The effects of tracheal tube cuffs filled with air, saline or alkalinised lidocaine on haemodynamic changes and laryngotracheal morbidity in children: a randomised, controlled trial

Abstract

We studied the effects of tracheal tube cuffs filled with air, saline or alkalinised lidocaine on haemodynamic changes during tracheal extubation and postoperative laryngotracheal morbidity in children. We randomly allocated 164 children aged 3-13 years undergoing general anaesthesia to one of four groups; tracheal tube cuffs filled with air (n = 41); saline (n = 41); alkalinised lidocaine 0.5% (n = 41); or alkalinised lidocaine 1% (n = 41). Intracuff pressure was monitored and maintained below 20 cmH O. The mean (SD) increases in systolic blood pressure after tracheal extubation compared with before extubation were 10.9 (10.8) mmHg, 7.3 (17.7) mmHg, 4.1 (10.5) mmHg and 1.9 (9.5) mmHg in the air, saline, 0.5% and 1% alkalinised lidocaine groups, respectively (p = 0.021). The mean (SD) increases in diastolic blood pressure after tracheal extubation compared with before extubation were 3.9 (9.7) mmHg, 7.9 (14.6) mmHg, 0.7 (10.4) mmHg and 3.6 (6.9) mmHg in the air, saline, 0.5% and 1% alkalinised lidocaine groups, respectively (p = 0.019). The mean (SD) increases in heart rate after tracheal extubation compared with before extubation were 14.2 (7.6) beats.min , 15.5 (13.1) beats.min , 5.2 (9.6) beats.min and 4.1 (6.6) beats.min in the air, saline, 0.5% and 1% alkalinised lidocaine groups, respectively (p < 0.001). The incidence of sore throat 8 h after tracheal extubation was 22.0% in the air-filled group, 9.8% in the saline group, 4.9% in the 0.5% alkalinised lidocaine group and 2.4% in the 1% alkalinised lidocaine group, p = 0.015. We conclude that filling the tracheal tube cuff with alkalinised lidocaine-filled reduces the haemodynamic response to tracheal extubation and postoperative laryngotracheal morbidity in children.

Time to stop using uncuffed tracheal tubes in children?

“…The incidence of postoperative sore throat is higher when using uncuffed tracheal tubes , and this is attributed to repeat tracheal intubation but may also be the result of more intra‐operative movement of an uncuffed tracheal tube compared with a cuffed one; for example, when the patient's head and neck position are altered. The reduced incidence of postoperative sore throat that is observed when using a cuffed tracheal tube may be reduced even further by using tracheal tubes whose cuffs are filled with lidocaine, rather than air or saline .…”

Cuffed tracheal tubes: guilty now proven innocent

“…We believe that standards should be established to improve our poor compliance with these tasks . Future research might establish whether children are better after their tracheas are intubated with tubes in which the cuff is inflated with alkalinised lidocaine rather than air or saline . Particular attention should be paid to children in whom subglottic stenosis is more likely, for instance critically ill, small and premature neonates and infants.…”

Between evidence and commerce – the case of sufentanil sublingual tablet systems

“…The incidence of postoperative sore throat is higher when using uncuffed tracheal tubes [9], and this is attributed to repeat tracheal intubation but may also be the result of more intra-operative movement of an uncuffed tracheal tube compared with a cuffed one; for example, when the patient's head and neck position are altered. The reduced incidence of postoperative sore throat that is observed when using a cuffed tracheal tube may be reduced even further by using tracheal tubes whose cuffs are filled with lidocaine, rather than air or saline [10].…”