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The Effects of Intracuff Alkalinized Lidocaine on Patients Undergoing Uvulopalatopharyngoplasty and Prolonged Intranasal Intubation - In Vitro and In Vivo Pilot Study
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Yi Zou, Xiao Yan, Yingzi Ling , Si Ouyang, Jun Deng, Qian Huang, Wo Li, Yalin Li, Changquan Fu, Lai Wei, Yongping Liu, Gaoyin Kong
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American Journal of Medical Case Reports. 2021 9 (12). doi: 10.12691/ajmcr-9-12-22
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Keywords: intracuff, lidocaine, prolonged intubation
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Context: Endotracheal tube (ETT) frequently induces cough, hemodynamic response, postoperative sore throat, and hoarseness in patients with prolonged intubation. Intracuff alkalinized lidocaine (ICAL) is associated with reduced ETT related complications. This study investigated the effects of ICAL on obstructive sleep apnea (OSA) patients undergoing uvulopalatopharyngoplasty (UPPP) and prolonged intubation. In the in vitro study, we found that 5% sodium bicarbonate (NaHCO3) dramatically increased lidocaine diffusion from the ETT cuff in 24 h, and the diffusion rate of lidocaine was correlated with the dose of alkalinized lidocaine in the ETT cuff. In the in vivo pilot study, we recruited 7 OSA patients undergoing UPPP with intranasal intubation under general anesthesia, among these patients, 4 EET cuffs were filled with air, and 3 were filled with 2% lidocaine and 5% NaHCO3. All the patients were intubated overnight after surgery. We found that ICAL was ineffective to alleviate ETT induced agitation and cough at emergence from anesthesia. However, we found that ICAL significantly improved patients’ sleep quality and satisfaction in the postoperative intubation period. The hemodynamic response was also well suppressed in patients with ICAL compared to those with intracuff air. In addition, ICAL improved the attending nurses’ satisfaction that may reduce nurses’ workload in the postoperative period. No adverse effects occurred. According to our study, we recommend using ICAL in patients with prolonged intubation, and further study is warranted.
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