Effects of Alkalinized Intra-cuff Lidocaine on Postoperative Airway Complaints Following Cesarean Section

Abstract

Many reports have described postoperative airway complaints after endotracheal intubation for general anesthesia, however, none have addressed cesarean sections. We investigated the incidence and severity of postoperative airway complaints in pregnant women receiving elective general anesthesia and evaluated the effect of intratracheal cuff lidocaine administration on these complaints. Two hundred and ninety-four pregnant women undergoing elective cesarean sections under general anesthesia, with American Society of Anesthesiologists physical status ratings Ⅰ or Ⅱ, were randomly assigned to the two groups having endotracheal tube cuffs inflated with either air (group A, mean volume = 6.4 ± 1.8 mL) or alkalinized lidocaine (group L, mean volume = 6.2 ± 1.5 mL) (n = 147 in each group). Alkalinization of lidocaine was achieved by the addition of 8.4% NaHCO3 to a 1:10 ratio of lidocaine:NaHCO3. The incidence and severity of postoperative sore throat (POST), hoarseness, and coughing were evaluated during the 24 hours immediately following cesarean sections. The incidence of POST, hoarseness, and coughing were decreased in the group L (67.3%, 53.7%, and 9.5%, respectively) compared to the group A (78.9%, 69.4%, and 19%, respectively) (p=0.025, 0.006, and 0.02, respectively). Intracuff lidocaine significantly attenuated the severity of hoarseness. There was no significant difference in Apgar scores in neonates between the two groups. Intra-cuff lidocaine effectively decreased the incidence and severity of postoperative airway complaints in pregnant women undergoing cesarean sections without affecting fetal outcome.