Lignocaine in ETT cuff for aerosol prevention during COVID-19 - new method

A major worry for anesthesiologists during the current coronavirus illness (COVID-19) pandemic is aerosolization from coughing by COVID-19 patients. The predominant mode of transmission of this virus among healthcare practitioners is by aerosols. Diverse approaches have been described in the literature for minimizing aerosol production during the recovery from general anesthesia. However, various approaches, such as the mask over the tube technique, the use of spray boxes, and the application of plastic drapes to the patient's face, although advantageous, are time-consuming and bothersome. A recently published article suggested an unique method for preventing aerosols.

Administration of lignocaine jelly at a concentration of 4 percent for intracuff instillation during the perioperative phase reduces aerosol formation, which may be of great relevance during this pandemic. This is because lignocaine diffuses over the cuff membrane and anesthetizes the tracheal mucosa, hence lowering tracheal irritation and preventing coughing in the immediate postextubation phase. As aerosol formation is greater during extubation than during intubation, lignocaine is an effective and simple method for reducing aerosolization and, thus, the propagation of the virus.

In addition to other measures, such as the proper wearing and doffing of personal protective equipment, we suggest using lignocaine at a concentration of 4 percent to inflate endotracheal tube cuffs (instead of air). By reducing the frequency of coughing during extubation, this would aid in lowering the dissemination of aerosols. In addition, it will likely reduce post-extubation sore throat, pharyngitis, hoarseness, dysphagia, dysphonia, laryngospasm, and bronchospasm. In the perspective of the author, regular intracuff instillation of 4% lignocaine is one of the most straightforward, effective, and advantageous methods for reducing aerosol formation when extubating patients during this pandemic.

Reference –

Sethi, Priyanka; Kaur, Manbir,; Kumari, Kamlesh; Bhatia, Pradeep Role of lignocaine in aerosol prevention during COVID-19: A new perspective, Journal of Anaesthesiology Clinical Pharmacology: Volume 38 - Issue Suppl 1 - p S138-S139

doi: 10.4103/joacp.JOACP_690_20