Effects of benzydamine and lidocaine on cardiovascular and respiratory responses to extubation

Effectiveness of benzydamine hydrochloride puff to the endotracheal tube (ETT) cuff with and or intravenous (iv) 1.5 mg/kg lidocaine 5 minutes before entubation, on cardiovascular and respiratory responses after extubation were compared.Patients with an ASA physical status of I or II, between 18-65 years old, scheduled for elective surgery in supine position lasting over an hour with orotracheal intubation were enrolled. Enrolled patients were randomly assigned to one of 4 groups: in control group (CG) 10 mL iv saline was administered 5 min. before extubation, in lidocaine group (LG) 10 mL 1.5 mg/kg iv lidocaine was administered 5 min. before extubation, in benzydamine group (BG) benzydamine puff (4 puffs/each; 1 puff=0.270 mg) to the ETT cuffs with and 10 mL iv saline was administered 5 min. before extubation, in lidocaine and benzydamine group (LBG) benzydamine puff to the ETT cuffs and 10 mL 1.5 mg/kg iv lidocaine was administered 5 min. before extubation. Anesthetic induction and maintenance were standardized. After recording control parameters systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate, ET-CO2, SpO2 and endotracheal cuff pressure (ETTCP) were measured and recorded in 5 minute intervals throughout the surgery and after extubation hemodynamic parameters were noted every 5 minute from the hemodynamic parameters ?Heart pressure product? (HPP) score was determined. Patients were examined for postoperative sore throat (POST), coughing, hoarseness (POH), also respiratory symptoms like dyspne, laryngospasm, stridor, and gastrointestinal symptoms like nausea-vomiting before discharging to the ward and postoperatively at the 1., 6., 12., 24., 48.and 72. hours in the ward or were interviewed with telephone calls. Patients? demographic features, ASA physical status, and durations of anesthesia and surgeries were also recorded.The increase in heart rate was the lowest in LBG, the highest in CG. Increase in SAP was significant in CG but there was no difference among the other groups. In all groups, but the most in the CG there was an increase in DAP and MAP. Compared with control parameters in all groups there was an increase in HPP. There were no significant difference between and within the groups in terms of ET-CO2, SpO2 and ETTCP. Extubation criteria were the worst in the control group, the other groups were similar. The incidence of POST and POC were highest in CG, lowest in BG and LBG. The incidence of POH was similar in CG and LG, hence in BG and LBG none of the patients experienced POH.In conclusion, benzydamine puff to the ETT cuff with before entubation and administering intravenous 1.5 mg/kg lidocaine 5 minute before extubation alone or together were found effective in reducing but not preventing cardiovascular responses; however both technique effectively reduced respiratory side effects.