A comparative study on airway morbidity with air, saline, and alkalinized lidocaine used for inflation of tracheal tube cuffs.

Introduction: Laryngoscopy and endotracheal intubation are essential in securing the airway but also serve as intense noxious stimuli, which may result in airway morbidity in the postoperative period. Our study aimed to compare the incidence of airway morbidity associated with endotracheal intubation when the tracheal tube cuff was inflated with air, saline, or alkalinized lidocaine in the adult population. Materials and Methods: The study was conducted in a tertiary care hospital in India. American Society of Anesthesiologists Grade I and II patients aged 18-60 years, scheduled for surgeries under general anesthesia, were enrolled in the study. Exclusion criteria were anticipated difficult airway/failed intubation, respiratory tract infections, asthma, chronic obstructive pulmonary disease, pregnancy, and patients with gastroesophageal reflux. Patients were randomly allocated into one of three equal groups n = 40 (air, saline, and 2% lidocaine with 7.5% sodium bicarbonate as endotracheal tube [ETT] cuff inflation media). The primary outcome was postoperative sore throat (POST) and cough evaluated at the time of extubation, followed by 1 h and 24 h. The secondary outcomes were the incidence of hoarseness of voice and post-operative nausea and vomiting (PONV) reported by patients postoperatively at different intervals. Results: The study showed that the post-extubation incidence of cough was higher in ETT cuffs filled with air or saline than in alkalinized lidocaine at 0 h. POST was statistically significant in ETT cuffs filled with air or saline as compared to alkalinized lidocaine at 1 h. Hoarseness and PONV were lowest in the alkalinized lidocaine group. Conclusion: Filling the tracheal tube cuff with alkalinized lidocaine resulted in a lesser incidence of undesirable events post-intubation, which contributed to overall airway morbidity.