Probably one of the greatest benefits of being a trainee is the chance to rotate around different departments, different hospitals and work with different consultants. The variations in anaesthetic technique can be quite significant, and there always seems to be some aspect of it that I can take away for my own practice, either positive or negative. As such, I came to be working with a consultant I haven’t had chance to work with before and witnessed a fascinating piece of practice that I was amazed I had never seen before. Basically, every patient that got intubated had several sprays of lidocaine on their larynx at initial laryngoscopy. The impact on the extubation of these patients was quite remarkable. Instead of coughing, bucking, thrashing around and generally going bright red (not that all my extubations are like that), they opened their eyes, nodded in response to questions and were just generally very happy with this piece of plastic in their trachea (caution: case series was only an n of 2). To say I was impressed was a bit of an understatement. However, the questions quickly followed. The most obvious had to be; why doesn’t everyone do this? What’s the catch? What are the side effects and risks? It crossed my mind that this nicely numb larynx might not deal especially well with that chicken sandwich it comes across when back on the ward. My consultant hadn’t experienced any adverse events as a result of this (and used it frequently) and even described a few papers that had looked at this topic. Tempering my initial excitement with some scepticism I decided it would be worth a bit of research to see what the literature threw up.

As such we have ended up with this post, looking at one particular paper on the subject. After a few pubmed searches, this paper in Anesthesia & Analgesia surfaced:

Laryngotracheal Topicalization with Lidocaine Before Intubation Decreases the Incidence of Coughing on Emergence from General Anaesthesia.

It seemed a suitable starting point to build on my ‘n of 2’ personal experience to see if there was evidence of a similar degree of efficacy. A double blinded RCT in a major paper seemed a great place to start with this, so let’s have a look at it.

Last week we returned to the pub for the latest NWRAG journal club. This time we cast our eyes over one of the latest important reports in the form of the MBRRACE-UK report released in December 2014. MBRRACE, standing for the marginally less snappy ‘Mothers and Babies: Reducing Risk through Audit and Confidential Enquiries across the UK’, represents the latest version of the triennial reports looking at maternal deaths in the UK, previously under the acronyms of CMACE and CEMACH. Due to varying (apparently political and funding) issues, necessitating reorganisation, this report actual covers the 4 year period of 2009 to 2012. Similar to the previous incarnations that have been running since 1952, it examines all the maternal deaths that occur in the UK, striving to detect common themes of failure where practice and outcomes can be improved. At 120 pages the report is pretty hefty, but you can check it out at the link below. The aim of this blog was to provide something of a summary of our thoughts from reviewing the report, and which we think are the key points.

MBRRACE Homepage