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

Abstract

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.

Effect of tracheal tube cuff inflation with alkalinized lidocaine versus air on hemodynamic responses during extubation and post-operative airway morbidities in children: prospective observational cohort study, Ethiopia

“…This result is comparable with the study done by Soares et al that shows a reduction in the mean heart rate after extubation in the lidocaine group compared to the air group, with a p-value of 0.007 among the groups [28]. Additionally, the study done by using lidocaine and air in the adults' population which measured heart rates at 1, 2, 5, 10, and 30 min after extubation show a similar result to our study with the mean heart rate being lower in the lidocaine group at 5 min after extubation with a p-value of 0.003 [29].…”

Effects of topical dexamethasone in postoperative sore throat

“…In prior studies, techniques such as using intubation methods with minimal irritation, performing intubation after achieving complete neuromuscular blockade, or using small endotracheal tubes [ 19 ] have been found to be effective in reducing POST. Furthermore, preoperative administration of gabapentin as a preventive measure [ 5 ], the use of benzydamine hydrochloride spray on the semipermeable cuff of the endotracheal tube [ 20 ], and the application of betamethasone gel and lidocaine jelly on the cuff [ 21 ], as well as filling the cuff with 4% lidocaine instead of air [ 22 ], have been observed to be effective in reducing POST.…”

A Comparison between effectiveness and safety of endotracheal tube cuff filled with air, plain lignocaine and alkalinized lignocaine for postoperative sore throat and emergence phenomena

“…Though results appear to be similar to my study they did not advocate the use of alkaline lignocaine. Souissi et al 20 in their study in 2016 including 80 participants of a tertiary care centre who received intracuff alkalinized lidocaine or intracuff 0.9% saline showed that the use of 160 mg of intracuff alkalinized lignocaine is associated with a decreased incidence of cough upon emergence. This is in agreement with my study that lignocaine will produce the desired action after optimal duration for absorption.…”