Publication:

Post adenotonsillectomy coughing and laryngospasm in children: preextubation mini-dose suxamethonium, lidocaine, and their combination prove prophylactic

Background Post adenotonsillectomy coughing and laryngospasm in children entails deleterious sequelae, warranting continued search for effective prophylaxis. The aim was to determine the prophylactic efficacy of intravenous mini-dose (0.1 mg/kg) suxamethonium, 1.5 mg/kg lidocaine 1%, and their combination, against coughing and laryngospasm in children emerging from general anaesthesia after adenotonsillectomy.

Methods Ethical approval and parental written consent secured, 69 children, aged 1-6 years, of American Society of Anesthesiologists (ASA) class I were randomized into groups A, B, and C, of 23 each. All patients had general anaesthesia induced with propofol 2 mg/kg plus fentanyl 2 µ/kg, maintained with isoflurane 1-1.5% in 100% oxygen, and tracheal intubation facilitated by pancuronium 0.075 mg/kg. Two minutes after reversal dose of neostigmine, groups A, B and C respectively received 1.5 mg/kg lidocaine 1%, suxamethonium 0.1 mg/kg, and 1.5 mg/kg lidocaine 1% plus suxamethonium 0.1 mg/kg, intravenously. Tracheal extubation was done 90 seconds after study drug administration, and coughing and laryngospasm were assessed for 10 minutes using modified Minogue and Likert 4-point scales respectively.

Results All 69 subjects completed the study. The incidence of mild to moderate coughing was 22 (95.7%) in groups A and B, and 19 (82.6%) in group C, p=1.000. Laryngospasm occurred in none (0.0%) in group C, while in groups A and B its occurrence was 1(4.3%), p=1.000.

Conclusions Mini-dose suxamethonium or lidocaine 1.5 mg/kg prevented grade 3 coughing and laryngospasm; furthermore, their combination prevented grade 3 coughing and achieved zero incidence of laryngospasm.