Comparative evaluation of intra-cuff ropivacaine, bupivacaine, and lidocaine on emergence reactions after general anesthesia
Novelty in Biomedicine,
Vol. 10 No. 4 (2022),
Background: Emergence reactions are common after general anesthesia with tracheal intubation and can be
associated with severe hemodynamic consequences. Inflating the cuff with local anesthetic instead of air has been reported to prevent these problems. However, no definitive results have been obtained for the effectiveness of this method. This study tried to come to a more reasonable conclusion by conducting more studies, and we used a variety of local anesthetics.
Materials and Methods: This study was performed on 350 patients over 18 years undergoing general anesthesia using an endotracheal tube. Patients were divided into five groups based on endotracheal tube cuff inflation with lidocaine, ropivacaine, bupivacaine, isotonic saline, and air. After removing the endotracheal tube, patients were evaluated for cough, sore throat, and hoarseness.
Results: Cough, sore throat, and hoarseness were observed in 43.7%, 27.4%, and 4.6% of cases, respectively.
At all measured times, all reactions in all local anesthetic groups were weaker than in the air and saline groups.
The difference between the local anesthetic groups was not significant.
Conclusion: Using local anesthetics to inflate the endotracheal cuff reduces the incidence of emergence
reactions from general anesthesia.
- Cough, Hoarseness, Sore throat, Lidocaine, Ropivacaine, Bupivacaine
How to Cite
Lehmann M, Monte K, Barach P, Kindler CH. Postoperative patient complaints: a prospective interview study of 12,276 patients. J Clin Anesth. 2010;22(1):13–21.
Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg. 2004;99(4):1253–7.
Irwin RS. Complications of cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 SUPPL.):54S-58S.
Maruyama K, Yamada T, Hara K. Effect of clonidine premedication on postoperative sore throat and hoarseness after total intravenous anesthesia. J Anesth. 2006;20(4):327–30.
Sconzo JM, Moscicki JC, Difazio CA. In vitro diffusion of lidocaine across endotracheal tube cuffs. Reg Anesth. 1990;15(1):37–40.
Jaichandran. Diffusion of Lidocaine Buffered to An Optimal pH Across the Endotracheal Tube Cuff-An in-Vitro Study. Indian J Anaesth. 2008;52(5):536.
Momota Y, Kakudo T, Miyatani N, Miyake T, Tamura I, Oshita N, et al. Effect of distribution and membrane structure of alkalinized lidocaine across an endotracheal. J Osaka Dent Univ. 2016;1(50):1–6.
Fagan C, Frizelle HP, Laffey J, Hannon V, Carey M. The effects of intracuff lidocaine on endotracheal-tube-induced emergence phenomena after general Anesthesia. Anesth Analg. 2000;91(1):201–5.
Kumar RDC, Hirsch NP. Clinical evaluation of stethoscope-guided inflation of tracheal tube cuffs. Anaesthesia. 2011;66(11):1012–6.
Banihashem N, Alijanpour E, Hasannasab B, Zarei A. Prophylactic effects of lidocaine or beclomethasone spray on post-operative sore throat and cough after orotracheal intubation. Iran J Otorhinolaryngol. 2015;27(80):179–84.
Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, et al. Complications of Thyroid Surgery: Analysis of a Multicentric Study on 14,934 Patients Operated on in Italy over 5 Years. World J Surg. 2004;28(3):271–6.
Papavasiliou AK, Magnadottir HB, Gonda T, Franz D, Harbaugh RE. Clinical outcomes after carotid endarterectomy: Comparison of the use of regional and general anesthetics. J Neurosurg. 2000;92(2):291–6.
Van Ramshorst GH, Nieuwenhuizen J, Hop WCJ, Arends P, Boom J, Jeekel J, et al. Abdominal wound dehiscence in adults: Development and validation of a risk model. World J Surg. 2010;34(1):20–7.
Basali A, Mascha EJ, Kalfas L, Schubert A. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. Anesthesiology. 2000;93(1):48–54.
Bhattacharya M, Kallet RH, Ware LB, Matthay MA. Negative-Pressure Pulmonary Edema. Chest. 2016;150(4):927–33.
