Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: a randomized clinical trial

Navarro, Laís Helena Camacho; Bráz, José Reinaldo Cerqueira; Nakamura, Giane; Lima, Rodrigo Moreira e; Silva, Fredson de Paula E; Módolo, Norma Sueli Pinheiro

doi:10.1590/s1516-31802007000600004

Cited by 34 publications

(54 citation statements)

References 35 publications

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“…at extubation) was statistically significant at 5, 10, 30, and 60 min after extubation. Navarro et al, did not observe any change in heart rates [1,10]. It was observed in our study that the heart rates were lower and more stable in the lidocaine group.…”

Section: Discussionsupporting

confidence: 47%

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Instillation of 4% lidocaine versus air in the endotracheal tube (ETT) cuff to evaluate post intubation morbidity-a randomized double blind study

Rao¹,

Snigdha²,

Alai³

et al. 2013

J Anesthesiol Clin Sci

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Background: Endotracheal intubation for airway management in general anaesthesia is associated with post intubation morbidities due to prolonged inflation of the ETT cuff. Many studies have used Lidocaine by instillation in the ETT cuff and its diffusion to the underlying tracheal mucosa there by reducing local irritation and inflammation of the airway. Aims: To study the favorable effects of lidocaine(4%)instillation in the endotracheal tube cuff in surgical patients as compared to air. Settings and design: The study was done in a multispeciality teaching hospital. Eighty patients were selected and randomly divided into two groups. Methods and Material: Eighty patients of ASA -I & II status posted for general surgery were randomly selected and divided into two groups after randomization.All these general surgeries lasted for duration of 30-45 minutes. Blood loss intraop.was around 200-300ml only. All these patients received first dose of I.V.fentanyl for analgesia at induction. In forty patients air was filled in ETT cuff and in remaining patients lidocaine (4%) 3-5ml was instilled keeping the cuff pressure between 20-22mmHg. Coughing and hemodynamic parameters were noted at and after extubation. Intubation related morbidities were compared between the two groups. Patients with hypertension, COPD, recurrent respiratory infections etc. and those needing postop ventilator supports were excluded. Statistical analysis used:The database of all parameters were analysed using "STATA SOFTWARE VERSION10.0". Results:The study showed a significant difference in the incidence of post-operative sore throat in group I(air) and group II (lidocaine). Lidocaine group had lesser sore throat incidence. There was no significant change in heart rate initially but showed a significant change in both the study groups at later intervals. Similarly there was a highly significant change in blood pressure in both the study groups at 2, 5, 10, 30 and 60 min after extubation. Conclusions: Lidocaine can be used for instillation in ETT cuff to minimize the postintubation morbidities.

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Section: Discussionsupporting

confidence: 47%

“…The diffusion of the local anaesthetic depended on various factors such as the non-ionised fraction of the local anaesthetic, alkalinization, temperature, duration of procedure and concentration of local anaesthetic [10].…”

Section: Discussionmentioning

confidence: 99%

Instillation of 4% lidocaine versus air in the endotracheal tube (ETT) cuff to evaluate post intubation morbidity-a randomized double blind study

Rao¹,

Snigdha²,

Alai³

et al. 2013

J Anesthesiol Clin Sci

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“…This supports a previous observation by Navarro et al that showed intracuff alkalinized lidocaine to result in less irritation on the throat than air-filled cuffs at 24 hr postextubation. 24 In our study, we used only 2 mL of 2% intracuff alkalinized lidocaine. In the future, increasing the volume to 4 mL and increasing the concentration to 4% need to be tested to determine whether this could result in a better diffusion rate.…”

Section: Discussionmentioning

confidence: 99%

The effects of lidocaine spray and intracuff alkalinized lidocaine on the occurrence of cough at extubation: a double-blind randomized controlled trial

D’Aragon

Beaudet

Gagnon

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Our study aimed to evaluate the effects of lidocaine sprayed onto the larynx and/or injected into the tracheal tube cuff to decrease the incidence of cough at extubation and postoperative sore throat. Methods One hundred twenty women scheduled for gynecological surgery \ 120 min in duration were enrolled in this randomized double-blind prospective study. Prior to tracheal intubation, 4% lidocaine or 0.9% saline was sprayed onto the patients' supra-and subglottic areas.After tracheal intubation, the tracheal tube cuff was filled with either an alkalinized 2% lidocaine solution or 0.9% saline. This resulted in four groups: spray-cuff, spray-saline, saline-cuff, and saline-saline. A logistic regression comprising the two factors was used for analysis. The primary outcome was the incidence of cough at extubation. The secondary outcome was the incidence and severity of sore throat reported by patients at 15 min, 60 min, and 24 hr after tracheal extubation. Results Cough occurred in 42%, 24%, 63%, and 69% of patients in the spray-cuff, spray-saline, saline-cuff, and saline-saline groups, respectively. The use of lidocaine spray decreased the incidence of cough at extubation (odds ratio = 0.256; 95% confidence interval 0.118 to 0.554; P \ 0.001); however, the use of intracuff alkalinized lidocaine had no impact on the occurrence of cough (P = 0.471). Severity of sore throat was clinically low (visual analog scale [VAS] B 3) in all groups. No significant difference was observed in hoarseness, dysphagia, nausea, or vomiting. Conclusion Sprayed lidocaine decreases the incidence of cough at tracheal extubation in surgeries of less than two hours. The use of alkalinized lidocaine into high-volume/ low-pressure endotracheal cuffs had no impact on decreasing the incidence of cough or pain.

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“…Sore throat is a frequent side effect of general anaesthesia and is reported between 30% -70% of patients after extubation. 3,6 Postoperative sore throat is ranked by American Society of Anesthesiologists as eighth most important problem of current clinical anaesthesiology. 1 Postoperative sore throat following tracheal intubation is due to mucosal erosion caused by cuff of endotracheal tube, 2 trauma from intubation and mucosal dehydration.…”

Section: Discussionmentioning

confidence: 99%

“…1 Postoperative sore throat following tracheal intubation is due to mucosal erosion caused by cuff of endotracheal tube, 2 trauma from intubation and mucosal dehydration. 3 The prevalence of postoperative sore throat also varies with diameter, type of endotracheal tube 4 and cuff pressure used. Postoperative sore throat contributes to postoperative morbidity and patient dissatisfaction.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Ketamine Gargle for Attenuating Postoperative Sore Throat in Patients Undergoing General Anaesthesia With Endotracheal Intubation

Thoppil¹,

Imanual²

2017

jemds

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Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: a randomized clinical trial

Cited by 34 publications

References 35 publications

Instillation of 4% lidocaine versus air in the endotracheal tube (ETT) cuff to evaluate post intubation morbidity-a randomized double blind study

Instillation of 4% lidocaine versus air in the endotracheal tube (ETT) cuff to evaluate post intubation morbidity-a randomized double blind study

The effects of lidocaine spray and intracuff alkalinized lidocaine on the occurrence of cough at extubation: a double-blind randomized controlled trial

Efficacy of Ketamine Gargle for Attenuating Postoperative Sore Throat in Patients Undergoing General Anaesthesia With Endotracheal Intubation

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