Topical Versus Intravenous Lidocaine in Children With Upper Respiratory Infection Undergoing Anesthesia: A Randomized, Double Blind, Clinical Trial

Abstract

Background:The current randomized double-blind clinical trial aimed to compare the incidence of post-operative cough with intravenous vs. topical lidocaine in children with mild upper respiratory infection (URI) anesthetized with laryngeal mask airway (LMA) in the university-affiliated medical center.Objectives:To assess the incidence of adverse respiratory event including cough, apnea, laryngospasm, bronchospasm following two different methods of lidocaine administration in anesthetized children with mild URI.Patients and methods:One hundred and thirty pediatric patients with mild URI (within the previous two weeks) aged between one and six years were enrolled. They were candidates to undergo immediate full ophthalmic examination, and randomly divided into two groups of 65to receive intravenous (1.5 mg/kg) or topical lidocaine on LMA. Anesthesia was induced with sevoflurane, subsequently LMA was inserted when the patient was in deep anesthesia status and maintained on (50% N2O, 50% O2) and 3% sevoflurane. Spontaneous ventilation was maintained throughout the procedure and LMA was removed in deep anesthesia. Outcomes (cough, laryngospasm, bronchospasm and vomiting) were evaluated peri-operatively and one day post-operation.Results:One hundred and twenty four patients fulfilled the trial. Cough (primary outcome) was significantly more frequent among those with topical compared with intravenous lidocaine (46% vs. 26%; P = 0.004). The incidence of laryngospasm (32% vs. 27%), bronchospasm (18% vs. 12%), desaturation (18% vs. 12%) and vomiting (5% vs. 2%) was not statistically different between the groups.Conclusions:The pediatric patients undergoing general anesthesia with LMA with intravenous lidocaine experienced fewer incidence of postoperative cough compared to the ones in the topical lidocaine group.

Is Corticosteroid of No Use for Pediatric Patients with Common Cold Undergoing Anesthesia? A Randomized, Double-Blind, Clinical Trial

“…The inclusion criteria for pediatric patients were as follows: (1) age range of 1 - 6 years; (2) parents’ recognition of mild URI symptoms (eg, cough, sneeze, and nasal discharge or congestion), initiated within the past 2 weeks; (3) no evidence of the symptoms of bacterial (eg, ill appearance evaluated by the anesthesiologist, axillary temperature > 38°C, and purulent discharge or sputum) or lower respiratory tract infection (eg, crackles or wheezing sounds); and (4) any other medical condition (eg, respiratory conditions, cardiac diseases, allergies, conditions resulting in difficult airway management, and neurological disorders). All the patients had to be anesthetized for the ophthalmologic examination in a short period of time (less than 6 weeks) to prevent any deleterious outcomes ( 6 , 7 ).…”

“…URI was diagnosed based on a positive history of nasal congestion or discharge, initiated 2 weeks prior to surgery, as mentioned by the parents or guardians ( 6 , 7 ). On the day of surgery, preanesthesia symptoms of common cold (eg, runny nose, nasal congestion, cough, sputum, and sneeze) were evaluated by an anesthesiologist (appendix 1 in the supplementary file) ( 6 , 7 ). Patients who scored above 2 on any of the items in the questionnaire were considered to have moderate to severe URI and were not enrolled in the study.…”

“…Based on previous studies, coughing, given its higher incidence among adverse respiratory events, was measured as the primary outcome through direct observation during recovery and a telephone call on the first postoperative day (appendix 2 in the supplementary file) ( 6 , 7 ).…”

“…The secondary outcomes were as follows (appendix 2 in the supplementary file): (1) bronchospasm, assessed by the anesthesiologist and characterized by inspiratory/expiratory wheezing sounds ( 6 , 7 ); (2) apnea characterized by the absence of air flow for more than 10 seconds through the airway without any respiratory effort ( 6 , 7 ); and (3) laryngospasm (partial) indicated by stridor sounds for more than 10 seconds ( 6 , 7 ). Furthermore, desaturation and vomiting were scored and evaluated ( 6 , 7 ). Any cardiovascular events or 7-day readmission due to respiratory problems were reported ( 6 , 7 ).…”

“…Furthermore, desaturation and vomiting were scored and evaluated ( 6 , 7 ). Any cardiovascular events or 7-day readmission due to respiratory problems were reported ( 6 , 7 ).…”