Effect Of Topical Ropivacaine On The Response To Endotracheal Tube During Emergence From General Anesthesia

Background: The airway reflex caused by endotracheal tube such as cough is common accompanied with severe fluctuations of hemodynamics during emergence.Studies have shown that topical or systemic use of lidocaine can reduce airway responses.However,it is not clear whether long-acting local anesthetic ropivacaine can increase tracheal tube tolerance during emergence as lidocaine.This prospective double-blind randomized controlled trial aimed to investigate whether topical ropivacaine can reduce extubation response and postoperative sore throat.Methods: Fifty-four patients undergoing thyroidectomy under general anesthesia were randomly assigned to two groups.The patients in treatment group were received 0.75% ropivacaine,which was sprayed on the tracheal mucosa,epiglottis,tongue base,and glottis to achieve uniform surface anesthesia before intubation.As control,patients in control group were received the same volume saline on the same location.The primary outcome was the incidence and severity of cough during peri-extubation.The second outcome was hemodynamic changes and the score of postoperative pharyngeal pain.Results: The incidence(34.62% vs.76.92%,P = 0.002)of cough during extubation were lower in treatment group compared to control group.The difference was statistically significant.Patients in treatment group showed more stable vital signs during extubation.Meanwhile,the sore throat visual acuity score at 12 h after surgery was lower in treatment group than that in control group(2.00 vs.3.50,P = 0.040).Conclusion: Topical anesthesia with 0.75% ropivacaine before intubation can reduce the incidence of cough during peri-extubation.Meanwhile,it reduced hemodynamic fluctuations and postoperative throat pain without influence patients recovery.Trial registration: Chinese Clinical Trial Registry,Chi CTR1800014412(date of registration January 2018).