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

Document Type : Original Article


1 Cardio-Oncology Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

3 Rasool Akarm Hospital, Iran University of Medical Sciences, Tehran, IR Iran.


Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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)


  1. Sarkar J, Anand T, Kamra SK. Hemodynamic response to endotracheal intubation using C-Trach assembly and direct laryngoscopy. Saudi J Anaesth. 2015; 9(4):343-7.
  2. Soltani HA, Aghadavoudi O. The effect of different lidocaine application methods on postoperative cough andsore throat. J Clin Anesth 2002; 14:15e847.
  3. Beecham GB, Bansal P, Nessel TA, Goyal A. Lidocaine. 2021 Aug 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30969703. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539881/
  4. Burki N.K. and Lee L.Y. Blockade of airway sensory nerves and dyspnea in humans Pulm Pharmacol Ther, 2010,23, pp. 279-282
  5. Tanelian D.L. and MacIver M.B. Analgesic concentrations of lidocaine suppress tonic A-delta and C fiber discharges produced by acute injury .Anesthesiology, 1991, pp. 934-936
  6. Woolf C.J. and Wiesenfeld-Hallin Z. The systemic administration of local anaesthetics produces a selective depression of C-afferent fibre evoked activity in the spinal cord .Pain, 23 1985, pp. 361-374
  7. Yang SS, Wang NN, Postonogova T, Yang GJ, McGillion M, Beique F, Schricker T. Intravenous lidocaine to prevent postoperative airway complications in adults: a systematic review and meta-analysis. British Journal of Anaesthesia, 2020 124(3): 314e323.
  8. George SE, Singh G, Mathew BS, Fleming D, Korula G. A Comparison of the effect of lignocaine instilled through the endotracheal tube and intravenous lignocaine on the extubation response in patients undergoing craniotomy with skull pins: a randomized double blind clinical trial ,J Anaesthesiol Clin Pharmacol, 2013 29, pp. 168-172
  9. Paulissian R, MD, Ramez Salem M., MD, Ninos J. Joseph, BS .Hernodynamic Responses to Endotracheal Extubation After Coronary Artery Bypass Grafting, Anesth Analg 1991; 73:1-5
  10. Aljonaieh K.I. Effect of intravenous lidocaine on the incidence of postextubation laryngospasm: a double-blind, placebo-controlled randomized trial .Saudi J Anaesth, 2018, 12 pp. 3-9
  11. Shabnum T, Ali Z, Naqash IA, Mir AH, Azhar K, Zahoor SA, Mir AW. Effects of Lignocaine Administered Intravenously or Intratracheally on Airway and Hemodynamic Responses during Emergence and Extubation in Patients Undergoing Elective Craniotomies in Supine Position. Anesth Essays Res. 2017 Jan-Mar; 11(1): 216–222