Intracuff alkalinized lignocaine improves endotracheal tube induced emergence phenomenon

Abstract

Background: Endotracheal intubation for airway management in general anaesthesia is associated with post intubation morbidities due to prolonged inflation of the ETT cuff with air. Lidocaine by instillation in the ETT cuff and its diffusion through semipermeable membrane causes reduction in mucosal irritation and inflammation. Objectives To compare the endotracheal tube (ETT) cuff pressure inflated with air or alkalinized lignocaine during anaesthesia and evaluate clinical symptoms such as coughing and sore throat (postoperative sore throat [POST]) following tracheal extubation. Material and Methods: This was a prospective randomized controlled study conducted over a period of 6 months. We included 60 patients in age group of 18–55 years posted for elective laparoscopic operative gynecological surgeries of duration more than 90 min under general anaesthesia with N2O‑O2 mixture. Patients were randomized using computer‑generated randomization table into air and lignocaine group. The ETT cuff was inflated with air or alkalinized lignocaine (2% lignocaine with 7.5% sodium bicarbonate, in the proportions of 19.0:1.0 ml) to the volume that prevented air leak using cuff pressure manometer. After extubation, an independent observer blinded to study group recorded the presence or absence of coughing and POST at immediately, 1,6,12h and 24 h postoperatively. Results: Demographic data, baseline characteristics (American Society of Anaesthesiologists grade, intracuff volume/cuff pressure at start of surgery), and duration of anaesthesia were comparable among study groups (P>0.05). Cuff pressure and volume achieved in the end of surgery were much noteworthy higher in air group as compared to lignocaine group (P < 0.0001). Incidence of coughing and POST at immediately, 1,6,12h and 24 h postoperatively was significantly higher in air group compared to lignocaine group. Conclusion: This study showed the significance of use of alkalinized 2% lignocaine in prevention of rise of cuff pressure and incidence of coughing and POST.