Comparison of Transtracheal Dexmedetomidine with Transtracheal Lidocaine in Patients Undergoing Bronchoalveolar Lavage
-
Moein Daneshmand
,
Alireza Jahangirifard
,
Ali Nazembokaee
,
Marzie Shahrabi
,
Lida Fadaizadeh
,
Alireza Salimi
,
Kobra Rafiei
Abstract
Background: Airway management is a routine part of any type of anesthesia; therefore, the present study was designed to compare the effect of transtracheal dexmedetomidine and transtracheal lidocaine in patients undergoing bronchoalveolar lavage and other adverse events.
Methods: Individuals aged 18 to 65 years that were candidates for bronchoalveolar lavage in three groups were included in the study. All three groups of patients underwent a standard treatment with the same anesthesia method with the same treatment group. Patients were administered lidocaine (4 cc 2% lidocaine), dexmedetomidine (0.5 g/kgµ dexmedetomidine), and lidocaine + dexmedetomidine (4 cc 2% lidocaine + 0.5 g/kgµ dexmedetomidine) groups.
Results: A total 150 patients with a mean age of 57.2±16.32 were evaluated in three equal groups. The clinical status of the patients showed that the patients in the combined use of dexmedetomidine and lidocaine group underwent sedation significantly more than the other two groups. The incidence of cough in dexmedetomidine and lidocaine group of patients was significantly lower than in the other groups.
Conclusion: The simultaneous use of transtracheal lidocaine and dexmedetomidine significantly reduces the incidence of cough in patients undergoing bronchoalveolar lavage.
[1] Irwin RS. Complications of cough. Chest. 2006;1291:54S–8S.
[2] Francis CK, Singh JB, Polansky BJ. Interruption of aberrant conduction of atrioventricular junctional tachycardia by cough. N Engl J Med. 1972;2867:357–8.
[3] Kim HJ, Kim JS. A cardiovascular collapse following vigorous cough during spinal anesthesia. Korean J Anesthesiol. 2013;656(Suppl):S49–50.
[4] Benedict EB. Rupture of the bronchus from bronchoscopy during a paroxysm of coughing. JAMA. 1961;178:509–10.
[5] Choi EK, Kwon N, Park SJ. Comparison of the effects of oxycodone versus fentanyl on airway reflex to tracheal extubation and postoperative pain during anesthesia recovery after laparoscopic cholecystectomy: A double-blind, randomized clinical consort study. Medicine. 2018;9713:e0156.
[6] Clivio S, Putzu A, Tramèr MR. Intravenous lidocaine for the prevention of cough. AnesthAnalg. 2019;1295:1249–55.
[7] Liu Y, Ai D, Wang X. Efficacy of perioperative intravenous dexmedetomidine administration for the prevention of postoperative sore throat: A meta-analysis. J Int Med Res. 2021;495:3000605211017686.
[8] Mahjoubifard M, Heidari M, Dahmardeh M, Mirtajani SB, Jahangirifard A. Comparison of dexmedetomidine, lidocaine, and fentanyl in attenuation hemodynamic response of laryngoscopy and intubation in patients undergoing cardiac surgery. Anesthesiology research and practice. 2020;2020:4814037.
[9] Sun L, Guo R, Sun L. The impact of prophylactic intravenous lidocaine on opioid-induced cough: A meta-analysis of randomized controlled trials. J Anesth. 2014;283:325–33.
[10] Fan X, Cai H, Pan B, Xie Y. Comparison of dexmedetomidine and remifentanil on reducing coughing during emergence from anesthesia with tracheal intubation: A meta-analysis. Front Pharmacol. 2022;13:993239. doi: 10.3389/fphar.2022.993239.
[11] Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Int J Surg. 2010;85:336–41.
[12] Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. AnesthAnalg. 2004;994:1253–7.
[13] Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi: 10.1136/bmj.l4898.
[14] Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.
[15] Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;504:1088–101.
[16] Guyatt GH, Oxman AD, Santesso N, Helfand M, Vist G, Kunz R, et al. GRADE guidelines: 12. Preparing summary of findings tables-binary outcomes. J Clin Epidemiol. 2013;662:158–72.
[17] Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials. 1996;171:1–12.
