Alkalinization of intracuff lidocaine: efficacy and safety

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.     

Alkalinization of intra-cuff lidocaine and use of gel lubrication protect against tracheal tube-induced emergence phenomena

Background. We sought to determine the benefits of using alkalinizedlidocaine 40 mg to fill the cuff of a tracheal tube (ETT) incombination with water-soluble gel lubrication to prevent post-intubationsore throat. Methods. The work included an in vitro study of the diffusionof alkalinized lidocaine solution through the low-pressure,high-volume cuff of an ETT. We also performed a randomized controlledstudy (n=20 patients in each group) that included a group whoreceived an alkalinized lidocaine-filled ETT cuff with lubricationof the tube using water-soluble gel (Group G), and two controlgroups who received an alkalinized lidocaine-filled cuff withETT lubrication with water (Group W) or an air-filled cuff withETT lubrication with water (Group C). Results. Water-soluble gel lubrication (Group G) produced alower incidence of sore throat during the 24-h post-extubationperiod than lubrication with water alone in the cuffs filledwith alkalinized lidocaine (Group W), and compared with theair control group. The ability of lidocaine to pass throughthe cuff of an ETT when water-soluble gel and/or water alonewas used as a lubricant was similar, as determined by lidocaineplasma concentrations (C_max 45 ng ml^–1). Cough andrestlessness before tracheal extubation were decreased in patientswith the alkalinized lidocaine-filled cuffs compared with theair-filled cuffs. After extubation, nausea, vomiting, dysphoniaand hoarseness were greater for patients with air-filled cuffscompared with the lidocaine-filled cuffs. No significant differencebetween the groups was recorded in arterial blood pressure andheart rate. In vitro data suggest that the lower the NaHCO₃injection volume, the greater the release of lidocaine acrossa low-pressure, high-volume cuff. Conclusions. These data show benefits of using an alkalinizedlidocaine-filled ETT cuff in combination with water-solublegel lubrication in preventing post-intubation sore throat. Br J Anaesth 2004; 92: 361–6     

Lidocaine 10% in the endotracheal tube cuff: blood concentrations, haemodynamic and clinical effects

The purpose of this study was to evaluate the effects (common haemodynamic variables, peak cuff pressures, the incidence of reaction ('bucking') during extubation and the incidence of sore throat after operation) of lidocaine 10% instilled into the endotracheal tube cuff in intubated patients. Plasma concentrations of lidocaine were assayed. Seventy ASA class I-II patients scheduled for plastic surgery were studied. Patients were randomly divided in two groups: the cuff of the endotracheal tube was inflated with either lidocaine 10% (group L) or with saline (group S) immediately after endotracheal intubation. In group L patients, the haemodynamic changes were less (P < 0.05), and the peak cuff pressure was lower (P < 0.01) than for group S. At extubation, more patients reacted ('bucked') in group S (70.5% vs. 19.4%, P < 0.01). The incidence and severity of sore throat were significantly lower in group L 1 and 24-h after extubation. Plasma lidocaine concentrations did not reach toxic values. Lidocaine 10%, compared with saline, in the endotracheal tube cuff was associated with less disturbance of haemodynamic responses and less incidence of bucking during tracheal extubation. Lidocaine was also effective in reducing of incidence and severity of sore throat after operation.     

The effects of lidocaine spray and intracuff alkalinized lidocaine on the occurrence of cough at extubation: a double-blind randomized controlled trial

Purpose

Our study aimed to evaluate the effects of lidocaine sprayed onto the larynx and/or injected into the tracheal tube cuff to decrease the incidence of cough at extubation and postoperative sore throat.

