Survey of throat pack use: An oral surgery perspective

Anna Dargue,Eithne Fyfe

doi:10.1111/ors.12602

Abstract

AbstractAimPrevious national surveys highlighted variation in throat pack use, lack of team‐approach and poor adherence to safety processes. A recent review found no evidence supporting anaesthetist‐inserted throat packs. A survey of oral surgeons was undertaken to establish current practice.Materials and methodsAnonymous online questionnaire publicised via BAOS.ResultsFewer oral surgeons are placing throat packs routinely. There is a trend towards surgeons placing throat packs rather than anaesthetists. Four‐fifths of surgeons are following best safety processes: radio‐opaque material, throat pack from swab count, WHO ‘sign out’ check for removal. The increase in surgeons’ view that they have responsibility for throat pack removal is consistent with more surgeons placing throat packs. Increase in surgeons’ awareness of throat pack incidents. A quarter of surgeons cognisant of recent recommendations.ConclusionsContinued variation found in oral surgeons’ use of throat packs. The decrease in routine throat pack use suggests increased decision‐making by surgeons. A change in practice from anaesthetists to surgeons inserting throat packs noted. It appears this change is driven by anaesthetists, given the lack of knowledge of recent recommendations by oral surgeons. A striking improvement in adherence to safety processes observed. No adoption of team‐approach to throat pack use. It is vital now to establish an evidence‐base for throat pack use during oral surgical procedures.

Highlights

The UK National Patient Safety Agency (NPSA) released a 2009 alert to reduce the risk of throat pack retention after surgery.[1]
Throat packs can be used during any general anaesthetic but most commonly they are placed for ear, nose and throat (ENT) and oral and maxillofacial surgical (OMFS) procedures in the UK
The survey was publicised via the British Association of Oral Surgeons (BAOS) website and social media accounts; it was accessible for a three-month period, March to June 2020

Summary

Introduction

The UK National Patient Safety Agency (NPSA) released a 2009 alert to reduce the risk of throat pack retention after surgery.[1] They recommended local revision of policies and procedures to ensure: justification for throat pack use for each patient; at least one visual and one documentary check are used whenever they are placed; that all staff are fully informed. The NPSA proposed local adaptation of the World Health Organisation (WHO) surgical safety checklist to include throat packs. The nationally reported incidence of throat pack retention is small (see Table 1), there are serious potential repercussions including life-threatening airway obstruction.[2]. Throat packs can be used during any general anaesthetic but most commonly they are placed for ear, nose and throat (ENT) and oral and maxillofacial surgical (OMFS) procedures in the UK. Recognized indications are to prevent ingestion or aspiration of blood and/or debris, airway protection when using lasers and for stabilizing an artificial airway.3–5 Accepted disadvantages include sore throat from several randomized trials of nasal surgery.[6,7] International variation in use suggests subjective rather than evidence-based practice.[1,6]

Objectives

Methods

Findings

Discussion

Conclusion