The Effects of Intracuff Alkalinized Lidocaine on Patients Undergoing Uvulopalatopharyngoplasty and Prolonged Intranasal Intubation - In Vitro and In Vivo Pilot Study

Yi Zou¹, Xiao Yan², Yingzi Ling¹, Si Ouyang³, Jun Deng², Qian Huang¹, Wo Li¹, Yalin Li¹, Changquan Fu¹, Lai Wei¹, Yongping Liu^1, and Gaoyin Kong^1,

¹Department of Anesthesiology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Research Center for Anesthesiology of ERAS in Hunan Province, Changsha, China

²Department of Pharmacy, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China

³Department of Otorhinolaryngology Head and Neck Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China

Cite this paper

Yi Zou, Xiao Yan, Yingzi Ling, Si Ouyang, Jun Deng, Qian Huang, Wo Li, Yalin Li, Changquan Fu, Lai Wei, Yongping Liu and Gaoyin Kong. The Effects of Intracuff Alkalinized Lidocaine on Patients Undergoing Uvulopalatopharyngoplasty and Prolonged Intranasal Intubation - In Vitro and In Vivo Pilot Study. American Journal of Medical Case Reports. 2021; 9(12):748-753. doi: 10.12691/AJMCR-9-12-22

Abstract

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.

Keywords

intracuff, lidocaine, prolonged intubation

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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