Impact of topical airway anesthesia on immediate postoperative cough/bucking: a systematic review and meta-analysis

Sakae, Thiago Mamoru; Souza, Renato Lucas Passos de; Brandão, Julio Cezar Mendes

doi:10.1016/j.bjane.2021.03.016

Acessibilidade / Reportar erro

Brasil

Brazilian Journal of Anesthesiology

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Systematic Review • Braz. J. Anesthesiol. 73 (1) • Jan-Feb 2023 • https://doi.org/10.1016/j.bjane.2021.03.016 copy

Impact of topical airway anesthesia on immediate postoperative cough/bucking: a systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Postoperative cough may occur after tracheal intubation, but it is indistinct which drug is best at diminishing these events. Additionally, airway reflexes are commonly accompanied by severe hemodynamics responses during emergence.

Objectives

To evaluate the role of topical airway anesthesia on immediate post-extubation cough/bucking and extubation time.

Methods

Randomized clinical trials from MEDLINE, EMBASE, CENTRAL, and LILACS published until December 23, 2020 were included. Our primary outcome was postoperative cough/bucking incidence which was compared between local anesthetics and controls. Extubation times were likewise considered. Predisposition appraisal and subgroup, affectability investigations were likewise performed.

Results

The pooled analysis found a 45% reduction in cough incidence after treatment with topical airway local anesthetic (RR = 0.55; 95% CI: 0.42 to 0.72; p< 0.001). The number needed to treat (NNT) was 4.61. The intervention showed no differences in reduction of the extubation time (mean difference = -0.07; 95% CI: -0.14 to 0.28; p= 0.49).

Conclusion

Topical airway anesthesia demonstrated better than placebo or no medication in reducing immediate post-extubation cough/bucking. Further studies could have this objective to combine the different ways to perform better outcomes for patients.

Keywords
Airway management; Topical anesthesia; Intubation, intratracheal; Cough; Anesthesia recovery period; Airway extubation

Trial	Sample size	Male %	ASA physical status	Duration (min)	Surgery types	Anesthesia maintenance	Intervention/Comparator	Outcomes
Arslan 2013	54	87.0	I-II	16.4 ± 4.4	Laryngeal microsurgery	Sevoflurane	1 - Lidocaine 10% spray	No reduction in cough incidence and laryngospasm. Agitation lower in lidocaine group.
				14.9 ± 5.3			2 - Saline spray
Bousselmi 2014	80	Sex ratio 1.2 to 2.3	I-III	82 ± 34	Not described	Propofol + Remifentanil	1 - Saline instillation + saline cuff	Reduction in cough incidence and sore throat.
				80 ± 42			2 - Saline instillation + lidocaine cuff
				72 ± 32			3 - Lidocaine instillation + saline cuff
				76 ± 36			4 - Lidocaine instillation + lidocaine cuff
D’Aragon 2013	116	0%	I-II	30-120	Elective gynecologic procedure	Desflurane	1 - 4% lidocaine 4 mL spray + lidocaine cuff	Reduction in cough incidence (NNT 3.05). No influence in sore throat.
		All female					2 - 4% lidocaine 4 mL spray + NS cuff
							3 - NS spray + lidocaine cuff
							4 - NS spray + NS cuff
Diachun 2001	46	Not described	I-III	Not described	Non ear, nose and throat surgery	Isoflurane	1 - Lidocaine 2% TT 2 mg.kg^-1 spray	Reduction in cough incidence.
						+N2O	2 - Saline 4 mL
							3 - Nothing
Dutta 2016	45	42.2	I-III	Not described	Not decribed	Sevoflurane	1 - Lidocaine 10% TT 1.5 mg.kg^-1	No reduction in cough and extubation time
							2- NS i.v + NS spray
							3 - Dex 0.3 ug. kg^-1 + NS spray
Fang 2018	52	25.0	I-II	Until 4 hours	Thyroidectomy	Propofol + Remifentanil	1 - Ropivacaine 0,75% 6 mL	Reduction in cough. No influence on sore throat and extubation time.
							2 - Saline 6 mL
Gupta 2006	50	Not described	Not described	Not described	Carotid endarterectomy	Volatile	1 - Lidocaine 4% 4 mL TT	Reduction in cough.
							2 - NS 4 mL TT
Jee 2003	75	70.6	Not described	106.8 ± 44.7	Orthopaedic, plastic, lower abdominal surgery	Enflurane	1 - No drug	Reduction in number of coughs (5 and 10 min).
				123.4 ± 55.9			2 - Lidocaine 2% TT 1 mg.kg^-1 spray 5 min before extubation
				103.6 ± 40.8			3 - IV lidocaine 1 mg.mL^-1
Lee 2011	55	61.8	I	28.9 ± 7.2	Laryngeal microscopic surgery	Sevoflurane + N2O	1 - Lidocaine 10% TT 1.5 mg.kg^-1	No reduction in cough incidence, reduction in number of coughs.
				30.1 ± 7.9			2 - No treatment
Li 2016	322	56.5	I-III	90.7 ± 23.6	Urology, otolaryngology, ophthalmologic, orthopedic	Sevoflurane	Lidocaine 2% TT 4 mg.kg^-1	Reduction in cough, laryngospasm, desaturation. No influence on extubation time.
				86.9 ± 30.3			Saline 0,9% 4 mL
Paltura 2018	64	45.3	I	20 to 25 min	Suspension laryngoscopy for benign laryngeal diseases	Sevoflurane	1 - Lidocaine 10% spray 7 puffs	No reduction in cough incidence and extubation time. Agitation lower in lidocaine spray group.
							2 - Lidocaine 2% 1 mL (cotton swap)
							3 - Control (nothing applied)
Shabnum 2017	60	61.6	I-II	240 ± 18.67	Craniotomies	Isoflurane	1 - IV Lignocaine 2% 1.5 mg.kg^-1 + intratracheal placebo	Reduction in cough incidence. No influence in extubation time.
				244.5 ± 16.08			2 intratracheal lignocaine 2% 1.5 mg.kg^-1 + IV placebo
				265 ± 18.17			3 - IV + intratracheal placebo
Soltani 2002	204	57.8	I-II	45 ± 0.6	Cataract surgery	Halothane + N2O	1 - lidocaine 10% spray distal end ETT	I.V. lidocaine promotes reduction in cough incidence. No influence in extubation time.
							2 - lidocaine 10% spray laryngopharyngeal structures
							3 - 2% lidocaine jelly ETT
							4 - i.v. Lignocaine 2% 1.5 mg.kg^-1 at the end of surgery
							5 - 2% lidocaine intracuff
							6 - normal saline end ETT
Yamasaki 2013	60	45.0	I-II	124 ± 52	Tympanoplasty	Propofol + Remifentanil	1 - Lidocaine 4% 3 mL transtracheal	Reduction in cough/severe cough.
				226 ± 54			2 - No medication
Zamora Lozano 2007	78	48.7	I-II	60-120 min	General, gynaecology, orthopedic, ophtalmological, plastic, urological	Volatile	1 - Lidocaine 2% TT 5 mL	Reduction in cough.
							2 - Lidocaine 2% IV 5 mL
							3 - Saline 0,9% 5 mL
							4 - Lidocaine 2% 5 mL intracuff

Sociedade Brasileira de Anestesiologia (SBA) Rua Professor Alfredo Gomes, 36, Botafogo , cep: 22251-080 - Rio de Janeiro - RJ / Brasil , tel: +55 (21) 97977-0024 - Rio de Janeiro - RJ - Brazil
E-mail: editor.bjan@sbahq.org

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author. E-mail:thiagosakae@gmail.com (T.M. Sakae).