Efficacy of intra-cuff alkalinized lidocaine compared to low dose lidocaine infusion in reducing extubation induced emergence phenomena

Background & objectives: The commonest method to secure airway in general anesthesia is with the use of endotracheal tube (ETT). However, ETT-induced airway and circulatory reflexes also complicate the emergence, which may lead to potentially harmful complications. We aimed to assess the efficacy of intra-cuff alkalinized lidocaine (ICAL) compared to inj. lidocaine injected intravenously (IV) in minimizing the ETT induced emergence phenomena during recovery and extubation. Methodology: 60 patients who were candidate for elective intermediate duration operations and were in ASA class 1 and 2 were enrolled in the study. Patients were randomly assigned either to receive ICAL (mixture of 1:1 of lidocaine 2% and 1.4% NaHCO3) or 2% lidocaine 1mg/ kg IV. During recovery from anesthesia and extubation, the frequency of coughing was recorded. The patients were also monitored for development of sore throat, hoarseness of voice, laryngeal spasm and pharyngeal pain during the emergence process, and the vital signs were monitored. The data of the study were analyzed using the SPSS software 20. Statistical comparisons were done by means of independent t-test. The correlation was done between all parameters using chi-square test. Logistic regression was used to calculate odds ratio (ORs) and 95% confidence interval (CI). p <= 0.05 was considered as statistically significant. Results: ICAL is more potent in preventing cough (p = 0.005), severity of coughing (p = 0.047) and also in preventing sore throat (p = 0.014) compared to inj. lidocaine injected IV. There were no other side effects noted. ICAL is associated with better maintenance of both MAP and HR (p = 0.004 and 0.055 respectively). Although both groups showed increase in sympathetic stimulation. Conclusions: The efficacy of intra-cuff alkalinized lidocaine is significantly higher than IV lidocaine in suppressing cough, severity of cough, sympathetic stimulation and sore throat in patient undergoing surgeries of one to two hours duration.