Intracuff buffered lidocaine versus saline or air – “A comparative study for smooth extubation in patients with hyperactive airways undergoing eye surgery”

Venkatakrishnan V Jaichandran, InderMohan Bhanulakshmi, Viswanathan Jagadeesh


Background: Increased cough and restlessness during emergence from general anaesthesia in patients undergoing ophthalmologic surgical procedures might result in increased intraocular pressure, ruptured sutures and suprachoroidal haemorrhage which can be detrimental to the outcome of surgery. In hyperactive airway patients, as the cough receptors are in the hypersensitized stage, they tend to cough more frequently and violently during extubation. Hence in these patients, we sought to determine the benefits of filling the endotracheal tube cuff with either buffered lidocaine, saline or air so as to prevent endotracheal tube induced coughing during emergence from general anaesthesia.

Methods: Seventy five patients either with history of chronic smoking or recently treated upper respiratory tract infections were randomly assigned into 3 groups (n=25) based on the type of endotracheal tube cuff inflation as follows: Group A (Air), Group B (6ml of normal saline) and Group C (6ml of 2%lidocaine + 0.5ml of 7.5% Sodium bicarbonate). A second blinded anaesthetist graded the extubation as: Grade 0 (No cough), Grade 1 (cough<15s) and Grade 2 (cough >15s).

Results: Extubation was smooth in Group C compared with B and A (p<0.0001). The incidence of sore throat was found to be lower in both liquid groups, B and C compared with Group A at 1 hr (p<0.0001) and 24 hours (p<0.01) postoperatively.

Conclusion: Injecting buffered lidocaine into the endotracheal tube cuff, produces smooth extubation even in patients with hyperactive airways as the cough receptors in the tracheal mucosa get blocked by the increased diffusion of uncharged base form across the hydrophobic polyvinyl chloride walls of the cuff.
KEY WORDS: General anaesthesia, lidocaine, cough, ophthalmologic surgical procedure.


General anaesthesia, lidocaine, cough, ophthalmologic surgical procedure.

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South Afr J Anaesth Analg: ISSN (Print): 2220-1181, ISSN (Web): 2220-1173

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