The Journal of craniofacial surgery · 2025
Efficacy of Above- Versus Below-Cuff Lidocaine Injection Via Double-Cuff Endotracheal Tube in Reducing Extubation-Related Coughing in Neurosurgical Patients.
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Tian Ying, Wu Xiao-Hong, Zhang Ke, Guan Xiao-Qin, Yu Ming-Shuai
Аннотация
BACKGROUND: Coughing during extubation is frequently observed in patients undergoing neurosurgery and may adversely impact cerebral hemodynamics. This randomized controlled trial evaluated the efficacy and safety of lidocaine administration through a double-cuff endotracheal tube in mitigating extubation-related coughing, by comparing two delivery techniques.
METHODS: In this double-blind, randomized, controlled trial, 147 patients scheduled for elective neurosurgery were enrolled. Five minutes following admission to the post-anesthesia care unit (PACU), the study drug was administered via the double-cuff endotracheal tube. Participants were randomized into three groups: Group A received lidocaine via above-cuff injection, Group B via below-cuff injection, and Group C received no intervention (control), with 49 participants per group. The primary outcome was the incidence of moderate-to-severe coughing during extubation. Secondary outcomes included the overall incidence of coughing, intraoperative propofol consumption, postoperative recovery parameters, incidence of extubation-related complications and adverse events, and visual analogue scale (VAS) scores for sore throat at 1 hour and 24 hours post-extubation.
RESULTS: Group A exhibited a significantly lower incidence of moderate-to-severe coughing compared with Groups B and C (P < 0.05). The total incidence of coughing was also significantly lower in Group A compared with Group C, and in Group B compared to Group C (P < 0.05). A significant group-by-time interaction was observed for heart rate and mean arterial pressure, with Groups A and B demonstrating smaller hemodynamic fluctuations than Group C. At 1 hour post-extubation, Group A reported the lowest VAS scores for sore throat (P < 0.001).
CONCLUSION: Administration of lidocaine above or below the cuff of a double-cuff endotracheal tube during neurosurgical extubation effectively reduces the incidence of coughing. The above-cuff technique demonstrated the most pronounced benefit in suppressing extubation-related coughing and improving postoperative comfort.
METHODS: In this double-blind, randomized, controlled trial, 147 patients scheduled for elective neurosurgery were enrolled. Five minutes following admission to the post-anesthesia care unit (PACU), the study drug was administered via the double-cuff endotracheal tube. Participants were randomized into three groups: Group A received lidocaine via above-cuff injection, Group B via below-cuff injection, and Group C received no intervention (control), with 49 participants per group. The primary outcome was the incidence of moderate-to-severe coughing during extubation. Secondary outcomes included the overall incidence of coughing, intraoperative propofol consumption, postoperative recovery parameters, incidence of extubation-related complications and adverse events, and visual analogue scale (VAS) scores for sore throat at 1 hour and 24 hours post-extubation.
RESULTS: Group A exhibited a significantly lower incidence of moderate-to-severe coughing compared with Groups B and C (P < 0.05). The total incidence of coughing was also significantly lower in Group A compared with Group C, and in Group B compared to Group C (P < 0.05). A significant group-by-time interaction was observed for heart rate and mean arterial pressure, with Groups A and B demonstrating smaller hemodynamic fluctuations than Group C. At 1 hour post-extubation, Group A reported the lowest VAS scores for sore throat (P < 0.001).
CONCLUSION: Administration of lidocaine above or below the cuff of a double-cuff endotracheal tube during neurosurgical extubation effectively reduces the incidence of coughing. The above-cuff technique demonstrated the most pronounced benefit in suppressing extubation-related coughing and improving postoperative comfort.