Alkalinization of intra-cuff lidocaine and use of gel lubrication protect against tracheal tube-induced emergence phenomena

Abstract

These data show benefits of using an alkalinized lidocaine-filled ETT cuff in combination with water-soluble gel lubrication in preventing post-intubation sore throat.

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

“…6 Dehydration and irritation of the mucosa are responsible for mucosal pain following intubation; 19 thus, it is important to monitor pain even after surgery of short duration. In contrast with other studies where 10% lidocaine, sterile water, or water soluble gels were used as lubricants, [7][8][9]18,19 in our study, the outside wall of the cuff membrane was not lubricated prior to its use. The VAS scores monitored in our study were in the low range (B 3/10), similar to those reported by Estebe et al 7,8 or by Navarro et al 19 at one hour and 24 hr.…”

“…The in vitro diffusion rate of alkalinized lidocaine was found to be similar to low-volume/high-pressure cuffs and high-volume/low-pressure cuffs. 8 Other groups have proposed to prefill the ETT cuffs with lidocaine 90 min prior to intubation in order to condition the cuff's semi-permeable membrane. 18,19 This approach could yield interesting results in the case of short duration surgeries, but it remains time-consuming in a day-to-day clinical setting.…”

“…5 According to the literature, the incidence of cough at emergence ranges from 40 to 96%. [6][7][8][9][10] Different methods have been proposed to decrease the adverse effects associated with mucosal irritation caused by the endotracheal tube (ETT), including the administration of opioids, extubation under deep anesthesia, use of fluticasone, and injection of intravenous lidocaine. 4,[10][11][12][13][14][15] Although intravenous anesthetics have been shown to be effective in reducing the incidence of cough at emergence, time can be delayed until the patient can respond to simple orders.…”

“…6 Other researchers have opted to lubricate the ETT cuff to decrease mucosal irritation. 8,9,18,19 For surgical procedures exceeding two hours, intracuff alkalinized 2% lidocaine has been shown to be more effective in decreasing the incidence of cough than a cuff filled with air or lidocaine alone. This effect was due primarily to the semi-permeable properties of the high-pressure/low-volume ETT cuff membrane and the high pH of the solution allowing gradual diffusion of lidocaine.…”

“…This effect was due primarily to the semi-permeable properties of the high-pressure/low-volume ETT cuff membrane and the high pH of the solution allowing gradual diffusion of lidocaine. 7,8 Nevertheless, none of these methods, when used alone, suppressed cough entirely at extubation.…”