Methods

One hundred twenty women scheduled for gynecological surgery < 120 min in duration were enrolled in this randomized double-blind prospective study. Prior to tracheal intubation, 4% lidocaine or 0.9% saline was sprayed onto the patients’ supra- and subglottic areas. After tracheal intubation, the tracheal tube cuff was filled with either an alkalinized 2% lidocaine solution or 0.9% saline. This resulted in four groups: spray-cuff, spray-saline, saline-cuff, and saline-saline. A logistic regression comprising the two factors was used for analysis. The primary outcome was the incidence of cough at extubation. The secondary outcome was the incidence and severity of sore throat reported by patients at 15 min, 60 min, and 24 hr after tracheal extubation.

Results

Cough occurred in 42%, 24%, 63%, and 69% of patients in the spray-cuff, spray-saline, saline-cuff, and saline-saline groups, respectively. The use of lidocaine spray decreased the incidence of cough at extubation (odds ratio = 0.256; 95% confidence interval 0.118 to 0.554; P < 0.001); however, the use of intracuff alkalinized lidocaine had no impact on the occurrence of cough (P = 0.471). Severity of sore throat was clinically low (visual analog scale [VAS] ≤ 3) in all groups. No significant difference was observed in hoarseness, dysphagia, nausea, or vomiting.

Conclusion

Sprayed lidocaine decreases the incidence of cough at tracheal extubation in surgeries of less than two hours. The use of alkalinized lidocaine into high-volume/low-pressure endotracheal cuffs had no impact on decreasing the incidence of cough or pain.     

Intracuff pressure and tracheal morbidity: influence of filling with saline during nitrous oxide anesthesia.

BACKGROUND: Diffusion of nitrous oxide into the cuff of the endotracheal tube results in an increase in cuff pressure. Excessive endotracheal tube cuff pressure may impair tracheal mucosal perfusion and cause tracheal damage and sore throat. Filling the cuff of the endotracheal tube with saline instead of air prevents the increase in cuff pressure due to nitrous oxide diffusion. This method was used to test whether tracheal morbidity is related to excess in tracheal cuff pressure during balanced anesthesia. METHODS: Fifty patients with American Society of Anesthesiologists physical status I or II were randomly allocated to two groups with endotracheal tube cuffs initially inflated to 20-30 cm H(2)O with either air (group A) or saline (group S). Anesthesia was maintained with isoflurane and nitrous oxide. At the time of extubation, a fiberoptic examination of the trachea was performed by an independent observer, and abnormalities of tracheal mucosa at the level of the cuff contact area were scored. Patients assessed their symptoms (sore throat, dysphagia, and hoarseness) at the time of discharge from the postanesthesia care unit and 24 h after extubation on a 101-point numerical rating scale. RESULTS: Cuff pressure increased gradually during anesthesia in group A but remained stable in group S. The incidence of sore throat was greater in group A than in group S in the postanesthesia care unit (76 vs. 20%) and 24 h after extubation (42 vs. 12%; P < 0.05). Tracheal lesions at time of extubation were seen in all patients of group A and in eight patients (32%) of group S (P < 0.05). CONCLUSION: Excess in endotracheal tube cuff pressure during balanced anesthesia due to nitrous oxide diffusion into this closed gas space causes sore throat that is related to tracheal mucosal erosion.     

Intracuff Pressure and Tracheal Morbidity: Influence of Filling Cuff with Saline during Nitrous Oxide Anesthesia

Background : Diffusion of nitrous oxide into the cuff of the endotracheal tube results in an increase in cuff pressure. Excessive endotracheal tube cuff pressure may impair tracheal mucosal perfusion and cause tracheal damage and sore throat. Filling the cuff of the endotracheal tube with saline instead of air prevents the increase in cuff pressure due to nitrous oxide diffusion. This method was used to test whether tracheal morbidity is related to excess in tracheal cuff pressure during balanced anesthesia.

