Background: Cough and hyperdynamic reaction cause considerable discomfort, and they may lead to postoperative surgical complication. To reduce coughing and hemodynamics during emergence, the efficacy of laryngotracheal spraying with lidocaine before intubation is not clear, particularly, in children. We investigated such effect during emergence from general anesthesia, in children. Methods: Children were studied in a double blind manner: 105 ASA physical status I-II, aged 2－16 yrs, undergoing tonsillectomy and adenoidectomy. Patients were randomly grouped into three (A, B, and C) by the lidocaine spray before endotracheal intubation: 4% lidocaine to the group A (n = 32), 10% lidocaine to the group B (n = 36), and normal saline to the group C (n = 37). The same dose (2 mg/kg) of lidocaine was applied. During emergence, patients were observed their cough and hemodynamics. Results: Lidocaine spray, irrespective of concentration, did not significantly diminish the cough and the hemodynamic reaction across the groups before and after the extubation as well as in the recovery room (P value = 0.44, 0.86, 0.17). Conclusions: These findings support that the laryngotracheal spraying with lidocaine (2 mg/kg of 4% and 10%) before endotracheal intubation does not reduce the cough and hemodynamic reactions during emergence from general anesthesia in children. (Korean J Anesthesiol 2007; 53: S 1～6)

/pdf/the-effect-of-lidocaine-spray-before-endotracheal-intubation-8udniq9cdf.pdf

The Effect of Lidocaine Spray Before Endotracheal Intubation on the Incidence of Cough and Hemodynamics during Emergence in Children.

Perioperative management of patients undergoing tracheal resection and reconstruction: a retrospective observational study

The Effect of 10 % Lidocaine Spray on Hemodynamic, the incidence of Cough and Postoperative Sore Throat Accompanied by Endotracheal Intubation Background : Laryngoscopy and endotracheal  intubation  are potential  stimuli  that can  frequently induce   increased sympathetic activity, cough and postoperative sore throat. Furthermore cough and hyperdynamic  reaction cause considerable discomfort, and  they may  lead  to postoperative surgical complication. To reduce coughing and hemodynamic during emergence, the efficacy of pharyngolaryngeal spraying with lidocaine before intubation is not clear. The authors studied the effect of 10 % lidocaine (Xylocaine® 10 %  Spray, Astra, Sweden ) spray on hemodynamic responses, the incidence of cough and postoperative sore throat after laryngoscopy and endotracheal intubation. Methods :  Seventy two ASA I patients undergoing elective surgery were allocated random to two groups. Control group was intubated without 10 % lidocaine spray. Study group was intubated with 10 % lidocaine spray to pharyngolaryngeal site 2 puff during the induction of anesthesia. During emergence, patients were observed their cough and hemodynamics. Results : The results obtained were as follows. Compared with the control group, mean arterial blood pressure was significantly decrease  in 10 %  lidocaine spray group at  immediately post  intubation, 3 minutes and 5 minutes after  intubation. An  increase  in heart  rate was significantly decrease  in 10% lidocaine spray groups at 3 minutes and 5 minutes after intubation. But the incidence of arrhythmia and postoperative sore throat were not different between two groups. Lidocaine spray did not significantly diminish the cough and the hemodynamic reaction across the groups before and after the extubation as well as in the recovery room. Conclusions :   The elevation of blood pressure and an increase in heart rate accompanied by endotra - cheal intubation can be prevented with 10 % lidocaine spray to pharyngolaryngeal site before intubation. But lidocaine spray does not reduce the sore throat, the cough and hemodynamic reactions during emergence from general anesthesia. Keywords : Anesthetics, local : lidocaine, intubation, cough, emergence

The Effect of 10 % Lidocaine Spray on Hemodynamic, the incidence of Cough and Postoperative Sore Throat Accompanied by Endotracheal Intubation

