Saingur V K, Naaz S, Ozair E, Asghar A
Dr. Baba Saheb Ambedkar Medical College and Hospital, Rohini, Delhi, India.
Department of Anesthesiology, All India Institute of Medical Sciences, Patna, India.
South Afr J Crit Care. 2022 May 6;38(1). doi: 10.7196/SAJCC.2022.v38i1.484. eCollection 2022.
Airway irritation caused by prolonged inflation of endotracheal tube (ETT) cuff results in post-intubation morbidities.
We aimed to study intracuff lidocaine and alkalised lidocaine on sedation or analgesia requirements of patients undergoing mechanical ventilation in the intensive care unit (ICU). The primary outcome was to calculate the total dose of propofol and fentanyl required to obtund the unwanted airway and circulatory reflexes. Secondary outcomes were to determine the frequency and severity of cough and haemodynamic parameters.
It was a double-blinded, randomised controlled study in the ICU after emergency laparotomy, in patients aged 20 - 55 years, and classified as American Society of Anesthesiologists (ASA) classes 1E and 2E with tube . Exclusion criteria were patients with body mass index >30 kg/m² , haemodynamic instability, requiring positive end-expiratory pressure ≥7 cm HO, and a history of chronic obstructive pulmonary disease. After ethics clearance and written consent, patients were randomly assigned into two groups (36 in each), Group L (ETT cuff inflated with lidocaine 2%) and Group AL (cuff inflated with a mixture of lidocaine 2% and sodium bicarbonate 1:1).
Mean dose of propofol consumed in Group AL was significantly less than that in Group L (p<0.001). The mean standard deviation (SD) fentanyl utilisation in Group AL was 1 323.61 (187.27) µg, and that in Group L was 1433.09 (42.58) µg (p=0.040). Group L patients had a significantly higher incidence of cough than those in Group AL (p=0.01). There was no significant difference in the mean arterial pressure (p=0.22), although heart rate was significantly higher in Group L (p<0.001).
Alkalised lidocaine reduces the requirement of sedation, analgesia, and the incidence of cough in intubated patients maintaining haemodynamic stability when compared with lidocaine.
Alkalised lidocaine when used in endotracheal tube cuff inflation reduces the need for sedation and analgesia in mechanically-ventilated patients, and improves haemodynamic stability.
气管内导管（ETT）套囊长时间充气引起的气道刺激会导致插管后发病。
我们旨在研究套囊内利多卡因和碱化利多卡因对重症监护病房（ICU）接受机械通气患者镇静或镇痛需求的影响。主要结局是计算抑制不必要的气道和循环反射所需的丙泊酚和芬太尼总剂量。次要结局是确定咳嗽的频率和严重程度以及血流动力学参数。
这是一项在急诊剖腹术后ICU中进行的双盲、随机对照研究，研究对象为20 - 55岁、美国麻醉医师协会（ASA）分级为1E和2E且使用气管导管的患者。排除标准为体重指数>30 kg/m²、血流动力学不稳定、需要呼气末正压≥7 cm H₂O以及有慢性阻塞性肺疾病病史的患者。经伦理批准并获得书面同意后，患者被随机分为两组（每组36例），L组（ETT套囊用2%利多卡因充气）和AL组（套囊用2%利多卡因和碳酸氢钠1:1的混合物充气）。
AL组丙泊酚平均消耗量显著低于L组（p<0.001）。AL组芬太尼平均标准差（SD）用量为1323.61（187.27）μg，L组为1433.09（42.58）μg（p = 0.040）。L组患者咳嗽发生率显著高于AL组（p = 0.01）。平均动脉压无显著差异（p = 0.22），尽管L组心率显著更高（p<0.001）。
与利多卡因相比，碱化利多卡因可降低插管患者的镇静、镇痛需求以及咳嗽发生率，同时维持血流动力学稳定。
气管内导管套囊充气时使用碱化利多卡因可减少机械通气患者的镇静和镇痛需求，并改善血流动力学稳定性。
