Effect of Intracuff Alkalinized Lignocaine on the Incidence of Post Operative Sore Throat and Cough

Nasreen Kaja, (2019) Effect of Intracuff Alkalinized Lignocaine on the Incidence of Post Operative Sore Throat and Cough. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION: Post operative sore throat is the most common complaint after endotracheal intubation and is seen in upto 90% of the patients. It maybe considered along with endotracheal tube emergence phenomenon with laryngeal edema and ischemia. Chemical and mechanical irritation of the tracheal mucosa influences the incidence of cough at emergence from general anesthesia, potentially leading to significant postoperative complications. Sore throat during emergence in a lighter plane of anaesthesia can result in detrimental hemodynamic changes. These changes are particularly undesirable in patients undergoing neurosurgical and, ophthalmic or those who have an increased risk of adverse cardiovascular event. Both in-vivo and in-vitro studies have been conducted on endotracheal tube cuffs filled with lignocaine. Past studies using high doses of lignocaine are associated with complications in the event of rupture of cuff. Sodium bicarbonate is hence added to increase the diffusion of lignocaine low doses of through the cuff thereby preventing complications like sore throat, restlessness, nausea, vomiting, dysphonia and hoarseness of voice. So in this study we compared the effect of intracuff alkalinized lignocaine and air in minimizing the incidence of post operative sore throat and cough after endotracheal intubation in general anaesthesia. AIM OF THE STUDY: 1.To compare the incidence of post operative sore throat after general anaesthesia while using air and alkalinized lignocaine as the cuff inflation media of the endotracheal tube. 2. To study the incidence of cough, vomiting, hoarseness of voice and aspiration after extubation while inflating the cuff of the endotracheal tube with alkalinized lignocaine. MATERIALS AND METHODS: This study was done in patients undergoing elective surgical procedures lasting for more than two hours under general anesthesia in the Department of Otorhinolaryngology and Department of General Surgery, Stanley Medical College, Chennai. This was a randomized, prospective comparative study conducted on 150 patients over a period of six months. Patients were explained about the procedure in detail and informed written consent was obtained. The approval of the Institutional Ethical Committee was obtained. STUDY DESIGN: Prospective, randomized, comparative, single blinded study was conducted. INCLUSION CRITERIA: All patients assessed under ASA physical status classification I and II aged 18-60 yrs scheduled to undergo surgery under general anaesthesia lasting for more than 2 hours. EXCLUSION CRITERIA: 1. Patients with difficult airway i.e. Modified Mallampatti grade III/IV, 2. Patients with history suggestive of Gastro esophageal reflux, 3. Patients with history of laryngeal or tracheal surgery and history of asthma, cardiovascular disease, smoking. 4. Recent respiratory infection, 5. Requirement of more than one attempt for endotracheal intubation. 6. Patients who need nasogastric tube intraoperatively. 7. Surgery lasting less than 40 min. 8. No consent for study. FINDINGS: A prospective observational study on the effect of intracuff alkalinized lignocaine on the incidence of post operative sore throat and cough after general anaesthesia in a tertiary care center revealed the following findings. All patients assessed under ASA physical status classification I and II aged 18- 60 yrs scheduled to undergo surgery lasting for more than 2 hours were included in the study. CONCLUSION: In our study we conclude that inflating the cuff of the endotracheal tube with alkalinized lidocaine avoids the cuff overinflation due to rapid trans-cuff N2O diffusion during general anesthesia with nitrous-oxygen mixture. Hence, inflating the endotracheal tube cuff with alkalinized lignocaine is an alternative method to prevent post operative sore throat and other potential complications of extubation including post operative cough and hoarseness of voice which results from cuff overinflation in patients undergoing general anaesthesia.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Intracuff Alkalinized Lignocaine, Incidence, Post Operative Sore Throat and Cough.
Subjects: MEDICAL > Anaesthesiology
Depositing User: Subramani R
Date Deposited: 19 Aug 2019 01:08
Last Modified: 19 Aug 2019 01:08
URI: http://repository-tnmgrmu.ac.in/id/eprint/11039

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