Methods : Fifty patients with American Society of Anesthesiologists physical status I or II were randomly allocated to two groups with endotracheal tube cuffs initially inflated to 20-30 cm H2O with either air (group A) or saline (group S). Anesthesia was maintained with isoflurane and nitrous oxide. At the time of extubation, a fiberoptic examination of the trachea was performed by an independent observer, and abnormalities of tracheal mucosa at the level of the cuff contact area were scored. Patients assessed their symptoms (sore throat, dysphagia, and hoarseness) at the time of discharge from the postanesthesia care unit and 24 h after extubation on a 101-point numerical rating scale.

Results : Cuff pressure increased gradually during anesthesia in group A but remained stable in group S. The incidence of sore throat was greater in group A than in group S in the postanesthesia care unit (76 vs. 20%) and 24 h after extubation (42 vs. 12%;P < 0.05). Tracheal lesions at time of extubation were seen in all patients of group A and in eight patients (32%) of group S (P < 0.05).     

The effects of intracuff lidocaine on endotracheal-tube-induced emergence phenomena after general anesthesia

Coughing during emergence from general anesthesia is a common clinical problem. We sought to determine whether inflating the endotracheal tube cuff with lidocaine would create a reservoir of local anesthetic, which might diffuse across the cuff membrane to anesthetize the mucosa, thus attenuating stimulation during extubation of the trachea. A total of 63 patients undergoing elective surgery were enrolled in a prospective, randomized, double-blinded study. After intubation of the trachea with an endotracheal tube, the cuff of the tube was inflated with either lidocaine 4%, saline, or air. After extubation, a blinded observer noted heart rate, blood pressure, oxygen saturation, end-tidal isoflurane concentration, and the incidence of coughing. Data were analyzed by using analysis of variance, Student's t-test, and the chi(2) test for multiple variables. The groups were demographically comparable. There was no difference in hemodynamic or oxygen saturation data between either group. The incidence of coughing was decreased in the lidocaine group for the time period of 4-8 min postextubation (P < 0.05). We conclude that inflation of the cuff of the endotracheal tube can reduce the incidence of coughing in the initial postextubation period, a finding that may benefit certain patient groups in which this is particularly desirable. IMPLICATIONS: Tracheal intubation with an endotracheal tube is often necessary during anesthesia. After intubation, inflating a cuff around the endotracheal tube maintains a seal. This can result in coughing during emergence from anesthesia. Our study shows that inflating the cuff of an endotracheal tube with lidocaine rather than air can reduce the incidence of postextubation coughing.     

Postoperative hoarseness and sore throat after tracheal intubation: effect of a low intracuff pressure of endotracheal tube and the usefulness of cuff pressure indicator]

Many clinical reports have described postoperative hoarseness and sore throat after general anesthesia. In most cases, these symptoms were attributed to high pressure of the endotracheal tube cuff. The recommended cuff pressure is less than 25 mmHg, as excessive pressure produces ischemia of the tracheal mucosa. However, within the safe pressure range, postoperative hoarseness and sore throat are still often observed. In this study, one hundred and ninety patients of ASA classes I or II were allocated randomly to two groups, low cuff pressure group (< 15 mmHg) or high cuff pressure group (15-25 mmHg), using continuous monitoring with a cuff pressure gauge. We investigated the incidence of postoperative hoarseness and sore throat at 24 hours after intubation and on the seventh postoperative day. The incidence of postoperative hoarseness and sore throat was significantly decreased in the low pressure group at 24 hours after intubation as compared with the high pressure group, but there was no significant difference between the two groups on the seventh postoperative day. These results suggest that keeping the cuff pressure under 15 mmHg can prevent postoperative hoarseness or sore throat at 24 hours after intubation, and that a cuff pressure gauge is thought to be one of the indispensable monitors during anesthesia.     

