Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine
a randomized clinical trial
Keywords:
Intratracheal intubation, Cough, Pharyngitis, Hoarseness, LidocaineAbstract
CONTEXT AND OBJECTIVE: High intracuff pressure in endotracheal tubes (ETs) may cause tracheal lesions. The aim of this study was to evaluate the effectiveness and safety of endotracheal tube cuffs filled with air or with alkalinized lidocaine. DESIGN AND SETTING: This was a prospective clinical study at the Department of Anesthesio- logy, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS: Among 50 patients, ET cuff pressures were recorded before, 30, 60, 90 and 120 minutes after starting and upon ending nitrous oxide anesthesia. The patients were randomly allocated to two groups: Air, with ET cuff inflated with air to attain a cuff pressure of 20 cmH2O; and Lido, with ET cuff filled with 2% lidocaine plus 8.4% sodium bicarbonate to attain the same pressure. ET discomfort before tracheal extuba- tion, and sore throat, hoarseness and coughing incidence were studied at the time of discharge from the post-anesthesia care unit, and sore throat and hoarseness were studied 24 hours after anesthesia. RESULTS: Pressures in Lido cuffs were significantly lower than in Air cuffs (p < 0.05). Tracheal complaints were similar for the two groups, except for lower ET discomfort and sore throat incidence after 24 hours and lower systolic arte- rial pressure at the time of extubation in the Lido group (p < 0.05). CONCLUSION: ET cuffs filled with alkalinized lidocaine prevented the occurrence of high cuff pressures during N2O anesthesia and reduced ET discomfort and postoperative sore throat incidence. Thus, alkalinized lidocaine-filled ET cuffs seem to be safer than conventional air- filled ET cuffs.
Downloads
References
Klainer AS, Turndorf H, Wu HW, Maewal H, Allender P. Surface alterations due to endotracheal intubation. Am J Med. 1975;58(5):674-83.
Combes X, Schauvliege F, Peyrouset O, et al. Intracuff pressure and tracheal morbidity: influence of filling with saline during nitrous oxide anesthesia. Anesthesiology. 2001;95(5):1120-4.
Martins RHG, Braz JRC, Bretan O, Figueiredo PR, Defaveri
J. Lesões precoces da intubação endotraqueal. [Early injuries of the endotracheal intubation]. Rev Bras Otorrinolaringol. 1995;61(5):343-8.
Berlauk JF. Prolongeal endotracheal intubation vs. tracheostomy. Crit Care Med. 1986;14(8):742-5.
Stauffer JL, Olson DE, Petty TL. Complications and con- sequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med. 1981;70(1):65-76.
Nordin U. The trachea and cuff-induced tracheal injury. An experimental study on causative factors and prevention. Acta Otolaryngol Suppl. 1977;345:1-71.
Stanley TH, Kawamura R, Graves C. Effects of nitrous oxide on volume and pressure of endotracheal tube cuffs. Anesthesiology. 1974;41(3):256-62.
Beebe DS. Complications of tracheal intubation. Semin Anesth Perioperat Med Pain. 2001;20:166-72.
Sconzo JM, Moscicki JC, DiFazio CA. In vitro diffusion of lidocaine across endotracheal tube cuffs. Reg Anesth. 1990;15(1):37-40.
Huang CJ, Tsai MC, Chen CT, Cheng CR, Wu KH, Wei TT. In vitro diffusion of lidocaine across endotracheal tube cuffs. Can J Anaesth. 1999;46(1):82-6.
Navarro RM, Baughman VL. Lidocaine in the endotracheal tube cuff reduces postoperative sore throat. J Clin Anesth. 1997;9(5):394-7.
Hirota W, Kobayashi W, Igarashi K, et al. Lidocaine added to a tracheostomy tube cuff reduces tube discomfort. Can J Anaesth. 2000;47(5):412-4.
Huang CJ, Hsu YW, Chen CC, et al. Prevention of coughing induced by endotracheal tube during emergence from general anesthesia--a comparison between three different regimens of lidocaine filled in the endotracheal tube cuff. Acta Anaesthesiol Sin. 1998;36(2):81-6.
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(1):201-5.
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;17(7):436-42.
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(3):319-23.
Estebe JP, Dollo G, Le Corre P, et al. Alkalinization of intracuff lidocaine improves endotracheal tube-induced emergence phe- nomena. Anesth Analg. 2002;94(1):227-30.
Soltani HA, Aghadavoudi O. The effect of different lidocaine application methods on postoperative cough and sore throat. J Clin Anesth. 2002;14(1):15-8.
Braz JR, Navarro LH, Takata IH, Nascimento Júnior P. En- dotracheal tube cuff pressure: need for precise measurement. Sao Paulo Med J. 1999;117(6):243-7.
