Estebe J-P, Delahaye S, Le Corre P, Dollo G, Le Naoures A, Chevanne F, Ecoffey C
Service d'Anesthésie Réanimation Chirurgicale 2, Université de Rennes 1, Rennes, France.
Br J Anaesth. 2004 Mar;92(3):361-6. doi: 10.1093/bja/aeh078.
We sought to determine the benefits of using alkalinized lidocaine 40 mg to fill the cuff of a tracheal tube (ETT) in combination with water-soluble gel lubrication to prevent post-intubation sore throat.
The work included an in vitro study of the diffusion of alkalinized lidocaine solution through the low-pressure, high-volume cuff of an ETT. We also performed a randomized controlled study (n=20 patients in each group) that included a group who received an alkalinized lidocaine-filled ETT cuff with lubrication of the tube using water-soluble gel (Group G), and two control groups who received an alkalinized lidocaine-filled cuff with ETT lubrication with water (Group W) or an air-filled cuff with ETT lubrication with water (Group C).
Water-soluble gel lubrication (Group G) produced a lower incidence of sore throat during the 24-h post-extubation period than lubrication with water alone in the cuffs filled with alkalinized lidocaine (Group W), and compared with the air control group. The ability of lidocaine to pass through the cuff of an ETT when water-soluble gel and/or water alone was used as a lubricant was similar, as determined by lidocaine plasma concentrations (C(max) 45 ng x ml(-1)). Cough and restlessness before tracheal extubation were decreased in patients with the alkalinized lidocaine-filled cuffs compared with the air-filled cuffs. After extubation, nausea, vomiting, dysphonia and hoarseness were greater for patients with air-filled cuffs compared with the lidocaine-filled cuffs. No significant difference between the groups was recorded in arterial blood pressure and heart rate. In vitro data suggest that the lower the NaHCO(3) injection volume, the greater the release of lidocaine across a low-pressure, high-volume cuff.
These data show benefits of using an alkalinized lidocaine-filled ETT cuff in combination with water-soluble gel lubrication in preventing post-intubation sore throat.
我们试图确定使用40毫克碱化利多卡因填充气管导管（ETT）的套囊并结合水溶性凝胶润滑以预防插管后咽痛的益处。
这项工作包括一项体外研究，即碱化利多卡因溶液通过ETT的低压大容量套囊的扩散情况。我们还进行了一项随机对照研究（每组20例患者），其中一组接受用碱化利多卡因填充ETT套囊并用水溶性凝胶润滑导管（G组），两个对照组分别接受用碱化利多卡因填充套囊并用清水润滑ETT（W组）或用空气填充套囊并用清水润滑ETT（C组）。
在拔管后24小时内，与单独用水润滑填充碱化利多卡因的套囊（W组）相比，水溶性凝胶润滑（G组）导致咽痛发生率更低，并且与空气对照组相比也是如此。通过利多卡因血浆浓度（C(max) 45 ng x ml(-1)）测定，当使用水溶性凝胶和/或仅用水作为润滑剂时，利多卡因穿过ETT套囊的能力相似。与用空气填充套囊的患者相比，用碱化利多卡因填充套囊的患者气管拔管前的咳嗽和躁动减少。拔管后，与用利多卡因填充套囊的患者相比，用空气填充套囊的患者恶心、呕吐、发声困难和声音嘶哑更严重。各组之间在动脉血压和心率方面未记录到显著差异。体外数据表明，碳酸氢钠注射量越低，利多卡因通过低压大容量套囊的释放量越大。
这些数据表明，使用碱化利多卡因填充的ETT套囊并结合水溶性凝胶润滑在预防插管后咽痛方面具有益处。