The effect of betamethasone gel in reducing sore throat, cough, and hoarseness after laryngo-tracheal intubation

BACKGROUND AND AIMS: Tracheal intubation for general anesthesia often leads to traumatization of the airway mucosa resulting in postoperative sore throat, hoarseness and cough. This study was undertaken to determine the effects of betamethasone gel in reducing these complications. MATERIALS AND METHODS: One hundred patients (ASA I-II) to undergo endotracheal intubation, were randomly divided equally into two groups; 50 Case (Group A). 50 Control (Group B). The tracheal tubes for Case Group A were lubricated with 0.05% betamethasone gel and for the Control Group B with KY gel. Patients were interviewed at end of procedures and 1 and 24 hour after extubation. RESULTS: The incidence and severity of sore throat, hoarseness and cough, 1 and 24 hours postoperatively was reduced significantly in Case Group A. CONCLUSION: Betamethasone gel, when was used for lubrication of endotracheal tubes pre-operatively, was shown to be effective in decreasing postoperative sore throat, hoarseness, and cough.     

预防性使用地塞米松可降低双腔气管导管拔管后咽痛及声嘶发生率

背景：手术后咽痛及声嘶是气管插管，特别是双腔气管导管插管后的主要并发症。我们开展此项前瞻、随机、双盲的安慰剂对照研究，来评价地塞米松用以降低手术后咽痛及声嘶发生率和严重程度的效能。方法本研究选择了166例（18～75岁）使用双腔气管导管插管的胸外科手术患者。在全麻诱导之前，以双盲、前瞻性的随机方法分为地塞米松（静脉给予）0．1mg／kg组（D1组）、0．2mg／kg组（D2组）和安慰剂组（P组）。分别记录Cormack—Lehane评分的声门暴露度、双腔管插管阻力、尝试插管次数、完成插管时间以及插管维持时间。在拔管后1及24小时，利用视觉模拟评分（VAS，0=没有疼痛；100=可以想象的最剧烈疼痛）来评价咽痛及声嘶程度。结果拔管1小时后，咽痛、声嘶发生率及咽痛程度与P组（53％，36％，VAS30．9）相比，D1组（31％，P=0．021；11％，P=0．003；VAS12．4，P〈0．001）与D2组（11％，P=0．001；4％，P=0．001；VAS6．6，P〈0．001）均低。拔管24小时后，D2组（27％，P=0．002；15％，P=0．001；VAS29．9，P〈0．002）咽痛、声嘶发生率及咽痛程度显著低于D1组（47％，31％，VAS43．9）及P组（57％，45％，VAS51．3）。同时未发现与注射地塞米松相关的并发症的发生。结论预防性使用0．2mg／kg地塞米松能显著降低双腔气管导管拔管后１及24小时咽痛、声嘶发生率及严重程度。     

快通道胃肠手术后咽部并发症处理方法的比较

目的探讨一种有效防治快通道胃肠道手术后咽部并发症的处理方法,以更好满足临床和患者的要求。 方法采用前瞻性、随机、双盲的研究方法,选择本院拟在全麻下行开腹胃肠道手术者280例,随机分为4组,各70例,A组（对照组）,气管导管用医用石蜡油润滑;B组,气管导管用丁卡因胶浆润滑;C组,气管导管用丁卡因胶浆润滑+插管后静注地塞米松10 mg;D组,C组基础上加静注帕瑞昔布钠40 mg。记录并比较各组麻醉拔管后10 min、30 min、1 h、6 h、12 h、24 h时的术后咽喉痛（POST）发生率及严重程度,观察在PACU期间1 h内的吸痰例数。 结果拔管后10 min观察点同期比较,B、C、D组POST发生率低于A组（P<0.05）;30 min观察点同期比较,B、C、D组POST发生率低于A组（P<0.05）,D组分别低于B、C组（P<0.05）;1 h观察点同期比较,B、C、D组POST发生率低于A组（P<0.05）,D组分别低于B、C组（P<0.05）;6 h观察点同期比较,D组POST发生率低于A组（P<0.05）;12 h、24 h观察点组间POST发生率差异无统计学意义。在PACU观察期间的吸痰人数,C、D组发生率低于A、B组（P<0.05）;A、B组之间,C、D组间发生率差异无统计学意义。 结论气管导管润滑复合静脉用药的多模式处理可有效防止POST,复合静注激素可有效减少拔管后气道分泌物。     

