Improving endotracheal tube tolerance with intracufflidocaine: a meta-analysis of randomized controlled trials

The aim of this study was to compare the efficacy in alleviating the endotracheal tube related discomfort and the safetyof intracufflidocaine (in different forms) with air and/or normal saline (NS) during general anesthesia with tracheal intubation. Cochrane Central Register of Controlled Trials, PubMed and Embase were searched for relevant studies. Thirteen randomized, controlled trials involving 1 010 patients were ultimately identified. A meta-analysis of all randomized controlled trials fulfilling the predefined criteria was performed. Random-effect model and subgroup studies were used when significant heterogeneity existed among those trials. Compared with air and NS, intracufflidocaine could significantly alleviate the severity of sore throat at different time points (15min, 30min, 1h, 2h, 3h, 6h, 12h and 24h after extubation) and the occurrence of cough, restlessness, postoperative nausea and vomiting, dysphonia and hoarseness. Besides intracufflidocaine brought about a significant prolongation of spontaneous ventilation time. It was worth mentioning that, compared withlidocaine or its hydrochloride form, alkalinized lidocainewas much more efficient in reducing the severity of sore throat and prolonging spontaneous ventilation time. The present meta-analysis indicates that intracufflidocaine can significantly improve endotracheal tube tolerance and this improvement can be strengthened by alkalinization of lidocaine.