Buffered Lidocaine as an Endotracheal Tube Cuff Media In Immediate Postoperative Cardiac Surgery Patients And Its Effect On Sedation Requirements: A Prospective Feasibility Study.

Abstract

Tracheal mucosal inflammation and irritation caused by the endotracheal tube (ETT) may exacerbate symptoms of pain and discomfort which create challenges including ETT tolerance and postintubation emergence phenomena. Various sedative and analgesic agents are used to mitigate these symptoms, however, there is concern that such medications may contribute to prolonged duration of intubation, length of intensive care unit (ICU) stay, as well as increased morbidity. This randomized control pilot study explored the feasibility and potential efficacy of instillation of a buffered lidocaine solution as an ETT cuff medium in adult rapid recovery eligible cardiac surgical patients. Thirty-two patients were randomized to the intervention (1.8% lidocaine/0.76% sodium bicarbonate) or control (air) group. Data were analyzed using median, standard deviation (SD), Wilcoxon rank sum, mean ± SD, two-sample t-test, and Fisher's exact test. The intervention arm demonstrated a trend toward a reduction in the incidence of cough at ICU arrival (0 versus 22%), incidence of pharyngitis at all time intervals, and propofol requirement (345 ± 248 mg versus 1,158 ± 1,426 mg) with no difference in adverse events between groups. These results support the development of larger studies to confirm the efficacy and feasibility of buffered lidocaine as an ETT cuff medium in this population.