Prevention of Coughing Induced by Endotracheal Tube during Emergence from General Anesthesia -A Comparison between Three Different Regimens of Lidocaine Filled in the Endotracheal Tube Cuff

預防全身麻醉甦醒時氣管內管引起之咳嗽－比較三種氣管內管氣囊中Lidocaine配方之成效

黃俊仁(Chun-Jen Huang) ； 徐永偉(Yung-Wei Hsu) ； 陳建全(Chien-Chuan Chen) ； 柯元弼(Yuan-Pi Ko) ； 饒瑞泓(Ruey-Horng Rau) ； 吳國驊(Kuo-Hwa Wu) ； 魏志濤(Tze-Taur Wei)

《Acta Anaesthesiologica Sinica》 36卷2期 (1998/06) Pp. 81-86

摘要

Background: ＂Deep＂ extubation, administration of intravenous (IV) narcotics, IV lidocaine and forestalling local spray of lidocaine have been used to help diminish coughing during emergence. However, the respective efficacy of these techniques has not been concluded. Sconzo et al. indicated that endotracheal tube (ETT) cuff might serve as a reservoir for local anesthetic. Alkalizing and warming are two techniques frequently used to increase in the proportion of uncharged drugs available. Matias indicated that alkalization could prompt a 63-fold increase of the rate of diffusion of lidocaine across the ETT cuff. Huang et al. also observed that alkalization together with warming could achieve a 118-fold increase further. However, the in vivo effects of ETT-cuff lidocaine have not been studied. Methods: Eighty patients of ASA Class I-II undergoing elective surgeries were included. They were randomly assigned into four groups. After tracheal intubation, the ETT cuff was filled with one of the following solutions: normal saline 6 ml (Group A), 4% lidocaine 6 ml at room temperature (Group B), 4% lidocaine 5 ml +7% sodium bicarbonate 1 ml at room temperature (Group C), and 4% lidocaine 5 ml + 7% sodium bicarbonate 1 ml warmed to 38°C (Group D). Changes of vital signs as well as the times of coughing in the course of extubation and post-extubation complications were recorded. One way ANOYA (SPSS for windows) was used for data analysis. Results: The respective number of coughing per patient in the experimental groups (Group B, C and D) was significantly less than the saline or control group (mean = 9.70, 9.15 and 3.95, respectively, p ＜ 0.05). The incidence of sore throat in Group C and Group D was significantly less than the control group (35% and 25%, respectively, p ＜ 0.05). Regarding the hemodynamic changes, systolic arterial pressure (SAP) and mean arterial pressure (MAP) were higher in Group B and C (p ＜ 0.05) before extubation. Conclusions: Alkalized and warmed lidocaine prestored in the endotracheal tube (ETT) cuff can greatly reduce ETT-induced coughing and thus promote a smoother emergence from general anesthesia with endotracheal intubation.

關鍵字

Anesthesia, general ； Anesthetics, local: lidocaine ； Cough

並列摘要

背景：全身麻醉正甦醒時氣管內管所引起之咳嗽可能引起很嚴重的後果，因此有很多研究及方法被提出，希望能有效防止咳嗽的發生，其大致可區分為以下四大類：深度拔管、經靜脈給予lidocaine、經靜脈給予類鴉片製劑、及局部施以局部麻醉劑，然而以上四種方法均各有其缺點。有研究指出氣管內管氣囊中加入lidocaine可有效預防於全身麻醉甦醒時，氣管內管所引起之咳嗽；然而這些研究均屬體外實驗，此次人體實驗研究主要目的即在探討氣管內管氣囊中lidocaine預防咳嗽之效應，並且鹼化之lidocaine及加溫之lidocaine的效應亦是首度被研究。方法：八十位ASA I-II預接受常規手術之成人患者被隨意分配成相同人數的四組，病患接受全身麻醉，氣管內管氣囊依組別分別加入以下溶液：A組－生理食鹽水6毫升，B組－24°C 4% lidocaine 6毫升，C組－24°C 4% lidocaine 5毫升加重碳酸鈉1毫升，D組－38°C 4% lidocaine 5毫升加重碳酸鈉1毫升。拔管前後咳嗽次數、生命特徵、及立即之併發症均被記錄並分析。結果：D組病患拔管前後咳嗽之次數遠較其他三組為少（mean=3.95，p＜0.001），術後喉嚨痛的比率也是最低（25%，p＜0.05）；然而沒有一組配方可以完全預防全身麻醉甦醒時氣管內管引起之咳嗽。結論：將鹼化及加溫後之lidocaine注入氣管內管氣囊中，可有效減少於全身麻醉甦醒時，氣管內管所引起之咳嗽。

並列關鍵字

麻醉，全身 ； 麻醉劑，局部：lidocaine ； 咳嗽