Controlled comparison between betamethasone gel and lidocaine jelly applied over tracheal tube to reduce postoperative sore throat, cough, and hoarseness of voice

BACKGROUND: Postoperative sore throat, cough, and hoarseness of voice though minor sequelae after general tracheal anaesthesia can be distressing to the patient. METHODS: This prospective, randomized, double blind, controlled study compares the incidence of postoperative sore throat, cough, and hoarseness of voice after general tracheal anaesthesia when applying betamethasone gel (betamethasone group) or lidocaine jelly (lidocaine group) on the tracheal tube. One hundred and fifty ASA class I and II patients undergoing elective surgeries under general orotracheal anaesthesia were randomized into three groups: betamethasone gel, lidocaine jelly, and control groups. In the post-anaesthesia care unit, a blinded anaesthesiologist interviewed all patients on postoperative sore throat, cough, and hoarseness of voice at 1, 6, 12, and 24 h after operation. RESULTS: In the first 24 h after surgery, the incidence of postoperative sore throat was 40, 100, and 100%; cough was 6, 40, and 28%; and hoarseness of voice was 4.1, 32.9, and 50%, for the betamethasone, lidocaine and control groups, respectively. The incidence of postoperative sore throat, cough, and hoarseness of voice was significantly lower in the betamethasone group compared with the other two groups (P<0.05). CONCLUSIONS: A wide spread application of betamethasone gel on the tracheal tube decreases the incidence and severity of postoperative sore throat, cough, and hoarseness of voice.     

Does sealing endotracheal tube cuff pressure diminish the frequency of postoperative laryngotracheal complaints after nitrous oxide anesthesia?

STUDY OBJECTIVES: To study endotracheal tube (ETT) cuff pressures during nitrous oxide (N2O) anesthesia when the cuffs are inflated with air to achieve sealing pressure, and to evaluate the frequency of postoperative laryngotracheal complaints. DESIGN: Prospective, randomized, blind study. SETTING: Metropolitan teaching hospital. PATIENTS: 50 ASA physical status I and II patients scheduled for elective abdominal surgery. INTERVENTIONS: Patients received standard general anesthesia with 66% N2O in oxygen. In 25 patients, the ETT cuff was inflated with air to achieve a sealing pressure (Pseal group). In 25 patients, the ETT cuff was inflated with air to achieve a pressure of 25 cm H2O (P25 group). MEASUREMENTS AND MAIN RESULTS: ETT intracuff pressures were recorded before (control) and at 30, 60, 90, 120, and 150 minutes during N2O administration. We investigated the frequency and intensity of sore throat, hoarseness, and dysphagia in patients in the Post-Anesthesia Care Unit (PACU) and 24 hours following tracheal extubation. The cuff pressures in the Pseal group were significantly lower than in the P25 group at all time points studied (p < 0.001), with a significant increase with time in both groups (p < 0.001). The cuff pressures exceeded the critical pressure of 30 cm H2O only after 90 minutes in the Pseal group and already by 30 minutes in the P25 group. The frequency and intensity of sore throat, hoarseness, and dysphagia were similar in both groups in the PACU and 24 hours after tracheal extubation (p > 0.05). CONCLUSIONS: Minimum ETT sealing cuff pressure during N2O anesthesia did not prevent, but instead attenuated, the increase in cuff pressure and did not decrease postoperative laryngotracheal complaints.     

