Evaluation of Cardiovascular Responses to Endotracheal Intubation With Alkalinized Lignocaine and Air Cuff Inflation Techniques

Background Endotracheal intubation is a routine but critical aspect of airway management during general anesthesia. However, it frequently triggers reflex sympathetic stimulation due to mechanical irritation of the laryngotracheal structures, leading to notable increases in heart rate and blood pressure. These hemodynamic changes can be particularly concerning in patients with underlying cardiovascular disorders such as hypertension or ischemic heart disease. This study was designed to assess the efficacy of alkalinized lignocaine for endotracheal cuff inflation in attenuating these responses, compared to conventional air inflation. Methods This prospective, randomized, comparative clinical study enrolled 60 adult patients scheduled for elective surgical procedures under general anesthesia. Participants were randomly assigned to two equal groups. In Group A, the endotracheal tube cuff was inflated with air, while in Group B, the cuff was filled with 2% lignocaine alkalinized using 8.4% sodium bicarbonate in a standardized 19:1 ratio. In both groups, cuff inflation was performed until no audible air leak was detected on auscultation, and the cuff pressure was subsequently adjusted to approximately 25 cmH₂O using a cuff pressure manometer to ensure consistency and minimize mucosal trauma. Hemodynamic parameters - including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) - were meticulously recorded at baseline and at 1, 3, 5, and 10 minutes following tracheal intubation. Data were analyzed using appropriate statistical tests, with a p-value < 0.05 considered statistically significant. Results Baseline demographic and clinical characteristics were comparable between the two groups, with no statistically significant differences prior to intervention. Group B demonstrated significantly attenuated increases in HR, SBP, DBP, and MAP at all post-intubation time points, with the most pronounced reduction observed at the 1-minute mark. For instance, HR at 1-minute post-intubation averaged 103.4 ± 8.6 bpm in Group A versus 91.2 ± 7.3 bpm in Group B (p < 0.001). Additionally, patients in Group B achieved near-baseline hemodynamic values more rapidly than those in Group A. Conclusion Inflation of the endotracheal tube cuff with alkalinized lignocaine is a simple, effective, and noninvasive technique to attenuate the hemodynamic stress response associated with endotracheal intubation. Incorporating this method into routine anesthetic practice may improve cardiovascular stability, particularly in high-risk patients.