A Randomized Clinical Study to Compare the Emergence Phenomena after General Anaesthesia With 2% Lignocaine Jelly And 4% Lignocaine Intracuff

Abstract

Background: Anaesthesiologists do experience varying degree of problems with extubation. Coughing during emergence from general anesthesia is a common problem. We sought to determine whether inflating endotracheal tube cuff with lignocaine would create a reservoir of local anaesthetic, which might diffuse across the cuff membrane to anaesthetize the mucosa, thus attenuating stimulation during extubation of the trachea. Objective: To assess incidence of coughing and hemodynamic changes post extubation with 2% lignocaine jelly and 4% lignocaine intracuff. Study design: 1 year randomized clinical study. Methods: After obtaining approval from institutional ethical committee, 140 patients of ASA I and II, age of 18 to 65 years were studied. After intubation with an endotracheal tube, the cuff inflated with 4% lignocaine in one group and air in another group, 2% lignocaine jelly applied over the cuff which was to be inflated with air and cuff pressure set at 20 cm H 2 O with Rusch Endotest cuff inflator. Cuff pressure recorded just before extubation. After extubation, a blinded observer recorded incidence of coughing, heart rate and blood pressure. Data was analyzed statistically. Results: The groups were demographically comparable. Significant changes were observed in cuff pressures. We observed that 4% lignocaine intracuff reduces the incidence of coughing for the time period 0-5 minutes post extubation ( P<0.001) . There was significant decrease in hemodynamic response ( P<0.001) in intracuff lignocaine group. Conclusion: 4% lignocaine intracuff significantly reduces post extubation coughing and decreases hemodynamic response to extubation in addition maintains constant cuff pressure.