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Effect of Different Thoracic Anesthesia on Postoperative Cough

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Effect of Different Thoracic Anesthesia on Postoperative Cough 3547 Original Article Effect of different thoracic anesthesia on postoperative cough Zhenzhu Chen, Qinglong Dong, Lixia Liang Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China Contributions: (I) Conception and design: Q Dong; (II) Administrative support: Z Chen; (III) Provision of study materials or patients: L Liang; (IV) Collection and assembly of data: Z Chen; (V) Data analysis and interpretation: Z Chen, Q Dong; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Qinglong Dong, MD. Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, No. 151, Yanjiang Rd., Guangzhou 510120, China. Email: [email protected]. Background: The objective of the study is to retrospectively analyze the cough status after double lumen tube (DLT) and spontaneous respiration thoracic anesthesia, to compare the degree of influence of anesthesia and surgical factors, and to investigate whether spontaneous respiration anesthesia can reduce the incidence of cough. Methods: Postoperative follow-ups were performed on 1,162 patients from July 2011 to December 2015 who meet the selected conditions, whose surgical approach is limited to VAST bullectomy, wedge resection, segmentectomy, or lobectomy. Patients’ probability of cough in 1st day (T1), 2nd days (T2), 3rd days (T3), 1st month (T4), 3rd months (T5), 6th months (T6) and 12th months (T7) after thoracoscopic surgery were recorded, as well as the Leicester cough questionnaire (LCQ) survey results, visual cough score (VAS), and cough symptom scores. All cases were divided into double-lumen endotracheal tubes anesthesia group (group T, n=925 cases) and spontaneous respiratory anesthesia group (group S, n=456 cases), and group S was further divided into intravenous composite intercostal nerve block anesthesia group (group SB, n=157 cases) and intravenous combined epidural anesthesia group (group SE, n=299 cases). Results: The probability of cough decreases with the increasing of postoperative time (P<0.05). The probability of cough is similar between group SE and group SB (P>0.05). The probability of cough in group T is significantly higher than other groups at any time point (P<0.05). In group T, the symptom of cough is the most severe, the scores of physiological, psychological, and social parts of LCQ are the lowest, and the VAS score is the highest (P<0.05), but all these are similar in group SE and group SB (P>0.05). The duration of antibiotic application, the days of chest drainage tube indwelling, and the days of hospital stay are all lower in group S than in group T (P<0.05). Conclusions: There is a correlation between pulmonary surgery and postoperative cough. The probability of postoperative cough is higher in the more invasive patients. The probability of coughing is approximately 27% to 36% at 3 months after surgery, and approximately 2.6% to 7.9% in one year after surgery. The combination of surgery and anesthesia methods increases the probability of cough from 48.9% to 65.1% at 3 months after surgery, and about 20.5% to 22.8% in 1 year after surgery. Spontaneous respiration anesthesia can significantly reduce the probability of cough, improve postoperative recovery, and improve postoperative quality of life. Keywords: Postoperative cough; double lumen tube (DLT); spontaneous respiration anesthesia Submitted Apr 18, 2018. Accepted for publication May 15, 2018. doi: 10.21037/jtd.2018.05.126 View this article at: http://dx.doi.org/10.21037/jtd.2018.05.126 © Journal of Thoracic Disease. All rights reserved. jtd.amegroups.com J Thorac Dis 2018;10(6):3539-3547 3540 Chen et al. Effect of different thoracic anesthesia on postoperative cough Introduction block) without endotracheal intubation or just with supraglottic artificial airway (such as laryngeal mask). Sore throat and cough are common complications of These factors enable patients to avoid pressure or tracheal intubation. It is reported that the incidence of volume damage that may exist during unilateral postoperative sore throat is 14.4% to 50% and cough pulmonary mechanical ventilation, improve pulmonary is 50% to 94.7% (1). Postoperative cough is a great shunt, and avoid the adverse effects caused by residual challenge for patients owing to its delaying rehabilitation muscle relaxation. A series of recent studies show that after thoracic surgery. Chronic and intractable coughs non-tracheal intubation and anesthesia with spontaneous seriously affect postoperative rehabilitation and lower breathing can be safely applied to video-assisted thoracic the quality of patients’ life. It has been reported that surgery, thymus, and other operations (7). cough after pulmonary resection (CAP) is a common Will spontaneous respiration anesthesia be effective complication. The occurrence probability of CAP is as to reduce thoracic postoperative cough problems when high as 25% to 50%. The occurrence probability of CAP performing thoracic surgery without an endotracheal tube? will be more than 50% within 1 year after