Effect of intravenous oxycodone on the physiologic responses to extubation following general anesthesia

Jiang, Menglu; Ji, Jiawei; Li, Xin; Liu, Zhenqing

doi:10.1186/s12871-021-01350-5

Cited by 9 publications

(7 citation statements)

References 19 publications

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“…The definition of active extubation was the patient tried to pull the tracheal tube out by hand, but it was not pulled out (special staff ensured that the tube was not removed) during recovery from anaesthesia. The definition of postoperative cough was more than 5 spontaneous coughs that lasted longer than 5 s within the first 24 h after extubation, as previously described [ 10 ]. Cardiovascular reactions prior to extubation included systolic blood pressure (SBP) (mmHg), diastolic blood pressure (DBP) (mmHg), heart rate (HR) (beats/min), plasma concentrations of epinephrine (E) (pmol/l) and norepinephrine (NE) (pmol/l).…”

Section: Methodsmentioning

confidence: 99%

“…SBP, DBP, and HR were measured with a monitor. Blood samples were collected immediately before extubation and 1 min after extubation from the arm without an intravenous infusion, according to a previous report [ 10 ]. Concentrations of epinephrine and norepinephrine, were measured using a commercially available ELISA kit (IBL, Germany) and an ELISA plate reader (BioTek, Winooski, VT, USA).…”

Section: Methodsmentioning

confidence: 99%

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Compound lidocaine/prilocaine cream combined with tetracaine prevents cough caused by extubation after general anaesthesia: a randomised controlled trial

Zhang

Zhao

et al. 2023

BMC Anesthesiol

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Background Coughing caused by tracheal extubation is common following general anaesthesia. Heavy aerosol production by coughing during recovery from general anaesthesia in patients with respiratory infections (especially COVID-19) may be one of the highest risk factors for infection in healthcare workers. The application of local anaesthetics to the endotracheal tube is an effective method to reduce coughing. The most commonly used anaesthetics are compound lidocaine/prilocaine cream and tetracaine spray. However, coughing still occurs when the two anaesthetics are used alone. We speculated that the application of compound lidocaine/prilocaine combined with tetracaine spray would better prevent coughing caused by tracheal extubation. Methods Patients scheduled for laparoscopic cholecystectomy or cholecystectomy combined with common bile duct exploration under general anaesthesia were randomly assigned to Group C (saline spray), Group L (2 g compound lidocaine/prilocaine cream contains 5 mg of lidocaine and 5 mg prilocaine)), Group T (tetracaine) and Group F (compound lidocaine/prilocaine cream combined with tetracaine). The incidence of coughing, the endotracheal tube tolerance assessment, the incidence of agitation, the active extubation rate, the incidence of postoperative pharyngeal pain and the incidence of postoperative cough were recorded and analysed. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and the plasma concentrations of epinephrine and norepinephrine were measured immediately before extubation and 1 min after extubation. Results A total of 211 patients were randomly assigned to Group C (53 cases), Group L (52 cases), Group T (52 cases) and Group F (54 cases). The primary result is assessment of the incidence of cough. The patients emerged from general anaesthesia, 96% of Group C had cough, which was significantly reduced in Group L (61.5%, P < 0.001), Group T (75%, P < 0.05) and Group F (22.2%, P < 0.001). Group F had a significantly reduced incidence of cough compared to Group L and Group T (P < 0.05 or P < 0.01, respectively). The secondary results were assessed. The endotracheal tube tolerance score in Group C ((1, 3) 4, P < 0.001) was higher than Group L ((0, 1) 2), Group T ((0, 1.25) 3) and Group F ((0, 0) 1). Group F had a significantly lower score than Group L and Group T (P < 0.05, P < 0.01, respectively). The incidence of agitation and the active extubation rate were also higher in Group C (96.2% and 71.7%, respectively, P < 0.001) than Group L (48.1% and 15.4%, respectively), Group T (61.5% and 26.9%, respectively) and Group F (17.3% and 7.7%, respectively). Blood pressure, HR and plasma concentrations of epinephrine and norepinephrine were significantly higher in Group C than in all other groups at the time of extubation and 1 min after extubation (P < 0.001). Group F exhibited significantly reduced blood pressure, heart rate and plasma concentrations of epinephrine and norepinephrine compared to Group L and Group T (P < 0.05, P < 0.01 or P < 0.001, respectively). The incidence of postoperative pharyngeal pain and the incidence of postoperative cough were not significantly different among the groups. Conclusions Compound lidocaine/prilocaine cream combined with tetracaine may be a more effective approach for preventing coughing and stabilising circulation during extubation following general anaesthesia. This may play an important role in preventing medical staff from contracting respiratory infectious diseases. Trial registration Chinese Clinical Trial Registry: ChiCTR2200058429 (registration date: 09–04-2022) “retrospectively registered”.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Compound lidocaine/prilocaine cream combined with tetracaine prevents cough caused by extubation after general anaesthesia: a randomised controlled trial

Zhang

Zhao

et al. 2023

BMC Anesthesiol

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“…Studies on exploring the effectiveness and safety of oxycodone for general anesthesia tracheal intubation have shown that oxycodone has less effect on blood pressure and heart rate than fentanyl and has a relatively smooth circulation[ 52 , 54 - 56 ]. Another issue to consider with oxycodone as an induction drug is its effect on anesthetic awakening and extubation.…”

