Lidocaine added to a tracheostomy tube cuff reduces tube discomfort

Abstract

Purpose: To examine whether lidocaine diffusion across an endotracheal tube cuff affects tracheostomy tube discomfort. Methods: Two tracheostomy tube cuffs were inflated with 5 ml lidocaine 4% solution and air at 20 cmH2O, and then placed in 20 ml distilled water at 37°C. After vigorous stirring, 100 μl of this water was then sampled immediately then 1, 2, 4, 8, 24 hr later to measure lidocaine concentration by high-performance liquid chromatography. Sixteen patients undergoing tracheostomy following oral cancer resection were randomly assigned to two groups: lidocaine (n=8) and placebo (n=8). A tracheostomy tube cuff was inflated with 5 ml lidocaine 4% or saline 0.9% and air to a cuff pressure of 20 cmH2O, in the lidocaine and placebo groups respectively. Tube discomfort was evaluated using a visual analogue scale at 0, 0.5, 1, 2 and 4 hr after lidocaine or saline administration. Neither analgesics nor sedatives was given during the evaluation period. Results: Lidocaine time-dependently diffused across the tracheostomy tube cuff. Thirty and 60 min after cuff inflation lidocaine concentrations in the water bath reached approximately 8 and 17 μg·m1-1 representing 160 and 340 μg in 20 ml of water, respectively. The VAS decreased from 53.5 ± 10.6 to 25.1 ± 9.8 mm (P < 0.01) 0.5 hr following lidocaine administration which continued until the end of evaluation period. In the placebo group, VAS did not change. Conclusion: Lidocaine diffusion across the tracheostomy tube cuff reduces tube discomfort.