Intracuff lidocaine improves endotracheal tube induced emergence phenomena in patients with hyperactive air way

ABSTRACT

Thirty adult patients of both sexes with hyperactive airway, scheduled for elective surgery more than one hour duration, were assigned to inflate the cuff of an endotracheal tube with 2.5 ml [50 mg] lidocaine hydrochloride to improve the endotracheal tube induced emergence phenomena. Patients were anaesthetized according to a standard protocol. There was insignificant change in heart rate and mean arterial blood pressure at extubation compared with that before induction. The incidence of coughing was 20% from 0-4 min. and 12% from 4-8 min., with no reported coughing at 25-60 min post extubation. There was no significant difference between the initial volume of air injected into the cuff and that removed from it. There was also, no lidocaine removed from the cuff. The mean extubation and spontaneous ventilation time were prolonged. The incidence of bucking and hoarsness at extubation were 5.7% and 6.7% respectively. Patients experienced neither restlessness before extubation nor dysphonia or postoperative nausea and vomiting after extubation. The visual analog scale for post operative sore throat showed significant reduction throughout the whole study periods. In conclusion, the use of intracuff lidocaine hydrochloride 2% is a relatively easy and safe practice with minimal stress response at extubation. It decreases coughing, bucking and sore throat, thus promoting smooth emergence from general anaesthesia in those patients in whom tracheal stimulation may be undesirable