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Published on: January 13, 2017
Lidocaine vs. Mometasone Furoate Around the Pediatric Tracheal Tube Cuff: Hemodynamic Stress Response and
Ali Ulvi Ölç1, Mehmet Yılmaz2, Kemal Tolga Saraçoğlu3
1Department of Anesthesiology and Reanimation, Elbistan State Hospital, Kahramanmaras 46300, Turkey.
Insights
Topical lidocaine and mometasone spray around the tracheal tube cuff in children reduced postoperative cough. Lidocaine also suppressed hemodynamic stress responses during tracheal intubation and extubation, improving patient outcomes.
Area of Science:
- Anesthesiology and critical care medicine
- Pediatric surgery and airway management
- Pharmacology of local anesthetics and corticosteroids
Background:
- Airway and respiratory complications are common anesthesia-related issues in children, posing significant risks.
- The hemodynamic stress response during tracheal intubation and extubation can lead to adverse cardiovascular events.
- Effective strategies are needed to mitigate these complications and improve patient safety during pediatric anesthesia.
Purpose of the Study:
- To evaluate the effect of topical lidocaine and mometasone spray on the hemodynamic stress response in children undergoing tracheal intubation and extubation.
- To determine the impact of these agents on the incidence of postoperative airway complications, including cough.
Main Methods:
- A randomized controlled trial involving 91 pediatric patients (ASA I-II, 0-16 years) undergoing elective surgery.
- Three groups were established: topical mometasone furoate spray, topical 10% lidocaine spray, and a control group with normal saline.
- Hemodynamic parameters (blood pressure, heart rate) and SpO2 were monitored throughout the perioperative period; patients were followed for 24 hours postoperatively.
Main Results:
- Lidocaine group showed a statistically significant decrease in diastolic and mean arterial pressures post-intubation and reduced heart rate post-extubation.
- Postoperative cough was significantly reduced in the lidocaine and mometasone groups compared to the control group (p=0.009).
- While trends suggested decreased sore throat, dyspnea, hoarseness, and bronchospasm, these did not reach statistical significance.
Conclusions:
- Topical application of lidocaine and mometasone around the tracheal tube cuff in children effectively reduces postoperative cough.
- Lidocaine, specifically, demonstrates efficacy in suppressing the hemodynamic stress response associated with tracheal intubation and extubation.
- These findings suggest that topical lidocaine and mometasone are valuable adjuncts for improving airway management and patient comfort in pediatric anesthesia.
Abstract:
Introduction: According to the results of the APRICOT study, airway and respiratory complications constitute 60% of all anesthesia-related complications and may be life-threatening. The primary aim of this study was to evaluate the effect of lidocaine and mometasone spray on the hemodynamic stress response during tracheal intubation and extubation in children. Our secondary aim was to determine its effect on the incidence of postoperative airway complications. Materials and Methods: Following Ethics Committee approval (No: KIIA 2018/489) and clinical trial registration (No: NCT04085744), patient recruitment was initiated only after obtaining parental consent. Children of ASA I-II aged 0 to 16 years and undergoing elective surgery were included. A total of 91 patients were randomly divided into 3 groups. Group M: Patients treated with a topical corticosteroid 0.05% mometasone furoate spray (n = 30). Group L: Patients sprayed with 10% lidocaine (n = 30). Control group: Patients treated with 0.9% normal saline applied around the cuff (n = 31). The systolic, diastolic, and mean blood pressures, heart rate, and SpO2 values were recorded before operation, after induction, before and after tracheal intubation, and before and after extubation. Patients were followed up for 24 h postoperatively. Results: A statistically significant decrease was found in the lidocaine group for diastolic and mean arterial pressures measured after tracheal intubation (p = 0.018 and p = 0.027, respectively). There was a significant decrease in heart rate values in Group L after extubation (p = 0.024). Cough was observed in 5 patients in the control group at the postoperative 12th hour, but not in the other groups (p = 0.009). The distribution of sore throat severity, dyspnea, and hoarseness and the incidence of early postoperative bronchospasm, recorded in all follow-up periods, decreased; however, it did not show a statistically significant difference. Conclusions: In conclusion, this study revealed that the topical application of lidocaine and mometasone around the tracheal tube cuff in children not only reduces postoperative cough but also, in the case of lidocaine, suppresses the hemodynamic stress response during both tracheal intubation and extubation.
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