Change in Endotracheal Tube Cuff Pressure during Nitrous Oxide Anaesthesia: A Comparison between Air and Distilled Water Cuff Inflation

Nl, Ahmad; Am, Norsidah

doi:10.1177/0310057x0102900511

Cited by 16 publications

(6 citation statements)

References 22 publications

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“…This overinflation of the ETT cuff has been associated with damage to the pharyngeal mucosa and recurrent laryngeal nerve palsy (17). The lack of hyperpressure is probably one advantage of liquid filling of ETT cuffs (18,19). However, despite the absence of overinflation in our control group, filling the cuff with alkalinized L-HCl allowed a significant improvement of ETT cuff tolerance.…”

Section: Discussionmentioning

confidence: 73%

Alkalinization of Intracuff Lidocaine: Efficacy and Safety

Estèbe¹,

Gentili²,

Corre³

et al. 2005

Anesthesia & Analgesia

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When alkalinized lidocaine instead of air is used to fill the endotracheal tube (ETT) cuff, coughing, and bucking are decreased during extubation when ventilation is controlled with N2O. However, sodium bicarbonate (NaHCO3) used to transform lidocaine hydrochloride (L-HCl) to lidocaine base induces a pH increase that could be irritating for mucosa in the case of cuff rupture. Therefore, we determined, in a randomized controlled study with controlled patient ventilation without N2O, whether the smallest concentrations of NaHCO3 (1.4% versus 8.4%) reduced diffusion (in vitro evaluation) and other secondary clinical benefits. After pH determination of different solutions (2 mL of 2% L-HCl and 2 to 6 mL of 8.4%, or 1.4% NaHCO3), an in vitro lidocaine diffusion through the ETT cuffs was evaluated (2 mL of 2% L-HCl and 3 mL of 8.4% or 1.4% NaHCO3). Then, adult patients scheduled for total thyroidectomy surgery were consecutively enrolled (n = 20 for each group). The ETT cuff was filled with air (group air) or with alkalinized lidocaine (2 mL of 2% L-HCl) using 8.4% (group large dose) or 1.4% (group small dose) of NaHCO3. After tracheal extubation, sore throat was evaluated by visual analog scale as the main end-point of the study. Hoarseness, bucking, dysphonia, dysphagia, cough, restlessness, and postoperative nausea and vomiting were also evaluated. There was a slight tendency toward a slower release when a small concentration of NaHCO3 was used (i.e., 1.4%). Compared with group air, the alkalinized-lidocaine groups had a significant reduction in sore throat during the 24-h postoperative period (P < 0.0001). The difference was not significant between the two alkalinized lidocaine groups. This increase in ETT tolerance was confirmed by the analysis of secondary end-points. No laryngospasm, rupture of ETT cuff, or depression of the swallowing reflex were recorded. A decrease in sore throat during the postoperative period was recorded when the cuff was inflated with a small dose of alkalinized lidocaine (i.e., 40 mg of L-HCl and 1.4% of NaHCO3) rather than with air when ventilation was controlled without N2O.

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Section: Discussionmentioning

confidence: 73%

Alkalinization of Intracuff Lidocaine: Efficacy and Safety

Estèbe¹,

Gentili²,

Corre³

et al. 2005

Anesthesia & Analgesia

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“…Third, inflating ETC with lidocaine could avoid the cuff overinflation due to rapid trans-cuff N 2 O diffusion during general anesthesia [ 38 , 44 , 45 ]. Since overinflated cuff might bring forth damage to pharyngeal mucosa and recurrent laryngeal nerve palsy [ 46 ], using liquid to replace air as cuff medium should be carefully considered [ 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Intracuff Lidocaine on Postoperative Sore Throat and the Emergence Phenomenon: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2015

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BackgroundPostoperative sore throat and other airway morbidities are common and troublesome after endotracheal tube intubation general anesthesia (ETGA). We propose lidocaine as endotracheal tube (ETT) cuff inflation media to reduce the postintubation-related emergence phenomenon.MethodsWe searched PubMed, EMBASE, and Cochrane databases systematically for randomized controlled trials (RCTs) that have investigated the outcome of intracuff lidocaine versus air or saline in patients receiving ETGA. Using a random-effects model, we conducted a meta-analysis to assess the relative risks (RRs) and mean difference (MD) of the incidence and intensity of relevant adverse outcomes.ResultsWe reviewed nineteen trials, which comprised 1566 patients. The incidence of early- and late-phase postoperative sore throat (POST), coughing, agitation, hoarseness, and dysphonia decreased significantly in lidocaine groups, with RRs of 0.46 (95% confidence interval [CI]: 0.31 to 0.68), 0.41 (95% CI: 0.25 to 0.66), 0.43 (95% CI: 0.31 to 0.62), 0.37 (95% CI: 0.25 to 0.55), 0.43 (95% CI: 0.29 to 0.63), and 0.19 (95% CI: 0.08 to 0.5), respectively, when compared with the control groups. The severity of POST also reduced significantly (mean difference [MD] -16.43 mm, 95% CI: -21.48 to -11.38) at 1 h and (MD -10.22 mm, 95% CI: -13.5 to -6.94) at 24 h. Both alkalinized and non-alkalinized lidocaine in the subgroup analyses showed significant benefits in emergence phenomena prevention compared with the control.ConclusionOur results indicate that both alkalinized and non-alkalinized intracuff lidocaine may prevent and alleviate POST and postintubation-related emergence phenomena.

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“…In a study by Besir A et al, the ETT cuffs were insufflated with saline and air in patients under low flow general anesthesia using N 2 O. The ETT cuff pressures were found to be lower in the saline-insufflated group with the prevention of the diffusion of N 2 O into the cuff, and the sore throat was significantly lower in the saline-insufflated group during the postoperative period [33].…”

Section: Discussionmentioning

confidence: 99%

Comparison of endotracheal tube cuff pressures inflated with saline or air in gynecological laparoscopic surgery

Şahın

Beşir

Akdoğan

et al. 2021

Marmara Medical Journal

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Objective: We compared the air or saline insufflated endotracheal tube (ETT) cuff pressures and their effects on postoperative respiratory complications in gynecological laparoscopic surgeries in the Trendelenburg position (TP). Patients and Methods: This prospective study was carried out on a total of 60 patients, whose ages ranged from 18 to 65 years and who were classified by the American Society of Anesthesiologists (ASA) as I-III. They were scheduled for gynecological laparoscopic surgery in TP. Patients included in the study were randomly divided into two groups as the saline (Group S, n=30) and air (Group A, n=30) groups. ETT cuff pressures and peak airway pressures were recorded immediately after intubation and at 10-minute intervals during the intraoperative period. Results: The cuff pressure and maximum cuff pressure values in the saline group were significantly lower than in the air group in the 50-minute (p<0.05). The sore throat and analgesic consumption were significantly lower in Group S in postoperative 24 hours (p<0.001, for all). Conclusion: The intraoperative cuff pressures, postoperative sore throat, and analgesic consumption were lower in the salineinsufflated group than in the air-insufflated group in gynecological laparoscopic surgery in TP.

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Change in Endotracheal Tube Cuff Pressure during Nitrous Oxide Anaesthesia: A Comparison between Air and Distilled Water Cuff Inflation

Cited by 16 publications

References 22 publications

Alkalinization of Intracuff Lidocaine: Efficacy and Safety

Alkalinization of Intracuff Lidocaine: Efficacy and Safety

Effect of Intracuff Lidocaine on Postoperative Sore Throat and the Emergence Phenomenon: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Comparison of endotracheal tube cuff pressures inflated with saline or air in gynecological laparoscopic surgery

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