Aim:  The aim of this study was to evaluate the effectiveness and safety of endotracheal tube cuffs filled with air, plain lignocaine and alkalinized lignocaine during general anesthesia and evaluate clinical symptoms such as pain, coughing, restlessness and postoperative sore throat following tracheal extubation.

Materials and Methods: This was a prospective randomized controlled study conducted in a tertiary care hospital over a period of 2 year. We included 90 patients in age group of 20-60 years posted for elective surgeries of duration 2-5 hrs under general anesthesia. Patients were randomized using computer generated randomization table into air, plain lignocaine group and alkalinized lignocaine group. The endotracheal tube cuff was inflated with air or plain and alkalinized lignocaine to the volume that prevented air leak using cuff pressure manometer. After extubation, observer blinded to study group recorded the presence or absence of coughing, pain, restlessness and postoperative sore throat at immediately, 1 h and 24 h postoperatively.

Results:  Incidence of coughing, pain, restlessness and postoperative sore throat (POST) at immediately, 1 h and 24 h postoperatively was significantly higher in air group compared to lignocaine group and was lowest in alkalinized lignocaine group which was statistically significant.

Conclusion: Alkalinized lignocaine filled endotracheal cuffs are  safer than conventional air or plain lignocaine  filled endotracheal cuffs  as it produces less coughing, pain, restlessness and sore throat postoperatively.

Keywords: Endotracheal,  Sore throat. Cough. Lignocaine. Alkalinized.

1. Singh Bajwa S, and Jindal R .Quality control and assurance in anesthesia: A necessity of the modern times. Anesth Essays Res. 2014 May-Aug; 8(2): 134–138
2. Lehmann M, Monte K, Barach P, et al. Postoperative patient complaints: a prospective interview study of 12,276 patients. J Clin Anesth 2010; 22: 13–21. 3.
3. Fagan C, Frizelle HP, Laffey J, Hannon V and Carey M: The effects of intracuff lidocaine on endotracheal-tube-induced emergence phenomena after general anesthesia. Anesth Analg 2000, 91:201-5.
4. Bartlett D Jr. Jeffrey P, Sants Ambrojio G, Wise JCM. Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: a randomized clinical trial Department of Anesthesiology, Article | PubMed, Brazil  Sao Paulo Med J. 2007;125(6):322-8. 
5. Combes X,  Schauvlleje  F,  Peyrouset  O  et  al.  Intracuff  pressure  and tracheal morbidity, influence of filling with saline during nitrous oxide anaesthesi Anaesthesiology 2001; 95: 1120-4.
6. Mitchell V, Adams T and Calder Choice of cuff inflation medium during nitrous oxide anaesthesia. Anaesthesia 1999; 54: 32-36.
7. Fagan C, Frizette HP, Laffey J, Hannon V, Carey The effects of intracuff lidocaine on endotracheal tube induced emergence phenomenon after general anaesthesia. Anaesth Analg 2000; 91: 201-5.
8. Estebe JP,  Delahaye  S,  Corre  PL,  Dollo  G,  Naoures  L,  Chvanne F,     Ecoffey C. Alkalinization of intracuff lidocaine and use of gel lubrication protect   against tracheal tube induced emergence phenomenon. Anesth Analg 2002; 94: 227-30.
9. Sconzo JM,  Moscicki  JC,  Difazia  CA.  Invitro  diffusion  of  lidocaine across endotracheal tube cuffs. Reg Anesth 1990; 15: 37-40.
10. Ahmad NL, Norsidah A Change in endotracheal tube cuff pressure during nitrous oxide anaesthesia: A comparison between air and distilled water cuff inflation. Anaesth Intensive Care 2001; 29: 510-514.
11. Navarro RM, Baughman VL. Lidocaine in the endotracheal tube cuff reduces postoperative sore throat. J Clin Anaesth 1997; 9: 394-3
12. Altintas F,  Bozkurt  P,  Kaya  G,  Akkan  G.  Lidocaine  10%  in  the     endotracheal tube cuff: Blood concentration, hemodynamic and clinical effects. Eur J Anaesthesiol 2000; 17: 436-44
13. Bennett MH,  Isert  PR,  Cumming  RG.  Postoperative  sore  throat  and hoarseness following tracheal intubation using air or saline to inflate the cuff: A randomized control trial. Anaesth Intensive Care 2000; 28: 408-41
14. Jones GOM, Hale De, Wasmuth CE, Homi J, Smith ER, Viljoen J. A survey of acute complications associated with endotracheal intubatio Cleveland Clinic Quarterly 1968; 35: 23-3.
15. Soltani HA, Aghadavoudi, The effect of different lidocaine application methods on postoperative cough and sore throat. J Clin Anaesth 2002; 14:15-18.
16. Estebe J P,  Gentili M,  Le Corre P,  Dollo G,  Chevanne F, and Ecoffey   C. Alkalinization of Intracuff Lidocaine: Efficacy and Safety. Anesth Analg 2005;101:1536 –41.
17. Ali NP,  Tauhid-ul-Mulck  M,  Noor  MM,  Mollick  M,  Ahmed  M, Chowdhury MRA. lidocaine as endotracheal tube cuff inflating age JAFMC Bangladesh. Vol 5, No 1 (June) 2009.
18. Singh Hemjit T, Devi Eshori L, Raj M, Rajkumar G, Thokchom Singh R, Singh Ratan N. Effect of Intracuff Plain Lignocaine and Alkalinized Lignocaine for Prevention of Postoperative Sore Throat. IJHRMLP, Vol: 03 No: 02 July, 2017.
19. Acharya G,   Gill R S, Chandra Arya P, and  Arora K. Comparision of intracuff lignocaine and air and its related complications. ejpmr, 2016,3(4), 382-387
20. Rao M, Snigdha,  Alai T  Kumar V. Instillation of 4% lidocaine versus air in the endotracheal tube (ETT) cuff to evaluate post intubation morbidity-a randomized double blind study . Journal of Anesthesiology and Clinical Science 2013, Herbert open access journals 2:19.
21. Souissi, H, Fre´chette, Y, Murza, A , Masse M, RRT , Marsault, E,  Sarret, P , D’Aragon, F , Parent, A.  Sansoucy, Y, Intracuff 160 mg alkalinized lidocaine reduces cough upon emergence from N2O-free general anesthesia: a randomized controlled trial. Can J Anesth/J Can Anesth (2016) 63:862–870
22. Lam F, Lin Y-C, Tsai H-C, Chen T-L, Tam K-W, Chen C-Y. Effect of Intracuff Lidocaine on Postoperative Sore Throat and the Emergence Phenomenon: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Landau R, ed. PLoS ONE. 2015;10(8):e0136184.
23. 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. Pubmed,. 2012 Mar-Apr;58(2):248-53
24. 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. Anesthesia, Essays and Researches. 2017;11(4):1057-1063.

Prof Prativa Panda

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