Abstract
BackgroundPostoperative sore throat and other airway morbidities are common and troublesome after endotracheal tube intubation general anesthesia (ETGA). We propose lidocaine as endotracheal tube (ETT) cuff inflation media to reduce the postintubation-related emergence phenomenon.MethodsWe searched PubMed, EMBASE, and Cochrane databases systematically for randomized controlled trials (RCTs) that have investigated the outcome of intracuff lidocaine versus air or saline in patients receiving ETGA. Using a random-effects model, we conducted a meta-analysis to assess the relative risks (RRs) and mean difference (MD) of the incidence and intensity of relevant adverse outcomes.ResultsWe reviewed nineteen trials, which comprised 1566 patients. The incidence of early- and late-phase postoperative sore throat (POST), coughing, agitation, hoarseness, and dysphonia decreased significantly in lidocaine groups, with RRs of 0.46 (95% confidence interval [CI]: 0.31 to 0.68), 0.41 (95% CI: 0.25 to 0.66), 0.43 (95% CI: 0.31 to 0.62), 0.37 (95% CI: 0.25 to 0.55), 0.43 (95% CI: 0.29 to 0.63), and 0.19 (95% CI: 0.08 to 0.5), respectively, when compared with the control groups. The severity of POST also reduced significantly (mean difference [MD] -16.43 mm, 95% CI: -21.48 to -11.38) at 1 h and (MD -10.22 mm, 95% CI: -13.5 to -6.94) at 24 h. Both alkalinized and non-alkalinized lidocaine in the subgroup analyses showed significant benefits in emergence phenomena prevention compared with the control.ConclusionOur results indicate that both alkalinized and non-alkalinized intracuff lidocaine may prevent and alleviate POST and postintubation-related emergence phenomena.
Highlights
The postintubation-related emergence phenomenon is a cluster of airway complications associated with tracheal intubation or extubation after general anesthesia
Intracuff Lidocaine for Emergence Phenomenon dysphonia decreased significantly in lidocaine groups, with relative risks (RRs) of 0.46 (95% confidence interval [CI]: 0.31 to 0.68), 0.41, 0.43, 0.37, 0.43, and 0.19, respectively, when compared with the control groups
The severity of Postoperative sore throat (POST) reduced significantly at 1 h and (MD -10.22 mm, 95% CI: -13.5 to -6.94) at 24 h
Summary
The postintubation-related emergence phenomenon is a cluster of airway complications associated with tracheal intubation or extubation after general anesthesia. During emergence from general anesthesia, patients may experience vigorous coughing, agitation or restlessness which might increase intracranial, intra-thoracic or intra-abdominal pressure, resulting in bronchospasm, wound dehiscence, and bleeding [7,8,9]. Other laryngeal complication such as hoarseness, dysphonia, or dysphagia was noted during the postoperative care [10,11,12]. We propose lidocaine as endotracheal tube (ETT) cuff inflation media to reduce the postintubation-related emergence phenomenon
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