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Objective:To investigate the effect of citric acid-induced cough on swallowing function and serum substance P in stroke patients with early tracheotomy.Methods:Forty-nine post-stroke tracheotomy patients admitted to the Department of Neurosurgery at the First Affiliated Hospital of Soochow University from January 2018 to July 2019 were selected as study subjects. They were divided into intervention group ( n=24) and control group ( n=25) using the random digit table. The control group was subjected to routine nursing, while the intervention group was given citric acid to induce cough based on routine care. The intervention time was 1 week. The swallowing function and serum substance P levels were compared between the two groups before and after the intervention. Results:After the intervention, 45.8% (11/24) of the patients in the intervention group were assessed as having "strong" swallowing function, compared to 28.0% (7/25) in the control group, with a statistically significant difference in swallowing function between the two groups ( Z= -2.22, P<0.05), and the level of substance P in the intervention group was (283.40 ± 134.82) ng/L, significantly higher than that of the control group (203.59 ± 126.16) ng/L ( t=2.14, P<0.05). Conclusions:Citric acid-induced cough helped stroke patients with early tracheotomy to produce effective swallowing action and up-regulate substance P in serum to promote recovery of swallowing function.
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Background: This study was conducted in GMC Jammu to evaluate ICU stay and cost effectiveness in patients with cervical spine trauma undergoing early fixation (within 24-72 hours after trauma) versus late fixation (delayed fixation after applying traction and waiting for return of cough reflex).Methods: Retrospective and prospective study was done by collecting data from admission register and patient follow-up during 2016-2019. 50 patients were admitted as cervical spine trauma, out of which 38 were operated upon and ten managed conservatively. 15 patients were operated within 72 hours of admission with absent cough reflex and 23 were put on cervical traction and operated upon after return of cough reflex.Results: Average ICU stay for 15 patients (4 females 11 males) immediately operated ranged from 10 to 15 days along with prolonged mechanical ventilation. Average ICU stay for 23 patients (16 males and 7 females) operated after returning of cough reflex ranged from 3-4 days with considerably decreased requirement of mechanical ventilation.Conclusions: Delayed fixation of cervical spine after returning of cough reflex shortens post-operative ICU stay and is considerably more cost effective than early fixation.
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OBJECTIVE: To observe the impact of "Tongyuan" (regulating the Governor Vessel to tranquilize mental activities, conducting qi back to its origin) acupuncture treatment on cough reflex, pulmonary infection and swallowing function in stroke patients undergoing tracheotomy. METHODS: Seventy-four cerebral stroke patients with tracheo-tomy were randomly allocated to scalp acupuncture and "Tongyuan" acupuncture groups (n=37 in each group). All the patients of the two groups received basic treatment, including treatment of primary diseases, routine nursing, respiratory muscle training, physical therapy, acupuncture of Chize (LU5), Quchi (LI11), Hegu (LI4), Weizhong (BL40), Zusanli (ST36). In addition, for patients of the scalp acupuncture group, the middle 2/5 of Dingnieqianxiexian (MS6), the middle 2/5 of Dingniehouxiexian (MS7) and Dingpangerxian (MS9) on the contralateral side of lesions were punctured with filiform needles. For patients of the "Tongyuan" acupuncture group, Baihui (GV20), Zhongwan (GV12), Guanyuan (CV4), Qihai (CV6), Tianshu (ST25), Feishu (BL13), Pishu (BL20) were needled. The treatment in both groups lasted 30 minutes each time, once daily, 6 times a week for 4 weeks. The cough reflex grading score (CRGS, assessed according to cough, independent expectoration, sputum suction), clinical pulmonary infection score (CPIS, assessed according to the body temperature, white blood cell count, airway secretion in 24 h, PaO2/FiO2, infiltration status, cultured pathogenic bacteria), and swallowing function were evaluated by a researcher who was blinded to the grouping and treatment procedures. The success rate of extubation was calculated in a week at the end of treatments. RESULTS: After the treatment, the CRGS and CPIS of both groups were apparently decreased in