Abstract

Background: Emergence coughing after general anesthesia with an endotracheal tube (ETT) is a frequent occurrence related to airway irritation, and it can result in the spread of infectious respiratory droplets and hemodynamic instability. This is of particular concern when caring for patients with suspected or confirmed airborne infections. The irritation of the tracheal mucosa by the endotracheal tube (ETT) stimulates the cough reflex as anesthesia lightens. For this reason, preventing coughing at emergence is important to protect both patients and providers.

Clinical Question: In patients requiring general anesthesia with an ETT, does the use of intracuff lidocaine, compared with intracuff air or saline, result in a reduced incidence of coughing during emergence?

Discussion: Compared with air or saline, intracuff lidocaine maintained more stable cuff pressures and attenuated hemodynamic responses to extubation. Studies showed that alkalinization improved the effectiveness of intracuff lidocaine and hastened the onset of action. Findings from multiple studies are consistent and support the reliability and safety of intracuff lidocaine for routine anesthesia care. Intracuff lidocaine was also more effective than intravenous lidocaine in preventing emergence cough, providing a localized benefit with minimal systemic absorption.

Conclusion: The evidence collectively supports intracuff lidocaine as a simple, inexpensive, and effective method for achieving smooth emergence.

Author Details

Sadeidra Daniel, DNP(c), BSN, RN; Cassandra King, DNP, CRNA

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Endotracheal Tubes, Lidocaine, Cough, Airway Extubation, Throat, Intracuff Lidocaine, Emergence Cough, Patient Safety

Advisor

Allyson Maddox

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2026-03-17

Full Text of Presentation

wf_yes

Download
Click on the above link to access the poster.

Additional Files

Abstract.pdf (105 kB)

Share

COinS