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Suppression of cough during emergence from general anesthesia: laryngotracheal lidocaine through a modified endotracheal tube.

Author(s): Diachun CA, Tunink BP, Brock-Utne JG.

Affiliation(s): Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305-5640, USA. Carol_Diachun@urmc.rochester.edu

Publication date & source: 2001, J Clin Anesth. , 13(6):447-51

STUDY OBJECTIVE: To ascertain if coughing during emergence from general anesthesia can be suppressed with a modified endotracheal tube. DESIGN: Randomized, double-blind, controlled study. SETTING: Operating rooms at a university hospital. PATIENTS: 46 adult ASA physical status I, II, and III patients requiring elective surgery. INTERVENTIONS: Patients underwent general anesthesia with the laryngotracheal instillation of topical anesthesia (LITA) endotracheal tube (ETT). Thirty minutes before anticipated extubation, one investigator administered, via the LITA tube injection port onto the laryngotracheal mucosa, one of the following according to randomized preselection: 2 mg/kg with 4% lidocaine (Group I; n = 15); 4 mL with saline (Group 2;n = 16); and nothing (Control; n = 15). At the completion of surgery, with the patient adequately anesthetized, the oropharynx was gently suctioned, and the isoflurane was then turned off. When the isoflurane end-tidal concentration was < or =0.2%, the neuromuscular block was reversed and the inspiratory oxygen concentration was increased to 100% while awaiting the return of spontaneous ventilation. MEASUREMENTS: An observer who was blinded to the study drug regimens judged the presence or absence of cough upon emergence, over a 1-minute period. The observer noted the responses to the following verbal commands, in this order: 1) "open your eyes", 2) "grip my hand", and 3) "lift your head". Coughing was defined as any evidence of irritation from having a tube in the trachea. Blood samples for plasma lidocaine levels were taken at the time of extubation from patients who received lidocaine (Group 1). MAIN RESULTS: Seventy-five percent of patients were found to have complete cough suppression upon emergence, while Group 2 (saline) had 14% and Group 3 (the control) only had 13% suppression. CONCLUSIONS: The technique of laryngotracheal topical lidocaine administered by the LITA tube can, in most cases, provide a smooth emergence from general anesthesia without coughing.

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