Souissi Houssine, Fréchette Yannick, Murza Alexandre, Masse Marie-Hélène, Marsault Éric, Sarret Philippe, D'Aragon Frédérick, Parent Alexandre J, Sansoucy Yanick
Department of Anesthesiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, J1H 5N4, QC, Canada.
Department of Pharmacology and Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, J1H 5N4, QC, Canada.
Can J Anaesth. 2016 Jul;63(7):862-70. doi: 10.1007/s12630-016-0652-8. Epub 2016 Apr 13.
Chemical and mechanical irritation of the tracheal mucosa influences the incidence of cough at emergence from general anesthesia, potentially leading to significant postoperative complications. This study evaluates the benefits of endotracheal tube (ETT) intracuff alkalinized lidocaine during N2O-free general anesthesia by 1) assessing the in vitro effect of alkalinization on lidocaine diffusion kinetics across the cuff's membrane and 2) evaluating, in a randomized controlled clinical trial, the impact of 160 mg of intracuff alkalinized lidocaine on cough upon emergence from anesthesia for surgery lasting > 120 min.
In the in vitro study, diffusion kinetics of various intracuff alkalinized lidocaine amounts (40, 80, and 160 mg) were compared to their non-alkalinized lidocaine controls. In the clinical trial, 80 adult patients (American Society of Anesthesiologists physical status I-III) undergoing urological or gynecological surgery expected to last > 120 min and scheduled for N2O-free general anesthesia were enrolled. The ETT cuffs (high-volume, low-pressure) were filled with either 160 mg of alkalinized lidocaine or a comparable volume of 0.9% saline. The primary outcome was the incidence of cough upon emergence from anesthesia. Sore throat, hoarseness, and postoperative nausea and vomiting were evaluated as secondary outcomes.
Our in vitro study confirmed that alkalinization increases lidocaine diffusion across the membrane of ETT cuffs and suggested that the lidocaine diffusion rate is associated with the initial intracuff lidocaine quantity. Our clinical trial demonstrated that, compared with the saline group, 160 mg of intracuff alkalinized lidocaine reduced the incidence of cough upon emergence from N2O-free general anesthesia (76% vs 34%, respectively; difference 42%; 95% confidence interval, 21% to 62%; P < 0.001) while having no clinical impact on secondary outcomes.
The use of 160 mg of intracuff alkalinized lidocaine is associated with a decreased incidence of cough upon emergence from N2O-free general anesthesia > 120 min. This trial was registered at www.clinicaltrials.gov (NCT01774292).
气管黏膜的化学和机械刺激会影响全身麻醉苏醒期咳嗽的发生率，可能导致严重的术后并发症。本研究评估了在无笑气全身麻醉期间气管内导管（ETT）套囊内碱化利多卡因的益处，方法如下：1）评估碱化对利多卡因跨套囊膜扩散动力学的体外影响；2）在一项随机对照临床试验中，评估160mg套囊内碱化利多卡因对持续时间超过120分钟手术麻醉苏醒时咳嗽的影响。
在体外研究中，比较了不同剂量（40、80和160mg）套囊内碱化利多卡因与其未碱化利多卡因对照的扩散动力学。在临床试验中，纳入了80例成年患者（美国麻醉医师协会身体状况分级I-III级），他们接受预计持续时间超过120分钟的泌尿外科或妇科手术，并计划进行无笑气全身麻醉。ETT套囊（大容量、低压）填充160mg碱化利多卡因或等量的0.9%盐水。主要结局是麻醉苏醒时咳嗽的发生率。咽痛、声音嘶哑以及术后恶心和呕吐作为次要结局进行评估。
我们的体外研究证实，碱化可增加利多卡因跨ETT套囊膜的扩散，并表明利多卡因扩散速率与套囊内初始利多卡因量有关。我们的临床试验表明，与盐水组相比，160mg套囊内碱化利多卡因降低了无笑气全身麻醉苏醒时咳嗽的发生率（分别为76%和34%；差异42%；95%置信区间，21%至62%；P<0.001），而对次要结局无临床影响。
使用160mg套囊内碱化利多卡因与持续时间超过120分钟的无笑气全身麻醉苏醒时咳嗽发生率降低有关。本试验已在www.clinicaltrials.gov注册（NCT01774292）。
