
==== Front
BMC Anesthesiol
BMC Anesthesiol
BMC Anesthesiology
1471-2253
BioMed Central London

2695
10.1186/s12871-024-02695-3
Case Report
Postoperative exacerbated cough hypersensitivity syndrome induces dramatic respiratory alkalosis, lactatemia, and electrolyte imbalance
Baettig Sascha Jan sascha.baettig@usz.ch

1
Fend Raluca Ruxandra 1
Gero Daniel 3
Gutschow Christian 3
Schlaepfer Martin 12
1 https://ror.org/01462r250 grid.412004.3 0000 0004 0478 9977 Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
2 https://ror.org/02crff812 grid.7400.3 0000 0004 1937 0650 Institute of Physiology, University of Zurich, Zurich, Switzerland
3 https://ror.org/01462r250 grid.412004.3 0000 0004 0478 9977 Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
11 9 2024
11 9 2024
2024
24 32318 2 2024
23 8 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Background

The perioperative management of patients with chronic cough or cough hypersensitivity syndrome and its sometimes severe effects is currently under-researched and under-reported.

Case presentation

A 46-year-old female patient with a history of chronic cough and Cough Hypersensitivity Syndrome. After laparoscopic hiatoplasty and anterior fundoplication under general anesthesia, experienced a pronounced exacerbation of coughing symptoms. Despite prompt and extensive treatment involving antitussives, inhalants, anxiolytics, and sedatives, the symptoms remained uncontrollable. Within a few hours, the patient developed a respiratory alkalosis with severe and life-threatening electrolyte shift (pH 7.705, pCO2 1.72 kPa, K+ 2.1 mmol/l). Lactatemia lasted for more than 12 hours with values up to 6.6 mmol/l. Acute bleeding, pneumothorax, and an acute cardiac event were ruled out. Deep analgosedation and inhalation of high-percentage local anesthetics were necessary to manage the clinical symptoms.

Conclusions

This case highlights the challenging nature of chronic cough and hypersensitivity syndrome perioperatively. A tailored anesthesiologic approach, exclusion of other provoking medical problems, and knowledge of possible management and treatment options are key.

Keywords

Postoperative cough
Respiratory alkalosis
Lactatemia
Recovery room
issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
==== Body
pmcCase presentation

A 46-year-old female patient has been suffering from a chronic dry cough since a Sars-Cov-2 infection in 2020. The cough is characterized by its dry and unremitting nature, predominantly manifesting at night time, worsening while in a supine position, and intensifying following food and fluid intake. The severity of the symptoms reached a point where the patient was compelled to discontinue employment. Following a comprehensive multidisciplinary evaluation, the patient was diagnosed with Cough Hypersensitivity Syndrome. At the time of surgery, the daily long-term medication consisted of 200 mg codeine, 240 mg dexlansoprazole, 20 mg famotidine, 30 mg baclofen, and 1800 mg gabapentin. Multiple therapeutic trials were undertaken, encompassing bronchodilator agents, inhaled and systemic corticosteroids, proton pump inhibitors/antacids, opioids, prokinetics, psychotropic drugs, and antitussive medications, including gefapixant (a specific P2X3 receptor agonist). However, all of these were unsatisfactory to the patient. Notably, she reported that the sole effective therapeutic intervention prior to the surgery involved the inhalation of short-acting local anesthetics (up to 10 times daily with lidocaine 100 mg per application). This was continued perioperatively. Given the patient's resistance to pharmacological treatment and pathological 24-hour pH measurements (DeMeester score 45.2, pathological for GERD over 14.7), the presence of a hypotensive lower esophageal sphincter and a significant reduction in quality of life (GERD Health-Related Quality of Life Score 43 out of 75 points), the surgical team opted for a laparoscopic hiatoplasty and an anterior fundoplication.

We performed a “Rapid Sequence Induction” (sufentanil/propofol/rocuronium) in a sitting position, due to a significant increase in coughing in flat position. The intubation was conducted video-assisted using a 7.0 mm endotracheal tube. We maintained anesthesia by effector target concentration-controlled propofol infusion and continuous bispectral index (BIS) monitoring: 1664 mg propofol, 75 mcg sufentanil, and 70 mg rocuronium were administered cumulatively. Further analgesic and co-analgesic therapy consisted of 1 g metamizole, 4 mg dexamethasone, and 8 mmol magnesium-sulfate. The intraoperative course was uneventful. A gastric tube was placed immediately after intubation and suction was performed twice without any relevant amount of gastric fluid. The muscle relaxation was not reversed due to a spontaneous recovery, confirmed by an accelerometrically measured train of four (TOF) ratio of 100%. Extubation was performed again in a semi-sitting position.

