Intracuff alkalinized lidocaine to prevent postoperative airway complications:A meta-analysis

BACKGROUND 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.AIM To perform a systematic review and meta-analysis of intracuff alkalinized lidocaine for the prevention of postoperative airway complications.METHODS 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.RESULTS 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).CONCLUSION Intracuff alkalinized lidocaine is an effective adjuvant that can decrease airway complications,such as coughing,hoarseness,and sore throat.

Unilateral Hypoglossal Nerve Palsy after the Use of a Novel Supraglottic Airway Device

Background: The LMA® Protector™ Airway is a new supraglottic airway device with Cuff Pilot™ Technology that enables visual monitoring of intra-cuff pressure, to reduce the risk of complications from an overinflated device. Case: We present a case of unilateral hypoglossal nerve injury after its use. In our knowledge, this is the first reported case of hypoglossal nerve injury after LMA® Protector™ use. Learning Points: Hypoglossal nerve injury is a rare but distressing complication of LMA use. The greater horn of the hyoid bone is a potential site of injury, as the cuff of the LMA may compress the nerve against bone. In our patient, possible contributing factors included cuff overinflation with/without failure of the Cuff Pilot™ technology, inappropriate sizing and placement of an unfamiliar device. Fortuitously, injury is often neuropraxia with complete recovery in 6 months following conservative management. Consideration should be given to down-sizing the device for Asian patients who tend to have smaller jaws for their weight range. We caution that whilst the green zone of the Cuff Pilot™ corresponds to 40 - 60 cm H2O cuff pressure, it may be more than the “just-seal” pressure required and the cuff may still be overinflated relative to the size of the patient’s airway.