Endotracheal Tube Insertion Conditions - Comparison Between Topical and Intravenous Lignocaine with Ketamine

Abstract

Objective: To compare the insertion conditions of endotracheal tube using topical and intravenous lignocaine alongside ketamine induction. 

Study Design: Randomised control trial study 
Place and Duration of Study: This study was conducted at the department of Anaesthesiology, ICU and Pain medicine at Mohiuddin Islamic Medical College teaching hospital, Mirpur, Azad Kashmir and Akhtar Saeed Medical College Farooq teaching hospital, Rawalpindi from 6th April 2023 to September 2025. 

Methods: This study included one hundred ASA I, II and stable III elective surgical patients in our two tertiary care hospitals between 2023 and 2025. Patients were randomized into group T (topical lignocaine) and group I 
(intravenous lignocaine). Endotracheal tube was inserted after modified rapid sequence induction general anesthesia with ketamine. After optimal insertion conditions ensured consultant anesthetist intubated the patient. Conditions for endotracheal intubations recorded during and post intubation in both groups.

Results: Fifty elective surgery patients were randomly assigned in two groups, group T (Topical lignocaine) and group I (Intravenous lignocaine). The mean age in group T was 43 years  and in group I it was 41 years. There were  8 males in group T and no males in group I while  42 females in group T and  50 females in group I. At induction gagging was noted in  2 (4%) patients in group T while  14 (28%) patients in group I patients (p < 0.001). At induction coughing was noted in  2 (4%) patients in group T while  14 (28%) patients in group I (p<0.001). Laryngospasm was not noted at induction in patients in group T while mild laryngospasm only in one patient in group I (p<0.31). Post operative sore throat (POST) found significant (p<0.001) in group I (22%) after 1st hour of extubation.

Conclusion: Topical lignocaine gargles for endotracheal tube insertion improves the acceptable endotracheal tube insertion conditions compared to intravenous lignocaine in elective surgeries with ketamine induction making it a valuable choice in low income countries for elective and emergency surgeries anaesthesia.