The Effect of Intracuff Low Dose Alkalinized Lidocaine With and Without Dexamethasone on Extubation Response: A Prospective, Double-Blind, Randomized Control Trial

Abstract

Background: Intubation with a cuffed endotracheal tube is the gold standard for securing a definitive airway. Bucking over the tube during extubation can result in a potentially dangerous hemodynamic response. Tracheal tube cuff can be used as a reservoir for drugs to blunt this response. Lidocaine, a local anesthetic can achieve this by anesthetizing the airway. Dexamethasone has been known to potentiate the effect of lidocaine and has an intrinsic anti-inflammatory property. Methods: A prospective double-blind randomized control trial was conducted in a tertiary hospital for patients undergoing elective surgeries under general anesthesia requiring endotracheal intubation. Sixty patients were randomized equally into one of three groups. Cuff was inflated with saline (Group-S), 40 mg alkalinized lidocaine (Group-L), 40 mg alkalinized lidocaine with 8 mg dexamethasone (Group-LD). Heart rate, blood pressure and bucking were recorded during extubation, and post-operative sore throat were assessed. Results: All groups were comparable with regard to demographics, quantity of drug instilled in the cuff, duration of extubation and baseline hemodynamics. Group-L had the lowest incidence of hemodynamic changes during extubation, even lower than Group-LD. (p=0.020). Group-L and Group-LD had a lower incidence of bucking when compared to placebo (p<0.001). Both Group-L and Group-LD revealed a lower grade of sore throat in the early post-operative period. Conclusion: Instilling endotracheal tube cuff with 40 mg alkalinized significantly blunts hemodynamic response and bucking during extubation, and sore throat in the early post-operative period compared to placebo. Addition of 8 mg dexamethasone does not improve hemodynamic extubation response.