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Randomized Controlled Trial
. 2024 Jul 1;24(1):216.
doi: 10.1186/s12871-024-02606-6.

Effect of cuff inflation with lidocaine, saline, and air on tracheal tube cuff pressure during laparoscopic resection of colorectal neoplasms: a randomized clinical trial

Xuan Wang  1 , Jie Zhang  2 , Guangli Zhu  3 , Shenquan Cai  2 , Qingtong Zhang  2 , Manlin Duan #  4 , Shanwu Feng #  5
Affiliations
Randomized Controlled Trial

Effect of cuff inflation with lidocaine, saline, and air on tracheal tube cuff pressure during laparoscopic resection of colorectal neoplasms: a randomized clinical trial

Xuan Wang et al. BMC Anesthesiol. .

Abstract

Background: Tracheal tube cuff pressure will increase after pneumoperitoneum when the cuff is inflated with air, high pressure can cause tracheal mucosal damage. This prospective trial aimed to assess if inflating with normal saline or lidocaine can prevent increase of tracheal tube cuff pressure and tracheal mucosal damage in laparoscopic surgeries with general anesthesia. Whether changes of tracheal tube cuff transverse diameter (CD) can predict changes of tracheal tube cuff pressure.

Methods: Ninety patients scheduled for laparoscopic resection of colorectal neoplasms under general anesthesia were randomly assigned to groups air (A), saline (S) or lidocaine (L). Endotracheal tube cuff was inflated with room-temperature air in group A (n = 30), normal saline in group S (n = 30), 2% lidocaine hydrochloride injection in group L (n = 30). After intubation, tracheal tube cuff pressure was monitored by a calibrated pressure transducers, cuff pressure was adjusted to 25 cmH2O (T0.5). Tracheal tube cuff pressure at 15 min after pneumoperitoneum (T1) and 15 min after exsufflation (T2) were accessed. CD were measured by ultrasound at T0.5 and T1, the ability of ΔCD (T1-0.5) to predict cuff pressure was accessed. Tracheal mucous injury at the end of surgery were also recorded.

Results: Tracheal tube cuff pressure had no significant difference among the three groups at T1 and T2. ΔCD had prediction value (AUC: 0.92 [95% CI: 0.81-1.02]; sensitivity: 0.99; specificity: 0.82) for cuff pressure. Tracheal mucous injury at the end of surgery were 0 (0, 1.0) in group A, 0 (0, 1.0) in group S, 0 (0, 0) in group L (p = 0.02, group L was lower than group A and S, p = 0.03 and p = 0.04).

Conclusions: Compared to inflation with air, normal saline and 2% lidocaine cannot ameliorate the increase of tracheal tube cuff pressure during the pneumoperitoneum period under general anesthesia, but lidocaine can decrease postoperative tracheal mucosa injury. ΔCD measured by ultrasound is a predictor for changes of tracheal tube cuff pressure.

Trial registration: Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

Keywords: Endotracheal tube cuff pressure; Laparoscopic surgery; Lidocaine; Normal saline; Tracheal mucosa injury.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The TD at the level of the suprasternal notch measured by ultrasound. The high-frequency hockey stick probe was coated with ultrasound gel before being held perpendicular to the midline of the trachea and the TD at the level of the suprasternal notch was measured. The shadow: trachea; TD: tracheal transverse diameter
Fig. 2
Fig. 2
The CD at the level of the suprasternal notch measured by ultrasound. To find the maximal diameter of the tracheal tube cuff, we first placed the probe on the level of the suprasternal notch to confirm the placement of the tracheal tube cuff, then slowly moved the probe upright toward the head to find the maximal diameter of the tracheal tube cuff. The shadow: cuff; CD: tracheal tube cuff transverse diameter
Fig. 3
Fig. 3
Evaluation of tracheal mucous injury using a bronchofiberscope. The bronchofiberscope was inserted using the transtracheal tube until it reached the tracheal tube cuff. Then, the cuff was deflated, and the tracheal tube was extubated carefully to avoid the tip of the tracheal tube falling into the glottis
Fig. 4
Fig. 4
Consort flow chart that outlines patients’ assignment. This study enrolled 96 of 211 eligible patients, and 6 were excluded from the analysis: 3 were lost to follow-up, 1 was intubated more than once during anesthesia induction, and 2 had delayed emergence. Therefore, 90 patients were included in the final analysis
Fig. 5
Fig. 5
ROC for ΔCD and ΔTD for prediction of tracheal tube cuff pressure. ΔCD had the highest prediction value (AUC: 0.92 [95% CI: 0.81–1.02]; cutoff: 0.03; sensitivity: 0.99; specificity: 0.82), ΔTD had no prediction value (AUC: 0.66 [95% CI: 0.51–0.80]; cutoff: 0.05; sensitivity: 0.74; specificity: 0.65). ROC: receiver operating characteristic curve; ΔTD: tracheal transverse diameter’s variation; ΔCD: tracheal tube cuff transverse diameter’s variation; AUC: area under curve; CI: confidence interval
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