Effects of Using Intravenous Lidocaine on Reducing the Complications of Tracheal Tube Removal After Cardiac Surgery: A Randomized Clinical Trial

Coughing during anesthesia or extubation is a probable event that can cause hemodynamic changes due to an increase in chest pressure or the stimulation of the adrenergic system. We aimed to compare the effects of IV lidocaine with those of IV normal saline (as a placebo) on diminishing the incidence of coughs and sore throats, laryngospasms, and hemodynamic changes during tracheal extubation in the ICU after cardiac surgery.
 
The present randomized clinical trial assigned 50 candidates for simple cardiac valve or coronary bypass surgery to 2 groups (each group =25) to receive IV lidocaine or a placebo before tracheal tube removal after cardiac surgery in the ICU. Hemodynamic changes, the level of consciousness-restlessness (RASS), and the incidence of coughs were evaluated in both study groups. Four patients in the lidocaine group and 5 in the control group were lost to follow-up. Finally, 21 patients in the lidocaine group and 20 patients in the control group were analyzed.
 
The rates of hemodynamic changes in the 2 groups were not statistically different. The changes in the level of consciousness based on the RASS were not significant in the 2 groups. The incidence of coughs based on the mentioned 3 criteria showed a statistically significant difference between the lidocaine and placebo groups.
 
IV lidocaine after cardiac surgery can be part of the weaning and extubation process without hemodynamic complications to reduce the incidence of coughs. (Iranian Heart Journal 2023; 24(3): 45-53)