Intracuff alkalinized lidocaine attenuates airway irritation and hemodynamic responses during extubation: a...

Endotracheal intubation and extubation are commonly associated with airway irritation, including coughing, sore throat, and hemodynamic instability during the periextubation period. Intracuff lidocaine diffuses across the endotracheal tube cuff to provide topical tracheal anesthesia, and alkalinization enhances this diffusion by increasing the non-ionized fraction.

This retrospective observational study aimed to compare the effects of intracuff alkalinized lidocaine and intravenous lidocaine on airway irritation and hemodynamic responses during the periextubation period.

Periextubation airway responses and hemodynamic parameters were retrospectively evaluated in patients receiving either intracuff alkalinized lidocaine or intravenous lidocaine as part of routine clinical practice. Perioperative data were independently recorded by anesthesiologists and subsequently extracted from anesthesia records. Outcome assessment and data extraction were performed by an investigator not involved in intraoperative management and unaware of group allocation. Statistical analyses followed a predefined analytical approach.

Of 155 patients assessed, 120 were included in the final analysis (intracuff alkalinized lidocaine, n = 60; intravenous lidocaine, n = 60). The number of cough episodes within the first 10 min after extubation was significantly lower in the intracuff alkalinized lidocaine group. Postoperative sore throat and foreign body sensation were also less frequent. Within-patient analysis showed smaller and more transient postoperative heart rate increases in patients receiving intracuff alkalinized lidocaine.

Intracuff alkalinized lidocaine was associated with reduced airway irritation and improved periextubation hemodynamic stability compared with intravenous lidocaine, suggesting it may be a simple and clinically effective strategy to improve extubation quality.