Post-operative sore throat: effect of lignocaine jelly and spray with endotracheal intubation. Lidocaine in the endotracheal tube cuff reduces postoperative sore throat. Alkalinization of intracuff lidocaine improves endotracheal tube-induced emergence phenomena. Prophylactic laryngo-tracheal aerosolized lidocaine against postoperative sore throat. Alkalinization of intra-cuff lidocaine and use of gel lubrication protect against tracheal tube-induced emergence phenomena. Alkalinization of intracuff lidocaine: efficacy and safety. Postoperative sore throat: effect of lidocaine jelly and pomade on endotracheal intubation. Effect of additives in lidocaine spray on postoperative sore throat, hoarseness and dysphagia after total intravenous anaesthesia. Lidocaine 10% in the endotracheal tube cuff: blood concentrations, haemodynamic and clinical effects. Pressure and volume changes of tracheal tube cuff following inflation with various inflating agents during nitrous oxide anesthesia. Effects of intravenous lidocaine prior to intubation on postoperative airway symptoms. Postoperative sore throat: incidence and severity after the use of lidocaine, saline, or air to inflate the endotracheal tube cuff. Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: a randomized clinical trial. The effect of different lidocaine application methods on postoperative cough and sore throat.
The effects of laryngeal lignocaine spray and/or lignocaine jelly as lubricants were studied on the incidence of sore throat, hoarseness, or tracheal irritability as evidenced by either a tendency to cough or frank coughing after intubation with a Sensiv tube (Searle Medical Products). Pressure in the medium-volume, low-pressure cuff was controlled and kept below 2.5 kPa (25 cmH2O) during anaesthesia. The side-effects of 94 surgical patients were recorded in a double-blind manner in the recovery room and on the first post-operative day. The lowest number of patients (62%) with side-effects was found in the control group and the greatest (95%) after the combination of lignocaine jelly and spray (P less than 0.05). The number of side-effects after lignocaine jelly alone was 85% and after the spray alone 68%. Women were more prone to have side-effects, especially sore throat and hoarseness, than men (P less than 0.05). Induced hypotension did not increase the incidence of side-effects. Endotracheal cuff pressures were also studied in 114 patients during N2O-O2 anaesthesia and in 54 patients after the replacement of N2O with nitrogen. The minimum occluding pressure required was 1 kPa (10 cmH2O). In 42% of the patients receiving N2O a limiting value of 2.5 kPa (25 cmH2O) was reached during anesthesia in a mean time of 74 min (range 25-180 min). After the replacement of N2O with nitrogen, the cuff pressure decreased from 1.8 kPa (18 cmH2O) to 0.7 kPa (7 cmH2O) over 40 min. It is concluded that lignocaine jelly with the use of a spray significantly increases post-operative side-effects. To test the hypothesis that continuous application of local anesthesia at the contact area between the endotracheal tube cuff and trachea would reduce both the incidence and severity of postoperative sore throat by blocking the tracheal pain receptors with local anesthetic delivered via endotracheal tube (ETT) cuff.
                Double-blind randomized study.
                University affiliate hospital.
                106 ASA physical status I and II patients.
                Patients' ETT cuffs were inflated with either air or lidocaine. The cuffs of the lidocaine group were prefilled with lidocaine for 90 minutes prior to intubation to saturate the cuff membrane. One hour and 24 hours following extubation, patients were asked about the presence and severity of postoperative sore throat.
                There was no difference between groups in demographics or anesthetic management. The incidence of sore throat was significantly different at the 24-hour evaluation (59% air vs. 32% lidocaine, p = 0.01). Severity of sore throat was significantly worse with air at both evaluation periods (1 hour = 18.7 +/- 27.0 air vs. 7.90 +/- 18.1 lidocaine, p = 0.02; 24 hours = 25.6 +/- 27.5 air vs. 14.5 +/- 24.8 lidocaine, p = 0.03).
                Using lidocaine to inflate the ETT cuff decreases the severity of postoperative sore throat at one hour, and both the incidence and severity at 24 hours. 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.
