UNDER CONTROL A nebulizer or IV push can help quell a patient's coughing during surgery.

If a patient starts coughing during surgery, there are 2 ways to stop the hacking.

Coughing in pre-op. If the coughing is apparent in pre-op, set up a nebulizer treatment with 4% lidocaine. When patients inhale, the nebulizer delivers a cloud of ultra-small particles that numbs everything from the tips of their noses to the bottoms of their lungs. Their tracheal reflexes are blunted and the coughing stops. The half-life of lidocaine is about an hour, which is usually plenty of time to get patients through surgery.

Coughing during surgery. If the patient has a coughing fit in the OR, deliver an IV push of 100 mg of lidocaine. All it takes is about 15 seconds, or one circulation. The lidocaine goes from the arm to central circulation, and then to pulmonary circulation, where it blunts the reflexes of the trachea, the larynx and the recurrent laryngeal nerve system. One caution: Make absolutely sure the effect has subsided before you let patients drink anything in post-op. Otherwise, the involuntary protective mechanisms that protect their lungs may not function properly.

I've used the IV lidocaine technique mostly during eye surgeries, but it's a good one to have in your arsenal for any kind of delicate conscious-sedation surgery around the face, including cataract surgery (see sidebar). And with increasing numbers of patients taking ACE inhibitors, which are known to cause chronic coughing, for high blood pressure, it's likely to become more and more useful as time goes on.

Michael W. Barts, CRNA
Barts Professional Pain Service
[email protected]