[18] Kothari D, Tandon N, Singh M, Kumar A. Attenuation of circulatory and airway responses to endotracheal extubation in craniotomies for intracerebral space occupying lesions: Dexmedetomidine versus lignocaine. Anesth Essays Res. 2014;81:78–82.
[19] Mahjoubifard M, Heidari M, Dahmardeh M, Mirtajani SB, Jahangirifard A. Comparison of dexmedetomidine, lidocaine, and fentanyl in attenuation hemodynamic response of laryngoscopy and intubation in patients undergoing cardiac surgery. Anesthesiol Res Pract. 2020;4814037.
[20] Gosai N, Jansari A, Solanki R, Patel D, Prajapati D, Patel B. A comparative study of the effect of dexmedetomidine and lignocaine on hemodynamic responses and recovery following tracheal extubation in patients undergoing intracranial surgery. Int J Basic Clin Pharmacol. 2015;42:371.
[21] Asgari S, Behnaz F, Ommi D, Zandpazandi S, Eraghi MM. The effect of Dexmedetomidine on suppression of the bispectral index score and hemodynamic response during laryngoscopy and intubation in addicted patients in supratentorial brain tumor surgery, a randomized double-blinded controlled trial. Trends Anaesth Crit Care. 2023;53:101293.
[22] Hu S, Li Y, Wang S, Xu S, Ju X, Ma L. Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgery. BMC Anesthesiol. 2019;191:66.
[23] Pradhan A, Pandey A, Kumar Nayak L. To compare the effects of intravenous dexmedetomidine and lignocaine on hemodynamic responses and airway reflexes during tracheal extubation in patients undergoing laparoscopic surgeries. Int J Health Clin Res. 2021;410:1–6.
[24] Safneedha VS. Dexmedetomidine versus Lignocaine for extubation in patients undergoing craniotomies. Indian J Clin Anaesth. 2021;82:326–30.
[25] Burki NK, Lee LY. Blockade of airway sensory nerves and dyspnea in humans. Pulm Pharmacol Ther. 2010;234:279–82.
[26] Tanelian DL, MacIver MB. Analgesic concentrations of lidocaine suppress tonic A-delta and C fiber discharges produced by acute injury. Anesthesiology. 1991;745:934–6.
[27] Woolf CJ, Wiesenfeld-Hallin Z. The systemic administration of local anaesthetics produces a selective depression of C-afferent fibre evoked activity in the spinal cord. Pain. 1985;234:361–74.
[28] Ochs HR, Knüchel M, Abernethy DR, Greenblatt DJ. Dose-independent pharmacokinetics of intravenous lidocaine in humans. J Clin Pharmacol. 1983;234:186–8.
[29] Estebe JP. Intravenous lidocaine. Best Pract Res ClinAnaesthesiol. 2017;314:513–21.
[30] Lam F, Lin YC, Tsai HC, Chen TL, Tam KW, Chen CY. Effect of intracuff lidocaine on postoperative sore throat and the emergence phenomenon: A systematic review and meta-analysis of randomized controlled trials. PLoS One. 2015;108:e0136184. doi: 10.1371/journal.pone.0136184.
[31] Tung A, Fergusson NA, Ng N, Hu V, Dormuth C, Griesdale DEG. Medications to reduce emergence coughing after general anaesthesia with tracheal intubation: A systematic review and network meta-analysis. Br J Anaesth. 2020
[32] Bang SR, Ahn HJ, Kim HJ, Kim GH, Kim JA, Yang M, et al. Comparison of the effectiveness of lidocaine and salbutamol on coughing provoked by intravenous remifentanil during anesthesia induction. Korean J Anesthesiol. 2010;595:319–22.
[33] Mikawa K, Nishina K, Takao Y, Shiga M, Maekawa N, Obara H. Attenuation of cardiovascular responses to tracheal extubation: Comparison of verapamil, lidocaine, and verapamil-lidocaine combination. AnesthAnalg. 1997;855:1005–10.
[34] Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: A multifactorial concept. RegAnesth Pain Med. 2004;296:564–75.
[35] Aouad MT, Zeeni C, Al Nawwar R, Siddik-Sayyid SM, Barakat HB, Elias S, et al. Dexmedetomidine for improved quality of emergence from general anesthesia. AnesthAnalg. 2019;1296:1504–11.
