When alkalinized
lidocaine instead of air is used to fill the endotracheal tube (ETT) cuff, coughing, and bucking are decreased during extubation when ventilation is controlled with N2O. However,
sodium bicarbonate (NaHCO3) used to transform
lidocaine hydrochloride (L-HCl) to
lidocaine base induces a pH increase that could be irritating for mucosa in the case of cuff
rupture. Therefore, we determined, in a randomized controlled study with controlled patient ventilation without N2O, whether the smallest concentrations of NaHCO3 (1.4% versus 8.4%) reduced diffusion (in vitro evaluation) and other secondary clinical benefits. After pH determination of different solutions (2 mL of 2% L-HCl and 2 to 6 mL of 8.4%, or 1.4% NaHCO3), an in vitro
lidocaine diffusion through the ETT cuffs was evaluated (2 mL of 2% L-HCl and 3 mL of 8.4% or 1.4% NaHCO3). Then, adult patients scheduled for total
thyroidectomy surgery were consecutively enrolled (n = 20 for each group). The ETT cuff was filled with air (group air) or with alkalinized
lidocaine (2 mL of 2% L-HCl) using 8.4% (group large dose) or 1.4% (group small dose) of NaHCO3. After tracheal extubation,
sore throat was evaluated by visual analog scale as the main end-point of the study.
Hoarseness, bucking,
dysphonia,
dysphagia,
cough,
restlessness, and
postoperative nausea and vomiting were also evaluated. There was a slight tendency toward a slower release when a small concentration of NaHCO3 was used (i.e., 1.4%). Compared with group air, the alkalinized-
lidocaine groups had a significant reduction in
sore throat during the 24-h postoperative period (P < 0.0001). The difference was not significant between the two alkalinized
lidocaine groups. This increase in ETT tolerance was confirmed by the analysis of secondary end-points. No
laryngospasm,
rupture of ETT cuff, or depression of the swallowing reflex were recorded. A decrease in
sore throat during the postoperative period was recorded when the cuff was inflated with a small dose of alkalinized
lidocaine (i.e., 40 mg of L-HCl and 1.4% of NaHCO3) rather than with air when ventilation was controlled without N2O.