Quality improvement in anesthetic practice--incidence of sore throat after using small tracheal tube

BACKGROUND AND OBJECTIVE: Sore throat following surgery is common and is due to multitude of factors. The highest incidence of sore throat tends to occur in patients who have undergone tracheal intubation. Between 14.4% to 50% of intubated patients complain of sore throat and hoarseness in the immediate postoperative period, 3% of them are still hoarse after a week. This contributes to higher incidence of postoperative morbidity and patient dissatisfaction of the service. A prospective study was conducted to demonstrate the incidence of hoarseness and sore throat following the use of small tracheal tubes. METHODS: Adult patients, 16 years old and above, presented for tonsillectomy, nasal surgery and/or for functional endoscopic sinus surgery (FESS) were included in the study. Patients who had signs of, common cold were excluded from the study. Size 7-7.5 mm cuffed tracheal tube was used in males and size 6-6.5 mm in females. Patients were asked during 24 hours postoperatively about the presence of hoarseness of voice and of their satisfaction of the service. RESULTS: There were 1618 patients 883 males and 735 females, ages: 16-62 yrs included in the study between February 2000 and end of May 2003. 189 (11.7%) developed postoperative hoarseness of voice and 1429 (88.3%) did not have hoarseness or sore throat (P = 0.0001). Patient satisfaction was 95%. CONCLUSIONS: The use of small tube in intubating the trachea, together with other measures such as lubricating the tube with water soluble jelly, careful airway instrumentation, intubation only when patient was fully relaxed, careful suctioning technique, and extubation when the tracheal tube cuff was fully deflated, have dramatic effects on minimizing the incidence of postoperative hoarseness and sore throat. Accordingly, patient satisfaction has been reported to be high.     

Comparação de alterações na pressão do balonete do tubo endotraqueal usando ar versus óxido nitroso nos gases anestésicos durante cirurgias abdominais laparoscópicas

Background and objectives

The purpose of this study was to compare the endotracheal tube cuff pressure changes during laparoscopic surgeries using air versus nitrous‐oxide in anesthetic gas mixture; and to observe the incidences of postoperative sore throat, hoarseness and dysphagia.

The effect of different lidocaine application methods on postoperative cough and sore throat

STUDY OBJECTIVE: To evaluate the efficacy of various ways of lidocaine application in reducing postoperative cough and sore throat. DESIGN: Double-blind, randomized study. SETTING: University-affiliated hospital. PATIENTS: 204 ASA physical status I and II patients scheduled for cataract surgery with general anesthesia. INTERVENTIONS: Patients were randomized to six groups (G1, G2, G3, G4, G5, and G6), according to lidocaine application method. Before endotracheal intubation, in the G1 and G2 groups, 10% lidocaine was sprayed on the distal end of the endotracheal tubes (ETTs; G1) and laryngopharyngeal structures (G2). In the G3 group, the distal ends of the ETTs were lubricated with 2% lidocaine jelly. Intravenous (IV) lidocaine was administered to the G4 group at the conclusion of surgery. Intracuff lidocaine was used in the G5 group; in the G6 group, the terminal end of the ETTs were lubricated with normal saline. MEASUREMENTS: At the end of surgery and after extubation, patients were observed to record the number of coughs. At 1 hour and at 24 hours following extubation, sore throat was evaluated. MAIN RESULTS: In the recovery room, 64.4% of the patients experienced cough, with greatest frequency in the G3, G6, and G2 groups, and the least in the G5 and G4 groups. The frequency of sore throat was significantly different among the six groups at 1 hour and at 24 hours, with greater frequency in the G3, G2, and G6 groups. CONCLUSIONS: Using lidocaine to inflate the ETT cuff or IV lidocaine at the end of surgery decreases the frequency of postoperative cough and sore throat and would provide better outcome for patients and the physician.     

