The effect of intracuff alkalized lidocaine and dexamethasone on post-extubation morbidities in smoker patients undergoing laparoscopic surgery: A double blind randomized control study

Endotracheal intubation is associated with post-operative cough, hoarseness and sore throat. Smoking inclines patients to perioperative morbidities. The aim of the study was to compare between the effect of the combination of alkalinized 2% lidocaine and dexamethasone (LD), alkalinized 2% lidocaine alone (L), dexamethasone alone (D), and air (A) on decreasing post-extubation morbidities (cough, sore throat and hoarseness), when inflated in the endotracheal tube cuff in patients who were undergoing laparoscopic surgery under general anesthesia. The main objective was to study the favorable effects of these combinations compared to air, to reduce post-extubation morbidities. A prospective, randomized, controlled, double-blind study was used. One-hundred smoking patients who underwent laparoscopic surgery participated in the study. Participants were randomly allocated to receive intra-cuff endotracheal tube agents; either alkalinized 2% lidocaine (L group, n=25), dexamethasone (D group, n=25), alkalinized 2% lidocaine + dexamethasone (LD group, n=25), or air (control group) (A group, n=25). Morbidities were evaluated at emergence, 2 hours, 8 hours and 24 hours after surgery. All 100 patients completed the study. The groups were comparable in terms of patient characteristics, anesthetic, and surgical data. The incidence of cough at 24 hours’ post-surgery in group A (n=3 (12%)) was significantly higher than in group L (n=0 (0%)) (p = 0.037), group D (n=0 (0%)) (p = 0.037) and group LD (n=0 (0%)) (p = 0.037). Moreover, the incidence of sore throat at 24 hours’ post-surgery in group A (n=8 (32%)) was significantly higher than group L (n=0 (0%)) (p <0.000), group D (n=0 (0%)) (p =0.000) and group LD (n=0 (0%)) (p =0.000). Furthermore, incidence of hoarseness at 24 hours’ post-surgery in group A (n=10 (40%)) was significantly higher than group L (n=0 (0%)) (p = 0.001), group D (n=0 (0%)) (p=0.001) and group LD (n=1 (4%)) (p = 0.001). The instillation of the combination of alkalized lidocaine and dexamethasone or lidocaine alone in the endotracheal tube cuff was superior to dexamethasone alone or the control group in reducing the incidence and the severity of post-extubation morbidities, which are cough, sore throat and hoarseness.