Effectiveness of lidocaine as an endotracheal tube (ETT) cuff inflating agent: A single center experience

Background: Endotracheal intubation, which involves inserting a cuffed tube to secure the airway and facilitate ventilation, can lead to postoperative sore throat, a common complication that affects patient satisfaction and recovery. Traditionally, endotracheal tube (ETT) cuffs are inflated with air, but this can cause overinflation due to nitrous oxide diffusion, potentially exacerbating complications. Alternative inflation methods, such as using saline or lidocaine, have been explored to reduce these issues. Lidocaine, a local anesthetic and anti-inflammatory agent, may help by diffusing through the cuff to provide local anesthesia and minimize sore throat and other airway symptoms. Aim of the study: This study aimed to compare lidocaine's effectiveness with air and saline as a better cuff inflating agent. Methods: This one-year prospective study at the Department of Anaesthesia and Pain Medicine, Anwer Khan Modern Medical College, Dhaka, Bangladesh included 144 patients undergoing abdominal surgeries under general anesthesia. Patients were randomly divided into three groups: Group A with endotracheal tube (ETT) cuffs inflated with air, Group B with distilled water, and Group C with 2% lidocaine, each group containing 48 patients. Inclusion criteria included ASA 1 and ASA 2 patients aged 18-50 with surgeries lasting less than 5 hours. Exclusion criteria were difficult intubations, recent sore throat, smoking, or nasogastric tubes. Postoperative symptoms like sore throat and hoarseness were assessed at 1-3 and 22-24 hours. Data were analyzed using ANOVA and t-tests. Results: In the study, the mean ages were similar across groups: Group A (45.83±6.88 years), Group B (44.52±7.25 years), and Group C (45.21±6.29 years). The sex ratio and body weight were comparable, with no significant differences (P>0.05). The ASA grade distribution was consistent across groups, indicating similar health statuses. Group A experienced higher sore throat incidence at 1-3 hours (62.5%) but not significantly. After 22-24 hours, Group C showed a significant decrease (4.17%, P<0.05). Group A had higher dysphasia (43.75%) and hoarseness (52.08%) initially, but Group C improved significantly by 22-24 hours, showing lower incidences (0%, P<0.05). Conclusion: Lidocaine outperforms air and saline as an endotracheal tube (ETT) cuff inflating agent, significantly reducing postoperative sore throat, dysphagia, and hoarseness 22-24 hours after extubation. This study shows that lidocaine can enhance patient comfort and satisfaction, providing a simple, cost-effective way to improve post-surgical outcomes.