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.
What's It About?
What Did They Find?
Is It Any Good?
The outcome was done by a blinded, independent observer, and though I’m not completely convinced about the rigour of their categorisation, it seems passable and they have at least been clearly described (the duration of bouts of coughing). Is this a valid way for categorisation the severity of coughing? I’m not sure, but as I said it seems reasonable. As the authors note, it is a scenario where there is likely to be some variation in the other components of the anaesthetic that might also have an influence on the extent of coughing, but you would expect that having it double blinded and randomised would negate any confounding role that this may play.
Bringing it all together, I can think of three components to this technique. Firstly, is it effective? This paper seems to provide some strong weight to this being so, and there are few other trials with similar results. Secondly, is it beneficial? Well other than making you look pretty awesome at extubation, there are a few clinical scenarios where a smooth extubation will definitely be benefical. Surgical and patient factors that will benefit from a none-hypertensive, tacchycardic, raised intra-thoracic/cranial/ocular pressure scenario are plentiful. But how does this balance against the third component; is it safe? The answer to that doesn’t lie within this paper, or the others I have looked at so far, and I would personally struggle to even begin to estimate it. Whilst definitely interesting, an interesting idea is all it will remain for myself at the moment. Hopefully I shall come across a paper that sheds some more light on this final aspect that may change things.
Thanks again for reading. Please let me know if this is a technique you use regularly or if there are any papers you have come across that have looked at this safety profile. I’ll try add a bit more if I unearth any new ones. Until then, thanks once again.
- Anesthesia & Analgesia; Laryngotracheal Topicalisation
- Medical Science Monitor: Local Aiway Anaesthesia
Image courtesy of freedigitalphotoes.net/David Castillo Dominici