Lidocaine 10% in the endotracheal tube cuff: blood concentrations, haemodynamic and clinical effects (original) (raw)
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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.
La Tunisie médicale, 2014
Tracheal intubation results in an alteration of the laryngeal mucosa which can lead to undesirable effects at emergence from anaesthesia. Local anesthetics, when administered topically, may represent an interesting alternative to reduce these side effects. In this trial, we aimed to evaluate the effect of lidocaine in preventing tracheal intubation related side effects at emergence from anaesthesia, when instilled onto the glottis before intubation or used to inflate the endotracheal tube cuff. Eighty patients scheduled to elective surgery of less than 120 minutes under general anaesthesia were enrolled in this prospective, randomized, controlled, double blind study. As they receive instillation of 2% lidocaine or saline onto the glottis before intubation, and as they have their endotracheal tube cuff filled with 2% lidocaine or saline, the patients were randomized in four groups. S-S (Saline instillation and saline in the cuff); S-Lido (saline instillation and lidocaine in the cuff...
Lidocaine as Endotracheal Tube Cuff Inflating Agent
Journal of Armed …, 2009
A prospective study was carried on 120 patients undergoing surgical operations lasting less than 90 minutes. The incidence of postoperative sore throat, dysphasia and hoarseness of voice with 2% lidocaine (Group L) as endotracheal cuff inflating agent was compared ...
Southern African Journal of Anaesthesia and Analgesia, 2009
Background: Increased cough and restlessness during emergence from general anaesthesia in patients undergoing ophthalmologic surgical procedures might result in increased intraocular pressure, ruptured sutures and suprachoroidal haemorrhage, which can be detrimental to the outcome of surgery. In hyperactive airway patients, as the cough receptors are in the hypersensitised stage, the patients tend to cough more frequently and violently during extubation. Hence, in such patients, we sought to determine the benefits of filling the endotracheal tube cuff with either buffered lidocaine, saline or air, so as to prevent endotracheal tube-induced coughing during emergence from general anaesthesia. Methods: Seventy five patients either with a history of chronic smoking or recently treated upper respiratory tract infections were randomly assigned into three groups (n = 25), based on the type of endotracheal tube cuff inflation, as follows: Group A (air), Group B (6 ml normal saline) and Group C (6 ml 2% lidocaine + 0.5 ml 7.5% sodium bicarbonate). A second, blinded anaesthetist, graded the extubation as: Grade 0 (no cough), Grade 1 (cough < 15s) and Grade 2 (cough > 15s). Results: Extubation was smooth in Group C compared with Groups B and A (p < 0.0001). Further, the incidence of sore throat was found to be lower in both liquid groups, B and C, compared with Group A at 1 h (p < 0.0001) and 24 h (p < 0.01) postoperatively. Conclusions: Injecting buffered lidocaine into the endotracheal tube cuff, produces smooth extubation even in patients with hyperactive airways as the cough receptors in the tracheal mucosa gets blocked by the increased diffusion of uncharged base form of the drug across the hydrophobic polyvinyl chloride wall of the cuff.
Sao Paulo Medical Journal, 2007
CONTEXT AND OBJECTIVE: High intracuff pressure in endotracheal tubes (ETs) may cause tracheal lesions. The aim of this study was to evaluate the effectiveness and safety of endotracheal tube cuffs filled with air or with alkalinized lidocaine. DESIGN AND SETTING: This was a prospective clinical study at the Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS: Among 50 patients, ET cuff pressures were recorded before, 30, 60, 90 and 120 minutes after starting and upon ending nitrous oxide anesthesia. The patients were randomly allocated to two groups: Air, with ET cuff inflated with air to attain a cuff pressure of 20 cmH2O; and Lido, with ET cuff filled with 2% lidocaine plus 8.4% sodium bicarbonate to attain the same pressure. ET discomfort before tracheal extubation, and sore throat, hoarseness and coughing incidence were studied at the time of discharge from the post-anesthesia care unit, and sore throat and hoarseness were stu...
Does intra-cuff alkalinized lidocaine prevent tracheal tube induced emergence phenomena in children?
2019
Aim: To study and investigate the efficacy of intra-cuff alkalinized lidocaine in the prevention of the endotracheal tube (ETT) induced emergence phenomena in children. Methodology: Fifty children, ages 6-12 years, ASA physical status I-II, scheduled for elective dental surgery under N2O free general anesthesia with an expected duration of 120 min or more, were randomly assigned one of the two groups (25 patients each); lidocaine group in which the cuff of ETT was inflated with a mixture of lidocaine 2% and sodium bicarbonate 8.4% and the saline group, in which tube cuff was inflated with 0.9% saline solution. Results: There were significant reduction in the incidence and severity (p=0.005 & p= 0.014) of cough at extubation and in the PACU (P=0.048 & P=0.014). The incidence and severity of postoperative sore throat was also reduced in the lidocaine group compared to the saline group (p=0.025 and 0.031 respectively). Moreover, there was a significant prolongation of the time to spont...
Postoperative sore throat (POST) is a common complication after endotracheal intubation. After tracheal intubation, the incidence of sore throat varies from 14.4% to 50%. The aim of the study was to compare between bezydamine hydrochloride gel, lidocaine 5% gel and lidocaine 10% spray on the endotracheal tube cuff as regards postoperative sore throat. The present study was carried out on 124 patients admitted to Alexandria university hospitals for lumbar fixation surgery requiring general anesthesia. Patients were randomly allocated into 4 groups. Benzydamine hydrochloride gel, 5% lidocaine hydrochloride gel, 10 % lidocaine hydrochloride spray, or normal saline were applied on ETT cuffs before endotracheal intubation. The patients were examined for sore throat (none, mild, moderate, or severe) at 0, 1, 6, 12, and 24 hours after extubation. The results were collected, analyzed and presented in tables and figures.The highest incidence of POST occurred at 6 hours after extubation in all groups. There was a significantly lower incidence of POST in the benzydamine group than 5% lidocaine gel, 10% lidocaine spray, and normal saline groups. The benzydamine group had significantly decreased severity of POST compared with the 10% lidocaine, 5% lidocaine, and normal saline groups at observation time point. Compared with the 5% lidocaine the 10% lidocaine group had significantly increased incidence and severity of POST after extubation. Compared with normal saline the 10% lidocaine group had increased incidence of POST, yet the severity of POST was increased in the saline group. There were no significant differences among groups in local or systemic side effects. So in conclusion, benzydamine hydrochloride gel on the ETT cuff is a simple and effective method to reduce the incidence and severity of POST. Application of 10% lidocaine spray should be avoided because of worsening of POST where incidence increased but not the severity in relation to 5%lidocaine gel. Applying 5% lidocaine on the ETT cuff does not prevent POST but its application is better than lidocaine 10%spray or saline.