North Clin Istanb. Ahead of Print: NCI-33407 | DOI: 10.14744/nci.2021.33407

A randomized controlled trial to study the effect of intratracheal and intravenous lignocaine on airway and hemodynamic response during emergence and extubation following general anaesthesia

Divya V. Gladston¹, Sudha Padmam², Rajasree Omanakutty Amma¹, Rachel Cherian¹, Jagathnath Krishna K M³, Jayasree Vijayan¹, Nimmy George¹, Praveen Rajendran^1
1Department of Anaesthesiology, Regional Cancer Centre, Trivandrum, Kerala, India.
²Department Of Palliative Medicine, Regional Cancer Centre, Trivandrum, Kerala, India.
³Division of Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Trivandrum, Kerala, India.

Background: Intratracheal (IT) and intravenous (IV) lignocaine suppress airway reflex and hemodynamic response during extubation, but studies regarding this are sparse. The primary aim was to compare the effect of IT and IV lignocaine on attenuation of airway reflex to endotracheal extubation and secondary aim was to compare the hemodynamic responses to extubation, using lignocaine by the two different routes.
Methods: Seventy-five female patients with comparable age, Body Mass Index, American Society of Anaesthesiologists Physical Status undergoing carcinoma breast surgery were randomized into three groups. Group A received 2% lignocaine 3mg/kg intratracheally 5 minutes and Group B received 2% lignocaine 1.5mg/kg intravenously 3 minutes before extubation. Group C was control group. The airway and hemodynamic responses were noted in terms of episodes of cough during emergence and extubation. Categorical variables assessed using Fisher’s exact test and continuous variables assessed using one-way Analysis of Variance.
Results: Cough suppression was present in groups A and B, with better results observed with intratracheal than with intravenous lignocaine. In control group, grade III cough reflex was present predominantly. There was a statistically significant difference (P < 0.001) in blood pressure and heart rate between Group A versus Group C and in Group B versus Group C, but not between Group A and Group B.
Conclusion: IT lignocaine administered prior to extubation significantly attenuates post extubation cough reflex than IV lignocaine. Both IT and IV lignocaine can effectively attenuate the airway and hemodynamic response to extubation.

Keywords: airway reflex, carcinoma breast, cough grade, extubation, hemodynamic stress response, intratracheal, intravenous, lignocaine, randomized controlled trial.

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