Miller KA, Harkin CP, Bailey PL. Postoperative tracheal extubation. Anesth Analg. 1995;80(1):149–72.
Hartley M, Vaughan RS. Problems associated with tracheal extubation. Br J Anaesth. 1993;71(4):561–8.
Yukioka H, Hayashi M, Terai T, Fujimori M. Intravenous lidocaine as a suppressant of coughing during tracheal intubation in elderly patients. Anesth Analg. 1993;77(2):309–12.
Liu H, Zhou C, Ji J. Effects of using different dose of dexmedetomidine during tracheal extubation for patients with parotidectomy after general anesthesia. Shanghai Kou Qiang Yi Xue [Internet]. 2016 Jun [cited 2022 May 3];25(3):368–72. Available from: http://www.sjos.cn/EN/abstract/abstract5748.shtml
Inoue Y, Koga K, Sata T, Shigematsu A. Effects of fentanyl on emergence characteristics from anesthesia in adult cervical spine surgery: A comparison of fentanyl-based and sevoflurane-based anesthesia. J Anesth. 2005;19(1):12–6.
Cho H, Kim H, Baek S, Jung K. The effect of remifentanil infusion on coughing during emergence from general anesthesia with desflurane. Korean J Anesthesiol. 2008;55(6):670.
Younes M. Intracuff lidocaine 2&x0025; for prevention of postoperative cough and sore throat. Al-Azhar Assiut Med J. 2018;16(1):43.
Souissi H, Fréchette Y, Murza A, Masse MH, Marsault É, Sarret P, et al. Une solution de 160 mg de lidocaïne alcalinisée dans le ballonnet réduit la toux à l’émergence d’une anesthésie générale sans N2O: une étude randomisée contrôlée. Can J Anesth. 2016;63(7):862–70.
Lam F, Lin YC, Tsai HC, Chen TL, Tam KW, Chen CY. Effect of intracuff lidocaine on postoperative sore throat and the emergence phenomenon: A systematic review and meta-analysis of randomized controlled trials. PLoS One [Internet]. 2015 Aug 19 [cited 2022 May 3];10(8). Available from: http://clinicaltrials.gov/
Rizvanović N, Čaušević S, Hrnčić N, Hatibović H. Effect of intracuff alkalinized 2% lidocaine on endotracheal tube cuff pressure and postoperative throat symptoms in anaesthesia maintained by nitrous oxide. Med Glas. 2019;16(1):13–21.
Wetzel LE, Ancona AL, Cooper AS, Kortman AJ, Loniewski GB, Lebeck LL. The effectiveness of 4% intracuff lidocaine in reducing coughing during emergence from general anesthesia in smokers undergoing procedures lasting less than 1.5 hours. AANA J. 2008;76(2):105–8.
Bousselmi R, Lebbi MA, Bargaoui A, Romdhane M Ben, Messaoudi A, Ben Gabsia A, et al. La lidocaïne réduit les effets indésirables de l’intubation trachéale quand elle est instillée sur la glotte et non pas quand elle est utilisée pour gonfler le ballonnet de la sonde: Etude randomisée, contrôlée, en double aveugle. Tunisie Medicale. 2014;92(1):29–33.
Amjad Khan M, Javid Siddiqi K, Aqeel M, Professor A. Lidocaine 4% spray is better than intracuff lidocaine 2% for reducing the incidence of post-extubation cough in patients undergoing total abdominal hysterectomy. In: Anaesth Pain & Intensive Care. 2014. p. 162–6.
Ghalibaf M, Baradaran R. Comparising effects of lidocaine 2% and bupivacaine 0/25% infiltrating into endotracheal tube’s cuff in order to reduce in occurance of cough, bucking and laryngospasm during emergence from anesthesia [sic]. J Med Counc Islam Repub Iran. 2010;28(2):238.
McLachlan M, Gamble J, O’Brien JM, McKay WP, Bajwa JS. Intracuff local anesthetic to reduce postoperative sore throat: a randomized clinical trial. Can J Anesth. 2020;67(4):495–7.
