Discussion
sore throat, Competing interests, postoperative cough, cough, PONV, postoperative sore throat, bucking episodes
SORE THROAT, SECONDARY, NEUROMUSCULAR BLOCKADE
The results of our Lidocaine at the End (LATE) study showed profound effects of IV lidocaine on early and late recovery without delaying extubation when given at the end of the surgery after the skin closure was completed, neuromuscular blockade reversal was given, and anesthetic gases were turned off.The most striking improvement was the decreased number of patients who bucked before extubation by more than half (GSaline 91% vs GLido 38%), number needed to treat (NNT) of two, as well as the number of bucking episodes (GLido 0 [0-7] vs GSaline 5 [0-19]). Early coughing was also improved (GSaline 42% vs GLido 18%), with a NNT of four. This agrees with the findings of a recent meta-analysis, which showed a NNT of five for postoperative cough (Although the exact mechanism of how IV lidocaine reduces bucking and coughing is not well understood, the timing of its administration is important. If IV lidocaine is given too early, its effect could already be dissipating. Indeed, IV lidocaine did not reduce post-extubation cough when it was given on average 21 minutes before extubation (Our study confirmed the beneficial effect of IV lidocaine on postoperative sore throat. It almost completely eliminated it, with only two patients reporting sore throat within 24 h, with a NNT of 2.4. The meta-analysis (The influence of IV lidocaine bolus administered on emergence on PONV was less investigated, and the evidence was of very low quality. A meta-analysis of perioperative infusion of lidocaine showed a reduction in PONV (Limitations of our study include that it was done in one center, in only one type of surgery, and during relatively short duration of surgery. Our results may not be generalized to other types of surgery. Since we administered IV lidocaine at the end of the surgery, one may expect similar results in longer surgeries. Another limitation is the small number of patients in each group, which may render the study underpowered for the secondary outcome (PONV), as discussed above. The strength of our study is that anesthesia emergence was standardized and extubation timing was highly predictable. We believe that it is important to separate extubation bucking from postoperative coughing. These conditions may have different etiologies: pre-extubation bucking is mostly, if not exclusively, caused by direct ETT stimulation of the trachea but post-extubation coughing is mostly caused by secretions and injury of the tracheal mucosa. We think that in future studies pre-extubation bucking should be separately reported from post-extubation/post-operative coughing. An additional strength is that our study showed “raw” (without any PONV prophylaxis) effect of IV lidocaine on PONV.In summary, our LATE study showed an overwhelming beneficial effect of an IV lidocaine 1.5 mg/kg bolus given eight minutes before extubation on bucking, coughing, sore throat, increase in HR and BP, as well as PONV without any delay in extubation time.In accordance with the ICMJE recommendations (Funding from department resources only.Ethical approval granted by the Institutional Ethics Committee, General Hospital Zadar (01-1280/07).Declaration of authorship both authors conceived and designed the study; TS acquired the data; both authors analyzed and interpreted the data; both authors drafted the manuscript; both authors critically revised the manuscript for important intellectual content; both authors gave approval of the version to be submitted; both authors agree to be accountable for all aspects of the work.Competing interests All authors have completed the Unified Competing Interest form at 