Immediately after extubation, the well-known dry cough re-surfaced with increasing intensity. The patient denied dyspnoea, pain, or alterations in the quality of the symptoms. Symmetrical thoracic excursions and breath sounds with discrete obstructive noises were objectified. The jugular veins were not congested. There was no tachypnoea, stridor, hemoptysis, or hypoxia. The patient's long-term medication, which included codeine, baclofen, and gabapentin, was resumed within the first-hour post-extubation, with missed doses administered promptly. Due to increasing pain as a result of the aggravated cough, the analgetic therapy was extended. In the recovery room, she received 75mg of diclofenac, 10mg of morphine, 2mg of lorazepam, and 150 mcg of clonidine within the first 2 hours. Inhalation therapy with salbutamol/ipratropium bromide was also administered twice due to the mild obstructive background noise. Despite escalated therapeutic interventions, the cough symptoms persisted, causing increasing distress for the patient. A tachypnoea or panic attack in the classical sense could not be objectified. The symptom-relieving sitting position became increasingly challenging due to the sedative medications. Two hours post-extubation, arterial blood gas analyses revealed a worsening condition marked by progressive hypocapnia (with a PaCO2 as low as 1.72kPa) and respiratory alkalosis (with a maximum pH of 7.705). Corresponding electrolyte imbalances included hypokalemia (reaching a minimum of 2.1 mmol/l), hypocalcemia (ionized calcium minimum 1.06 mmol/l), and lactatemia (peaking at 6.6 mmol/l), while bicarbonate and base excess remained within normal limits (Table 1).Table 1 Relevant summarised findings

aBGA - timing	Shortly before extubation	Extubation + 1,5h	Extubation +2h	Extubation + 3h	Extubation + 4h	
pH	7.42	7.62	7.70	7.60	7.43	
pCO2 (kPa)	4.90	2.31	1.72	2.45	4.33	
HCO3- (mmol/l)	24.8	24.0	23.7	23.4	23.0	
Hb (g/L)	134	146	136	134	130	
Na+ (mmol/l)	136	137	137	134	138	
K+ (mmol/l)	3.9	3.0	2.1	2.5	2.8	
Ca++ (mmol/l)	1.16	1.11	1.06	1.12	1.13	
Cl- (mmol/l)	108	107	108	108	107	
Lac (mmol/l)	1.1	6.2	6.5	3.6	5.2	
BE	+0.1	-3.2	-3.8	-3.4	-2.2	
12-channel EKG, extubation + 2h

E-FAST examination revealed no signs of pneumothorax, pericardial infusion or relevant intraabdominal free fluid. Further a visually preserved left and right ventricular pump function was objectified. A chest x-ray was without abnormalities, and no relevant pneumoperitoneum could be detected in the upper abdomen (horizontal recording). The 12-lead ECG showed a normocardic sinus rhythm with an over-twisted left position and change typical of severe hypokalaemia (diffuse intraventricular conduction delay, generalized ST-segment depression, T-wave flattening and increased U-wave in the chest wall leads) (Figs. 1 and 2). The corrected QT time was regular at 416ms. The monitor showed frequent monomorphic ventricular extrasystoles without high-grade arrhythmia or ventricular fibrillation. The cardiac biomarkers, particularly the high-sensitivity troponin T, were normal and without a dynamic. In the further broad laboratory analysis, we found only slightly elevated transaminases, which we interpreted in the context of the preoperative overdose of dexlansoprazole. We decided not to perform an emergency CT scan to rule out pulmonary embolism due to the low clinical pre-test probability (Well's score 0 points) and because the patient would not have tolerated a (supine) CT scan without reintubation.Fig. 1 Electrocardiogram extremity leads

