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The Effectiveness of 4% Intracuff Lidocaine in Reducing Coughing During Emergence From General Anesthesia in Smokers Undergoing Procedures Lasting Less Than 1.5 Hours/Response

To the Editor: The Wetzel et al1 article examining 4% intracuff lidocaine on emergence coughing in smokers neglected to mention studies using alkalinized lidocaine in the endotracheal tube cuff. Estebe2-4 showed alkalinized intracuff lidocaine reduced coughing and restlessness before tracheal extubations compared to air filled cuffs. In vitro studies showed alkalinization of lidocaine with sodium bicarbonate allowed diffusion of 65% (vs 1% without sodium bicarbonate) of neutral base form of lidocaine during 6 hours. I use intracuff alkalinized lidocaine during cases of more than 1 hour. My clinical experience has shown that coughing and hemodynamic disturbances during emergence are lessened ...

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