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GENERAL ARTICLES

Alkalinization of Intracuff Lidocaine Improves Endotracheal Tube-Induced Emergence Phenomena

Jean-Pierre Estebe, MD^*, Gilles Dollo, PharmD PhD, Pascal Le Corre, PharmD PhD, Alain Le Naoures, MD^*, François Chevanne, BS, Roger Le Verge, PharmD PhD, and Claude Ecoffey, MD^*

*Service d’Anesthésie Réanimation Chirurgicale 2 and Laboratoire de Pharmacie Galénique et Biopharmacie, Université de Rennes, Rennes, France

Address correspondence and reprint requests to Jean-Pierre Estebe, MD, 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

We sought to evaluate the effect of filling an endotracheal tube cuff with 40 mg lidocaine alone (Group L) or alkalinized lidocaine (Group LB) in comparison to an Air Control group (Group C) on adverse emergence phenomena in a randomized controlled study (n = 25 in each group). The incidence of sore throat was decreased for Group LB in comparison to Group L during the 24 postextubation hours. The difference between Group L and Group C remained significant in the two postextubation hours only. Plasma lidocaine levels increased when lidocaine was alkalinized (C_max were 62.5 ± 34.0 ng/mL and 3.2 ± 1.0 ng/mL for Groups LB and L, respectively). Cough and restlessness before tracheal extubation were decreased in Group LB compared with Group L and in Group L compared with Group C. Nausea, postoperative vomiting, dysphonia, and hoarseness were increased after extubation in Group C compared with the liquid groups, and a better tolerance was recorded with Group LB compared with Group L. The increase of arterial blood pressure and cardiac frequencies during the extubation period was less in the liquid groups than in the control group and less in Group LB compared with Group L. We concluded that use of intracuff alkalinized lidocaine is an effective adjunct to endotracheal intubation.

IMPLICATIONS: Use of 40 mg of alkalinized lidocaine, rather than lidocaine or air, to fill the endotracheal tube cuff reduces the incidence of sore throat in the postoperative period. This approach also decreases hemodynamic effects, restlessness, dysphonia, and hoarseness.

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