Fig. 2 Electrocardiogram chest leads

Therapy and outcome

The patient was closely monitored overnight in the recovery room after the surgical procedure. In addition to the previously mentioned (co-)analgetic and sedative therapy, a high-dose intravenous electrolyte replacement was initiated, encompassing a total of 60 mmol of potassium-chloride and 4.5 mmol of calcium-gluconate. Concurrently, the analgosedation described earlier was expanded in the recovery room to include 300 mcg of clonidine, 2 mg of midazolam, and 50 mg of ketamine. Due to the limited efficacy of inhaling lidocaine 1% (10 ml each), it was replaced by lidocaine 2% (5 ml each). To retain CO2, an oxygen reservoir mask but low-flow oxygen (4-6 l/min) was used. Under the mentioned analgosedation (RASS -3 up to temporary -4) and the therapeutic measures described, normalization of respiratory alkalosis and acid/base status was achieved within 4 hours after extubation. The cough persisted despite analgosedation, although with reduced intensity. The lactataemia resolved within 12 hours after extubation. Apart from the well-known persistent cough, the further 24-hour monitoring in the recovery room was uneventful. During the subsequent three-day inpatient hospitalization, the cough symptoms reduced to the preoperative initial level. In the short term, there was increasing dysphagia, particularly for solid foods. Within 10 weeks, the swallowing difficulties had spontaneously normalized. Further, the chronic cough and the related quality of life significantly improved.

Discussion

Cough, as a non-specific symptom of various pulmonary and extrapulmonary diseases, fulfills an important cleaning function of the airways in addition to mucociliary clearance, especially of macroscopic foreign bodies (https://www.degam.de/files/Inhalte/Leitlinien-Inhalte/Dokumente/DEGAM-S3-Leitlinien/053-013_Akuter%20und%20chronischer%20Husten/oeffentlich/053-013l_akuter%20und%20chronischer%20Husten_V3.1_18-01-22.pdf). According to international consensus, if symptoms persist longer than 8 weeks, the cough is considered chronic [1]. The global prevalence lies around 10% [2] but with noticeable regional differences (2- 18%) [3]. In addition to known risk factors as continued nicotine consumption, female sex, or low socioeconomic status [4, 5], the cause of chronic cough has often an underlying disease such as asthma, COPD, gastro-oesophageal reflux disease, upper airway cough syndrome (formerly postnasal-drip) or eosinophilic bronchitis. If the etiology is unclear, the literature speaks of "chronic idiopathic cough" or "unexplained chronic cough." Nevertheless, it is imperative to differentiate cough hypersensitivity syndrome from these categories since its triggers are generally identifiable. In the context of a viral respiratory infection, sensitization and low-threshold activation of the cough reflex occur following harmless thermal, chemical, or physical irritation [1].

In clinical practice, particularly during episodes of coughing, vigilance for "red flags" is advisable. These include stridor, asymmetric chest movements, abnormal or weakened breathing sounds, or fever. The presence of such symptoms may signify a more serious underlying condition, such as pulmonary embolism, status asthmaticus, pneumothorax, pneumonia, or foreign body aspiration. The patient reported a postoperative aggravation of the known chronic cough in the present case without indicating any new anamnestic or clinical aspects.

Intraoperative and immediate postoperative complications after laparoscopic fundoplication procedures are generally rare and mainly depend on the surgeon's experience [6]. The ACS (American College of Surgeons) Risk Calculator describes a probability of 3.2% for any complication and 2.8% for a severe complication. The overall mortality rate is 0.05% [7] in patients under 70 years old and correlates with the caseload at the hospital [8]. Procedure-specific complications include gastric or esophageal perforation, and injury to the liver or spleen with consecutive hemorrhage or pneumothorax [9]. However, rare complications such as pneumomediastinum [10], tension pneumothorax [11], or pericardial tamponades [12] are also reported. According to a Cochrane analysis, a bedside ultrasound examination is superior to a chest X-ray examination in terms of diagnostic accuracy for pneumothorax in emergency and trauma patients [13]. The sensitivity and specificity are 88% and 97% in (iatrogenic) post-interventional pneumothoraxes in patients with healthy lungs [14]. It is especially valuable due to its rapid availability in the recovery room.

