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Lidocaine added to a tracheostomy tube cuff reduces tube discomfort

Waka Hirota, DDS PhD^*, Wataru Kobayashi, DDS PhD^*, Keiichi Igarashi, DDS PhD^*, Yasuko Yagihashi, DDS PhD^*, Hiroto Kimura, DDS PhD^*, James Strupish, BSc and Kazuyoshi Hirota, MD

^* From the Departments of Dentistry and Oral Surgery and
Anesthesiology, University of Hirosaki School of Medicine, Hirosaki 036-8562, Japan, and
University Department of Anaesthesia and Pain Management, Leicester Royal Infirmary, Leicester LE1 5WW, UK.

Address correspondence to: Dr. K. Hirota, Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki 036-8562, Japan. Phone: +81-172-39-5111; Fax: +81-172-39-5112; E-mail: masuika{at}cc.hirosaki-u.ac.jp

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•ml^–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.

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