Instillation of Endotracheal Tube Cuff with Lignocaine to reduce Post-extubation Morbidity A Randomized Control Study

Objectives: The use of endotracheal (ET) intubation is associated with post extubation emergence phenomenon comprising of sore throat, hoarseness and cough. This has been attributed to the physical effects of the tube cuff on tracheal mucosa, and thus any means to reduce this pressure effect can significantly improve on adverse symptoms. This study thus aims to compare the effects of instillation of air versus lignocaine into the ET tube cuff, on the post extubation morbidity. Methods: Fifty patients were randomized into two groups of 25 members each group A (air) and group L (lignocaine). In the former, air was filled in ET cuff, while in latter, lidocaine (4%) 5ml was instilled keeping the cuff pressure between 20-22 mmHg. Cough and hemodynamic parameters were noted at and after extubation. Extubation related morbidities were compared between the two groups. Results: With both groups showing similar demographics, there was statistically significant difference in incidence of post-operative sore throat (60% and 22.7%, p=0.003) and hoarseness (44% and 16%, p=0.029) in group A and group L respectively. The cuff volumes of agents were found to be lesser (p<0.05) with lignocaine, indicating net diffusion across cuff membrane. Post operative nausea and vomiting were also appreciably reduced after lignocaine instillation (p=0.69, 0.43). Conclusion: Instillation of Lignocaine in ET tube cuff is better in reducing post extubation sore throat, hoarseness and cough in comparison to air. It has a simple, easily reproducible and inexpensive means to alleviate emergence phenomenon.