Remifentanil Versus Remifentanil-Lidocaine for Tracheal Extubation After Thyroidectomy

Tracheal extubation may be associated with coughing and hemodynamic responses, which may be undesirable after thyroid surgery. Pharmacological strategies such as remifentanil and intravenous lidocaine may attenuate airway reflexes during emergence from general anesthesia.

This prospective, randomized, double-blind, parallel-group study is designed to evaluate whether the addition of intravenous lidocaine to remifentanil improves the quality of tracheal extubation compared with remifentanil alone in patients undergoing elective thyroidectomy.

Sixty adult patients will be randomly allocated in a 1:1 ratio to receive either remifentanil alone or remifentanil combined with intravenous lidocaine during emergence from anesthesia. Extubation conditions, coughing, hemodynamic variables, respiratory events, recovery characteristics, and postoperative airway-related symptoms will be evaluated.

• remifentanil (Drug): Remifentanil will be administered intravenously at 0.02-0.06 µg/kg/min during anesthesia and titrated according to the study protocol during the emergence period.
• Lidocaine %2 ampoule (Drug): Lidocaine 1.5 mg/kg will be administered intravenously as a slow bolus over 1-2 minutes during surgical dressing before tracheal extubation.

Primary outcomes

• Incidence of Cough During Tracheal Extubation [During tracheal extubation]: Cough will be assessed during tracheal extubation. The presence or absence of cough will be recorded for each participant. Cough severity will also be graded using a 4-point cough scale, with higher scores indicating more severe coughing.

Secondary outcomes

• Hemodynamic Response During Extubation [Before extubation, at extubation, and at 1 and 5 minutes after extubation]: Heart rate will be recorded to evaluate the hemodynamic response to tracheal extubation.
• Incidence of Postoperative Sore Throat [At 1 hours and 24 hours after surgery]: Postoperative sore throat will be assessed using a 4-point severity scale: 0 = no sore throat, 1 = mild sore throat, 2 = moderate sore throat, and 3 = severe sore throat. Postoperative sore throat will be defined as a score ≥1.
• Incidence of Postoperative Hoarseness [At 1 hours and 24 hours after surgery]: Postoperative hoarseness will be assessed using a 4-point severity scale: 0 = no hoarseness, 1 = mild hoarseness, 2 = moderate hoarseness, and 3 = severe hoarseness. Postoperative hoarseness will be defined as a score ≥1.

Sex: All, ages: 18 Years to 65 Years

Inclusion Criteria:

* Age 18 to 65 years American Society of Anesthesiologists (ASA) physical status I or II Scheduled for elective thyroidectomy under general anesthesia Body mass index (BMI) <35 kg/m² Able to provide written informed consent

Exclusion Criteria:

* History of chronic respiratory disease, including asthma or chronic obstructive pulmonary disease (COPD) Active upper or lower respiratory tract infection Known airway abnormality or anticipated difficult airway Known allergy or hypersensitivity to lidocaine Planned postoperative intubation or extubation in the intensive care unit Refusal to participate or withdrawal of consent

• saadet nur YALCIN SATICI, Principal investigator, Pamukkale University