Medalha S, Oliveira LC, Godoy I. Avaliação da pressão no balonete das cânulas endotraqueais e de traqueostomia em pacientes na Unidade de Terapia Intensiva. Rev Bras Terap Intensiva. 1999;11:90-3.
Spittle CSN, Beavis SE. Do you measure cuff pressure? A survey of clinical practice. Br J Anaesth. 2001;87:344-5.
Vyas D, Inweregbu K, Pittard A. Measurement of tracheal tube cuff pressure in critical care. Anaesthesia. 2002;57(3):275-7.
Fernandez R, Blanch L, Mancebo J, Bonsoms N, Artigas A. Endotracheal tube cuff pressure assessment: pitfalls of finger estimation and need for objective measurement. Crit Care Med. 1990;18(12):1423-6.
Brandt L. Prevention of nitrous oxide-induced increases in endotracheal tube cuff pressure. Anesth Analg. 1991;72(2):262- 3.
Karasawa F, Okuda T, Mori T, Oshima T. Maintenance of stable cuff pressure in the Brandt tracheal tube during anaesthesia with nitrous oxide. Br J Anaesth. 2002;89(2):271-6.
Navarro LHC, Braz JRC, Pletsch AK, Amorim RB, Módolo NSP. Estudo comparativo das pressões dos balonetes de tubos traqueais contendo ou não válvula reguladora de pressão de Lanz. [Comparative study of tracheal tube pressures with or without Lanz pressure regulation system]. Rev Bras Anestesiol. 2001;51(1):17-27.
Karasawa F, Mori T, Kawatani Y, Ohshima T, Satoh T. Deflation- ary phenomenon of the nitrous oxide-filled endotracheal tube cuff after cessation of nitrous oxide administration. Anesth Analg. 2001;92(1):145-8.
Fujikawa M, Mizoguchi H, Kawamura J, et al. A new endotra- cheal tube with a cuff impervious to nitrous oxide: constancy of cuff pressure and volume. Anesth Analg. 1995;81(5):1084-6.
Jensen PJ, Hommelgaard P, Sondergaard P, Eriksen S. Sore throat after operation: influence of tracheal intubation, intracuff pressure and type of cuff. Br J Anaesth. 1982;54(4):453-7.
Walmsley AJ, Burville LM, Davis TP. Cuff failure in polyvinyl chloride tracheal tubes sprayed with lignocaine. Anaesthesia. 1988;43(5):399-401.
Estebe JP, Delahaye S, Le Corre P, et al. Alkalinization of intra-cuff lidocaine and use of gel lubrication protect against tracheal tube-induced emergence phenomena. Br J Anaesth. 2004;92(3):361-6.
Bennett MH, Isert PR, Cumming RG. Postoperative sore throat and hoarseness following tracheal intubation using air or saline to inflate the cuff--a randomized controlled trial. Anaesth Intensive Care. 2000;28(4):408-13.
Tu HN, Saidi N, Leiutaud T, Bensaid S, Menival V, Duvaldestin
P. Nitrous oxide increases endotracheal cuff pressure and the incidence of tracheal lesions in anesthetized patients. Anesth Analg. 1999;89(1):187-90.
Mehta S, Myat HM. The cross-sectional shape and cir- cumference of the human trachea. Ann R Coll Surg Engl. 1984;66(5):356-8.
Tonnesen AS, Vereen L, Arens JF. Endotracheal tube cuff residual volume and lateral wall pressure in a model trachea. Anesthesiology. 1981;55(6):680-3.
Mandoe H, Nikolajsen L, Lintrup U, Jepsen D, Molgaard J. Sore throat after endotracheal intubation. Anesth Analg. 1992;74(6):897-900.
Suzuki N, Kooguchi K, Mizobe T, Hirose M, Takano Y, Tanaka Y. [Postoperative hoarseness and sore throat after tracheal intubation: effect of a low intracuff pressure of endotra- cheal tube and the usefulness of cuff pressure indicator]. Masui. 1999;48(10):1091-5.
Yukioka H, Yoshimoto N, Nishimura K, Fujimori M. Intra- venous lidocaine as a suppressant of coughing during tracheal intubation. Anesth Analg. 1985;64(12):1189-92.
Gonzalez RM, Bjerke RJ, Drobycki T, et al. Prevention of endotracheal tube-induced coughing during emergence from general anesthesia. Anesth Analg. 1994;79(4):792-5.
DiFazio CA, Neiderlehner JR, Burney RG. The anesthetic potency of lidocaine in the rat. Anesth Analg. 1976;55(6):818-21.
