| Summary: | Introduction:
Coughing and bucking during recovery from general anesthesia was the
physiological responses to tracheal extubation. Endotracheal tube as a foreign
body caused irritation and tactile stimuli which elucidated airway reflexes.
Incidence of coughing during extubation was about 70%. Many experts have
proofed effectivity of intravenous lidocaine to reduce coughing and hemodynamic
reflex responses during tracheal extubation. Theoretically, administration of an
opioid agonist also attenuates coughing during extubation. Fentanyl was the
option because of the advantages in reducing cough reflex during extubation. Aim
of the study were to compare the effect between administration of fentanyl 1 μg
kg-1 and lidocaine 1,5 mg kg-1 intravenously to reduce coughing during awake
extubation.
Methods:
This randomized controlled double blinded trial was conducted in 2012 December
until 2013 January. One hundred and thirty two, male and female patients, aged
18-60 years old, ASA physical status I-II underwent the obstetric-gynecologic or
orthopedic, oncologic, urologic, digestive and plastic surgery under general
anesthesia were included. The patients who fulfilled inclusion and exclusion were
randomly assigned into one of F (fentanyl) or L (lidocaine) group who received
1μg kg-1 or 1,5 mg kg-1 before extubation, respectively. Each patient had same
anesthetic techniques. Coughing were assessed during extubation, 5 minutes after
extubation and at PACU admission. Patients referred as cough when cough score
3-4. Hemodynamic changes and sedation were recorded as secondary outcomes.
PONV and sore throat were also compared and managed in the PACU.
Results:
There were no patient whom suffered from grade 3 or 4 coughing or
laryngospasms during extubation or 5 min after extubation or at PACU
admission. Cough severity found were grade 1 and 2. Incidence of grade 1
coughing at extubation were 10 patients (15.2%) in fentanyl group and 22
patients (33.3%) in lidocaine group, while grade 2 coughing were 7 patients (7%)
in fentanyl group and 20 patients (30.3%) in lidocaine group. The difference were
statistically significant.
Conclusions:
Administration of 1 μg/kg of fentanyl i.v at skin closure has similar efficacy to
avoid incidence of heavy coughing during extubation when compared with
administration of 1.5 mg/kg i.v of lidocaine at 2 minutes before extubation, but
fentanyl showed better attenuation for the cough reflex during extubation without
sympathetic stimulation, respiratory depression or laryngospasm.
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