Effect of Intracuff Alkalinized Lidocaine alone and combining with Dexamethasone on Post-extubation emergence in Smokers undergoing Elective surgeries under General Anesthesia.

Abstract

BACKGROUND: Emergence phenomena following general anesthesia can be very distressing to the patient. However, these adverse effects are usually overlooked. This study was undertaken to evaluate the effects of intracuff alkalinized lidocaine and dexamethasone in attenuating ETT induced emergence phenomena.

OBJECTIVES:

1) To determine the effect of intracuff alkalinized lidocaine, alkalinized lidocaine plus dexamethasone and saline on the occurrence and severity of post-operative cough, sore throat and hoarseness in smokers for 24 hours after surgery.

2) To evaluate the efficacy of intracuff alkalinized lidocaine, alkalinized lidocaine plus dexamethasone and saline in maintaining intracuff pressure.

3) To evaluate hemodynamic changes that occur during emergence from general anesthesia in the three groups.

STUDY DESIGN: Prospective, observational study.

PARTICIPANTS: 90 male patients, 20-50 years of age with history of smoking for >5 years, ASA II and III.

METHODS: The patients were divided into 3 groups of 30 patients each to receive either alkalinized lidocaine or alkalinized lidocaine with dexamethasone or normal saline as an agent for inflation of ETT cuff.

RESULTS: Intra-operatively cuff pressure increased in all the 3 groups (p value >0.05). The cough was more severe and frequent in NS group (p value <0.05). Occurrence and severity of sore throat was more in NS group (83%) and less in L group (50%) and LD group (40%) at 1 hour after extubation and 30% patients in NS group reported sore throat at 24 hours. Occurrence and severity of hoarseness was more in NS group (90%) and less in L group (56.7%) and LD group (43.3%) at 1 hour after extubation and 36.7% patients in NS group reported hoarseness at 24 hours.

CONCLUSION: Using alkalinized lidocaine with dexamethasone for filling the ETT cuff in order to reduce post-extubation reactions was as effective as alkalinized lidocaine, however both the methods were more effective than normal saline.

IMPLICATIONS: Using these agents as cuff filling mediums can be considered in patients with reactive airways to improve their tolerance to anesthesia.