In the reported case, sudden aggravation of the chronic cough was the primary cause of the severe hypocapnia, resulting in alkalosis and life-threatening electrolyte imbalances. Hyperventilation in the sense of psychiatric stress could not be objectified in the patient; she expressed herself in a differentiated manner throughout. Due to the pre-existing cough hypersensitivity syndrome and complication-free surgery, intubation seems to be the most likely trigger; an opioid-induced cough is also debatable. Hyperventilation is known to have a dramatic effect on the acid-base balance. Hypocapnia, primarily caused by coughing, accompanied by severe electrolyte and acid/base disturbances, has not been described in the literature to date. An interesting secondary finding was the persistence of lactatemia for more than 12 hours. In particular, type A lactic acidosis with underlying tissue hypoxia requires rapid diagnosis but could not be confirmed in this case. According to a meta-analysis, lactatemia is possible after inhalation therapy with the beta-2 agonist salbutamol in rare cases [15]. Of note, psychogenic hyperventilation - which we do not assume in this case - is associated with increased lactate levels and an inverse correlation between pCO2 and lactate concentration in 30% of patients [16]. While in septic [17] or cardiogenic [18] shock, the duration of lactic acidosis is an early predictor of mortality or multi-organ failure, the impact of lactatemia without acidosis is less well known. Lactatemia in the setting of psychogenic hyperventilation appears not to be associated with poor outcomes [16].

While a wide range of well-established drug therapy options exist for acute cough management, particularly for post-extubation cough, limited research has been conducted on perioperative management in patients with chronic cough.

Intravenous lidocaine administration is effective for reducing “post-extubation cough” [19]. In the present case, the existing lidocaine inhalation was continued only postoperative. Theoretically, it might have been possible to apply Lidocaine in a nebulized form via tubus right before extubation or in alkalized form in the block cuff of a tracheal tube, which could help to reduce coughing after extubation [20], but, at least in theory, can increase the risk of aspiration. Other data suggest that the combination of a low-dose propofol (0.25 mg/kg/KG) and ketamine (0.15 mg/KG) shortly before extubation may reduce the incidence of “post-extubation cough” [21]. Further, continuous administration of remifentanil or a bolus of dexmedetomidine (0.5 mcg/Kg/KG) 10 minutes before extubation [22] could be valuable therapy options. In retrospect, intravenous lidocaine and an earlier extension of the described drug therapy options might have been effective. Aggressive treatment of “post-extubation cough” seems reasonable in view of the described effects on the acid/base-associated increase in intracranial pressure [23], intraocular pressure, hemodynamic effects, and consecutive risk of bleeding [24]. Finally, severe cardiac arrhythmia, which can lead to cardiac arrest, is also mentioned in the literature [25]. Video laryngoscopy appears to be ideal for reducing excessive laryngeal pressure during intubation [26, 27], as laryngeal trauma is likely associated with postoperative cough [28].

Conclusion

Patients with chronic cough, especially with cough hypersensitivity syndrome, require extensive anesthesiological attention in the perioperative setting.

Efforts should be made to prevent the worsening of pre-existing cough when feasible. Multiple drug therapy options have demonstrated efficacy in reducing post-extubation cough and may be suitable for treatment in these particular cases. These options include topical or intravenous lidocaine, the bolus administration of agents such as ketamine, propofol, or dexmedetomidine, as well as the continuous administration of remifentanil.

Minimizing airway manipulation and trauma is crucial in patients with chronic cough. Primary video laryngoscopy and the tracheal tubes with smaller outside diameters can be valuable to mitigate postoperative cough-related complications.

This case underscores the significance of tailored anesthesiological approaches for patients with chronic cough and highlights potential strategies to optimize their perioperative care. Further research and clinical experience are warranted to refine and expand these approaches in managing chronic cough in surgical settings.

Abbreviations

RASS Richmond Agitation-Sedation Scale

mmol Millimole

kPa Kilopascal

pCO2 Partial pressure of CO2

mg Milligram

mcg Microgram

mm Millimetre

g Gram

kg Kilogram

KG Body weight

BE Base excess

None.

Authors’ contributions

Baettig: Concept/Planing, Writing and Editing the manuscript. Schlaepfer: Concept/Planing, Writing and Editing the manuscript. Fend/Gero/Gutschow: Editing the manuscript. All authors read and approved the final manuscript

Funding

None.

Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not necessary.

Consent of publication

Informed consent obtained from the participant for publication.

