Dexmedetomidine Combined With Lidocaine Laryngopharyngeal Spray Reduces Coughing During Extubation in Female Patients Undergoing Thyroidectomy

To the Editor We read with great interest the study by Wang et al,1 which demonstrated that the combination of dexmedetomidine and lidocaine laryngopharynx spray effectively suppresses the cough reflex during extubation and reduces postoperative sore throat in female patients undergoing thyroidectomy. We acknowledge their significant contribution to the field of pharyngeal spray application of dexmedetomidine and lidocaine for suppressing the cough reflex during extubation in thyroidectomy patients. However, regarding the results section of their study, we would like to discuss 2 points. First, the descriptions of the sedation assessment scales in the study are inconsistent. It is unclear whether the Richmond Agitation-Sedation Scale (RASS) or the Ramsay Sedation Scale (RSS) was used for postoperative sedation evaluation. In the Methods section ("Sedation levels were assessed with the RSS") and Table 3 ("Sedation levels were assessed with the RSS"), the authors explicitly refer to the RSS. However, in the Results ("In the PACU, the Dex-Lido group's Richmond Sedation-Agitation Scale scores were significantly higher than those of the Lido and Control groups") and Discussion ("agitation: this treatment may reduce the incidence and severity of postthyroidectomy sore throat, as well as agitation in the PACU"), the RASS is mentioned. While the RSS and RASS are related scales, their score categories represent different clinical meanings.2 Clarifying this discrepancy is critical for the accurate interpretation of the study findings. Second, the study provides insufficient details regarding the prevention, occurrence, and treatment of postoperative nausea and vomiting (PONV). In thyroidectomy patients without prophylactic antiemetics, the incidence of PONV is approximately 60% to 80%,3 making it a critical outcome measure in post-thyroidectomy care. While the Methods section specifies that PONV was recorded at 1, 6, 24, and 48 hours postoperatively, and the legend of Table 3 includes the abbreviation "PONV," the Results section fails to report the incidence or progression of PONV across groups. Instead, it only states the proportion of patients receiving antiemetic drugs postoperatively (eg, Table 3: Dex-Lido group 7/60 [12%], Lido group 7/60 [12%], and Control group 5/60 [8%]). The study enrolled a high-risk population for PONV, as highlighted by the following factors: total intravenous anesthesia (TIVA) is a protective factor against PONV, but other characteristics (eg, female sex, mean age <50 years, nonsmoking status, perioperative opioid use, thyroid surgery (neck surgery), surgical duration >1 hour, and postoperative neostigmine administration) are well-established risk factors for PONV.4,5 Apfel et al6 demonstrated that even with combined antiemetic therapy, the residual PONV rate remains high (~30%) in high-risk patients. Prophylactic combination antiemetic strategies are essential for reducing PONV incidence in such populations. Clarifying the perioperative anti-PONV measures implemented in this study and providing detailed data on PONV incidence across timepoints would enhance the interpretation of its findings.