[36] Kim DJ, Kim SH, So KY, Jung KT. Effects of dexmedetomidine on smooth emergence from anaesthesia in elderly patients undergoing orthopaedic surgery. BMC Anesthesiol. 2015;151:139. doi: 10.1186/s12871-015-0127-4.
[37] Miao M, Xu Y, Li B, Chang E, Zhang L, Zhang J. Intravenous administration of dexmedetomidine and quality of recovery after elective surgery in adult patients: A meta-analysis of randomized controlled trials. J Clin Anesth. 2020;65:109849. doi: 10.1016/j.jclinane.2020.109849.
[38] Wang W, Huo P, Wang E, Song W, Huang Y, Liu Z, et al. Dexmedetomidine infusion for emergence coughing prevention in patients undergoing an endovascular interventional procedure: A randomized dose-finding trial. Eur J Pharm Sci. 2022;177:106230.
[39] Duan G, Wang K, Peng T, Wu Z, Li H. The effects of intraoperative dexmedetomidine use and its different dose on postoperative sleep disturbance in patients who have undergone non-cardiac major surgery: A real-world cohort study. Nat Sci Sleep. 2020;12:209–19.
[40] Pandharipande P, Ely E, Maze M. Alpha-2 agonists: Can they modify the outcomes in the postanesthesia care unit? Curr Drug Targets. 2005;67:749–54.
[41] Yang X, Hu Z, Peng F, Chen G, Zhou Y, Yang Q, et al. Effects of dexmedetomidine on emergence agitation and recovery quality among children undergoing surgery under general anesthesia: A meta-analysis of randomized controlled trials. Front Pediatr. 2020;8:580226. doi: 10.3389/fped.2020.580226.
[42] Kim SY, Kim JM, Lee JH, Song BM, Koo BN. Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery. Br J Anaesth. 2013;1112:222–8.
[43] Kamibayashi T, Maze M, Weiskopf RB, Weiskopf RB, Todd MM. Clinical uses of α2-adrenergic agonists. Anesthesiology. 2000;935:1345–9.
[44] Szumita PM, Baroletti SA, Anger KE, Wechsler ME. Sedation and analgesia in the intensive care unit: Evaluating the role of dexmedetomidine. Am J Health Syst Pharm. 2007;641:37–44.
[45] Jessen Lundorf L, KorveniusNedergaard H, Møller AM. Perioperative dexmedetomidine for acute pain after abdominal surgery in adults. Cochrane Database of Systematic Reviews. 2016;22:CD010358.
[46] Demiri M, Antunes T, Fletcher D, Martinez V. Perioperative adverse events attributed to α2-adrenoceptor agonists in patients not at risk of cardiovascular events: Systematic review and meta-analysis. Br J Anaesth. 2019;1236:795–807
[2] Francis CK, Singh JB, Polansky BJ. Interruption of aberrant conduction of atrioventricular junctional tachycardia by cough. N Engl J Med. 1972;2867:357–8.
[3] Kim HJ, Kim JS. A cardiovascular collapse following vigorous cough during spinal anesthesia. Korean J Anesthesiol. 2013;656(Suppl):S49–50.
[4] Benedict EB. Rupture of the bronchus from bronchoscopy during a paroxysm of coughing. JAMA. 1961;178:509–10.
[5] Choi EK, Kwon N, Park SJ. Comparison of the effects of oxycodone versus fentanyl on airway reflex to tracheal extubation and postoperative pain during anesthesia recovery after laparoscopic cholecystectomy: A double-blind, randomized clinical consort study. Medicine. 2018;9713:e0156.
[6] Clivio S, Putzu A, Tramèr MR. Intravenous lidocaine for the prevention of cough. AnesthAnalg. 2019;1295:1249–55.
[7] Liu Y, Ai D, Wang X. Efficacy of perioperative intravenous dexmedetomidine administration for the prevention of postoperative sore throat: A meta-analysis. J Int Med Res. 2021;495:3000605211017686.
[8] Mahjoubifard M, Heidari M, Dahmardeh M, Mirtajani SB, Jahangirifard A. Comparison of dexmedetomidine, lidocaine, and fentanyl in attenuation hemodynamic response of laryngoscopy and intubation in patients undergoing cardiac surgery. Anesthesiology research and practice. 2020;2020:4814037.
