The effects of intracuff lidocaine on endotracheal-tube-induced emergence phenomena after general anesthesia

Coughing during emergence from general anesthesia is a common clinical prob lem. We sought to determine whether inflating the endotracheal tube cuff wi th lidocaine would create a reservoir of local anesthetic, which might diff use across the cuff membrane to anesthetize the mucosa, thus attenuating st imulation during extubation of the trachea. A total of 63 patients undergoi ng elective surgery were enrolled in a prospective, randomized, double-blin ded study. After intubation of the trachea with an endotracheal tube, the c uff of the tube was inflated with either lidocaine 4%, saline, or air. Afte r extubation, a blinded observer noted heart rate, blood pressure, oxygen s aturation, end-tidal isoflurane concentration, and the incidence of coughin g. Data were analyzed by using analysis of variance, Student's t-test, and the chi(2) test for multiple variables. The groups were demographically com parable. There was no difference in hemodynamic or oxygen saturation data b etween either group. The incidence of coughing was decreased in the lidocai ne group for the time period of 4-8 min postextubation (P < 0.05). We concl ude that inflation of the cuff of the endotracheal tube can reduce the inci dence of coughing in the initial postextubation period, a finding that may benefit certain patient groups in which this is particularly desirable.