randomized double-blind study. 100 smoking patients, undergoing laproscopic surgery under general anesthesia. Patients are divided randomly into 4 groups each of 25 patients. Patients are randomly allocated to receive a different intracuff endotracheal tube agents either [alkalinized 2% lidocaine (L group, n=25), dexamethazon, D group, n=25, alkalinized 2% lidocaine +dexamethason LD group, n=25, air, A group, n=25]. Their ETT cuffs were inflated according to the group in a volume sufficient to establish a cuff pressure that would prevent from leaking during positive pressure ventilation, at an intra-airway pressure of 20-25cm H2O.

Results: The groups were similar with respect to patient characteristics.

COUGHING

The incidence of cough at emergence of general anesthesia was significantly lower in the three groups (Lidocaine 3(12%), Dexamethasone 1(4%), Lidocaine plus Dexamethasone 0(0%)) compared to air group 12(48%) (p < 0.000) respectively. As well as the number of patients with cough in PACU in Dexamethasone 1(4%), Lidocaine plus Dexamethasone 0(0%)) postoperatively were significantly lower compared with air group and Dexamethzone group (p=0.000). The number of patients with no cough at 2 hr. in (Lidocaine 15(60%), Dexamethasone 21(84%), Lidocaine plus Dexamethasone 17(68%) postoperatively were significantly higher in the three groups compared with air group 3(12%) (p=0.000). as well as the number of patients with no cough at 8 hr. in (Lidocaine 24(96%)), Dexamethasone 24(96%), Lidocaine plus Dexamethasone 25(100%) postoperatively were significantly higher in the three groups compared with air group 4(16%) (p=0.000). The number of patients with no cough at 24 hours in (Lidocaine 25(100%), Dexamethasone 25(100%), Lidocaine plus Dexamethasone 25(100%) postoperatively were significantly higher in the three groups compared with air group 22(88%), (p=0.026).

SORE THROAT

There are significant differences between the number of patients with no sore throat at 2 hours in (Lidocaine 23(92%), Dexamethasone 11(44%), Lidocaine plus Dexamethasone 20(80%), (p=0.000) and air group 7(28%) (p=0.000). Further statistical analysis was shown that L group and LD group are superior to D group and A group. P= ≤0.05. The number of patients with no sore throat at 8 hours in (Lidocaine 24(96%), Dexamethasone 24(96%), Lidocaine plus Dexamethasone 25(100%), postoperatively were significantly higher in the three groups compared with air group 4(16%) (p=0.000) . As well as the number of patients with no sore throat at 24 hours in (Lidocaine 25(100%), Dexamethasone 25(100%) Lidocaine plus Dexamethasone 25(100%), postoperatively were significantly higher in the three groups compared with air group 4(16%) (p=0.000).

HOARSNESS

The number of patients with no hoarseness at 2 hours in (Lidocaine 12(48%), Dexamethasone 17(68%), Lidocaine plus Dexamethasone 16(64%), postoperatively were significantly higher in the three groups compared with air group 4(16%) (p=0.000). The number of patients with no hoarseness at 8 hours in (Lidocaine 19(76%), Dexamethasone 16(64%)), Lidocaine plus Dexamethasone 18(72%) postoperatively were significantly higher in the three groups compared with air group 4(16%) (p=0.000).The number of patients with no hoarseness at 24 hours in (Lidocaine 25(100%), Dexamethasone 25(100%), Lidocaine plus Dexamethasone 24(96%)  postoperatively were significantly higher in the three groups compared with air group 15(60%) (p=0.000).

There were no significant differences in laryngospasm, aphonia, PONV, between the study groups. There were no significant changes in heart rate and MAP between the study groups in all measurements.

Conclusion:  The present study demonstrated that the Intracuff alkalinized 2% lidocaine, dexamethasone and alkalinized 2% lidocaine +dexamethason significantly reduced the incidence of coughing, sore throat and hoarseness in smoker patients undergoing laparascopic surgery under general anesthesia. However, alkalinized 2% lidocaine and alkalinized 2% lidocaine +dexamethason lowered the incidence of cough, sore throat and hoarseness at all documented times, all the three drugs were superior to air and recommended to be considered in clinical practice to improve patients’ outcomes.

 

Keywords: Smoking; lidocaine; dexamethasone, cough; hoarseness; sore throat.

Conference
Conference Title
47th Global Nursing & Healthcare Conference March 01-03, 2018 London, UK Theme: Exploring latest innovations in Nursing and Health care
Conference Country
United Kingdom
Conference Date
Feb. 1, 2018 - Feb. 3, 2018
Conference Sponsor
An-Najah National University