Competing interests

The authors declare no competing interests.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
==== Refs
References

1. Visca D Beghè B Fabbri LM Papi A Spanevello A Management of chronic refractory cough in adults Eur J Intern Med 2020 81 15 21 10.1016/j.ejim.2020.09.008 32958373
Visca D, Beghè B, Fabbri LM, Papi A, Spanevello A. Management of chronic refractory cough in adults. Eur J Intern Med. 2020;81:15–21.32958373 10.1016/j.ejim.2020.09.008
2. Song WJ Chang YS Faruqi S Kim JY Kang MG Kim S Jo EJ Kim MH Plevkova J Park HW The global epidemiology of chronic cough in adults: a systematic review and meta-analysis Eur Respir J 2015 45 5 1479 1481 10.1183/09031936.00218714 25657027
Song WJ, Chang YS, Faruqi S, Kim JY, Kang MG, Kim S, Jo EJ, Kim MH, Plevkova J, Park HW, et al. The global epidemiology of chronic cough in adults: a systematic review and meta-analysis. Eur Respir J. 2015;45(5):1479–81.25657027 10.1183/09031936.00218714
3. Morice A, Dicpinigaitis P, McGarvey L, Birring SS: Chronic cough: new insights and future prospects. Eur Respir Rev 2021, 30(162).
4. Zhang J Perret JL Chang AB Idrose NS Bui DS Lowe AJ Abramson MJ Walters EH Lodge CJ Dharmage SC Risk factors for chronic cough in adults: A systematic review and meta-analysis Respirology 2022 27 1 36 47 10.1111/resp.14169 34658107
Zhang J, Perret JL, Chang AB, Idrose NS, Bui DS, Lowe AJ, Abramson MJ, Walters EH, Lodge CJ, Dharmage SC. Risk factors for chronic cough in adults: A systematic review and meta-analysis. Respirology. 2022;27(1):36–47.34658107 10.1111/resp.14169
5. Zeiger RS Schatz M Zhou Y Xie F Bali V Schelfhout J Das A Stern JA Chen W Risk Factors for Persistent Chronic Cough During Consecutive Years: A Retrospective Database Analysis J Allergy Clin Immunol Pract 2022 10 6 1587 1597 10.1016/j.jaip.2022.02.032 35272071
Zeiger RS, Schatz M, Zhou Y, Xie F, Bali V, Schelfhout J, Das A, Stern JA, Chen W. Risk Factors for Persistent Chronic Cough During Consecutive Years: A Retrospective Database Analysis. J Allergy Clin Immunol Pract. 2022;10(6):1587–97.35272071 10.1016/j.jaip.2022.02.032
6. Broeders JA Draaisma WA Rijnhart-de Jong HG Smout AJ van Lanschot JJ Broeders IA Gooszen HG Impact of surgeon experience on 5-year outcome of laparoscopic Nissen fundoplication Arch Surg 2011 146 3 340 346 10.1001/archsurg.2011.32 21422367
Broeders JA, Draaisma WA, Rijnhart-de Jong HG, Smout AJ, van Lanschot JJ, Broeders IA, Gooszen HG. Impact of surgeon experience on 5-year outcome of laparoscopic Nissen fundoplication. Arch Surg. 2011;146(3):340–6.21422367 10.1001/archsurg.2011.32
7. Niebisch S, Fleming FJ, Galey KM, Wilshire CL, Jones CE, Litle VR, Watson TJ, Peters JH: Perioperative risk of laparoscopic fundoplication: safer than previously reported-analysis of the American College of Surgeons National Surgical Quality Improvement Program 2005 to 2009. J Am Coll Surg 2012, 215(1):61-68; discussion 68-69.
8. Wang YR Dempsey DT Richter JE Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993–2006 Dis Esophagus 2011 24 4 215 223 10.1111/j.1442-2050.2010.01123.x 21073616
Wang YR, Dempsey DT, Richter JE. Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993–2006. Dis Esophagus. 2011;24(4):215–23.21073616 10.1111/j.1442-2050.2010.01123.x
9. Niebisch S Peters JH Update on fundoplication for the treatment of GERD Curr Gastroenterol Rep 2012 14 3 189 196 10.1007/s11894-012-0256-6 22395774
Niebisch S, Peters JH. Update on fundoplication for the treatment of GERD. Curr Gastroenterol Rep. 2012;14(3):189–96.22395774 10.1007/s11894-012-0256-6
10. Alshahrani W Almaary J Pneumomediastinum and ECG changes during laparoscopic Nissen fundoplication in a child; Case report Int J Surg Case Rep 2020 77 830 833 10.1016/j.ijscr.2020.11.034 33395906