                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. A randomized, double-blind study was carried out on 193 ASA I-II surgical patients to assess the effect of aerosolized lidocaine on sore throat, hoarseness and cough in connection with tracheal intubation. The study group received aerosolized lidocaine 100 mg 2 min before tracheal intubation, using a spray. The control group received no spray. The patients underwent a standardized general anaesthesia. The patients were interviewed when leaving the recovery room and the next day in the ward. Specific questions were asked regarding sore throat, cough and hoarseness. There were no significant differences between the two groups, which suggests that topical anaesthesia of the mucosa of the upper airway is ineffective as a means of ameliorating airway complaints in connection with tracheal intubation. We sought to determine the benefits of using alkalinized lidocaine 40 mg to fill the cuff of a tracheal tube (ETT) in combination with water-soluble gel lubrication to prevent post-intubation sore throat.
                The work included an in vitro study of the diffusion of alkalinized lidocaine solution through the low-pressure, high-volume cuff of an ETT. We also performed a randomized controlled study (n=20 patients in each group) that included a group who received an alkalinized lidocaine-filled ETT cuff with lubrication of the tube using water-soluble gel (Group G), and two control groups who received an alkalinized lidocaine-filled cuff with ETT lubrication with water (Group W) or an air-filled cuff with ETT lubrication with water (Group C).
                Water-soluble gel lubrication (Group G) produced a lower incidence of sore throat during the 24-h post-extubation period than lubrication with water alone in the cuffs filled with alkalinized lidocaine (Group W), and compared with the air control group. The ability of lidocaine to pass through the cuff of an ETT when water-soluble gel and/or water alone was used as a lubricant was similar, as determined by lidocaine plasma concentrations (C(max) 45 ng x ml(-1)). Cough and restlessness before tracheal extubation were decreased in patients with the alkalinized lidocaine-filled cuffs compared with the air-filled cuffs. After extubation, nausea, vomiting, dysphonia and hoarseness were greater for patients with air-filled cuffs compared with the lidocaine-filled cuffs. No significant difference between the groups was recorded in arterial blood pressure and heart rate. In vitro data suggest that the lower the NaHCO(3) injection volume, the greater the release of lidocaine across a low-pressure, high-volume cuff.
                These data show benefits of using an alkalinized lidocaine-filled ETT cuff in combination with water-soluble gel lubrication in preventing post-intubation sore throat. 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. nan Laryngo-tracheal lidocaine spray before intubation is associated with an increased risk of postoperative throat problems. Our study investigated the effect of additives contained in lidocaine spray on postoperative sore throat, hoarseness and dysphagia.
                We compared the incidence and severity of postoperative throat complications after laryngo-tracheal application of lidocaine spray (40 mg), lidocaine (40 mg) or normal saline as placebo during laryngoscopy with total intravenous anaesthesia in 122 ASA I-III patients aged 15-87 years in a double-blinded, placebo-controlled study. The incidence and severity of postoperative sore throat, hoarseness and dysphagia were evaluated on the day of and the day after surgery.
                Sore throat and dysphagia were significantly more severe after lidocaine spray was used than after lidocaine or placebo was used. However, there was no significant difference in the incidence or severity of postoperative sore throat, hoarseness or dysphagia between the lidocaine group and the placebo group throughout the study.