Peng F, Wang M, Yang H, Yang X, Long M. Efficacy of intracuff lidocaine in reducing coughing on tube: a systematic review and meta-analysis. J Int Med Res. 2020;48(2):300060520901872.
Rafiei MR, Arianpour N, Rezvani M, Ebrahimi A. Effects of intracuff dexamethasone on post-extubation reactions. J Res Med Sci. 2012;17(4):338–43.
Soltani HA, Aghadavoudi O. The effect of different lidocaine application methods on postoperative cough and sore throat. J Clin Anesth. 2002;14(1):15–8.
Estebe J-P, Dollo G, Le Corre P, Le Naoures A, Chevanne F, Le Verge R, et al. Alkalinization of Intracuff Lidocaine Improves Endotracheal Tube-Induced Emergence Phenomena. Anesth Analg. 2002;94(1):227–30.
Ahmady MS, Sadek S, Al-metwalli RR. Does intra-cuff alkalinized lidocaine prevent tracheal tube induced emergence phenomena in children? Anaesthesia, Pain Intensive Care. 2013;17(1):18–21.
Abraham JM, Abraham S, Varghese SM. How effective is intra-cuff lignocaine in reducing post-operative sore throat and emergence cough: a comparative study. Int J Basic Clin Pharmacol [Internet]. 2020;9(8):1226.
Lu J, Tian W, Cui L, Cai B, Zhang T, Huang N, et al. Lidocaine-eluting endotracheal tube effectively attenuates intubation related airway response. Ann Transl Med. 2021;9(10):871–1.
Yaghoubi S, Massoudi N, Kayalha H, Samimi K. Comparison of Tracheal Extubation Comfort between Two Endotracheal Tube Filling in Laparoscopic Cholecystectomy. J Cell Mol Anesth. 2019;4(4):112–20.
D’Aragon F, Beaudet N, Gagnon V, Martin R, Sansoucy Y. The effects of lidocaine spray and intracuff alkalinized lidocaine on the occurrence of cough at extubation: A double-blind randomized controlled trial. Can J Anesth. 2013;60(4):370–6.
Altintas F, Bozkurt P, Kaya G, Akkan G. Lidocaine 10% in the endotracheal tube cuff: Blood concentrations, haemodynamic and clinical effects. Eur J Anaesthesiol. 2000;17(7):436–42.
Navarro RM, Baughman VL. Lidocaine in the endotracheal tube cuff reduces postoperative sore throat. J Clin Anesth. 1997;9(5):394–7.
Budania L, Chamala V, Rao M, Virmani S, Goyal K, Nanda K. Effect of air, anesthetic gas mixture, saline, or 2% lignocaine used for tracheal tube cuff inflation on coughing and laryngotracheal morbidity after tracheal extubation. J Anaesthesiol Clin Pharmacol. 2018;34(3):386–91.
Pubu ZM, Bianba ZM, Yang G, CyRen LM, Pubu DJ, Lang KZS, et al. Factors affecting the risk of postpartum hemorrhage in pregnant women in tibet health facilities. Med Sci Monit. 2021;27.
Chen ZX, Shi Z, Wang B, Zhang Y. Intracuff alkalinized lidocaine to prevent postoperative airway complications: A meta-analysis. World J Clin Cases. 2021;9(34):10626–37.
Pitkanen M, Feldman HS, Arthur GR, Covino BG. Chronotropic and inotropic effects of ropivacaine, bupivacaine, and lidocaine in the spontaneously beating and electrically paced isolated, perfused rabbit heart. Reg Anesth. 1992;17(4):183–92.
Gómez REV, Araque HFG. Toxicity Due to Local Anesthetic Agents: Literature Review. Colomb J Anestesiol. 2011;39(1):40–54.
Groban L, Deal DD, Vernon JC, James RL, Butterworth J. Ventricular arrhythmias with or without programmed electrical stimulation after incremental overdosage with lidocaine, bupivacaine, levobupivacaine, and ropivacaine. Anesth Analg. 2000;91(5):1103–11.
- Abstract Viewed: 44 times
- pdf Downloaded: 22 times