Smooth Extubation and Smooth Emergence Techniques: A Narrative Review

Table 2

Comparison of pharmacologic adjuncts used in smooth emergence.

Techniques	Intracuff lidocaine	IV lidocaine	IV dexmedetomidine	IV remifentanil	IV calcium channel blockers	Topical benzydamine hydrochloride	Topical methylprednisolone
Proposed advantages	Reduction of postoperative cough, sore throat [53, 54], and dysphonia [55].	Attenuate increases in heart rate and mean arterial pressure [13, 34, 35] and postoperative cough and sore throat [56].	Reduction of postoperative cough [15, 44], nausea, and vomiting [45]. Increased respiratory rate [45]. Decreased agitation and need for rescue analgesic [45, 47].	Attenuate increases in heart rate and mean arterial pressure [36]. Reduction of postoperative cough [36, 44].	Attenuate increases in heart rate and mean arterial pressure [57, 58].	Decreased postoperative sore throat [59, 60].	Decreased postoperative sore throat and cough [61].
Proposed disadvantages	Unknown systemic absorption.	Cardiac arrhythmia local anesthetic toxicity (LAST).	Increased sedation, bradycardia, hypotension [15], time to emergence [47]. Expensive.	Increased postoperative nausea and vomiting. Added expense.	Hypotension. Heart block. Bradycardia.	Burning sensation and possible vomiting when applied [60].	Limited evidence. Systemic steroid absorption. Steroid effects.