Effects of lidocaine via the perforated outer cuff of dual-cuff endotracheal tube and remifentanil on the recovery profiles from general anesthesia of female patients undergoing thyroidectomy: an one-centre, double-blind, randomized study

Abstract Background: Cough caused by endotracheal tube (ETT) is ubiquitous and correlates with adverse outcomes. Remifentanil via target-controlled infusion (TCI) was one of cough prevention measures during recovery. In the pilot study, lidocaine via the perforated outer cuff of dual-cuff endotracheal tube also prevented cough to the ETT. We therefore compared these two preventions of cough during recovery after thyroidectomy in the one-centre, double-blind, randomized study in China from 09 / 10 / 2020 to 30 / 04 / 2021.Methods: Ninety-eight female patients, aged 18–65 years, with an American Society of Anesthesiologists I and II, were scheduled to undergo thyroidectomy. The ETT contains an internal cuff covered by an outer cuff with holes as lidocaine delivery channel. Patients were randomized to receive either 4 ml saline solution (Group R, n = 49) or 4 ml 2% lidocaine in the outer cuff (Group L, n = 49) at the beginning of the skin suture. Remifentanil 2 ng/ ml in Group R was maintained until extubation, while remifentanil in Group L was maintained until the end of the skin suture. The primary outcome was cough during patient transfer, 1 min before extubation and extubation. The secondary outcomes were hemodynamics and other recovery profiles. Results: The primary outcomes included remifentanil vs. lidocaine in the incidence of cough during patients transfer (0% vs.0%), 1 min before extubation (22% vs. 4%; P = 0.015), and extubation (61% vs.20%; P = 0.000). Compared with remifentanil, lidocaine more effectively decreased the rate of elevation of heart rate and hypoxemia at 5 min after extubation, spontaneous respiration recovery time, extubation time, duration of post-anesthesia care unit (PACU), and Richmond Agitation-Sedation Scale in agitated and Critical-Care Pain Observation Tool. Conclusion: Lidocaine via the perforated outer cuff of the ETT significantly improved recovery profiles from general anesthesia compared to remifentanil in female patients after thyroidectomy.Trial registration: Chinese Clinical Trial Registry (No. ChiCTR2000038653), registered on 27 / 09 / 2020.