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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(03): 354-361
DOI: 10.1055/s-0043-1760856
Original Article

Comparative Efficacy of Intracuff 1% and 2% Alkalinized Lignocaine with Saline on Endotracheal Tube-Induced Hemodynamic Changes and Emergence Phenomena in Neurosurgical Patients

Elugoti Mounisha
1   Department of Anesthesiology and Critical care, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
2   Department of Transplant Anesthesia, KIMS Hospitals, Secunderabad, India
,
Vandana Talwar
1   Department of Anesthesiology and Critical care, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
,
Pratibha Mudgal
1   Department of Anesthesiology and Critical care, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Abstract

Introduction Extubation is associated with hemodynamic changes and emergence phenomena leading to cough, sore throat, dysphonia, and dysphagia in the postoperative period. The aim of our study was to compare intracuff 2% alkalinized lignocaine with 1% alkalinized lignocaine and saline in reducing endotracheal tube induced emergence phenomena and haemodynamic changes at extubation in neurosurgical patients.

Materials and Methods In this randomized controlled study, 90 adult patients of either sex, scheduled to undergo neurosurgical procedures were randomly divided into three groups of 30 each to receive either 1% alkalinized lignocaine (AL1), 2% alkalinized lignocaine (AL2), or saline as cuff inflation media. Intracuff pressures and haemodynamic variables were noted intraoperatively and during emergence. The presence of postextubation cough, sore throat, dysphonia, and dysphagia were monitored until 24 hours postoperatively. Data were analyzed using Chi-square test and ANOVA. A p-value of less than 0.05 was considered significant.

Results The intracuff pressures were significantly less with alkalinized lignocaine as compared to saline, after 3 hours of induction. Post extubation, hemodynamic parameters and incidence of coughing and bucking at extubation were significantly less in Groups AL1 (p = 0.024) and AL2 (p = 0.02) as compared to saline. On assessment of laryngotracheal morbidity, the incidence of coughing was found to be significantly less with 2% alkalinized lignocaine as compared to saline (p = 0.021) at 1 hour after extubation. Sore throat was significantly less in Groups AL1 and AL2 as compared with saline at 1 hour (p = 0.008, 0.002 respectively) and 8 hours (p = 0.01 in both groups), and in Group AL2 versus saline at 24 hours (p = 0.044) after extubation. The incidence of dysphonia was significantly less in Groups AL1 and AL2 as compared with saline at 1 hour (p = 0.016, p = 0.002) and 24 hours (p = 0.012 in both groups) and in Group AL2 versus saline at 8 hours (p = 0.03) postoperatively. No significant differences were noted between 1% alkalinized lignocaine and 2% alkalinized lignocaine.

Conclusion Intracuff alkalinized lignocaine 1% and 2% were significantly better than saline in reducing coughing and bucking at extubation, post extubation haemodynamic changes and incidence of postoperative cough, sore throat, and dysphonia.

Keywords

alkalinized lignocaine - saline - intracuff pressure - hemodynamic response - postextubation cough - sore throat


