Development of a Protocol for Using Alkalinized Intrucuff Lidocaine for General Endotracheal Anesthesia

Abstract

Patient coughing and bucking during a surgical procedure, as well as post-operative sore throat (POST) and emergence phenomena cough, can be detrimental to patients after general endotracheal tube anesthesia. The use of alkalinized intracuff lidocaine as opposed to air as the medium for inflation of the endotracheal tube cuff is an evidence-based method to alleviate coughing intraoperatively as well as POST and emergence phenomena cough. This method is already being practiced by a faction of anesthesia providers for electrophysiology (EP) procedures, especially those using jet ventilation, at a large teaching hospital in Tucson, AZ, but this practice lacked an evidence-based protocol within the facility. Therefore, a protocol was written through a systematic process and evaluated by two anesthesia providers (Group 1) trained in the use of the DELBI tool to assess its overall quality (Siering, Eikermann, Hausner, Hoffmann-Eßer, & Neugebauer, 2013). The overall assessment of the protocol was rated to be 79%, which is considered high quality per the tool standards (AGREE, 2017). Following this finding, a presentation at the target hospital took place, which introduced the new protocol and explained the recommendations. A feasibility survey was administered to CRNAs in attendance (Group 2) to determine the clarity and feasibility of the protocol (n=10) as well as assess if any noted barriers were present (n=4). The results of the survey showed clarity at 97.5% and feasibility at 90%. The only stated barriers to the protocol were drug accessibility within the operating rooms (Pyxis) and/or receiving drugs in a timely manner from the pharmacy (n=3) and notification/agreement of the physician anesthesiologists (n=1). Therefore, the newly written protocol was recommended for use by the anesthesia providers at the project facility to safely and effectively use alkalinized intracuff lidocaine to prevent intraoperative cough as well as POST and emergence phenomena.