Effect of intracuff alkalinized 2% lidocaine on endotracheal tube cuff pressure and postoperative throat symptoms in anaesthesia maintained by nitrous oxide
Aim To compare the effects of endotracheal tube cuff inflation media, air, saline and alkalinized 2% lidocaine on increase of cuff pressure (CP) during nitrous oxide maintained anaesthesia and on incidence of postoperative throat symptoms (PTS), and to evaluate the incidence of postoperative throat mucosal injuries (PTMI) depending on cuff inflation medium. Methods Ninety patients who had undergone elective surgery were randomly allocated into 3 equal groups per cuff inflation media: air (group A), saline (group S) and alkalinized 2% lidocaine (group L). The CP was monitored immediately after cuff inflation and further 5, 15, 30, 60 and 90 minutes after intubation. The incidence and intensity of PTS, sore throat, hoarseness, dysphagia and cough were evaluated 2, 6 and 24 hours after extubation. The incidence and intensity of PTMI were evaluated 24 hours after exubation using indirect laryngoscopy examination. Results The highest increase of mean CP was recorded in the group A (18.7±4.9), it was significantly lower (6.4±1.1) in the group S, while it remained stable in the group L (0.7±0.7). All PTS occurred less frequently in the group L: sore throat (p<0.001), hoarseness and dysphagia (p<0.05), but the incidence of cough was not significantly different between the groups. The lowest incidence of PTMI was in the group L (p<0.001). Conclusion The increase of CP contributed to incidence of PTS. The intracuff alkalinized 2% lidocaine was superior to saline and air in the prevention of an increase of CP and reduction of the PTS incidence. There was a strong correlation between the incidence of PTS and PTMI.
Scuderi P. Postoperative sore throat: more answers than questions. Anesth Analg. 2010;831–2.
2.
Sole M, Penoyer D, Su X, Jimenez E, Kalita S, Poalillo E, et al. Assessment of endotracheal cuff pressure by continuous monitoring: a pilot study. Am J Crit Care. 2009;133–133.
3.
Sultan P, Carvalho B, Rose B, Cregg R. Endotracheal tube cuff pressure monitoring: a review of the evidence. J Perioper Pract. 2011;379–86.
4.
Aqil M, Khan M, Mansoor S, Mansoor S, Khokhar R, Narejo A. Incidence and severity of postoperative sore throat: a randomized comparison of glidescope with Macintosh laryngoscope. BMC Anesthesiol. 2017;127–34.
5.
Jaensson M, Gupta A, Nilsson U. Gender differences in sore throat and hoarseness following endotracheal tube or laryngeal mask airway: a prospective study. BMC Anaesthesiol. 2014;56.
6.
Mendels E, Brunings J, Hamaekers A, Stokroos R, Kremer B, Baijens L. Adverse laryngeal effects following short-term general anesthesia: a systematic review. Arch Otolaryngol Head Neck Surg. 2012;257–64.
7.
Garg R, Rath G, Bithal P, Prabhakar H, Marda M. Effects of retractor application on cuff pressure and vocal cord function in patients undergoing anterior cervical discectomy and fusion. Indian J Anaesth. 2010;292–5.
8.
Combes X, Schauvliege F, Peyrouset O, Motamed C, Kirov K, Dhonneur G, et al. Intracuff pressure and tracheal morbidity. Influence of filling with saline during nitrous oxide anesthesia. Anesthesiology. 2001;1120–4.
9.
Hu B, Bao R, Wang X, Liu S, Tao T, Xie Q, et al. The size of endotracheal tube and sore throat after surgery: a systematic review and meta-analysis. PLoS One. 2013;74467.
10.
Estebe J, Dollo G, Corre L, P, Naoures L, Chevanne A, et al. Alkalinization of intracuff lidocaine improves endotracheal tube-induced emergence phenomena. Anesth Analg. 2002;227–30.
11.
Taghavi G, Soleimani M, Razavi M, Salehi M. Reducing sore throat following laryngeal mask airway insertion: comparing lidocaine gel, saline, and washing mouth with the control group. Rev Bras Anesthesiol. 2015;450–4.
12.
ASA physical status classification system. 2014;
13.
Apfelbaum J, Hagberg C, Caplan R, Blitt C, Connis R, Nickinovich D, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on management of the difficult airway. Anesthesiology. 2013;251–70.
14.
Jain M, Tripathi C. Endotracheal tube cuff pressure monitoring during neurosurgery -manual vs. automatic method. J Anaesthesiol Clin Pharmacol. 2011;358–61.
15.
Chen B, Luo L, Jiang L, Wang R, Li J, Tan L. The effect of nitrous oxide on intracuff pressure of the size 2 ProSeal laryngeal mask airway. J Clin Anesth. 2011;214–7.
