Huang C J, Hsu Y W, Chen C C, Ko Y P, Rau R H, Wu K H, Wei T T
Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.
Acta Anaesthesiol Sin. 1998 Jun;36(2):81-6.
"Deep" extubation, administration of intravenous (i.v.) narcotics, i.v. lidocaine and forestalling local spray of lidocaine have been used to help diminish coughing during emergence. However, the respective efficacy of these techniques has not been concluded. Sconzo et al. indicated that endotracheal tube (ETT) cuff might serve as a reservoir for local anesthetic. Alkalizing and warming are two techniques frequently used to increase in the proportion of uncharged drugs available. Matias indicated that alkalization could prompt a 63-fold increase of the rate of diffusion of lidocaine across the ETT cuff. Huang et al. also observed that alkalization together with warming could achieve a 118-fold increase further. However, the in vivo effects of ETT-cuff lidocaine have not been studied.
Eighty patients of ASA Class I-II undergoing elective surgeries were included. They were randomly assigned into four groups. After tracheal intubation, the ETT cuff was filled with one of the following solutions: normal saline 6 ml (Group A), 4% lidocaine 6 ml at room temperature (Group B), 4% lidocaine 5 ml + 7% sodium bicarbonate 1 ml at room temperature (Group C), and 4% lidocaine 5 ml + 7% sodium bicarbonate 1 ml warmed to 38 degrees C (Group D). Changes of vital signs as well as the times of coughing in the course of extubation and post-extubation complications were recorded. One way ANOVA (SPSS for windows) was used for data analysis.
The respective number of coughing per patient in the experimental groups (Group B, C and D) was significantly less than the saline or control group (mean = 9.70, 9.15 and 3.95, respectively, p < 0.05). The incidence of sore throat in Group C and Group D was significantly less than the control group (35% and 25%, respectively, p < 0.05). Regarding the hemodynamic changes, systolic arterial pressure (SAP) and mean arterial pressure (MAP) were higher in Group B and C (p < 0.05) before extubation.
Alkalized and warmed lidocaine prestored in the endotracheal tube (ETT) cuff can greatly reduce ETT-induced coughing and thus promote a smoother emergence from general anesthesia with endotracheal intubation.
“深度”拔管、静脉注射麻醉药、静脉注射利多卡因以及预先使用利多卡因局部喷雾已被用于帮助减少苏醒期咳嗽。然而，这些技术的各自疗效尚未定论。斯孔佐等人指出气管导管（ETT）套囊可能作为局部麻醉药的储存库。碱化和加温是常用于增加游离药物比例的两种技术。马蒂亚斯指出碱化可使利多卡因通过ETT套囊的扩散速率提高63倍。黄等人还观察到碱化加加温可进一步使扩散速率提高118倍。然而，ETT套囊利多卡因的体内效应尚未得到研究。
纳入80例接受择期手术的ASA I-II级患者。他们被随机分为四组。气管插管后，ETT套囊注入以下溶液之一：6ml生理盐水（A组）、室温下的4%利多卡因6ml（B组）、室温下的4%利多卡因5ml + 7%碳酸氢钠1ml（C组）以及加温至38℃的4%利多卡因5ml + 7%碳酸氢钠1ml（D组）。记录生命体征变化以及拔管过程中的咳嗽次数和拔管后并发症。采用单因素方差分析（Windows版SPSS）进行数据分析。
实验组（B组、C组和D组）每位患者的咳嗽次数显著少于生理盐水组或对照组（分别为平均9.70、9.15和3.95，p < 0.05）。C组和D组的咽痛发生率显著低于对照组（分别为35%和25%，p < 0.05）。关于血流动力学变化，拔管前B组和C组的收缩压（SAP）和平均动脉压（MAP）较高（p < 0.05）。
预先储存在气管导管（ETT）套囊中的碱化和加温利多卡因可大大减少ETT引起的咳嗽，从而促进气管插管全身麻醉后更平稳的苏醒。