comparison with their own pre-treatment (P<0.05), suggesting an improvement of the cough reflex and pulmonary infection. Regarding the swallowing function, of the two 37 cases in the scalp acupuncture and "Tongyuan" acupuncture groups, 9(24.3%) and 19(51.4%) experienced marked improvement, 12(32.5%)and 14(37.8%) were effective, and 16(43.2%) and 4(10.8%)failed in the treatment, with the effective rate being 56.8% and 89.2%, respectively. In regard to the successful extubation, of the two 37 cases in the scalp acupuncture and "Tongyuan" acupuncture groups, 5(13.5%) and 11(29.8%)had a marked improvement, 10(27.0%)and 18(48.6%)were effective, and 22(59.5%)and 8(21.6%)failed, with the effective rate being 40.5% and 78.4%, respectively. The therapeutic effect of "Tongyuan" acupuncture was significantly superior to that of scalp acupuncture in decreasing CRGS and CPIS, and in improving the swallowing function and raising the rate of successful extubation (P<0.05). CONCLUSION: "Tongyuan" acupuncture treatment can improve cough reflex to remove sputum, reduce pulmonary infection, enhance swallowing function, and raise the success rate of extubation in stroke patients, which is better than scalp acupuncture.
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Objective To evaluate the application of cough reflex testing with various concentrations of citric acid for dysphagia post stroke. Methods 20 normal controls (NC), 20 stroke patients with dysphagia (SD) and 20 stroke patients without dysphagia (SND) were test-ed with cough reflex inhalated 4 kinds of dosage of citric acid:0.2 mol/L, 0.4 mol/L, 0.6 mol/L and 0.8 mol/L. Results The incidence of pass (coughed twice or more) decreased in the SD compared with those in the NC as inhalated citric acid of 0.2 mol/L and 0.4 mol/L (P0.05). 90%of the NC passed as inhalated citric acid of 0.4 mol/L;however, it was 45%in the SD, and increased when they inhalated more dosage of citric acid (P<0.05). The incidence of pass decreased under 0.2 mol/L citric acid in the SND compared with other concentra-tion (P<0.05). The result of the test was reliable interrater (κ=0.97). The incidence of cough was consistent of 96.8%with the same concen-tration. No asthma and asphyxia was observed. Conclusion Cough reflex testing with citric acid inhalation can be used to assess the defen-sive function of airway in lower concentration for dysphagia after stroke.
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ObjectiveTo investigate the clinical promoting effect of crossing nape electroacupuncture on the recovery of swallowing function and recovery from pulmonary infection in post-cerebral infarction patients with tracheotomy.MethodSixty post-cerebral infarction patients with cough reflex disorder and swallowing dysfunction associated with pulmonary infection receiving tracheotomy and tracheal intubation were subjects. They were allocated, using a random number table, to three groups, 20 cases each. In each group, the patients were enrolled in order of visits. The three groups were given the same basic treatment for fighting inflammation, resolving phlegm and improving blood supply. The crossing nape electroacupuncture group received bilateral points Fengchi (GB20), Yifeng (TE17), Dicang (ST4)-to-Jiache (ST6) and Lianquan (CV23) acupuncture with electrodes connected by left-right crossing. The acupuncture group received bilateral points Fengchi, Yifeng, Dicang-to-Jiache and Lianquan acupuncture without electrodes connected. The control group received basic treatment with Western drugs without acupuncture therapy. Observations were carried out using the Kubota’s water drinking test, the Toshima Ichiro Swallowing Assessment and the Clinical Pulmonary Infection Score. The clinical therapeutic effects were evaluated in the three groups.ResultThe therapeutic effects evaluated using the Kubota’s water drinking test and the Toshima Ichiro Swallowing Assessment were better in the crossing nape electroacupuncture group than in the acupuncture group and better in the acupuncture group than in the control group (P<0.05). The score of the Clinical Pulmonary Infection Score decreased in all the three groups. The promoting effect on recovery from pulmonary infection was marked in the crossing nape electroacupuncture group (P<0.01).ConclusionCrossing nape electroacupuncture has a marked improving effect on dysphagia in post-cerebral infarction patients with tracheotomy and tracheal intubation. It can promote recovery from pulmonary infection in post-cerebral infarction patients with cough reflex disorder receiving tracheotomy and tracheal intubation.