operation, Previous studies have failed to distinguish the effects of and will be 18% within 5 years. At the same time, the surgery (such as lung tissue trauma) and anesthetic factors researchers found that there was 25% probability of CAP (such as tracheal intubation) on cough. In this retrospective in patients who are long-term survival after lung cancer analysis, we analyze the postoperative cough status of these (2-4). According to Brouillette, the probability of cough two anesthesia methods, compare the degree of influence after tracheal intubation was 94.87%, compared with of anesthesia and surgical factors, and find out whether 17.94% in the LMA group (5). The Ramanathan team’s spontaneous respiration anesthesia could reduce the findings were consistent with Brouillette. They divided probability of cough. 60 patients randomly into tracheal intubation group and laryngeal mask group. The results showed that the postoperative cough rate was 83.3% in the tracheal Methods intubation group and 20% in the laryngeal mask group. General information Based on 76 cases of total thyroidectomy, such as Jung- Hee Ryu, also found that cough in the tracheal intubation Case admission requirement: group was more likely to happen than in the laryngeal (I) Age 18–65 years old, ASA I–II grade; mask group (6). Therefore, many scholars tried to (II) Mallampati airway grading: Grades I–II; reduce the complications of sore throat and cough after (III) Lung function tests pass, without asthma, serious intubation by using prophylactic topical drugs such as cardiovascular disease, COPD, blood system beclomethasone and lidocaine spray in tracheal catheter, diseases, or mental illness history; or by intravenously injecting dexamethasone and other (IV) Body mass index (BMI) <25 kg/m2; systemic drugs, but all these failed to avoid intubation (V) Without preoperative respiratory infection, chronic injury. Double lumen tube (DLT) is a traditional thoracic cough, history of cough, history of acid reflux, or anesthesia. DLT has a large diameter, a large cuff, and postnasal drip syndrome; requires a rotation angle to reach the target bronchus (VI) Surgery is limited to VAST bullectomy, wedge through the glottis, which makes it easier to cause resection, segmentectomy and lobectomy. complications, such as postoperative cough, sore throat, Excluding cases include: than a single-lumen catheter. Previous studies found that (I) Refusal to postoperative follow-up (the patient the operations of thoracic surgery, such as tracheal stump or family member is reluctant to accept the exposure, lymph node dissection, bronchial deformation, postoperative follow-up); diaphragmatic displacement, loss of lung capacity, (II) Loss of contact: cases of death or loss of contact. residual lung deformation and lung distention traction The anesthesia protocol was reviewed and approved by are the important causes of postoperative cough. the Institutional Ethics Committee of the First Affiliated In non-intubated thoracic surgery, spontaneous Hospital of Guangzhou Medical University. From July breathing anesthesia is performed under moderate 2011 to December 2015, a total of 1,162 cases of the sedation and analgesia (or composite regional nerve Center met the above conditions and were able to complete © Journal of Thoracic Disease. All rights reserved. jtd.amegroups.com J Thorac Dis 2018;10(6):3539-3547 Journal of Thoracic Disease, Vol 10, No 6 June 2018 3541 postoperative follow-ups. All cases were divided into and intraoperative thoracic vagal nerve block stagnation DLT intubation anesthesia group (group T, n=925 cases) (about 3 mL of 1:1 mixture of 0.75% ropivacaine and 2% and spontaneous respiratory anesthesia group (group S, lidocaine). During the surgery, spontaneous breathing was n=456 cases), and group S was further divided into maintained and nasal oxygen was used (3–5 L/min) without intravenous composite intercostal nerve block anesthesia any artificial airway. At the end of the operation, a chest group (group SB, n=157 cases) and intravenous compound drainage tube was left inside. epidural anesthesia group (group SE, n=299 cases). Group SE: after T7–8 or T8–9 line epidural puncture, the catheter was placed into the epidural space 3 cm into the head, the test volume was 2 mL of Anesthesia method 2% lidocaine, and 0.5% ropivacaine 4 to 5 mL (total All patients received intramuscular midazolam 8–10 mL) was given in 5 min intervals, adding 3 to (0.04–0.06 mg/kg) and atropine (0.01 mg/kg) 30 mins 5 mL every 45 minutes. After intravenous anesthesia before anesthesia, and the upper extremity venous access with propofol (TCI, 1.5–3.5 μg/mL) and remifentanil opens after admission. Noninvasive arterial blood pressure (0.03–0.05 μg/kg/min), a single dose of sufentanil (2–5 μg) (NBP), II lead electrocardiogram (ECG), heart rate (HR), was given if necessarily depending on the course of the pulse oxygen saturation (SpO2), respiratory frequency (RR) surgery. Visceral pleura, vagal nerve block, intraoperative and bispectral index (BIS) were monitored with a Philips breathing, airway management, and end of surgery were the InteliVue MP40 monitor.
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