Chen ZX, Shi Z, Wang B, Zhang Y. Intracuff alkalinized lidocaine to prevent postoperative airway complications: A meta-analysis. World J Clin Cases 2021; 9(34): 10626-10637 [PMID: 35004994 DOI: 10.12998/wjcc.v9.i34.10626]
Corresponding Author of This Article
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. zhangye_hassan@sina.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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: http://creativecommons.org/Licenses/by-nc/4.0/
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. zhangye_hassan@sina.com
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
ARTICLE HIGHLIGHTS
Research background
Tracheal intubation is the most commonly used airway management method in general anesthesia. However, this approach has been associated with some problems, such as postoperative airway complications, which are common phenomena and adverse reactions in patients who underwent elective general anesthesia. To reduce the occurrence of postoperative airway-related complications, many interventions have been proposed. Among these, intracuff alkalinized lidocaine can be used as local anesthesia, to reduce complications during extubation, and to avoid the side effects of lidocaine on the circulation and central nervous system during general application.
Research motivation
Intracuff lidocaine can be used as local anesthesia, to reduce complications during extubation, and to avoid the side effects of lidocaine on the circulation and central nervous system during general application. Nevertheless, lidocaine is not easy to diffuse in the cuff, and adding sodium bicarbonate can greatly enhance the diffusion ability of lidocaine, to achieve better action on the tracheal mucosa.
Research objectives
Perform a systematic review and meta-analysis to summarize the efficacy of intracuff alkalinized lidocaine in the prevention of postoperative airway-related complications.
Research methods
A comprehensive literature search of Pubmed (until May 2020), Embase (until May 2020), Cochrane (until May 2020), and Web of Science (until May 2020) was performed. Heterogeneity was assessed using the Cochrane Q test and I2 statistic. A fixed-effect model was used if heterogeneity was considered low. If I2 statistic ≥ 50% and P < 0.05, a random-effects model was applied to the data.
Research results
Twelve randomized trials (1175 patients) met the inclusion criteria. The meta-analysis showed that intracuff alkalinized lidocaine was associated with less cough compared to that produced by placebo. Similarly, intracuff alkalinized lidocaine was more effective than the control in reducing postoperative sore throat at 24 h and postoperative hoarseness. Five trials that included 476 participants demonstrated a large reduction in the visual analogue scale of a postoperative sore throat at 1 h or 24 h with the use of intracuff alkalinized lidocaine.
Research conclusions
Intracuff alkalinized lidocaine decreased postoperative airway complications, including coughing, hoarseness, and sore throat. Furthermore, for patients with a post-extubation sore throat, it could also reduce the degree of pain.
Research perspectives
The use of intracuff alkalinized lidocaine after tracheal intubation is a simple, economical and safe choice to prevent postoperative cough, sore throat, and hoarseness in adult patients. Anesthesiologists can use this technique in clinical patients.
