D E C E M B E R 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 1 7
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Coughing during surgery.
If the
patient has a coughing fit in the OR,
deliver an IV push of 100 mg of lido-
caine. All it takes is about 15 sec-
onds, or one circulation. The lido-
caine 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 absolute-
ly 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 con-
scious-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
montanan@itstriangle.com
Coughing Spell Cost
Patient Her Vision
A 77-year-old woman who
had a coughing fit during
cataract surgery might not
have lost the vision in one
eye (osmag.net/yebzg3) had
her anesthesiologist
employed either or both of
these strategies.