[9] Sun L, Guo R, Sun L. The impact of prophylactic intravenous lidocaine on opioid-induced cough: A meta-analysis of randomized controlled trials. J Anesth. 2014;283:325–33.
[10] Fan X, Cai H, Pan B, Xie Y. Comparison of dexmedetomidine and remifentanil on reducing coughing during emergence from anesthesia with tracheal intubation: A meta-analysis. Front Pharmacol. 2022;13:993239. doi: 10.3389/fphar.2022.993239.
[11] Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Int J Surg. 2010;85:336–41.
[12] Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. AnesthAnalg. 2004;994:1253–7.
[13] Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi: 10.1136/bmj.l4898.
[14] Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.
[15] Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;504:1088–101.
[16] Guyatt GH, Oxman AD, Santesso N, Helfand M, Vist G, Kunz R, et al. GRADE guidelines: 12. Preparing summary of findings tables-binary outcomes. J Clin Epidemiol. 2013;662:158–72.
[17] Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials. 1996;171:1–12.
[18] Kothari D, Tandon N, Singh M, Kumar A. Attenuation of circulatory and airway responses to endotracheal extubation in craniotomies for intracerebral space occupying lesions: Dexmedetomidine versus lignocaine. Anesth Essays Res. 2014;81:78–82.
[19] Mahjoubifard M, Heidari M, Dahmardeh M, Mirtajani SB, Jahangirifard A. Comparison of dexmedetomidine, lidocaine, and fentanyl in attenuation hemodynamic response of laryngoscopy and intubation in patients undergoing cardiac surgery. Anesthesiol Res Pract. 2020;4814037.
[20] Gosai N, Jansari A, Solanki R, Patel D, Prajapati D, Patel B. A comparative study of the effect of dexmedetomidine and lignocaine on hemodynamic responses and recovery following tracheal extubation in patients undergoing intracranial surgery. Int J Basic Clin Pharmacol. 2015;42:371.
[21] Asgari S, Behnaz F, Ommi D, Zandpazandi S, Eraghi MM. The effect of Dexmedetomidine on suppression of the bispectral index score and hemodynamic response during laryngoscopy and intubation in addicted patients in supratentorial brain tumor surgery, a randomized double-blinded controlled trial. Trends Anaesth Crit Care. 2023;53:101293.
[22] Hu S, Li Y, Wang S, Xu S, Ju X, Ma L. Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgery. BMC Anesthesiol. 2019;191:66.
[23] Pradhan A, Pandey A, Kumar Nayak L. To compare the effects of intravenous dexmedetomidine and lignocaine on hemodynamic responses and airway reflexes during tracheal extubation in patients undergoing laparoscopic surgeries. Int J Health Clin Res. 2021;410:1–6.
[24] Safneedha VS. Dexmedetomidine versus Lignocaine for extubation in patients undergoing craniotomies. Indian J Clin Anaesth. 2021;82:326–30.
[25] Burki NK, Lee LY. Blockade of airway sensory nerves and dyspnea in humans. Pulm Pharmacol Ther. 2010;234:279–82.
[26] Tanelian DL, MacIver MB. Analgesic concentrations of lidocaine suppress tonic A-delta and C fiber discharges produced by acute injury. Anesthesiology. 1991;745:934–6.
[27] Woolf CJ, Wiesenfeld-Hallin Z. The systemic administration of local anaesthetics produces a selective depression of C-afferent fibre evoked activity in the spinal cord. Pain. 1985;234:361–74.
[28] Ochs HR, Knüchel M, Abernethy DR, Greenblatt DJ. Dose-independent pharmacokinetics of intravenous lidocaine in humans. J Clin Pharmacol. 1983;234:186–8.
[29] Estebe JP. Intravenous lidocaine. Best Pract Res ClinAnaesthesiol. 2017;314:513–21.
[30] Lam F, Lin YC, Tsai HC, Chen TL, Tam KW, Chen CY. Effect of intracuff lidocaine on postoperative sore throat and the emergence phenomenon: A systematic review and meta-analysis of randomized controlled trials. PLoS One. 2015;108:e0136184. doi: 10.1371/journal.pone.0136184.