Alshahrani W, Almaary J. Pneumomediastinum and ECG changes during laparoscopic Nissen fundoplication in a child; Case report. Int J Surg Case Rep. 2020;77:830–3.33395906 10.1016/j.ijscr.2020.11.034
11. Sato Y Miwa T Hiroki K Tension pneumothorax during laparoscopic Nissen fundoplication in a child J Clin Anesth 2007 19 2 162 163 10.1016/j.jclinane.2006.11.002 17379134
Sato Y, Miwa T, Hiroki K. Tension pneumothorax during laparoscopic Nissen fundoplication in a child. J Clin Anesth. 2007;19(2):162–3.17379134 10.1016/j.jclinane.2006.11.002
12. Borrie AJ Cardiac tamponade: a rare complication of Nissen fundoplication ANZ J Surg 2018 88 10 E745 e746 10.1111/ans.13726 27565456
Borrie AJ. Cardiac tamponade: a rare complication of Nissen fundoplication. ANZ J Surg. 2018;88(10):E745-e746.27565456 10.1111/ans.13726
13. Chan KK, Joo DA, McRae AD, Takwoingi Y, Premji ZA, Lang E, Wakai A: Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department. Cochrane Database Syst Rev 2020, 7(7):Cd013031.
14. Shostak E Brylka D Krepp J Pua B Sanders A Bedside sonography for detection of postprocedure pneumothorax J Ultrasound Med 2013 32 6 1003 1009 10.7863/ultra.32.6.1003 23716522
Shostak E, Brylka D, Krepp J, Pua B, Sanders A. Bedside sonography for detection of postprocedure pneumothorax. J Ultrasound Med. 2013;32(6):1003–9.23716522 10.7863/ultra.32.6.1003
15. Liedtke AG, Lava SAG, Milani GP, Agostoni C, Gilardi V, Bianchetti MG, Treglia G, Faré PB: Selective ß2-Adrenoceptor Agonists and Relevant Hyperlactatemia: Systematic Review and Meta-Analysis. J Clin Med 2019, 9(1).
16. ter Avest E Patist FM Ter Maaten JC Nijsten MW Elevated lactate during psychogenic hyperventilation Emerg Med J 2011 28 4 269 273 10.1136/emj.2009.084103 20659878
ter Avest E, Patist FM, Ter Maaten JC, Nijsten MW. Elevated lactate during psychogenic hyperventilation. Emerg Med J. 2011;28(4):269–73.20659878 10.1136/emj.2009.084103
17. Bakker J Gris P Coffernils M Kahn RJ Vincent JL Serial blood lactate levels can predict the development of multiple organ failure following septic shock Am J Surg 1996 171 2 221 226 10.1016/S0002-9610(97)89552-9 8619454
Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL. Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg. 1996;171(2):221–6.8619454 10.1016/S0002-9610(97)89552-9
18. Oddo M Ribordy V Feihl F Rossetti AO Schaller MD Chioléro R Liaudet L Early predictors of outcome in comatose survivors of ventricular fibrillation and non-ventricular fibrillation cardiac arrest treated with hypothermia: a prospective study Crit Care Med 2008 36 8 2296 2301 10.1097/CCM.0b013e3181802599 18664785
Oddo M, Ribordy V, Feihl F, Rossetti AO, Schaller MD, Chioléro R, Liaudet L. Early predictors of outcome in comatose survivors of ventricular fibrillation and non-ventricular fibrillation cardiac arrest treated with hypothermia: a prospective study. Crit Care Med. 2008;36(8):2296–301.18664785 10.1097/CCM.0b013e3181802599
19. Yang SS Wang NN Postonogova T Yang GJ McGillion M Beique F Schricker T Intravenous lidocaine to prevent postoperative airway complications in adults: a systematic review and meta-analysis Br J Anaesth 2020 124 3 314 323 10.1016/j.bja.2019.11.033 32000978
Yang SS, Wang NN, Postonogova T, Yang GJ, McGillion M, Beique F, Schricker T. Intravenous lidocaine to prevent postoperative airway complications in adults: a systematic review and meta-analysis. Br J Anaesth. 2020;124(3):314–23.32000978 10.1016/j.bja.2019.11.033
20. Nath P Williams S Herrera Méndez LF Massicotte N Girard F Ruel M Alkalinized Lidocaine Preloaded Endotracheal Tube Cuffs Reduce Emergence Cough After Brief Surgery: A Prospective Randomized Trial Anesth Analg 2018 126 2 615 620 10.1213/ANE.0000000000002647 29189279
