Ropivacaine via trans-cricothyroid membrane injection inhibits the extubation response in patients undergoing surgery for maxillary and mandibular fractures

Extubation response can lead to cardiovascular and respiratory complications. Here, we aimed to evaluate the effect of ropivacaine injected via the trans-cricothyroid membrane on the extubation response. This prospective, double-blind, randomized study included 70 patients classified as American Society of Anesthesiologists status I-II, who required general anesthesia with nasotracheal intubation for maxillary and mandibular fracture surgery; patients were divided into the ropivacaine (20 mg) and dicaine (20 mg) groups. Both groups were injected via the trans-cricothyroid membrane. Mean arterial pressure (MAP), heart rate (HR), and incidence and severity of cough were recorded during intubation and extubation. During intubation, there was no significant intergroup difference in MAP or HR and no occurrence of coughing (P > 0.05). During extubation, MAP and HR were significantly lower in the ropivacaine group than the dicaine group (P < 0.05). The proportion of patients with no reports of cough was significantly higher in the ropivacaine group than in dicaine group (P < 0.05). The number of patients with grade 1 or 2 cough was significantly higher in the dicaine group than that in the ropivacaine group (P < 0.05). There was no significant intergroup difference in the rate of postoperative complications (P > 0.05). These results suggest that the administration of ropivacaine via trans-cricothyroid membrane injection can effectively inhibit the extubation response.