Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Systematic Review

Impact of topical airway anesthesia on immediate postoperative cough/bucking: a systematic review and meta-analysis

Thiago Mamoru Sakae, Renato Lucas Passos de Souza, Julio Cezar Mendes Brandão

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Postoperative cough may occur after tracheal intubation, but it is indistinct which drug is best at diminishing these events. Additionally, airway reflexes are commonly accompanied by severe hemodynamics responses during emergence.

To evaluate the role of topical airway anesthesia on immediate post-extubation cough/bucking and extubation time.

Randomized clinical trials from MEDLINE, EMBASE, CENTRAL, and LILACS published until December 23, 2020 were included. Our primary outcome was postoperative cough/bucking incidence which was compared between local anesthetics and controls. Extubation times were likewise considered. Predisposition appraisal and subgroup, affectability investigations were likewise performed.

The pooled analysis found a 45% reduction in cough incidence after treatment with topical airway local anesthetic (RR = 0.55; 95% CI: 0.42 to 0.72; p < 0.001). The number needed to treat (NNT) was 4.61. The intervention showed no differences in reduction of the extubation time (mean difference = -0.07; 95% CI: -0.14 to 0.28; p = 0.49).

Topical airway anesthesia demonstrated better than placebo or no medication in reducing immediate post-extubation cough/bucking. Further studies could have this objective to combine the different ways to perform better outcomes for patients.


Airway management;  Topical anesthesia;  Intubation, intratracheal;  Cough;  Anesthesia recovery period;  Airway extubation


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