Nath P, Williams S, Herrera Méndez LF, Massicotte N, Girard F, Ruel M. Alkalinized Lidocaine Preloaded Endotracheal Tube Cuffs Reduce Emergence Cough After Brief Surgery: A Prospective Randomized Trial. Anesth Analg. 2018;126(2):615–20.29189279 10.1213/ANE.0000000000002647
21. Chungsamarnyart Y Pairart J Munjupong S Comparison of the effects of intravenous propofol and propofol with low-dose ketamine on preventing postextubation cough and laryngospasm among patients awakening from general anaesthesia: A prospective randomised clinical trial J Perioper Pract 2022 32 3 53 58 32301388
Chungsamarnyart Y, Pairart J, Munjupong S. Comparison of the effects of intravenous propofol and propofol with low-dose ketamine on preventing postextubation cough and laryngospasm among patients awakening from general anaesthesia: A prospective randomised clinical trial. J Perioper Pract. 2022;32(3):53–8.32301388
22. Lee JS Choi SH Kang YR Kim Y Shim YH Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial Can J Anaesth 2015 62 4 392 398 10.1007/s12630-014-0295-6 25523837
Lee JS, Choi SH, Kang YR, Kim Y, Shim YH. Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial. Can J Anaesth. 2015;62(4):392–8.25523837 10.1007/s12630-014-0295-6
23. Carney N Totten AM O'Reilly C Ullman JS Hawryluk GW Bell MJ Bratton SL Chesnut R Harris OA Kissoon N Guidelines for the Management of Severe Traumatic Brain Injury Fourth Edition. Neurosurgery 2017 80 1 6 15 10.1227/NEU.0000000000001432 27654000
Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, et al. Guidelines for the Management of Severe Traumatic Brain Injury. Fourth Edition Neurosurgery. 2017;80(1):6–15.27654000 10.1227/NEU.0000000000001432
24. Irwin RS Complications of cough: ACCP evidence-based clinical practice guidelines Chest 2006 129 1 Suppl 54s 58s 10.1378/chest.129.1_suppl.54S 16428692
Irwin RS. Complications of cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):54s–8s.16428692 10.1378/chest.129.1_suppl.54S
25. Kim HJ Kim JS A cardiovascular collapse following vigorous cough during spinal anesthesia Korean J Anesthesiol 2013 65 6 Suppl S49 50 10.4097/kjae.2013.65.6S.S49 24478870
Kim HJ, Kim JS. A cardiovascular collapse following vigorous cough during spinal anesthesia. Korean J Anesthesiol. 2013;65(6 Suppl):S49-50.24478870 10.4097/kjae.2013.65.6S.S49
26. Gordon JK Bertram VE Cavallin F Parotto M Cooper RM Direct versus indirect laryngoscopy using a Macintosh video laryngoscope: a mannequin study comparing applied forces Can J Anaesth 2020 67 5 515 520 10.1007/s12630-020-01583-x 32152886
Gordon JK, Bertram VE, Cavallin F, Parotto M, Cooper RM. Direct versus indirect laryngoscopy using a Macintosh video laryngoscope: a mannequin study comparing applied forces. Can J Anaesth. 2020;67(5):515–20.32152886 10.1007/s12630-020-01583-x
27. Russell T Khan S Elman J Katznelson R Cooper RM Measurement of forces applied during Macintosh direct laryngoscopy compared with GlideScope® videolaryngoscopy Anaesthesia 2012 67 6 626 631 10.1111/j.1365-2044.2012.07087.x 22352799
Russell T, Khan S, Elman J, Katznelson R, Cooper RM. Measurement of forces applied during Macintosh direct laryngoscopy compared with GlideScope® videolaryngoscopy. Anaesthesia. 2012;67(6):626–31.22352799 10.1111/j.1365-2044.2012.07087.x
28. Hindman BJ Dexter F Gadomski BC Puttlitz CM Relationship Between Glottic View and Intubation Force During Macintosh and Airtraq Laryngoscopy and Intubation Anesth Analg 2022 135 4 815 819 35551148
Hindman BJ, Dexter F, Gadomski BC, Puttlitz CM. Relationship Between Glottic View and Intubation Force During Macintosh and Airtraq Laryngoscopy and Intubation. Anesth Analg. 2022;135(4):815–9.35551148
