The incidence of breath-holding, coughing, laryngospasm, bronchospasm, and secretions, were recorded. The severity of each complication was graded on a scale 0-3 (Table 1) and the total severity score for a particular complication in each group was calculated and compared between groups. Mild (SaO2 < 96%) and severe (SaO2 < 90%) episodes of arterial oxygen desaturation and the need to change to 100% FiO2 were recorded (SaO2 = arterial oxygen saturation).

Statistical analysis

The data analyzed using Statistical Package for Social Science (SPSS) version 26.

Demographic data were compared using Statistical t-test. Data presented by frequency and percentage. The incidence, severity of respiratory.

Complications and episodes of arterial oxygen desaturation were analyzed using Mann-Whitney U test and Chi-squared analysis. Statistical significance was a P < 0.05.

RESULTS

There were no demographic differences between groups (Table 2). The incidence and severity of respiratory complications occurring in emergence were recorded in Table 3.

The incidence and severity of cough were greater in Group B (no-Lidocaine) (P < 0.05). In Group A (Lidocaine) 31% of children (17/54) coughed, compared with 56% of children (36/64) in Group B (no-Lidocaine). Coughing severity score of 2 or 3 was recorded in 6% children (Group A), and 33% children (Group B). Coughing severity score of 3 occurred in 7% children (Group A), and 26% children (Group B).

Episodes of breath-holding were longer in Group B (no-Lidocaine) (P < 0.05). Moderate breath-holding (15-60 sec) and severe breath-holding (>60 sec) (severity score of 2 or 3) occurred with two children in Group A, compared with 14 children (26%) in Group B.

There was a high incidence of laryngospasm in Group A (Lidocaine), i.e. 52% of children (28/54), compared to Group B (no-Lidocaine) 59% of children (38/64) (P > 0.05).

A higher incidence (17%) (P < 0.05) of respiratory complications requiring change to 100% oxygen occurred in Group B (no-Lidocaine) compared to 4% of children in Group A (Lidocaine).

There were no differences between groups (Group A vs. Group B) with regard to the incidence of breath holding (26% vs. 31%), and secretions (30% vs. 31%), (P > 0.05).

Episodes of oxygen desaturation that occurred in both groups were not different (P >0.05). Oxygen saturation (SaO2) <96% occurred in 28% of children (15/54) (Group A), and 30% of children (19/64) (Group B). Oxygen saturation (SaO2) <90% occurred in 13% of children (7/54) (Group A), and 15.6% of children (10/64) (Group B).

DISCUSSION

The most commonly used inhalational anesthetic agents, Desflurane and Sevoflurane, substantially more expensive than isofurane [12]. However, Isolurane is also used for induction and maintenance of anesthesia. But, because of its pungency, it is irritant to the airways, causing cough, breath-holding, laryngospasm and episodes of arterial oxygen desaturation [13,14].

These problems are more prevalent in pediatric population, especially    unpremedicated patients [15-17].

Methods of topical lidocaine application included lidocaine spray onto the larynx, lidocaine spray to the supraglottic [18], glottic and subglottic areas, aerosol administration [19] or lidocaine jelly placed on the dorsal surface of the supraglottic airway device [20].

The use of IV lidocaine, compared with placebo, led to a large reduction in the incidence and severity of postoperative complications after Isoflurane anesthesia, The incidence and severity of coughing, and the incidence of laryngospasm, were greater and the duration of breath-holding was longer in the control group, Group B (no-Lidocaine) than in Group A (Lidocaine) (P< 0.05). There were no differences between groups regarding the incidence of breath-holding, and secretions (P > 0.05).

The exact mechanism of action of IV Lidocaine appears to be unknown. One postulated mechanism could be because of the fact that IV lidocaine suppresses the airway’s excitatory sensory C-fibers and the release of sensory neuropeptides [21], which decrease irritation and inflammation.

IV lidocaine appeared to be safe and did not result in any difference in adverse events.

There are insufficient data to determine a conclusion on the ideal dose of IV lidocaine for the prevention of cough. Both low dose (<1.5mg/kg) and high dose (1.5 mg/kg) represent effective measures for cough prevention with a non-significant statistical difference. However, in our study, we use a dose of 1.5 mg/kg which was reviewed by Clivio and colleagues, who examined the use of IV lidocaine to prevent intubation, extubation, and opioid-induced cough [22]. They reported a large reduction in cough with the use of IV lidocaine at 1.5mg/kg, as we concluded.

CONCLUSION

In conclusion, the use of IV lidocaine decreases the incidence and severity of coughing, the incidence of laryngospasm, the duration of breath-holding, and the need to change to 100% oxygen in pediatrics which was related to Isoflurane pungency. There was no effect on the incidence of secretions or breath-holding. Further work is needed to decide the most appropriate dose, time of administration, and any adverse effect of IV. Lidocaine in pediatrics.

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  Table 1
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  Table 2
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  Table 3