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GENERAL ARTICLES

Alkalinization of Intracuff Lidocaine: Efficacy and Safety

Jean-Pierre Estebe, MD, PhD^*, Marc Gentili, MD, PhD^*, Pascal Le Corre, PharmD, PhD, Gilles Dollo, PharmD, PhD, François Chevanne, BSc, and Claude Ecoffey, MD^*

*Service d’Anesthésie Réanimation Chirurgicale 2; Laboratoire de Biopharmacie, UPRES EA 3892, Université Rennes 1, Polyclinique Saint Vincent, Rennes, France

Address correspondence and reprint requests to Jean-Pierre Estebe, MD, PhD, Service d’Anesthésie Réanimation Chirurgicale 2, Hôpital Hôtel Dieu: 2 rue de l’Hôtel Dieu, 35000, Rennes, France. Address e-mail to jean-pierre.estebe{at}chu-rennes.fr.

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.

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