Effect of Intra-Cuff Tetracaine on Preventing Postoperative Sore Throat after Gynecological Surgery

Abstract

Background: Postoperative sore throat is one of the most common complications associated with endotracheal intubation. It has been reported that intra-cuff application of lidocaine could reduce its incidence and severity. In the present study, we would like to investigate the safety and efficacy of intra-cuff use of tetracaine, one of the most commonly used topical anesthetic, on prevention of postoperative sore throat.Methods: Female patients (age from 18-60) undergoing gynecological surgery under general anesthesia were included. Assigned randomly, the patients received one of the following cuff inflation media: air, 0.9% saline, 2% lidocaine or 1% tetracaine (N=25 in each group). The cuff was inflated with minimal occlusive volume technique. Intra-cuff pressure was measured with a manometer. The primary outcome was the severity of postoperative sore throat, assessed by visual analogue scale (VAS) at 6 hours after extubation. The secondary outcomes included the incidences of complications during emergence of anesthesia and extubation, such as tube intolerance, coughing, restlessness, hoarseness, and laryngospasm, as well as the VAS scores for sore throat at 24 and 48 hours after extubation. The safety and efficacy were further tested by pathological examination of tracheal mucosa after 4-hour intubation in animal study and measurement of diffused anesthetic via the cuff wall in in vitro study, respectively. Results: There was no difference in volume of inflation medium, or intra-cuff pressure between groups. Tetracaine significantly reduced the severity of postoperative sore throat during the 48-hour postoperative observation period, compared with lidocaine (P<0.05) or air (P<0.01). There were also fewer patients with tube intolerance, coughing, restlessness and hoarseness in tetracaine group, compared with lidocaine group (P<0.05) or air group (P<0.01). No abnormality was found in tracheal mucosa pathology and tetracaine diffused via the cuff wall continuously. Conclusions: Our study showed that inflating the cuff with tetraciane is safe and effective in preventing tube-induced emergence phenomena. Citation: Qing Zhu, Hai Wu, Hai-Bo Song, Ting Liu, Bei Liu, Chun-Lan Zheng, et al. Effect of intra-cuff tetracaine on preventing postoperative sore throat after gynecological surgery. J Anesth Perioper Med 2015; 2: 8-13. doi: 10.24015/JAPM.2015.0002 This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.