Intracuff alkalinized lidocaine to prevent postoperative airway complications: A meta-analysis

ARTICLE HIGHLIGHTS

Research background

Tracheal intubation is the most commonly used airway management method in general anesthesia. However, this approach has been associated with some problems, such as postoperative airway complications, which are common phenomena and adverse reactions in patients who underwent elective general anesthesia. To reduce the occurrence of postoperative airway-related complications, many interventions have been proposed. Among these, intracuff alkalinized lidocaine can be used as local anesthesia, to reduce complications during extubation, and to avoid the side effects of lidocaine on the circulation and central nervous system during general application.

Research motivation

Intracuff lidocaine can be used as local anesthesia, to reduce complications during extubation, and to avoid the side effects of lidocaine on the circulation and central nervous system during general application. Nevertheless, lidocaine is not easy to diffuse in the cuff, and adding sodium bicarbonate can greatly enhance the diffusion ability of lidocaine, to achieve better action on the tracheal mucosa.

Research objectives

Perform a systematic review and meta-analysis to summarize the efficacy of intracuff alkalinized lidocaine in the prevention of postoperative airway-related complications.

Research methods

A comprehensive literature search of Pubmed (until May 2020), Embase (until May 2020), Cochrane (until May 2020), and Web of Science (until May 2020) was performed. Heterogeneity was assessed using the Cochrane Q test and I² statistic. A fixed-effect model was used if heterogeneity was considered low. If I² statistic ≥ 50% and P < 0.05, a random-effects model was applied to the data.

Research results

Twelve randomized trials (1175 patients) met the inclusion criteria. The meta-analysis showed that intracuff alkalinized lidocaine was associated with less cough compared to that produced by placebo. Similarly, intracuff alkalinized lidocaine was more effective than the control in reducing postoperative sore throat at 24 h and postoperative hoarseness. Five trials that included 476 participants demonstrated a large reduction in the visual analogue scale of a postoperative sore throat at 1 h or 24 h with the use of intracuff alkalinized lidocaine.

Research conclusions

Intracuff alkalinized lidocaine decreased postoperative airway complications, including coughing, hoarseness, and sore throat. Furthermore, for patients with a post-extubation sore throat, it could also reduce the degree of pain.

Research perspectives

The use of intracuff alkalinized lidocaine after tracheal intubation is a simple, economical and safe choice to prevent postoperative cough, sore throat, and hoarseness in adult patients. Anesthesiologists can use this technique in clinical patients.