                These results suggest that additives in lidocaine spray, not lidocaine itself, contribute to the increase in postoperative throat problems. Therefore, lidocaine spray should be avoided to prevent these unnecessary complications. Our findings also confirm that laryngo-tracheal lidocaine application does not prevent sore throat, hoarseness or dysphagia after total intravenous anaesthesia. The purpose of this study was to evaluate the effects (common haemodynamic variables, peak cuff pressures, the incidence of reaction ('bucking') during extubation and the incidence of sore throat after operation) of lidocaine 10% instilled into the endotracheal tube cuff in intubated patients. Plasma concentrations of lidocaine were assayed. Seventy ASA class I-II patients scheduled for plastic surgery were studied. Patients were randomly divided in two groups: the cuff of the endotracheal tube was inflated with either lidocaine 10% (group L) or with saline (group S) immediately after endotracheal intubation. In group L patients, the haemodynamic changes were less (P < 0.05), and the peak cuff pressure was lower (P < 0.01) than for group S. At extubation, more patients reacted ('bucked') in group S (70.5% vs. 19.4%, P < 0.01). The incidence and severity of sore throat were significantly lower in group L 1 and 24-h after extubation. Plasma lidocaine concentrations did not reach toxic values. Lidocaine 10%, compared with saline, in the endotracheal tube cuff was associated with less disturbance of haemodynamic responses and less incidence of bucking during tracheal extubation. Lidocaine was also effective in reducing of incidence and severity of sore throat after operation. The study was designed to investigate the changes in pressure and volume of a tracheal tube-cuff inflated with air, mixture of N2O + O2, saline and 4% lidocaine during nitrous oxide anesthesia. This study was conducted in 80 patients (33 male & 47 female). The pressure and volume of a tracheal tube cuff increased with air, decreased with mixture of N2O + O2 and almost remained the same with saline and 4% lidocaine. The complications were more in the air group. We investigated whether intravenous lidocaine prior to endotracheal intubation influences the postoperative airway symptoms of sore throat, cough, and sputum. After ethics committee approval, 80 patients undergoing elective operations were studied. A total of 20 patients were given lidocaine 1.0 mg.kg(-1) (group L1), 20 patients were given lidocaine 1.5 mg.kg(-1) (group L2), and 40 patients received normal saline (group C). The sore throat incidence was 20% in group L1, 0 in group L2, and 40% in group C. Cough incidence was 0 in group L1, 20% in group L2, and 40% in group C. Sputum incidence was 35% in group L1, 25% in group L2, and 47.5% in group C. There were significant differences in the incidences (P < 0.01) and severity (P < 0.01) of sore throat and cough in groups C and L (groups L1 + L2). There were no significant differences between groups in terms of the incidence or severity of sputum. In conclusion, intravenous lidocaine prior to endotracheal intubation decreased the incidence of postoperative sore throat and cough. Postoperative sore throat occurs in up to 90% of intubated patients and is the most common complaint of patients after endotracheal intubation. A recent study suggested that the use of lidocaine to inflate the endotracheal tube cuff would decrease the incidence of postoperative sore throat. The purpose of this prospective randomized study was to compare the incidence and severity of sore throat after using lidocaine, saline, or air to inflate the endotracheal tube cuff. Variables typically associated with postoperative sore throat, including endotracheal cuff design, endotracheal tube size, intubation technique, laryngoscopy blade, airway placement, suctioning technique, and anesthetic technique, were controlled. The participants were all ASA physical status I, II, or III, female, adult patients undergoing general endotracheal anesthesia for gynecological procedures. The researcher administered the verbal analogue scale, Melzack's Present Pain Intensity Scale of the McGill Pain Questionnaire, to the 75 participants at two intervals, 1 to 3 hours postoperatively and 22 to 25 hours postoperatively, to assess postoperative sore throat. Analysis using the Kruskal-Wallis test suggested that there was no statistical difference in postoperative sore throat among the 3 groups. Lidocaine, saline, and air had similar effects on postoperative sore throat. 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. To evaluate the efficacy of various ways of lidocaine application in reducing postoperative cough and sore throat.
                Double-blind, randomized study.
                University-affiliated hospital.
                204 ASA physical status I and II patients scheduled for cataract surgery with general anesthesia.
                Patients were randomized to six groups (G1, G2, G3, G4, G5, and G6), according to lidocaine application method. Before endotracheal intubation, in the G1 and G2 groups, 10% lidocaine was sprayed on the distal end of the endotracheal tubes (ETTs; G1) and laryngopharyngeal structures (G2). In the G3 group, the distal ends of the ETTs were lubricated with 2% lidocaine jelly. Intravenous (IV) lidocaine was administered to the G4 group at the conclusion of surgery. Intracuff lidocaine was used in the G5 group; in the G6 group, the terminal end of the ETTs were lubricated with normal saline.
                At the end of surgery and after extubation, patients were observed to record the number of coughs. At 1 hour and at 24 hours following extubation, sore throat was evaluated.
                In the recovery room, 64.4% of the patients experienced cough, with greatest frequency in the G3, G6, and G2 groups, and the least in the G5 and G4 groups. The frequency of sore throat was significantly different among the six groups at 1 hour and at 24 hours, with greater frequency in the G3, G2, and G6 groups.
                Using lidocaine to inflate the ETT cuff or IV lidocaine at the end of surgery decreases the frequency of postoperative cough and sore throat and would provide better outcome for patients and the physician.