Effectiveness of intracuff alkalinized lidocaine associated with intravenous dexamethasone in reducing laryngotracheal morbidity in children undergoing general anesthesia for tonsillectomy: a randomized controlled trial
Eficácia da lidocaína alcalinizada intracuff associada à dexametasona intravenosa na redução da morbidade laringotraqueal em crianças submetidas a tonsilectomia: ensaio clínico randomizado
Morenna Ramos e Oliveira, Norma S.P. Modolo, Paulo Nascimento Jr., Rodrigo M. Lima, Devin Stirling, Glenio B. Mizubuti, Leopoldo Muniz da Silva, Lais H. Navarro
Abstract
Background
Postoperative sore throat is one of the main postoperative complaints in patients undergoing tonsillectomy. As the primary outcome, we aimed to determine whether endotracheal tube cuffs filled with alkalinized lidocaine are associated with a lower incidence of postoperative sore throat and anesthesia emergence phenomena in children undergoing tonsillectomy or adenotonsillectomy. We also assessed the potential additional benefits of IV dexamethasone in reducing postoperative laryngotracheal morbidity.
Methods
This is a clinical prospective, randomized, controlled trial. Patients were randomly allocated to one of four groups, as follows: air – endotracheal tube cuff filled with air; air/dex – endotracheal tube cuff filled with air and intravenous dexamethasone; lido – endotracheal tube cuff filled with alkalinized lidocaine; and lido/dex – endotracheal tube cuff filled with alkalinized lidocaine and intravenous dexamethasone. Perioperative hemodynamic parameters and the incidence of postoperative nausea and vomiting, coughing and hoarseness were recorded. Postoperative sore throat was assessed in the postanesthetic care unit and 24 hours post tracheal extubation.
Results
In total, 154 children aged 4–12 years, ASA physical status I or II, undergoing general anesthesia for elective tonsillectomy and adenotonsillectomy, were assessed for postoperative sore throat in this study. The incidence of postoperative sore throat 24 hours after tracheal extubation was significantly lower in the lido/dex group compared to groups air and air/dex (p = 0.01). However, no additional reduction in these symptoms was observed from the intravenous administration of dexamethasone when comparing the lido and lido/dex groups. Similarly, there were no differences among groups regarding perioperative hemodynamic variables or postoperative nausea and vomiting, coughing, and hoarseness during the study period.
Conclusion
Intracuff alkalinized lidocaine, associated with intravenous dexamethasone, might be effective in reducing sore throat 24 hours post-tonsillectomy or adenotonsillectomy in children when compared to the use of air as the cuff insufflation media.
Keywords
Resumo
Introdução
Dor de garganta pós-operatória é uma das principais queixas pós-operatórias em pacientes submetidos a tonsilectomia. Como desfecho primário, nosso objetivo foi determinar se os balonetes do tubo endotraqueal preenchidos com lidocaína alcalinizada estão associados a uma menor incidência de dor de garganta pós-operatória e fenômenos de emergência anestésica em crianças submetidas a tonsilectomia ou adenotonsilectomia. Também avaliamos os potenciais benefícios adicionais da dexametasona IV na redução da morbidade laringotraqueal pós-operatória.
Métodos
Este é um ensaio clínico prospectivo, randomizado e controlado. Os pacientes foram alocados aleatoriamente em um dos quatro grupos: ar – balonete do tubo endotraqueal preenchido com ar; ar/dex – balonete do tubo endotraqueal preenchido com ar e dexametasona intravenosa; lido – balonete de tubo endotraqueal preenchido com lidocaína alcalinizada; e lido/dex – balonete de tubo endotraqueal preenchido com lidocaína alcalinizada e dexametasona intravenosa. Parâmetros hemodinâmicos perioperatórios e a incidência de náuseas e vômitos pós-operatórios, tosse e rouquidão foram registrados. A dor de garganta pós-operatória foi avaliada na sala de recuperação pós-anestésica e 24 horas após a extubação traqueal.
Resultados
No total, 154 crianças de 4 a 12 anos, estado físico ASA 1 ou 2, submetidas à anestesia geral para tonsilectomia e adenotonsilectomia eletivas, foram avaliadas para dor de garganta pós-operatória neste estudo. A incidência de dor de garganta pós-operatória 24 horas após a extubação traqueal foi significativamente menor no grupo lido/dex em comparação aos grupos ar e ar/dex (p = 0,01). Entretanto, nenhuma redução adicional desses sintomas foi observada com a administração intravenosa de dexametasona quando comparados os grupos lido e lido/dex. Da mesma forma, não houve diferenças entre os grupos em relação às variáveis hemodinâmicas perioperatórias ou náuseas e vômitos pós-operatórios, tosse e rouquidão durante o período do estudo.
Conclusão
A lidocaína alcalinizada intracuff, associada à dexametasona intravenosa, pode ser eficaz na redução da dor de garganta 24 horas pós-amigdalectomia ou adenotonsilectomia em crianças quando comparada ao uso de ar como meio de insuflação do cuff.
Palavras-chave
Referências
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Submetido em:
20/08/2021
Aceito em:
27/07/2024
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