Alkalinization of intra-cuff lidocaine and use of gel lubrication protect against tube-induced emergence phenomena

Editor—I read Dr Estebe and colleagues' article with interest.¹They describe using lidocaine 2% 2 ml, alkalinized with sodiumbicarbonate 8.4% to a total volume of 4.5 ml, to fill high-volumelow-pressure tracheal tube cuffs. The aim was to increase lidocainediffusion across the cuff, and to reduce sore throat and otherintubation sequelae. It seemed to work well. Because sodium bicarbonate 8.4% is strongly hypertonic² and     

Effect of additives in lidocaine spray on postoperative sore throat, hoarseness and dysphagia after total intravenous anaesthesia

BACKGROUND: Laryngo-tracheal lidocaine spray before intubation is associated with an increased risk of postoperative throat problems. Our study investigated the effect of additives contained in lidocaine spray on postoperative sore throat, hoarseness and dysphagia. METHODS: We compared the incidence and severity of postoperative throat complications after laryngo-tracheal application of lidocaine spray (40 mg), lidocaine (40 mg) or normal saline as placebo during laryngoscopy with total intravenous anaesthesia in 122 ASA I-III patients aged 15-87 years in a double-blinded, placebo-controlled study. The incidence and severity of postoperative sore throat, hoarseness and dysphagia were evaluated on the day of and the day after surgery. RESULTS: Sore throat and dysphagia were significantly more severe after lidocaine spray was used than after lidocaine or placebo was used. However, there was no significant difference in the incidence or severity of postoperative sore throat, hoarseness or dysphagia between the lidocaine group and the placebo group throughout the study. CONCLUSION: These results suggest that additives in lidocaine spray, not lidocaine itself, contribute to the increase in postoperative throat problems. Therefore, lidocaine spray should be avoided to prevent these unnecessary complications. Our findings also confirm that laryngo-tracheal lidocaine application does not prevent sore throat, hoarseness or dysphagia after total intravenous anaesthesia.     

控制气管导管套囊压力对全麻手术患者气管插管相关性并发症的影响:前瞻性、多中心、随机、双盲研究

目的 探讨控制气管导管套囊压力对全麻手术患者气管插管相关性并发症的影响.方法 本研究为前瞻性、多中心、随机、双盲研究.择期拟行全麻手术患者509例,ASA分级Ⅰ或Ⅱ级,年龄11～89岁,体重35～92kg,性别不限,随机分为2组:对照组(C组)和套囊压力测定组(CPM组),记录手术时间和带管时间.各组随机选取20例带管时间120～180 min的患者,于拔除气管导管时行纤维支气管镜检查.拔除气管导管后24 h内随访咳嗽及痰中带血等气管插管相关性并发症的发生情况.结果 两组患者年龄、性别构成比、手术时间及带管时间差异无统计学意义(P＞0.05).与C组比较,CPM组患者咽喉痛及痰中带血的发生率降低(P＜0.05);随带管时间延长,C组咽喉痛及痰中带血的发生率均升高,CPM组仅咽喉痛的发生率升高(P＜0.01).纤维支气管镜检查可见气管粘膜不同程度损伤,C组较CPM组严重.结论 控制气管导管套囊压力有助于减少全麻手术患者术后气管插管相关性并发症的发生.     

Sore throat after endotracheal intubation.

Nitrous oxide can diffuse into the cuff of an endotracheal tube during tracheal intubation, and the cuff pressure against the tracheal wall may cause mucosal damage. An endotracheal tube has been developed (Brandt Anesthesia Tube) that effectively limits nitrous oxide-related intracuff pressure increases. We determined whether the incidence of postoperative sore throat could be reduced by using this tube. Forty-eight female patients, 18-50 yr of age, were included in the study. Endotracheal intubation was performed with either a Brandt Anesthesia Tube or a Mallinckrodt endotracheal tube. All patients were interviewed postoperatively after 20-30 h by individuals who did not know which tube was used. In the Mallinckrodt group, 12 of 20 patients had a sore throat and 10 patients had intracuff pressures greater than 25 mm Hg. Only 3 of 20 patients in the Brandt group had a sore throat. We found that the incidence of sore throats after intubation could be significantly reduced by using the Brandt Anesthesia Tube (P less than 0.005).