Comparative Efficacy of Intracuff 1% and 2% Alkalinized Lignocaine with Saline on Endotracheal Tube-Induced Hemodynamic Changes and Emergence Phenomena in Neurosurgical Patients.

Introduction  Extubation is associated with hemodynamic changes and emergence phenomena leading to cough, sore throat, dysphonia, and dysphagia in the postoperative period. The aim of our study was to compare intracuff 2% alkalinized lignocaine with 1% alkalinized lignocaine and saline in reducing endotracheal tube induced emergence phenomena and haemodynamic changes at extubation in neurosurgical patients. Materials and Methods  In this randomized controlled study, 90 adult patients of either sex, scheduled to undergo neurosurgical procedures were randomly divided into three groups of 30 each to receive either 1% alkalinized lignocaine (AL1), 2% alkalinized lignocaine (AL2), or saline as cuff inflation media. Intracuff pressures and haemodynamic variables were noted intraoperatively and during emergence. The presence of postextubation cough, sore throat, dysphonia, and dysphagia were monitored until 24 hours postoperatively. Data were analyzed using Chi-square test and ANOVA. A p -value of less than 0.05 was considered significant. Results  The intracuff pressures were significantly less with alkalinized lignocaine as compared to saline, after 3 hours of induction. Post extubation, hemodynamic parameters and incidence of coughing and bucking at extubation were significantly less in Groups AL1 ( p  = 0.024) and AL2 ( p  = 0.02) as compared to saline. On assessment of laryngotracheal morbidity, the incidence of coughing was found to be significantly less with 2% alkalinized lignocaine as compared to saline ( p  = 0.021) at 1 hour after extubation. Sore throat was significantly less in Groups AL1 and AL2 as compared with saline at 1 hour ( p  = 0.008, 0.002 respectively) and 8 hours ( p  = 0.01 in both groups), and in Group AL2 versus saline at 24 hours ( p  = 0.044) after extubation. The incidence of dysphonia was significantly less in Groups AL1 and AL2 as compared with saline at 1 hour ( p  = 0.016, p  = 0.002) and 24 hours ( p  = 0.012 in both groups) and in Group AL2 versus saline at 8 hours (p  = 0.03) postoperatively. No significant differences were noted between 1% alkalinized lignocaine and 2% alkalinized lignocaine. Conclusion  Intracuff alkalinized lignocaine 1% and 2% were significantly better than saline in reducing coughing and bucking at extubation, post extubation haemodynamic changes and incidence of postoperative cough, sore throat, and dysphonia.