Tracheal resection and reconstruction are the most effective treatments for tracheal stenosis, but the difficulties are surgery and maintaining ventilation performed on the patient's same airway. High-flow oxygen has begun to be applied to prolong the apnoea time in the tracheal anastomosis period for tracheal resection and reconstruction. This study aims to evaluate the effectiveness of apneic conditions with high-flow oxygen as the sole method of gas exchange during anastomosis construction.A prospective study was performed on 16 patients with tracheal stenosis, with ages ranging from 19 to 70, who underwent tracheal resection and reconstruction from April 2019 to August 2020 in 108 Military Central Hospital. During the anastomosis phase using high flow oxygen of 35-40 l.min-1 delivered across the open tracheal with an endotracheal tube (ETT) at the glottis in apnoeic conditions.The mean (SD) apnoea time was 20.91 (2.53) mins. Mean (SD) time anastomosis was 22.9 (2.41) mins. The saturation of oxygen was stable during all procedures at 98-100%. Arterial blood gas analysis showed mean (SD) was hypercapnia and acidosis acute respiratory after 10 mins of apnoea and 20 mins apnoea respectively. However, after 15 mins of ventilation, the parameters are ultimately returned to normal. All 16 patients were extubated early and safely at the end of the operation. There were no complications, such as bleeding, hemothorax, pneumothorax, or barotrauma.High-flow oxygen across the open tracheal under apnoeic conditions can provide a satisfactory gas exchange to allow tubeless anesthesia for tracheal resection and reconstruction. 

/pdf/apnoeic-oxygenation-with-high-flow-oxygen-for-tracheal-1colxpk1.pdf

Apnoeic oxygenation with high-flow oxygen for tracheal resection and reconstruction surgery

Ventilatory management of tracheal reconstruction surgery may require sophisticated anesthetic techniques. Most airway problems that occurred during the tracheal surgery can be prevented by passing an endotracheal tube of small size through the tracheal narrowing or locating a normal endotracheal tube just above the stenotic lesion. However, in case of high tracheal stenosis sited near the vocal cord, it is difficult to manage airway using a cuffed endotracheal tube because of high possibility of injury of the vocal cord, shallow placement of the tube and inability to apply positive pressure ventilation. The laryngeal mask airway has been used as an efficient ventilatory device in this situation. We report one case of high tracheal stenosis requiring end to end anastomosis, where airway management was successful without any complications using the proseal laryngeal mask airway (PLMA).

Anesthetic Management of Tracheal Reconstruction Surgery with Laryngeal Mask Airway: A case report

B ackground: During anesthesia in children sometimes we are confronted with airway obstruction due to for example laryngospasm or stridor just after tracheal extubation. The use of intravenous lidocaine to prevent laryngospasm or stridor is controversial. This study was undertaken to investigate the effect of intravenous lidocaine on the prevention of laryngospasm or stridor by checking oxygen saturation using a pulse oximeter. Methods: Sixty children undergoing strabismus surgery with general anesthesia (N2O-O2-enflurane were divided into two groups the L group (n = 32 received intravenous lidocaine 1 mg/kg and the S group (n = 28 received the same amount of saline both 5 minutes before extubation. The maximal and minimal levels of oxygen saturation were checked in the operation room and in the post anesthetic recovery room (PAR after tracheal extubation. The numbers of patients with have oxygen saturation of less than 95% were counted in each group. Respiratory depression and sedation scores were noted at PAR in both groups. Results: The number of cases that experienced laryngospasm or stridor w as 4 (12.5% in the L group and 3 (10.7% in the S group showing no significant difference. No respiratory depression was observed in either group and no difference in the sedation scores 5 15 30 minutes after arrival at PAR was observed between two groups. Conclusions: The intravenous administration of lidocaine 1 mg/kg 5 minutes before extubation in strabismus surgery did not prevent laryngospasm or stridor. (Korean J Anesthesiol 2003; 44: 733～738

The Effect of Lidocaine Injection Just before Extubation on Laryngospasm or Stridor in Pediatric Strabismus Surgery

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Anesthetic Management of Tracheal Reconstruction Surgery with Laryngeal Mask Airway: A case report

The Effect of Lidocaine Injection Just before Extubation on Laryngospasm or Stridor in Pediatric Strabismus Surgery