Sevoflurane is widely used to ambulatory pediatric anesthesia. But, sevoflurane is associated with a high incidence of emergence agitation in children. In this study, we examined the effect of single intravenous lidocaine prior to extubation on emergence agitation and cough in children undergoing adenotonsillectomy.

All patients received a standardized anesthetic regimen with 2-3% sevoflurane in 50% O₂/N₂O after anesthetic induction with intravenous glycopyrrolate 0.004 mg/kg, thiopental 5 mg/kg and vecuronium 0.1 mg/kg. In a double-blinded trial, 120 children (3-9 years) were randomly assigned to receive normal saline 0.1 ml/kg (Group C), 1% lidocaine 1 mg/kg (Group L1) or 2% lidocaine 2 mg/kg (Group L2), at 1 min after beginning of spontaneous respiration. After extubation, the sedation score and the incidence of agitation and cough were recorded.

The incidence of agitation and cough in Group L1 and L2 were significantly less than Group C (P < 0.05). At 5 min after arrival at postanesthetic care unit (PACU), more patients in Group L1 and L2 were in deeper sedation (the sedation score ≥ 2) than Group C. More patients in Group L1 were in deeper sedation than Group L2 and C at 10 min after arrival at PACU.

We conclude that intravenous lidocaine prior to extubation reduces emergence agitation and cough after sevoflurane anesthesia in children undergoing adenotonsillectomy.