In this episode, I’ll discuss adding dexmedetomidine to lidocaine for topical application to prevent cough during extubation of thyroidectomy patients.
The cough reflex that occurs with extubation can be especially problematic in thyroidectomy patients, as it may lead to bleeding and subsequent hemodynamic instability.
Topical lidocaine has been used to prevent cough from extubation from occuring, but a group of authors recently published in Anesthesia and Analgesia a randomized controlled trial that compared adding dexmedetomidine to topical lidocaine with lidocaine alone and placebo for the prevention of cough from extubation.
180 thyroidectomy patients were split evenly into the 3 groups. Dexmedetomidine plus lidocaine, lidocaine, or saline spray was applied to the supraglottic, glottic, and subglottic areas. The primary outcome was the incidence of cough reflex at extubation.
The incidence of cough reflex during extubation was 23% with the combination group, 47% with just lidocaine, and 70% with placebo. The differences between both active treatment groups and placebo were statistically significant. In addition, the difference in cough reflex during extubation was statistically significant in favor of the combination group compared to the lidocaine alone group.
When cough did occur, the severity was significantly less in the combination group compared to control as well.
The authors concluded:
The combination of dexmedetomidine and lidocaine laryngopharynx spray effectively suppresses the cough reflex during extubation, reduces postoperative sore throat, and stabilizes hemodynamics in female patients undergoing thyroid surgery.
Pharmacists can expect their anesthesiologists to request dexmedetomidine in the OR for this purpose.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
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