Publication History

Article published online:
24 June 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Sole ML, Su X, Talbert S. et al. Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range. Am J Crit Care 2011; 20 (02) 109-117 , quiz 118
    CrossrefPubMedGoogle Scholar
  • 2 Gaur P, Ubale P, Khadanga P. Efficacy and safety of using air versus alkalinized 2% lignoaine for inflating endotracheal tube cuff and its pressure effects on incidence of postoperative coughing and sore throat. Anesth Essays Res 2017; 11 (04) 1057-1063
    CrossrefPubMedGoogle Scholar
  • 3 Indu S, Arun MG, Mohamed T, Suvarna K. Effect of intracuff media-alkalinised lignocaine, saline, and air on endotracheal tube induced emergence phenomena: a randomized controlled study. J Evid Based Med Healthc 2016; 3: 3173-3177
    CrossrefGoogle Scholar
  • 4 Leech P, Barker J, Fitch W. Proceedings: changes in intracranial pressure and systemic arterial pressure during the termination of anaesthesia. Br J Anaesth 1974; 46 (04) 315-316
    CrossrefPubMedGoogle Scholar
  • 5 McHardy FE, Chung F. Postoperative sore throat: cause, prevention and treatment. Anaesthesia 1999; 54 (05) 444-453
    CrossrefPubMedGoogle Scholar
  • 6 Estebe JP, Dollo G, Le Corre P. et al. Alkalinization of intracuff lidocaine improves endotracheal tube-induced emergence phenomena. Anesth Analg 2002; 94 (01) 227-230
    CrossrefPubMedGoogle Scholar
  • 7 Jaensson M, Gupta A, Nilsson U. Gender differences in sore throat and hoarseness following endotracheal tube or laryngeal mask airway: a prospective study. BMC Anesthesiol 2014; 14: 56
    CrossrefPubMedGoogle Scholar
  • 8 Maroju NK, Anbalagan P, Kate V, Ananthakrishnan N. Improvement in dysphagia and quality of life with self-expanding metallic stents in malignant esophageal strictures. Indian J Gastroenterol 2006; 25 (02) 62-65
    PubMedGoogle Scholar
  • 9 Navarro LH, Lima RM, Aguiar AS, Braz JR, Carness JM, Módolo NS. The effect of intracuff alkalinized 2% lidocaine on emergence coughing, sore throat, and hoarseness in smokers. Rev Assoc Med Bras 2012; 58 (02) 248-253
    CrossrefPubMedGoogle Scholar
  • 10 Dobrin P, Canfield T. Cuffed endotracheal tubes: mucosal pressures and tracheal wall blood flow. Am J Surg 1977; 133 (05) 562-568
    CrossrefPubMedGoogle Scholar
  • 11 Fagan C, Frizelle HP, Laffey J, Hannon V, Carey M. The effects of intracuff lidocaine on endotracheal-tube-induced emergence phenomena after general anesthesia. Anesth Analg 2000; 91 (01) 201-205
    CrossrefPubMedGoogle Scholar
  • 12 Patel RI, Oh TH, Epstein BS. Effects of nitrous oxide on pressure changes of tracheal tube cuffs following inflation with air and saline. Anaesthesia 1983; 38 (01) 44-46
    CrossrefPubMedGoogle Scholar
  • 13 Navarro LHC, Braz JRC, Nakamura G, Lima RM, Silva FdeP, Módolo NSP. Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: a randomized clinical trial. Sao Paulo Med J 2007; 125 (06) 322-328
    CrossrefPubMedGoogle Scholar
  • 14 Rizvanović N, Čaušević S, Hrnčić N, Hatibović H. Effect of intracuff alkalinized 2% lidocaine on endotracheal tube cuff pressure and postoperative throat symptoms in anaesthesia maintained by nitrous oxide. Med Glas 2019; 16 (01) 7-12
    Google Scholar
  • 15 Lam F, Lin YC, Tsai HC, Chen TL, Tam KW, Chen CY. Effect of intracuff lidocaine on postoperative sore throat and the emergence phenomenon: a systematic review and meta analysis of randomised controlled trials. PLoS One 2015; 10 (08) e0136184
    CrossrefPubMedGoogle Scholar
  • 16 Rakhi T, Ranjan RK, Bhat S, Sunil BV. Comparison Between the Efficacy of Saline, Alkalinised Lignocaine 2% and Alkalinised Lignocaine 4% in the Cuff of Endotracheal Tube to Reduce the Incidence of Cough and Sorethroat During Extubation. Biomed Pharmacol J 2021; 14 (02) 755-760
    CrossrefGoogle Scholar
  • 17 Dollo G, Estebe JP, Le Corre P, Chevanne F, Ecoffey C, Le Verge R. Endotracheal tube cuffs filled with lidocaine as a drug delivery system: in vitro and in vivo investigations. Eur J Pharm Sci 2001; 13 (03) 319-323
    CrossrefPubMedGoogle Scholar
  • 18 Yukioka H, Yoshimoto N, Nishimura K, Fujimori M. Intravenous lidocaine as a suppressant of coughing during tracheal intubation. Anesth Analg 1985; 64 (12) 1189-1192
    CrossrefPubMedGoogle Scholar
  • 19 Diachun CA, Tunink BP, Brock-Utne JG. Suppression of cough during emergence from general anesthesia: laryngotracheal lidocaine through a modified endotracheal tube. J Clin Anesth 2001; 13 (06) 447-451
    CrossrefPubMedGoogle Scholar
  • 20 Acharya G, Gill RS, Arya PC, Arora KK. Comparison of intracuff lignocaine and air and its related complications. Eur J Pharm Med Res 2016; 3: 382-387
    Google Scholar
  • 21 Soares SM, Arantes VM, Módolo MP. 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; 72 (04) 496-503
    CrossrefPubMedGoogle Scholar