EFFICACY OF INTRAVENOUS LIGNOCAIN VS SEVOFLURANE IN PREVENTION OF COUGHING AND DESATURATION AT EXTUBATION IN CHILDREN
AbstractBackground: Inadvertent coughing and desaturation are the most commonly faced and feared respiratory complications in post–anaesthesia period. The study was done to compare the efficacy of intravenous lignocaine versus sevoflurane in prevention of coughing and desaturation at extubation in children less than 6 years of age. Methods: This Randomized Control Trial was carried out from May 2013 to May 2016, at Combined Military Hospital Nowshera after obtaining approval from the hospital ethics committee (IREC-0003/5/13/Aneas). Children aged three months to six years undergoing surgical procedures requiring the placement of definitive airway were randomly assigned into two groups. Patients were anaesthetized by standardized balanced anaesthesia technique. In Group A (n=355), three minutes prior to extubation lignocaine 2% was used intravenously. In Group B (n=355), isoflurane was switched off, breathing circuit changed and sevoflurane started at minimum alveolar concentration (MAC 3-4%) for 3 minutes prior to extubation. Assessment for extubation was clinical. Oxygen saturation and severity of coughing were noted for 5 consecutive minutes, after extubation. Results: In group-A, 156 patients were less than 2 years of age while in group-B, 135 patients were less than 2 years old. In group-A, 199 and in group-B, 220 children were 2–6 years of age respectively. Post stratification the p-value for weight was 0.17 (p-value >0.05) and t-statistic was 1.36. Post stratification p-value for gender was 0.12 (p-value>0.05) and chi square statistic was 2.49. Group A had more eventful extubation with 270 cases of cough (76%) as compared to group-B where it was noted in 199 cases (56%). Similarly, desaturation was observed in 85 cases in group-A (24%) as compared to 28 cases (8%) in group-B. The difference between the groups was statistically significant. Conclusion: Sevoflurane based anaesthetic vapours mixture causes statistical significant prevention from events like coughing episodes and desaturation in post-extubation in children less than six years of age undergoing elective surgery.Keywords: intravenous lignocaine (IV); sevoflurane; laryngospasm; post extubation
Moein Vaziri MT, Jouybar R, Moein Vaziri N, Moein Vaziri N, Panah A. Attenuation of cardiovascular responses and upper airway events to tracheal extubation by low dose propofol. Iran Red Crescent Med J 2013;15(4):298–301.
Hampson-Evans D, Morgan P, Farrar M. Pediatric laryngospasm. Pediatr Anaesth 2008;18(4):303–7.
Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, Higgs A. Difficult airway society guidelines for the management of tracheal Extubation. Anaesthesia 2012;67(3):318–40.
Burgoyne LL, Anghelescu DL. Intervention steps for treating laryngospasm in pediatric patients. Pediatr Anaesth 2008;18(4):297–302.
Miller R. Thyroid surgery. Anesthesia for eye, ear, nose and throat surgery. Miller’s Anesthesia 6th Ed. Phila Elsevier Churchill Livingstone. 2005;2540.
Alalami AA, Ayoub CM, Baraka AS. Laryngospasm: review of different prevention and treatment modalities. Paediatr Anaesth 2008;18(4):281–8.
Venkatesan T, Korula G. A comparative study between the effects of 4% endotracheal tube cuff lignocaine and 1.5 mg/kg intravenous lignocaine on coughing and hemodynamics during extubation in neurosurgical patients: A randomized controlled double-blind trial. J Neurosurg Anesthesiol 2006;18(4):230–4.
Oberer C, von Ungern-Sternberg BS, Frei FJ, Erb TO. Respiratory reflexes response of the larynx differs between sevoflurane and propofol in pediatric patients. J Am Soc Anesthesiol 2005;103(6):1142–8.
Jaryszak EM, Lander L, Patel AK, Choi SS, Shah RK. Prolonged recovery after out-patient pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2011;75(4):585–8.
Jaryszak EM, Shah RK, Vanison CC, Lander L, Choi SS. Polysomnographic variables predictive of adverse respiratory events after pediatric adenotonsillectomy. Arch Otolaryngol 2011;137(1):15–8.
Silva PS, Monteiro Neto H, Andrade MM, Neves CV. Negative-pressure pulmonary edema. A rare complication of upper airway obstruction in children. Pediatr Emerg Care 2005;21(11):751–4.
Afshan G, Chohan U, Qamar-Ul-Hoda M, Kamal RS. Is there a role of a small dose of propofol in the treatment of laryngeal spasm? Paediatr Anaesth 2002;12(7):625–8.
Eger EI 2nd. Cost in several flavors. Anesth Analg 2010;110(2):276–7.
Meyer T. Managing inhaled anesthesia: challenges from a health-system pharmacist perspective. Am J Health-Syst Pharm 2010;67(8 Suppl 4):S4–8.
Mikawa K, Nishina K, Takao Y, Shiqa M, Maekawa N, Obara H. Attenuation of cardiovascular responses to tracheal extubation: comparison of verapamil, lidocaine and verapamil-lidocaine combination. Anesth Analg 1997;85(5):1005–10.
Bidwai AV, Bidwai VA, Rogers CR, Stanley TH. Blood-pressure and pulse-rate responses to endotracheal extubation with and without prior injection of lidocaine. Anesthesiology 1979;51(2):171–3.
Sanikop CS. One-year randomized placebo controlled trial to study the effects of intravenous lidocaine in prevention of post extubation laryngospasm in children following cleft lip and cleft palate surgeries. Indian J Anaesth 2010;54(2):132–6.
Orliaguet GA, Gall O, Savoldelli GL, Couloigner V. Case scenario: perianesthetic management of laryngospasm in children. Anesthesiol 2012;116(2):458–71.
Tsui BC, Wagner A, Cave D, Elliott C, El-Hakim H, Malherbe S. The incidence of laryngospasm with 'No Touch' extubation technique after tonsillectomy and adenoidectomy. Anesth Analg 2004;98(2):327–9.
Llair JM, Hill DA, Bali IM, Fee JP. Tracheal intubating conditions after induction with sevoflurane 8% in children: a comparison of two intravenous techniques. Anaesthesia 2000;55(8):774–8.