[31] Tung A, Fergusson NA, Ng N, Hu V, Dormuth C, Griesdale DEG. Medications to reduce emergence coughing after general anaesthesia with tracheal intubation: A systematic review and network meta-analysis. Br J Anaesth. 2020
[32] Bang SR, Ahn HJ, Kim HJ, Kim GH, Kim JA, Yang M, et al. Comparison of the effectiveness of lidocaine and salbutamol on coughing provoked by intravenous remifentanil during anesthesia induction. Korean J Anesthesiol. 2010;595:319–22.
[33] Mikawa K, Nishina K, Takao Y, Shiga M, Maekawa N, Obara H. Attenuation of cardiovascular responses to tracheal extubation: Comparison of verapamil, lidocaine, and verapamil-lidocaine combination. AnesthAnalg. 1997;855:1005–10.
[34] Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: A multifactorial concept. RegAnesth Pain Med. 2004;296:564–75.
[35] Aouad MT, Zeeni C, Al Nawwar R, Siddik-Sayyid SM, Barakat HB, Elias S, et al. Dexmedetomidine for improved quality of emergence from general anesthesia. AnesthAnalg. 2019;1296:1504–11.
[36] Kim DJ, Kim SH, So KY, Jung KT. Effects of dexmedetomidine on smooth emergence from anaesthesia in elderly patients undergoing orthopaedic surgery. BMC Anesthesiol. 2015;151:139. doi: 10.1186/s12871-015-0127-4.
[37] Miao M, Xu Y, Li B, Chang E, Zhang L, Zhang J. Intravenous administration of dexmedetomidine and quality of recovery after elective surgery in adult patients: A meta-analysis of randomized controlled trials. J Clin Anesth. 2020;65:109849. doi: 10.1016/j.jclinane.2020.109849.
[38] Wang W, Huo P, Wang E, Song W, Huang Y, Liu Z, et al. Dexmedetomidine infusion for emergence coughing prevention in patients undergoing an endovascular interventional procedure: A randomized dose-finding trial. Eur J Pharm Sci. 2022;177:106230.
[39] Duan G, Wang K, Peng T, Wu Z, Li H. The effects of intraoperative dexmedetomidine use and its different dose on postoperative sleep disturbance in patients who have undergone non-cardiac major surgery: A real-world cohort study. Nat Sci Sleep. 2020;12:209–19.
[40] Pandharipande P, Ely E, Maze M. Alpha-2 agonists: Can they modify the outcomes in the postanesthesia care unit? Curr Drug Targets. 2005;67:749–54.
[41] Yang X, Hu Z, Peng F, Chen G, Zhou Y, Yang Q, et al. Effects of dexmedetomidine on emergence agitation and recovery quality among children undergoing surgery under general anesthesia: A meta-analysis of randomized controlled trials. Front Pediatr. 2020;8:580226. doi: 10.3389/fped.2020.580226.
[42] Kim SY, Kim JM, Lee JH, Song BM, Koo BN. Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery. Br J Anaesth. 2013;1112:222–8.
[43] Kamibayashi T, Maze M, Weiskopf RB, Weiskopf RB, Todd MM. Clinical uses of α2-adrenergic agonists. Anesthesiology. 2000;935:1345–9.
[44] Szumita PM, Baroletti SA, Anger KE, Wechsler ME. Sedation and analgesia in the intensive care unit: Evaluating the role of dexmedetomidine. Am J Health Syst Pharm. 2007;641:37–44.
[45] Jessen Lundorf L, KorveniusNedergaard H, Møller AM. Perioperative dexmedetomidine for acute pain after abdominal surgery in adults. Cochrane Database of Systematic Reviews. 2016;22:CD010358.
[46] Demiri M, Antunes T, Fletcher D, Martinez V. Perioperative adverse events attributed to α2-adrenoceptor agonists in patients not at risk of cardiovascular events: Systematic review and meta-analysis. Br J Anaesth. 2019;1236:795–807
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How to Cite
1.
Daneshmand M, Jahangirifard A, Nazembokaee A, Shahrabi M, Fadaizadeh L, Salimi A, Rafiei K. Comparison of Transtracheal Dexmedetomidine with Transtracheal Lidocaine in Patients Undergoing Bronchoalveolar Lavage. Arch Anesth & Crit Care. 2025;.
