To the Editor:-We read with some interest the recent description of the use of intravenous tubing connectors to administer bronchodilators to intubated patients. [1] We have found this device to be equally useful to administer tracheal lidocaine to intubated patients with the goal of decreasing their tendency to cough or “buck” on the endotracheal tube during emergence. Approximately 15 min before extubation and while the patient is still deeply anesthetized or paralyzed, the cuff on the endotracheal tube (ETT) is deflated, and 4 cc of 4% lidocaine is injected into the lumen of the ETT via the capnography port of the elbow connector. Continued positive pressure ventilation causes the lidocaine to bubble up around the deflated cuff producing good laryngotracheal anesthesia. We then reinflate the cuff and allow the patient to emerge from anesthesia in the usual fashion. This technique probably should not be attempted in patients with significant risk factors for regurgitation and aspiration, but we have found it to markedly smooth the emergence of many patients in whom it is desirable to minimize coughing during emergence.

Allen W. Burton, M.D.

Assistant Professor of Anesthesiology

Mark H. Zornow, M.D.

Phillipps Professor of Anesthesiology; Department of Anesthesiology; The University of Texas Medical Branch at Galveston; Suite 21 John Sealy; 301 University Boulevard; Galveston, Texas 77555–0591

(Accepted for publication April 26, 1997.)

Vu H, Kempen PM: Administering metered dose bronchodilators during general anesthesia (letter). Anesthesiology 1996; 85:691.