title: The effects of tracheal tube cuffs filled with air, saline or alkalinised lidocaine on haemodynamic changes and laryngotracheal morbidity in children: a randomised, controlled trial.
abstract: We studied the effects of tracheal tube cuffs filled with air, saline or alkalinised lidocaine on haemodynamic changes during tracheal extubation and postoperative laryngotracheal morbidity in children. We randomly allocated 164 children aged 3-13 years undergoing general anaesthesia to one of four groups; tracheal tube cuffs filled with air (n = 41); saline (n = 41); alkalinised lidocaine 0.5% (n = 41); or alkalinised lidocaine 1% (n = 41). Intracuff pressure was monitored and maintained below 20 cmH2O. The mean (SD) increases in systolic blood pressure after tracheal extubation compared with before extubation were 10.9 (10.8) mmHg, 7.3 (17.7) mmHg, 4.1 (10.5) mmHg and 1.9 (9.5) mmHg in the air, saline, 0.5% and 1% alkalinised lidocaine groups, respectively (p = 0.021). The mean (SD) increases in diastolic blood pressure after tracheal extubation compared with before extubation were 3.9 (9.7) mmHg, 7.9 (14.6) mmHg, 0.7 (10.4) mmHg and 3.6 (6.9) mmHg in the air, saline, 0.5% and 1% alkalinised lidocaine groups, respectively (p = 0.019). The mean (SD) increases in heart rate after tracheal extubation compared with before extubation were 14.2 (7.6) beats.min-1, 15.5 (13.1) beats.min-1, 5.2 (9.6) beats.min-1and 4.1 (6.6) beats.min-1in the air, saline, 0.5% and 1% alkalinised lidocaine groups, respectively (p < 0.001). The incidence of sore throat 8 h after tracheal extubation was 22.0% in the air-filled group, 9.8% in the saline group, 4.9% in the 0.5% alkalinised lidocaine group and 2.4% in the 1% alkalinised lidocaine group, p = 0.015. We conclude that filling the tracheal tube cuff with alkalinised lidocaine-filled reduces the haemodynamic response to tracheal extubation and postoperative laryngotracheal morbidity in children.
authors.affiliation: Department of Anaesthesiology, Botucatu School of Medicine, UNESP, São Paulo, Brazil.
authors.forename: S M F
authors.initials: SM
authors.lastname: Soares
authors.affiliation: Department of Anaesthesiology, Botucatu School of Medicine, UNESP, São Paulo, Brazil.
authors.forename: V M
authors.initials: VM
authors.lastname: Arantes
authors.affiliation: Department of Anaesthesiology, Botucatu School of Medicine, UNESP, São Paulo, Brazil.
authors.forename: M P
authors.initials: MP
authors.lastname: Módolo
authors.affiliation: Department of Ophthalmology, Ear, Nose and Throat, Head and Neck Surgery, Botucatu School of Medicine, UNESP, São Paulo, Brazil.
authors.forename: V J B
authors.initials: VJ
authors.lastname: Dos Santos
authors.affiliation: Department of Anaesthesiology, Botucatu School of Medicine, UNESP, São Paulo, Brazil.
authors.forename: L A
authors.initials: LA
authors.lastname: Vane
authors.affiliation: Department of Anaesthesiology, Botucatu School of Medicine, UNESP, São Paulo, Brazil.
authors.forename: L H
authors.initials: LH
authors.lastname: Navarro E Lima
authors.affiliation: Department of Anaesthesiology, Botucatu School of Medicine, UNESP, São Paulo, Brazil.
authors.forename: L G
authors.initials: LG
authors.lastname: Braz
authors.affiliation: Department of Anaesthesiology, Botucatu School of Medicine, UNESP, São Paulo, Brazil.
authors.forename: P
authors.initials: P
authors.lastname: do Nascimento
authors.affiliation: Department of Anaesthesiology, Botucatu School of Medicine, UNESP, São Paulo, Brazil.
authors.forename: N S P
authors.initials: NS
authors.lastname: Módolo
mesh_terms: D000293:Adolescent; D000388:Air; D060666:Airway Extubation; D000468:Alkalies; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods*; D007830:Larynx / Q000293:injuries*; D008012:Lidocaine; D008297:Male; D010612:Pharyngitis / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011312:Pressure; D011446:Prospective Studies; D000077330:Saline Solution; D014132:Trachea / Q000293:injuries*
chemical_list: D000468:Alkalies; D000077330:Saline Solution; D008012:Lidocaine
keywords: complications: sore throat; cuffed tracheal tubes; lidocaine paediatrics: airway management