Efficacy of intravenous lidocaine in prevention of post extubation laryngospasm in children undergoing cleft palate surgeries

Abstract

A one-year randomized placebo-controlled trial was conducted to study the effectiveness of intravenous lidocaine in the prevention of post extubation laryngospasm in children, following cleft palate surgeries. Children of age three months to six years were randomly assigned into two groups. Group P placebo (saline) and Group L (Lidocaine), 1.5 mg/kg. A sample size of 74 with n = 37 in each group was selected. The anaesthetic procedure was standardized. At the end of the procedure, three minutes after reversal, the study drug, that is, intravenous lidocaine (1.5 mg/kg) or placebo (saline) was administered and two minutes later the child was extubated. Following extubation for 10 minutes, the haemodynamic parameters, that is, pulse, blood pressure, oxygen saturation, severity of coughing, and laryngospasm were noted. The total reduction of laryngospasm and coughing was 29.9% and 18.92% with IV lidocaine. Significant alterations in haemodynamics and oxygen saturation were noted for 10 minutes, following extubation. Hence, intravenous lidocaine 1.5 mg/kg was effective in the prevention of post extubation laryngospasm in children undergoing cleft palate surgeries.

Effect of intravenous lidocaine on the incidence of postextubation laryngospasm: A double-blind, placebo-controlled randomized trial

“…In addition, a switch to sevoflurane would require conducting a discrete trial because the methodology would require a significant change due to a significant difference between desflurane and sevoflurane in the extubation period and the fact that no study has evaluated the effect of IV lidocaine administered more than 5 min before extubation. [ 2 10 16 17 18 ] Therefore, the appropriate time for administering IV lidocaine would need to be altered.…”

“…who used 1.5 mg/kg of IV lidocaine. [ 2 ] In addition, 14 patients (7 per group) had an accelerated HR during the extubation period. The seven patients in the placebo group had a postextubation laryngospasm, whereas none of the patients in the lidocaine group had a laryngospasm.…”

“…Although an association between laryngospasm and tachycardia has not yet been established, we found a strong association between these two parameters, as did Sanikop et al . [ 2 ] Therefore, we postulate that IV lidocaine primarily prevented postextubation laryngospasm caused by the irritability induced by the high concentration of desflurane[ 22 ] by holding superior laryngeal nerve sodium channels in specific functional states (i.e., open or inactive). Determining criteria for identifying patients at risk for developing postextubation laryngospasm who would benefit from lidocaine pretreatment is warranted.…”

“…The etiology of laryngospasm is unknown, but it may be due to an insufficient depth of anesthesia during tracheal intubation, a light plane of anesthesia during tracheal extubation, pain; or the presence of an airway irritant (such as a laryngoscope blade), an irritating volatile agent, a suction catheter, surgical debris, mucus, blood, or another foreign body. [ 1 2 3 ] Laryngospasm occurs in patients of both sexes and all ages. The incidence of laryngospasm reported to the Australian Incident Monitoring Study (AIMS) was 5%, and 22% of these cases occurred without an attributable cause.…”

The effects of propofol, ketamine and combination of them in prevention of coughing and laryngospasm in patients awakening from general anesthesia: A randomized, placebo-controlled, double blind clinical trial

“…[ 7 8 ] There are controversies about the role of anesthetized extubation (as opposed to awake extubation) in the prevention of laryngospasm. [ 8 ] Oral benzodiazepines,[ 9 ] intravenous lidocaine,[ 10 ] magnesium,[ 11 ] 5% carbon dioxide (in an animal experimentation) have been studied and some benefits have been reported. [ 12 ] Propofol is a common drug in routine general anesthesia, which is known as a strong depressant of airway reflexes at the anesthetic doses.…”