From the Department of Anesthesiology and Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal.
Department of Anesthesiology, All India Institute of Medical Sciences, Rishikesh, India.
Anesth Analg. 2019 Jul;129(1):220-225. doi: 10.1213/ANE.0000000000003842.
Postoperative sore throat (POST), hoarseness, and cough after tracheal intubation are not uncommon. Although both lidocaine and dexamethasone have been used independently to reduce these events, there is no study assessing the combined effects of lidocaine and dexamethasone.
This prospective, double-blind, randomized controlled study enrolled 180 patients requiring general anesthesia with endotracheal intubation for >90 minutes. They received 1 of the 4 intravenous agents just before induction of anesthesia: lidocaine (1.5 mg/kg) in group L, dexamethasone (8 mg) in group D, lidocaine (1.5 mg/kg) with dexamethasone (8 mg) in group DL, and placebo as normal saline in group NS. Standard anesthesia protocol was followed. Incidence and severity of a sore throat, cough, and hoarseness of voice were assessed up to 24 hours postoperatively. The primary outcome was the incidence of POST, and the main effects of dexamethasone and lidocaine were the primary interest.
Data of 45 patients in D, 44 in L, 44 in DL, and 43 in NS groups were analyzed. The incidence of a sore throat was 36%, 43%, 25%, and 56% in group D, L, DL, and NS, respectively (P = .02). Dexamethasone with or without lidocaine reduced the incidence of the POST (odds ratio, 0.44; 95% confidence interval, 0.24-0.82; P < .01). However, lidocaine was not effective in reducing POST (odds ratio, 0.62; 95% confidence interval, 0.33-1.14; P = .12). No difference was observed in the severity of a sore throat, incidence and severity of a cough, and hoarseness among the groups.
Dexamethasone, with or without lidocaine, was effective in reducing the incidence of POST in patients requiring prolonged tracheal intubation.
气管插管后咽痛（POST）、声音嘶哑和咳嗽并不少见。虽然利多卡因和地塞米松都已被独立用于减少这些事件，但尚无研究评估利多卡因和地塞米松的联合作用。
本前瞻性、双盲、随机对照研究纳入了 180 例需要全身麻醉和气管内插管超过 90 分钟的患者。他们在诱导麻醉前接受了以下 4 种静脉注射药物之一：利多卡因（1.5mg/kg）组 L、地塞米松（8mg）组 D、利多卡因（1.5mg/kg）联合地塞米松（8mg）组 DL 和生理盐水作为安慰剂的 NS 组。采用标准麻醉方案。术后至 24 小时评估咽痛、咳嗽和声音嘶哑的发生率和严重程度。主要结局为 POST 的发生率，地塞米松和利多卡因的主要作用是主要关注点。
D 组、L 组、DL 组和 NS 组分别有 45、44、44 和 43 例患者的数据纳入分析。D 组、L 组、DL 组和 NS 组的咽痛发生率分别为 36%、43%、25%和 56%（P=0.02）。地塞米松联合或不联合利多卡因可降低 POST 的发生率（比值比，0.44；95%置信区间，0.24-0.82；P<0.01）。然而，利多卡因在降低 POST 发生率方面无效（比值比，0.62；95%置信区间，0.33-1.14；P=0.12）。各组之间的咽痛严重程度、咳嗽发生率和严重程度以及声音嘶哑均无差异。
地塞米松联合或不联合利多卡因可有效降低需要长时间气管插管的患者 POST 的发生率。
