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GENERAL ARTICLES

Laryngotracheal Topicalization with Lidocaine Before Intubation Decreases the Incidence of Coughing on Emergence from General Anesthesia

From the Department of Anesthesia, Vancouver General Hospital and the University of British Columbia, Vancouver, BC, Canada

Address correspondence and reprint requests to Sean Minogue, FCARCSI, Department of Anaesthesia, The Adelaide and Meath Hospital Dublin incorporating the National Children’s Hospital, Tallaght, Dublin 24, Ireland. Address email to minogues{at}indigo.ie

Coughing on emergence can result in a number of undesirable side effects, including hypertension, tachycardia, tachyarrhythmias, increased intracranial pressure, and increased intraocular pressure. The efficacy of endotracheal spraying with lidocaine at the time of intubation in preventing coughing on emergence is unknown. In a double-blind placebo-controlled study, we randomized 50 ASA physical status I and II patients presenting for elective gynecological surgery <2 h duration to receive either endotracheal lidocaine 160 mg or placebo before intubation. Both groups were comparable in terms of demographics and intraoperative conditions. The incidence of coughing before tracheal extubation was less frequent in the lidocaine group (26%) than in the placebo group (66%, P < 0.01), as was the incidence after tracheal extubation (4% versus 30%, P = 0.022). This study supports the use of endotracheal lidocaine before intubation in patients undergoing general anesthesia for surgery <2 h duration where coughing on emergence is undesirable.

IMPLICATIONS: We studied the effect of laryngotracheal spraying with lidocaine before intubation on the incidence of coughing on emergence from general anesthesia in cases <2 h duration and found its use to be associated with a significantly decreased incidence of coughing on emergence.

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