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@#Objective To evaluate the application of cough reflex testing with various concentrations of citric acid for dysphagia post stroke. Methods 20 normal controls (NC), 20 stroke patients with dysphagia (SD) and 20 stroke patients without dysphagia (SND) were tested with cough reflex inhalated 4 kinds of dosage of citric acid: 0.2 mol/L, 0.4 mol/L, 0.6 mol/L and 0.8 mol/L. Results The incidence of pass (coughed twice or more) decreased in the SD compared with those in the NC as inhalated citric acid of 0.2 mol/L and 0.4 mol/L (P< 0.05), and decreased under 0.4 mol/L compared with the SND (P<0.05). There was no significant difference between the SND and the NC (P>0.05). 90% of the NC passed as inhalated citric acid of 0.4 mol/L; however, it was 45% in the SD, and increased when they inhalated more dosage of citric acid (P<0.05). The incidence of pass decreased under 0.2 mol/L citric acid in the SND compared with other concentration (P<0.05). The result of the test was reliable interrater (κ=0.97). The incidence of cough was consistent of 96.8% with the same concentration. No asthma and asphyxia was observed. Conclusion Cough reflex testing with citric acid inhalation can be used to assess the defensive function of airway in lower concentration for dysphagia after stroke.
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Objective To compare dexmedetomidine versus lidocaine for suppression of fentanyl-induced coughing during induction of general anesthesia in patients.Methods Two hundred ASA physical status Ⅰ or Ⅱ patients,aged 36-50 yr,undergoing elective gynecological operations under total intravenous anesthesia,were randomized into 2 groups (n =100 each):dexmedetomidine group (group D) and lidocaine group (group L).Dexmedetomidine 0.5 μg/kg was intravenously infused over 10 min at a rate of 0.05 μg· kg-1· min-1 starting from 20 min before induction of anesthesia in group D.Lidocaine 0.5 mg/kg was injected intravenously at 1 min before induction of anesthesia in group L.For induction of anesthesia,fentanyl was given first,and 2 min later the other drugs were given.The development and degree of coughing were recorded within 1 min after fentanyl injection.The occurrence of adverse events was recorded.Results The incidence of coughing was significantly higher and the degree of coughing was severer in group L than in group D (P ＜ 0.05).There was no signihicant difference in the incidences of hypotension and severe sinus bradycardia between groups D and L (P ＞ 0.05).Conclusion Dexmedetomidine 0.5 μg/kg injected before induction of anesthesia has better suppressive effect on fentanyl-induced coughing during induction of general anesthesia than lidocaine 0.5 mg/kg in patients.
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Injury to the bilateral internal branch of superior laryngeal nerve (ibSLN) brings on an impairment of the laryngeal cough reflex that could potentially result in aspiration pneumonia and other respiratory illnesses. We describe a patient with traumatic cervical injury who underwent bilateral ibSLN palsy after anterior cervical discectomy with fusion (ACDF). An 75-year-old man visited with cervical spine fracture and he underwent ACDF through a right side approach. During the post-operative days, he complained of high pitched tone defect, and occasional coughing during meals. With a suspicion of SLN injury and for the work up for the cause of aspiration, we performed several studies. According to the study results, he was diagnosed as right SLN and left ibSLN palsy. We managed him for protecting from silent aspiration. Swallowing study was repeated and no evidence of aspiration was found. The patient was discharged with incomplete recovery of a high pitched tone and improved state of neurologic status. The SLN is an important structure; therefore, spine surgeons need to be concerned and be cautious about SLN injury during high cervical neck dissection, especially around the level of C3-C4 and a suspicious condition of a contralateral nerve injury.
