Abstract
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. This was a prospective clinical study at the Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. 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 extubation, 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. 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 arterial pressure at the time of extubation in the Lido group (p < 0.05). 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.
Highlights
Endotracheal tubes (ETs) allow pressure to be maintained in the airways during the inhalation phase of artificial breathing and prevent exhalation of regurgitated gastroesophageal contents
The anthropometric and respiratory characteristics were similar in the two groups (p > 0.05), for example the duration of anesthesia and the time between stopping the use of anesthetic gases and extubation of the patient (p > 0.05)
The time for which patients remained in spontaneous respiration before fulfilling the parameters for extubation was considerably longer in the Air group (p = 0.047) (Table 1)
Summary
Endotracheal tubes (ETs) allow pressure to be maintained in the airways during the inhalation phase of artificial breathing and prevent exhalation of regurgitated gastroesophageal contents. The pressure of the ET cuff is transmitted to the tracheal mucosa. Nitrous oxide (N2O), a gaseous anesthetic used in daily anesthetic practice, diffuses inside ET cuffs, thereby raising their pressure.[2,7] Overinflation of the cuff and the consequent tracheal mucosa lesions result in sore throats, hoarseness and coughing, causing discomfort to patients after the removal of the intubation.[2,8]
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