Author: Zhao D, et al.
Anesthesia & Analgesia, August 19, 2025. doi:10.1213/ANE.0000000000007725
This letter to the editor comments on a recent randomized clinical trial by Wang et al. that investigated dexmedetomidine combined with lidocaine laryngopharyngeal spray for reducing coughing during extubation in thyroidectomy patients. The authors acknowledge the study’s contribution but raise two key concerns.
First, there is inconsistency in the sedation assessment tools reported: the Methods and tables reference the Ramsay Sedation Scale (RSS), while the Results and Discussion cite the Richmond Agitation-Sedation Scale (RASS). Since the two scales have different interpretations, this discrepancy could affect the reliability of the findings.
Second, the reporting of postoperative nausea and vomiting (PONV) is incomplete. Thyroidectomy patients are at particularly high risk for PONV due to multiple contributing factors, yet the trial did not present detailed time-based incidence data, only the percentage of patients who required antiemetics. Clarification of prophylactic measures and full reporting of PONV outcomes would strengthen the interpretation and clinical applicability of the results.
Key Takeaways
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The trial demonstrated that dexmedetomidine plus lidocaine spray reduces coughing during extubation.
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Inconsistent use of sedation scales (RSS vs RASS) raises concerns about data interpretation.
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PONV, a major risk in thyroidectomy patients, was underreported despite its clinical importance.
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High-risk populations require thorough reporting of PONV incidence and prophylactic measures.
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More detailed methodological clarity would enhance confidence in the trial’s conclusions.
Thank you to Anesthesia & Analgesia for publishing this thoughtful exchange on optimizing extubation management in thyroidectomy patients.