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Aged , Humans , Cough , Deglutition , Diskectomy , Laryngeal Nerves , Meals , Neck Dissection , Paralysis , Pneumonia, Aspiration , Reflex , SpineABSTRACT
Objective Preliminary study of the cough reflex sensitivity test in chronic cough patients with different gender,disease duration and causes to evaluate the clinical diagnostic significance of the test and further provide some information for the treatment of chronic cough.Methods Totally 108 chronic cough patients in our hospital were enrolled in the study with the final diagnosis of upper airway cough syndrome(UACS),cough variant asthma(CVA)and gastroesophageal reflux cough(GERC).They all went through the cough reflex sensitivity test and the retrospective analysis of the results was made.Results In 108 patients with chronic cough(76 UACS,19 CVA and 13 GERC),lgC5 was significantly slower in the female(1.80)than the male(2.40,P<0.05)and in the patients with cough duration over 12 months(1.80)than those with cough duration under 12 months(2.40,P<0.05).Cough sensitivity in patients with different causes was significantly different(P<0.05)with lower lgC5 in GERC patients(1.49)than CVA (2.40,P<0.05)and UACS(2.40,P<0.05)patients.Conclusion Cough sensitivity is different in chronic cough patients with different gender,disease duration and causes.Cough reflex sensitivity test is of great value in the etiology diagnosis of chronic cough.
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Objective To investigate the effect of preoperative administration of Dextromethorphan (DM) on cough reflex of patients during tracheal extubation under general anesthesia after obstructive sleep apnea syndrome (OSAS) operation. Methods Forty ASA Ⅰ-Ⅱ adult patients scheduled for uvulopalatopharyngoplasty (UPPP) under general anesthesia were randomly divided into control group and DM group (n=20 in each group). Patients in DM group received 0.3 mg/kg DM and control group took 5 ml normal saline preoperatively. Cough reflex of patients and adverse effects were recorded during tracheal extubation. Results Cough reflex during tracheal extubation was remarkably suppressed in DM group as compared with control group (P
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BACKGROUND: Lidocaine sprayed down the endotracheal tube (ETT) before extubation and during ETT removal was reported to prevent increases in blood pressure and heart rate during and after extubation. We hypothesized that lidocaine administered via this route would suppress the cough reflex associated with tracheal extubation. METHODS: Eighty-five patients requiring intubation in the supine position were studied. All patients received a standardized anesthetic protocol. At the end of surgery, the patients were randomly divided into three groups and given no drug (group 1-control), given 1 mg/kg 2% lidocaine sprayed down the ETT 5 minutes prior to extubation (group 2), or given intravenous lidocaine (IVL) 1 mg/kg 3 minutes prior to extubation (group 3). Extubation was performed when the patients met the criteria of extubation. Number of coughs was recorded from 5 minutes before until 5 minutes after extubation. Each value was compared among the three groups. RESULTS: Seventy-five patients completed this study (n = 25 for each group). The incidence of patients experiencing coughing was decreased in group 2 (P = 0.03), compared with group 3 or the control. Number of coughs per patient was significantly less in group 2 (P = 0.00). IVL did not significantly diminish the incidence or the amount of coughing compared with the control. CONCLUSIONS: Lidocaine sprayed down the ETT suppresses cough reflex and is more effective than IVL in blunting the cough reflex. This study indicates that lidocaine sprayed down the ETT has a topical anesthetic effect suppressing the cough reflex.
