Clinical Observation Of Intravenous Lidocaine On Inhibiting Cough During The Tracheal Extubation Period After Endoscopic Sinus Surgery

Objective:To observe the effects of intravenous lidocaine on inhibition cough and hemodynamics change during the tracheal extubation period after endoscopic sinus surgery.Methods:1.General information:A total of 130 patients aged 18-63 years,ASA grading Ⅰ-Ⅱthat undergoing elective endoscopic sinus surgery under general anesthesia were recruited for this prospective observational study.130 patients were divided into 5 groups(n=26)randomly:Group C intravenous injection of saline 5ml at the end of the operation.Group L1,L2,L3 and L4 were intravenous injection of 1%lidocaine 0.5 mg/kg,1.0 mg/kg,1.5 mg/kg,and 2.0 mg/kg intravenously at the end of the operation.2.Anesthesia management:All patients were routinely prepared before surgery,patients received total intravenous anesthesia propofol and remifentanil under pure oxygen inhalation,intravenous injection of cis-atracurium 0.2 mg/kg for anesthesia induction.Routine use tropisetron 4.48 mg and parecoxib sodium 40 mg.Controlled breathing by ventilator after tracheal intubation,anesthesia maintenance using propofol and remifentanil target-controlled infusion.Anesthetic depth will be estimated with bispectral index(BIS)monitoring,adjust the respiratory rate to maintain the end-tidal carbon dioxide between 35-45,BIS value maintained at 40-60.At the end of the operation,saline or lidocaine was injected into groups according to the experiment,and the tracheal tube was removed after the extubation indication was met.3.Index observation:Record the grade of cough response during extubation and record the heart rate(HR)and mean arterial pressure(MAP)at T0(before induction of anesthesia)、T1(at the end of surgery)、T2(immediately before extubation)、T3(5 minutes after extubation).Record the patient’s adverse reactions such as cough、sore throat、hoarseness、nausea and vomiting、postoperative bleeding and agitation after transferred to the postanesthesia care unit(PACU).4.Statistical analysis:IBM SPSS 22.0 software was used for statistical analysis.Continuous variables were expressed as mean±standard deviation(x±s).Categorical variables are expressed as counts or percentages.Chi-square test was used for comparison of count data,repeated measures ANOVA was used for comparison of measurement data,P<0.05 indicates the difference was statistically significant.Results:1.General information:130 patients with nasal endoscopic surgery,including 71 males and 59 females,aged from 18 to 65 years old,ASA grade Ⅰ to Ⅱ,Data analysis was performed on the gender,age,BMI,ASA grade,duration of anesthesia and duration of surgery of the 5 groups of patients,the differences in general conditions among the 5 groups of patients were not statistically significant(P>0.05).2.Comparison of cough:The incidence of cough in groups L1,L2,L3,and L4 were 80.77%,46.15%,34.62%,26.92%,and 23.08%,which were significantly lower than those in group C,and the rate gradually decreased with the increase of the injection dosage,the difference was statistically significant(P<0.05).3.Comparison of hemodynamics:HR and MAP of T2 and T3 in groups L1,L2,L3,and L4 were significantly lower than those in group C,the difference was statistically significant(P<0.05).There was no statistical significance compared with MAP and HR among L1,L2,L3 and L4 groups at various time points(P>0.05).4.Postoperative adverse reactions:There was no statistical significance in adverse reactions in groups L1,L2,L3 and L4 compared with group C(P>0.05).There was no statistical significance compared with adverse reactions among L1,L2,L3 and L4 groups(P>0.05).Conclusion:Intravenous lidocaine can effectively inhibit the cough and maintain the stability of hemodynamics during the tracheal extubation period after endoscopic sinus surgery.Intravenous lidocaine can inhibit the cough in a dose-dependent manner,the optimal dosage is 2.0 mg/kg.