16.
Shroff P, Patil V. Efficacy of cuff inflation media to prevent postintubation-related emergence phenomenon: air, saline and alkalinized lignocaine. Eur J Anaesthesiol. 2009;458–62.
17.
Estebe J, Gentili M, Corre L, Dollo P, Chevanne G, Ecoffey F, et al. Alkalinization of intracuff lidocaine: efficacy and safety. Anesth Analg. 2005;1536–41.
18.
Wetzel L, Ancona A, Cooper A, Kortman A, Loniewski G, Lebeck L. The effectivenes of 4% intracuff lidocaine in reducing coughing during emergence from general anesthesia in smokers undergoing procedures lasting less than 1.5 hours. AANA J. 2008;105–8.
19.
Tanaka Y, Nakayama T, Nishimori M, Tsujimura Y, Kawaguchi M, Sato Y. Lidocaine for preventig postperative sore throat. Cochrane Database Syst Rev. 2015;
20.
Lehmann M, Monte K, Barach P, Kindler C. Postoperative patient complaints: a prospective interview study of 12,276 patients. J Clin Anesth. 2010;13–21.
21.
Lam F, Lin Y, Tsai H, Chen T, Tam K, Chen C. Effect of intracuff lidocaine on postoperative sore throat and the emergence phenomenon: a systematic review and meta-analysis of randomized controlled trials. PLoS One. :136184.
22.
Liu J, Zhang X, Gong W, Li S, Wang F, Fu S, et al. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study. Anesth Analg. 2010;1133–7.
23.
Hamdan A, Sibai A, Rameh C, Kanazeh G. Shortterm effects of endotracheal intubation on voice. J Voice. 2007;762–8.
24.
Mendels J, Brunings J, Hamaekers A, Stokroos R, Kemer B, Baijens L. Adverse laryngeal effects following short-term general anesthesia: a systematic review. Arch Otolaryngol Head Neck Surg. 2012;257–64.
25.
Kowalczik I, Ryu W, Rabin D, Arango M, Duggal N. Reduced endotracheal tube cuff pressure to assess dysphagia after anterior cervical spine surgery. J Spinal Disord Tech. 2015;552–8.
26.
Arts M, Rettig T, Vries D, Wolfs J, Veld J, B. Maintaining endotracheal tube cuff pressure at 20 mmHg to prevent dysphagia after anterior cervical spine surgery; protocol of double-blind randomised controlled trial. BMC Musculoskelet Disord. 2013;280–4.
27.
Mazzone S. An overview of the sensory receptors regulating cough. Cough. 2005;2–2.
28.
Irwin R. Complications of cough: ACCP evidencebased clinical practice guidelines. Chest. 2006;(1):54S – 58.
29.
D’aragon F, Beaudet N, Gagnon V, Martin R, Sansoucy Y. The effects of lidocaine spray and intracuff alkalinized lidocaine on the occurrence of cough at extubation: a double-blind randomized controlled trial. Can J Anaesth. 2013;370–6.
30.
Souissi H, Frechette Y, Murza A, Masse M, Marsault E, Sarret P, et al. Intracuff 160 mg alkalinized lidocaine reduces cough upon emergence from N 2 O-free general anesthesia: a randomized controlled trial. Can J Anaesth. 2016;862–70.
31.
Widdicombe J. Neurophysiology of the cough reflex. Eur Respir J. 1995;1193–202.
32.
Mota L, Cavalho D, Brito G, V. Laryngeal complications by orotracheal intubation: literature review. Int Arch Otorinolaryngolog. 2012;236–45.
33.
Soares S, Arantes V, Módolo M, Santos D, Vane V, Navarro L, et al. The effects of tracheal tube cuffs filled with air, saline or alkalinised lidocaine on haemodynamic changes and laryngotracheal morbidity in children: a randomised, controlled trial. Anaesthesia. 2017;496–503.
34.
Altintas F, Bozkurt P, Kaya G, Akkan G. Lidocaine 10% in the endotracheal tube cuff: blood concentrations, haemodynamic and clinical effects. Eur J Anaesthesiol. 2000;436–42.
35.
Gaur P, Ubale P, Khadanga P. Efficacy and safety of using air versus alkalinized 2% lignocaine for inflating endotracheal tube cuff and its pressure effects on incidence of postoperative coughing and sore throat. Anesth Essays Res. 2017;1057–63.
36.
Navarro L, Braz J, Nakamura G, Lima R, Silva F De P, Módolo N. Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: a randomized clinical trial. Sao Paulo Med J. 2007;322–8.
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