Abstract
Objective: To determine if topical lignocaine used during microlaryngeal surgery under general anaesthesia confers significant clinical benefit by reducing the pressor response and laryngospasm that often occur during recovery. Study Design: Prospective double-blind randomised placebo-controlled trial in a UK Otolaryngology department. 85 patients undergoing elective microlaryngeal surgery receiving either 4 ml 4% lignocaine spray to the vocal cords and piriform fossae or 4 ml 0.9% saline spray to the same areas at induction of anaesthesia. Methods: Primary outcome measures were pulse and blood pressure recorded immediately before spray application and at 5 minute intervals during recovery for 20 minutes and the degree of laryngospasm or cough (absent, mild, moderate, severe) recorded at the same intervals. Secondary outcome measures included patient grading of post-operative throat discomfort on a visual analogue scale (1 to 100 mm) and analgesia requirements in the first 6 hours post-operatively. Results: 44 patients (mean age 58 years, 22 male, 22 female) were randomised to receive lignocaine and 41 patients (mean age 57 years, 24 male, 17 female) saline spray. No statistically significant difference was found between groups in mean pulse or mean systolic and diastolic blood pressure immediately before application of spray or during the recovery period. There was no difference in the degree of post-operative coughing or laryngospasm or analgesia requirements between the groups. Topical lignocaine was associated with more throat discomfort than saline (p=0.03; Diff 0.9; 95% C.I. 0.1 to 1.8). Conclusion: The use of topical lignocaine spray conferred no clinical benefit in this study.
Highlights
The pressor response and coughing which follow extubation are well documented during the immediate recovery period after many types of surgery
This study showed no benefit of topical lignocaine spray over
There was no significant reduction in post-operative coughing or laryngospasm conferred by topical lignocaine either
Summary
The pressor response and coughing which follow extubation are well documented during the immediate recovery period after many types of surgery. The pressor response is a sympathomimetic stress reponse. It comprises tachycardia and hypertension which can in turn lead to dysrhythmias, myocardial ischaemia and even myocardial infarction. It is routine practice for some anaesthetists to apply topical anaesthetic to the larynx at induction to prevent or reduce these problems. Bidwai et al demonstrated a reduced pressor response upon extubation in patients given topical lignocaine approximately five minutes before extubation in lower abdominal and gynaecological surgery [1]. Staffel et al found the risk of laryngospasm and stridor post adenotonsillectomy to be reduced by topical lignocaine applied just prior to intubation [2]. There is no evidence available at present to support the use of topical lignocaine in this way for microlaryngeal surgery
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