Summary background: Tonsillectomy is one of the most commonly performed procedures in otolagyngology. This procedure requires general anesthesia with tracheal intubation. Sore throat is a significant aspect of post-operative patient morbidity. Instillation of alkalinized lidocaine into the endotracheal tube (ET) cuff is a method with reported efficiency in promoting a smoother emergence from anesthesia and a decreased incidence of laryngeal morbidities after tracheal intubation. However, whether or not this method is helpful in children undergoing tonsillectomy has not been investigated previously. Moreover, the efficacy of dexamethasone (DEX) to reduce morbidity after pediatric tonsillectomy remains inconclusive. We aim to evaluate the effect of the instillation of alkalinized lidocaine into the ET cuff, with or without the association of intravenous (i.v.) DEX, on the incidence of postoperative sore throat and coughing, as well as their effect on anesthesia emergence. Methods: A total of 120 children aged 4-12 years undergoing elective tonsillectomy will be included in this prospective, randomized study. The patients will be randomly allocated in 4 groups according to the cuff inflation media (air or lidocaine) and the injection of i.v. DEX as follows: G1 - ET cuff inflated with air; G2 - ET cuff inflated with air + 0.2 mg.kg-1 of i.v. DEX; G3 - ET cuff inflated with lidocaine; and G4 - ET cuff inflated with lidocaine + 0.2 mg.kg-1 of i.v. DEX. In all 4 groups, intracuff injections (air or lidocaine) will be initiated immediately after insertion of the ET and terminated before the cuff pressure reaches 20 cm H2O. The DEX will be delivered at the induction of anesthesia. The incidence of agitation at the emergence of anesthesia will be recorded. The incidence of sore throat and coughing will be evaluated at the Post-Anesthesia Care Unit and 24h after surgery. Hemodynamic parameters (blood pressure and herat rate) will be also evaluated before and after ET extubation.
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