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Humans , Airway Extubation , Anesthetics , Blood Pressure , Cough , Heart Rate , Incidence , Intubation , Lidocaine , Reflex , Supine PositionABSTRACT
OBJECTIVE:To evaluate the inhibitory effect of hydrocortisone on fentanyl-induced cough reflex(FIC).METHODS:160 patients undergoing scheduled operation on abdominal region were randomized to receive Normal Saline 100 mL(Group Ⅰ)or hydrocortisone 100 mg added to 100 mL Normal Saline iv gtt(Group Ⅱ);15 minutes later,both groups were injected intravenously with fentanyl(2 ?g?kg-1)with injection time of 2 seconds.The frequency and the onset time of cough as well as the adverse drug reactions in the two groups were observed.RESULTS:The FIC incidence in Group Ⅱ was significantly lower than in Group Ⅰ(10% vs.35%),showing significant differences between the two groups(P
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Objective To investigate the role of the cough reflex sensitivity and airway neurogenic inflammation in the pathogenesis of cough post infectious(CPI).Methods Capsaicin provocation test and sputum inducing were performed in 10 patients with CPI(CPI group)and 10 healthy subjects(normal control group)to detect the cough reflex sensitivity and neurokinin of sputum.Total and differential cells count of induced sputum was performed.Substance P(SP),neurokinin A(NKA),neurokinin B(NKB)and calcitonin gene-related peptide(CGRP)in the supernatant of induced sputum were measured.The expression of SP,neurokinin 1 receptor and NKA in sputum cells was detected.Results The cough threshold(lg C5)of CPI was significantly lower than normal(1.16?0.61 vs 2.64?0.28,P
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BACKGROUND: Propofol and lidocaine have been purported to attenuate bronchoconstriction induced by fentanyl administration during induction of anesthesia. The purpose of the present study was to study the synergic bronchodilation effect of propofol mixed with lidocaine. METHODS: Two hundred and thirty four patients were randomly allocated to five groups: Group 1 (n = 60, normal saline 0.25 ml/kg followed by fentanyl 3ng/kg), Group 2 (n = 30, propofol 2 mg/kg mixed with normal saline 0.05 ml/kg followed by normal saline 0.06 ml/kg), Group 3 (n = 50, propofol 2 mg/kg mixed with normal saline 0.05 ml/kg followed by fentanyl 3ng/kg), Group 4 (n = 33, propofol 2 mg/kg mixed with lidocaine 1 mg/kg followed by normal saline 0.06 ml/kg) and Group 5 (n = 61, propofol 2 mg/kg mixed with lidocaine 1 mg/kg followed by fentanyl 3ng/kg). All patients were injected with fentanyl or normal saline two minutes after administration of propofol premixed with lidocaine or normal saline, respectively. We checked the cough reflex, injection pain, oxygen desaturation and chest wall rigidity. RESULTS: There was a significant difference in the incidence of cough reflex between group 1 and 3 or 5. The incidience of group 5 was significantly lower than in group 3. CONCLUSIONS: This study suggests that a propofol-lidocaine mixture should be considered when patients require bronchodilation during induction of anesthesia.
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Humans , Anesthesia , Bronchoconstriction , Cough , Fentanyl , Incidence , Lidocaine , Oxygen , Propofol , Reflex , Thoracic WallABSTRACT
BACKGROUND: Bronchodilation effect of propofol was known that it could prevent bronchoconstriction induced by fentanyl administration. The aim of this study was to investigate the dosage of propofol that inhibited cough reflex induced from fentanyl. METHODS: One hundred twenty patients were randomly allocated to four groups: Group 1 (n=30, fentanyl 3 microgram/kg), Group 2 (n=30, propofol 0.5 mg/kg, fentanyl 3 microgram/kg), Group 3 (n=30, propofol 1 mg/kg, fentanyl 3 microgram/kg), Group 4 (n=30, propofol 2 mg/kg, fentanyl 3 microgram/kg). Patients in Group 1 were injected fentanyl within a second. Other patients groups were injected fentanyl two minutes after administration of propofol dosage, respectively. We checked cough response, oxygen desaturation and chest wall rigidity. RESULTS: There was no significant difference in the incidence of cough response between Group 1 and 2. But, the incidence of Group 3 and 4 was significantly lower than in Group 1 and 2. CONCLUSIONS: Propofol of clinical doses for anesthetic induction inhibit cough reflex induced from fentanyl.