Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2021; 9(34): 10626-10637
Published online Dec 6, 2021. doi: 10.12998/wjcc.v9.i34.10626
Intracuff alkalinized lidocaine to prevent postoperative airway complications: A meta-analysis
Zhen-Xing Chen, Zhou Shi, Bin Wang, Ye Zhang
Zhen-Xing Chen, Zhou Shi, Bin Wang, Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
Ye Zhang, Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
Author contributions: Chen ZX, Wang B and Zhang Y participated in the design; Chen ZX and Shi Z extracted the data; Chen ZX, Wang B and Shi Z performed the quality assessment; Chen ZX performed the statistical analysis; Zhang Y wrote the manuscript.
Conflict-of-interest statement: The authors report no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ye Zhang, PhD, Doctor, Full Professor, Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei 230601, Anhui Province, China.
Received: May 8, 2021
Peer-review started: May 8, 2021
First decision: June 5, 2021
Revised: June 6, 2021
Accepted: August 17, 2021
Article in press: August 17, 2021
Published online: December 6, 2021

Post-extubation cough is a common phenomenon in surgical patients undergoing general anesthesia, which can lead to potentially dangerous complications. In this meta-analysis, we evaluated the efficacy and safety of intracuff alkalinized lidocaine in patients with tracheal intubation to prevent cough and other airway complications during the perioperative period.


To perform a systematic review and meta-analysis of intracuff alkalinized lidocaine for the prevention of postoperative airway complications.


PubMed, Embase, Cochrane, and Web of Science were searched for randomized controlled trials (RCTs) that compared intracuff alkalinized lidocaine to placebo. We used risk-of-bias assessment to assess the RCTs, and the quality of evidence was assessed using the grading of recommendations, assessment, development, and evaluations.


Twelve randomized trials (1175 patients) were analyzed. Meta-analysis showed that intracuff alkalinized lidocaine was associated with less cough compared to that produced by placebo [risk ratio (RR): 0.38; 95% confidence interval (CI): 0.23-0.63]. Similarly, intracuff alkalinized lidocaine was more effective than the control in reducing postoperative sore throat at 24 h (RR: 0.19; 95%CI: 0.09-0.41) and postoperative hoarseness (RR: 0.38; 95%CI: 0.21-0.69).


Intracuff alkalinized lidocaine is an effective adjuvant that can decrease airway complications, such as coughing, hoarseness, and sore throat.

Keywords: Cough, Hoarseness, Lidocaine, Sore throat, Airway complication, Intracuff, Meta-analysis

Core Tip: Our study is different to previous systematic reviews and meta-analysis. We focused on adult patients and included relevant literature on alkalinized lidocaine in the analysis. In addition, this is the first systematic review and meta-analysis to analyze lubrication of the cuff before intubation in order to eliminate the influence of confounding factors on the results.