Cuff failure in polyvinyl chloride tracheal tubes sprayed with lignocaine

Walmsley, A.; Burville, L. M.; Davis, Tessa

doi:10.1111/j.1365-2044.1988.tb09024.x

Cited by 15 publications

(8 citation statements)

References 1 publication

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“…Using a solution close to the physiological pH and a small dose of L-HCl (40 mg) reduces the risks of local anesthetic vascular absorption and mucosal irritation in case of ETT rupture, although ETT rupture has never been reported. Conversely, some cases of cuff rupture have been reported when L-HCl was used as lubricant or for local anesthesia (24). Hence, the current findings support the use of a 1.4% NaHCO 3 concentration to refill the cuff of the ETT.…”

Section: Discussionsupporting

confidence: 66%

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: Discussionsupporting

confidence: 66%

Alkalinization of Intracuff Lidocaine: Efficacy and Safety

Estèbe¹,

Gentili²,

Corre³

et al. 2005

Anesthesia & Analgesia

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“…First, unlike the inconclusive benefit of external topical application as tube lubricant [ 16 , 38 ], our result is definite. Moreover, evidence shows that mucosa damage and cuff rupture might be associated with lidocaine gel or spray on the ETC [ 41 , 42 ]. Second, intracuff administration prevents the risk of prolonged sedation after intravenous lidocaine injection [ 18 , 43 ].…”

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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“…Cuff lubrication using lidocaine gel or spray has been associated with increased adverse phenomena at the time of awakening from anesthesia induced by tracheal tubes 18 and may also rupture the cuff. 30 However, cuff lubrication with water-soluble gel, in association with alkalinized lidocaine, increases tracheal tube tolerance and reduces the incidence of postoperative sore throats. 31 The use of nasogastric probes during and after surgical operations has also been associated with signifi cantly increased incidence of postoperative sore throats, 32 which is the reason why their use was among the criteria for excluding patients from the present study.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: a randomized clinical trial

et al. 2007

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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 infl ated with air to attain a cuff pressure of 20 cmH 2 O; and Lido, with ET cuff fi lled 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 studied 24 hours after anesthesia. RESULTS:Pressures in Lido cuffs were signifi cantly lower than in Air cuffs (p < 0.05). Tracheal complaints were similar for the two groups, except for lower ET discomfort and sore throat incidence after 24 hours and lower systolic arterial pressure at the time of extubation in the Lido group (p < 0.05). CONCLUSION:ET cuffs fi lled with alkalinized lidocaine prevented the occurrence of high cuff pressures during N 2 O anesthesia and reduced ET discomfort and postoperative sore throat incidence. Thus, alkalinized lidocaine-fi lled ET cuffs seem to be safer than conventional airfi lled ET cuffs.

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Cuff failure in polyvinyl chloride tracheal tubes sprayed with lignocaine

Cited by 15 publications

References 1 publication

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

Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: a randomized clinical trial

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