Effect of Intracuff Lidocaine on Postoperative Sore Throat and the Emergence Phenomenon: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
BACKGROUND
Postoperative sore throat and other airway morbidities are common and troublesome after endotracheal tube intubation general anesthesia (ETGA). We propose lidocaine as endotracheal tube (ETT) cuff inflation media to reduce the postintubation-related emergence phenomenon.


METHODS
We searched PubMed, EMBASE, and Cochrane databases systematically for randomized controlled trials (RCTs) that have investigated the outcome of intracuff lidocaine versus air or saline in patients receiving ETGA. Using a random-effects model, we conducted a meta-analysis to assess the relative risks (RRs) and mean difference (MD) of the incidence and intensity of relevant adverse outcomes.


RESULTS
We reviewed nineteen trials, which comprised 1566 patients. The incidence of early- and late-phase postoperative sore throat (POST), coughing, agitation, hoarseness, and dysphonia decreased significantly in lidocaine groups, with RRs of 0.46 (95% confidence interval [CI]: 0.31 to 0.68), 0.41 (95% CI: 0.25 to 0.66), 0.43 (95% CI: 0.31 to 0.62), 0.37 (95% CI: 0.25 to 0.55), 0.43 (95% CI: 0.29 to 0.63), and 0.19 (95% CI: 0.08 to 0.5), respectively, when compared with the control groups. The severity of POST also reduced significantly (mean difference [MD] -16.43 mm, 95% CI: -21.48 to -11.38) at 1 h and (MD -10.22 mm, 95% CI: -13.5 to -6.94) at 24 h. Both alkalinized and non-alkalinized lidocaine in the subgroup analyses showed significant benefits in emergence phenomena prevention compared with the control.


CONCLUSIONS
Our results indicate that both alkalinized and non-alkalinized intracuff lidocaine may prevent and alleviate POST and postintubation-related emergence phenomena.
Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Institute of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Fai
F
Lam
Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
Yu-Cih
YC
Lin
Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.
Hsiao-Chien
HC
Tsai
Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Ta-Liang
TL
Chen
Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center for Evidence-based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Evidence-based Medicine Center, Taipei Medical University Hospital, Taipei, Taiwan.
Ka-Wai
KW
Tam
Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan.
Chien-Yu
CY
Chen
D000768:Anesthesia, General / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage*; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008012:Lidocaine / Q000008:administration & dosage*; D010612:Pharyngitis / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
D000779:Anesthetics, Local; D008012:Lidocaine