Section: New Advances In Clinical Applicationsmentioning

confidence: 99%

Advances in the clinical application of oxycodone in the perioperative period

Chen¹,

Wang²,

Zhang³

et al. 2022

WJCC

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To review the research progress of pure opioid receptor agonist oxycodone. The research progress of oxycodone in terms of pharmacokinetics, pharmacodynamics, adverse reactions, clinical application, combined medication and new progress in clinical application was summarized by referring to the literature. Oxycodone is a semi-synthetic thebaine derivative of opioid alkaloids, and is a pure opioid μ and κ receptor agonist. The main action sites are the central nervous system and visceral smooth muscle. Due to its advantages of low adverse reactions, good analgesic effects, and a wide range of safe doses, the drug has been widely used in the control of acute and chronic postoperative pain, as well as malignant and non-malignant pain. Since the end of the 20 th century, researchers have begun to formulate antipyretic analgesics, opioid receptor agonists, opioid receptor antagonists, dopamine receptor antagonists and other drugs with oxycodone in different proportions to enhance the analgesic effect. At the same time, it can reduce the dosage of oxycodone and reduce its adverse reactions, so as to achieve the purpose of limiting opioid abuse. With the continuous research on the efficacy and safety of oxycodone in the perioperative period at home and abroad, oxycodone has become the only dual-opioid potent analgesic that can be used in clinical work.

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“…The de nition of active extubation: the patient has the behavior of pulling out the tracheal tube by hand, but it is not pulled out (we have special staff to take care of it, and we will not let it happen) during recovery from anesthesia. The de nition of postoperative cough: spontaneous coughing more than 5 times and lasted longer than 5 s within the rst 24 h after extubation, as the previous assessments described [9].…”

Section: Parameter Measurementmentioning

confidence: 99%

“…The SBP, DBP, and HR were measured with a monitor. Blood samples were collected at immediately before extubation and one minute after extubation, from the arm that was not on intravenous infusion, according to previous reports [9]. Concentrations of blood hormones including epinephrine and norepinephrine were measured by ELISA using commercially available kit (IBL, Germany) and ELISA plate reader (BioTek, Winooski, VT, USA).…”

Section: Parameter Measurementmentioning

confidence: 99%

Compound Lidocaine cream combined with tetracaine prevents cough reaction of patients with general anesthesia caused by extubation: a randomised controlled trial

Zhang

Zhao

et al. 2022

Preprint

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Background: Coughing response caused by tracheal extubation is the most common in general anesthesia patients with tracheal intubation during recovery from anesthesia. However, high aerosol production by coughing during recovery from general anesthesia in patients with respiratory infections (especially COVID-19) is one of the highest risk factors for infection among healthcare workers. Application of local anesthetics to the endotracheal tube is an effective method to reduce the choking reaction. The most commonly used anaesthetics are compound Lidocaine cream and tetracaine injection. However, there is still a certain number of choking reactions in the clinic when the two anaesthetics are used alone. We speculate that the combined application of compound Lidocaine cream and tetracaine will play a better role in prevent coughing response caused by tracheal extubation.Methods: A total of 211 patients, who had undergone laparoscopic cholecystectomy or cholecystectomy combined with common bile duct exploration under general anesthesia, were randomly assigned to Group C (saline injection, 53 cases), Group L(compound lidocaine cream, 52 cases), Group T (tetracaine, 52 cases) and Group F (compound lidocaine cream combined tetracaine, 54 cases). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), levels of epinephrine and levels of norepinephrine were recorded or measured immediately before extubation and one minute after extubation. In addition, endotracheal tube tolerance, the incidence of bucking, the incidence of agitation, the active extubation rate, the incidence of postoperative pharyngeal pain and the incidence of postoperative cough were analyzed. Results: Blood pressure and heart rate as well as blood concentrations of epinephrine and norepinephrine were significantly higher in the group C compared with the every other group at the time of extubation as well as 1 min after extubation (P < 0.001). And group F significantly reduced the Blood pressure and heart rate as well as blood concentrations of epinephrine and norepinephrine compared group L or group T (P < 0.05, P < 0.01 or P < 0.001). When the patients emerged from general anesthesia, 96% of the group C had cough caused by sputum aspiration and extubation, which was significantly reduced by group L (61.5%, P < 0.001), group T (75%, P < 0.05) and group F (22.2%, P < 0.001), furthermore, group F significantly reduced the incidence of cough compared group L or group T (P < 0.01). Assessment of endotracheal tube tolerance, the score in the group C ((1, 3) 4, P < 0.001) is higher than group L ((0, 1) 2), group T ((0, 1.25) 3) and group F ((0, 0) 1), furthermore, group F significantly reduced the score compared group L or group T (P < 0.05, P < 0.01, respectively). The incidence of agitation and the active extubation rate were also higher in group C (96.2%, 71.7%, respectively, P < 0.001) than group L (48.1%, 15.4%, respectively), group T (61.5%, 26.9%，respectively) and group F (17.3%, 7.7%，respectively), furthermore，group F significantly reduced the incidence of cough compared group L or group T (P < 0.05 or P < 0.01). In addition, the incidence of postoperative pharyngeal pain and the incidence of postoperative cough were no statistical difference between every groupConclusions: Compound Lidocaine cream combined tetracaine may be a more advantageous approach for preventing choking and stabilizing circulation during extubation in emergence from general anesthesia, which may play an important role in preventing medical staff from contracting respiratory infectious diseases. Trial registration: Chinese Clinical Trial Registry: ChiCTR2200058429 (registration date: 09-04-2020) “retrospectively registered”.

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Effect of intravenous oxycodone on the physiologic responses to extubation following general anesthesia

Cited by 9 publications

References 19 publications

Compound lidocaine/prilocaine cream combined with tetracaine prevents cough caused by extubation after general anaesthesia: a randomised controlled trial

Compound lidocaine/prilocaine cream combined with tetracaine prevents cough caused by extubation after general anaesthesia: a randomised controlled trial

Advances in the clinical application of oxycodone in the perioperative period

Compound Lidocaine cream combined with tetracaine prevents cough reaction of patients with general anesthesia caused by extubation: a randomised controlled trial

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