Effect of Intracuff Inflation with Alkalinised Lignocaine, Saline and Air on Early Postoperative Airway Morbidity-A Randomised Control Trial UC05-UC09
Dr. Suvajit Podder,
Department of Anaesthesia, Main OT, K.S. Hegde Hospital, Mangaluru-575018, Karnataka, India.
Introduction: Endotracheal intubation is the gold standard of airway management, and usage of the cuffed Endotracheal Tube (ETT) is routine clinical practice. The ETT provides adequate ventilation and reduces aspiration risk. N2O, when used along with oxygen for maintenance, diffuses inside the cuff and increases the cuff pressure leading to laryngotracheal morbidity postoperatively. When alkalinised lignocaine and saline are instilled in the cuff, it prevents the increase of cuff pressure. Alkalinised lignocaine is more permeable and has additional anaesthetic property. We formulated this study to find out whether alkalinised lignocaine, saline or air is better for intubated patients.
Aim: To assess and compare the incidence and severity of post extubation airway morbidity when alkalinised lignocaine, saline and air is used for cuff inflation.
Materials and Methods: Ninety patients were randomly allocated, between 18-70 years of age who were posted for surgery under general anaesthesia with endotracheal intubation into three groups of 30 each. The cuff of the ETT was inflated with air in Group A, saline in Group B, alkalinised lignocaine in Group C. The three groups were compared regarding sore throat, hoarseness of voice and cough at intervals of two, four and six hours along with haemodynamic stability and smoothness of extubation. Statistical analysis was done using one-way ANOVA or Kruskal-Wallis test for continuous data and Chi-Square test for categorical data. Post-Hoc Bonferroni or Mann-Whitney test were used for intergroup comparison.
Results: The demographic data along with the duration of surgery and the volume of injectate in the cuff was comparable between the three groups. The incidence of sore throat, hoarseness of voice and cough was significantly less in Group C compared to Group A and B. The haemodynamic variations during extubation were also significantly less in Group C compared to the other two groups.
Conclusion: Alkalinised lignocaine instilled into the cuff of intubated patients undergoing general anaesthesia decreases the extubation response and the immediate postoperative airway morbidity.