title: Effects of Lignocaine Administered Intravenously or Intratracheally on Airway and Hemodynamic Responses during Emergence and Extubation in Patients Undergoing Elective Craniotomies in Supine Position.
abstract: BACKGROUND
  Sympathoadrenergic responses during emergence and extubation can lead to an increase in heart rate (HR) and blood pressure whereas increased airway responses may lead to coughing and laryngospasm. The aim of our study was to compare the effects of lignocaine administered intravenously (IV) or intratracheally on airway and hemodynamic responses during emergence and extubation in patients undergoing elective craniotomies.
  
  
  METHODS
  Sixty patients with physical status American Society of Anaesthesiologists Classes I and II aged 18-70 years, scheduled to undergo elective craniotomies were included. The patients were randomly divided into three groups of twenty patients; Group 1 receiving IV lignocaine and intratracheal placebo (IV group), Group 2 receiving intratracheal lignocaine and IV placebo (I/T group), and Group 3 receiving IV and intratracheal placebo (placebo group). The tolerance to the endotracheal tube was monitored, and number of episodes of cough was recorded during emergence and at the time of extubation. Hemodynamic parameters such as HR and blood pressure (systolic, diastolic, mean arterial pressure) were also recorded.
  
  
  RESULTS
  There was a decrease of HR in both IV and intratracheal groups in comparison with placebo group (P< 0.005). Rise in blood pressure (systolic blood pressure, diastolic blood pressure and mean arterial pressure) was comparable in both Groups 1 and 2 but was lower in comparison with placebo group (P< 0.005). Cough suppression was comparable in all the three groups. Grade III cough (15%) was documented only in placebo group.
  
  
  CONCLUSIONS
  Both IV and intratracheal lignocaine are effective in attenuation of hemodynamic response if given within 20 min from skull pin removal to extubation. There was comparable cough suppression through intratracheal route and IV routes than the placebo group.
authors.affiliation: Department of Anaesthesiology and Critical Care, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Tabasum
authors.initials: T
authors.lastname: Shabnum
authors.affiliation: Department of Anaesthesiology and Critical Care, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Zulfiqar
authors.initials: Z
authors.lastname: Ali
authors.affiliation: Department of Anaesthesiology and Critical Care, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Imtiaz Ahmad
authors.initials: IA
authors.lastname: Naqash
authors.affiliation: Department of Anaesthesiology and Critical Care, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Aabid Hussain
authors.initials: AH
authors.lastname: Mir
authors.affiliation: Department of Dentistry and Maxillofacial Surgery, SKIMS Medical College, Srinagar, Jammu and Kashmir, India.
authors.forename: Khan
authors.initials: K
authors.lastname: Azhar
authors.affiliation: Department of Anaesthesiology and Critical Care, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Syed Amer
authors.initials: SA
authors.lastname: Zahoor
authors.affiliation: Department of Anaesthesiology and Critical Care, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Abdul Waheed
authors.initials: AW
authors.lastname: Mir
keywords: Cough reflex; hemodynamic response; intratracheal; intravenous; lignocaine