Efficacy of intracuff lidocaine in reducing coughing on tube: a systematic review and meta-analysis

Abstract

Objective: To investigate the efficacy of intracuff lidocaine in reducing coughing and other endotracheal tube side effects and so ensure a smooth extubation process. Method: PubMed, EMBASE, and Cochrane Library databases were systematically searched for all randomised controlled trials (RCTs) published before June 30, 2019 that investigated the efficacy of intracuff lidocaine, with or without sodium bicarbonate, in reducing coughing and other complications related to endotracheal intubation. A random-effects model was used to conduct a meta-analysis to assess the relative risks (RRs) of the incidence of these intubation-related side effects. Results: 11 studies involving 843 patients were included in the meta-analysis. Compared with control groups (i.e., saline or air), intracuff lidocaine groups (alkalinized or non-alkalinized) had a significantly reduced incidence of coughing on tube. Similarly, intracuff lidocaine groups were more effective than control groups in reducing the incidence of other intubation-related complications. Conclusion: Intracuff alkalinized or non-alkalinized lidocaine significantly reduced coughing and other intubation-related complications during the extubation process.

Intracuff alkalinized lidocaine to prevent postoperative airway complications: A meta-analysis

“…Thirdly, regardless of whether lubricating the cuff before intubation may have an important impact on postoperative airway complications in patients undergoing endotracheal intubation, it is necessary to analyze lubrication of the cuff before intubation in order to eliminate the influence of confounding factors on the results. Finally, 12 RCTs were included in this study, while the previous study only included 9 RCTs[ 36 ] and 8 RCTs[ 37 ] in the alkalized lidocaine subgroup. Additional trials will provide more data and information to support the conclusions of this study.…”

“…Our results revealed that intracuff alkalinized lidocaine decreased postoperative airway complications. To achieve a significant therapeutic effect, large doses of lidocaine may be necessary without alkalinization[ 37 ]. According to Estebe et al [ 34 ], plasma lidocaine levels confirmed the increased diffusion of lidocaine through the cuff when lidocaine was alkalinized.…”

Smooth Extubation and Smooth Emergence Techniques: A Narrative Review

“…It should be noted that these pharmacologic aids may not have the same efficacy in high-risk patients. Despite these limiting factors, we discuss some of the more widely studied medications below ( Table 2 ) [ 13 , 15 , 34 – 36 , 45 , 47 , 53 – 56 , 59 – 63 ]. Other pharmacologic agents, such as ketamine, have been used to achieve smooth emergence [ 64 ].…”

“…Alkalinization or a combination of warming and alkalinization of the anesthetic can increase the proportion of the uncharged drug available for diffusion, thereby increasing the rate of diffusion [ 67 ]. Many studies have demonstrated the efficacy of intracuff lidocaine in decreasing cough and sore throat [ 53 – 55 ]. Two systematic reviews and meta-analyses demonstrated that both alkalinized and nonalkalinized intracuff lidocaine showed significant reduction of postoperative sore throat, coughing, and dysphonia compared to control groups without intracuff lidocaine [ 53 , 54 ].…”

Efficacy of perioperative intravenous dexmedetomidine administration for the prevention of postoperative sore throat: a meta-analysis

“…Recently, several pharmacological and non-pharmacological approaches for the prevention of POST have gained widespread acceptance in clinical settings. These include the use of smaller endotracheal tubes, 11 topical or intravenous application of corticosteroids or local anesthetics, 12 , 13 ketamine gargle, 14 topical application of magnesium 15 and others. Dexmedetomidine, a selective α2-adrenaline receptor agonist, has a dose-dependent sedative effect on respiration with minimal depressive effects.…”