Postoperative Sore Throat In Patients Research Articles

A Study to Evaluate the Efficacy of Preoperative Low-dose Nebulised Dexamethasone in Decreasing the Incidence of Postoperative Sore Throat in Patients Undergoing Surgery Under General Anaesthesia

Background and Aims: Postoperative sore throat (POST) is a stereotypical postoperative complication that usually occurs in approximately 21%–65% of patients who are under general anaesthesia and is ranked around eighth among the most undesirable subjective and unpleasant complaints by the society of American anaesthesiologist after general anaesthesia. As airway management is a crucial factor in the causation of POST, various methods, especially non-pharmacological, are used to reduce the incidence of postoperative sore throat with the use of a small-sized endotracheal tube with low intracuff pressures. The tracheal tube is applied with other agents that may help in reducing the symptoms such as steroids, lozenges, lignocaine, ketamine gargles, inhalation of steroids (also included in pharmacological methods used for reducing the incidence of postoperative sore throat). Aim and Objective: The aim of this study was to evaluate the efficacy of prophylactic low-dose nebulised dexamethasone for decreasing the incidence of post-extubation sore throat and to evaluate the complications of low-dose dexamethasone nebulisation in patients undergoing surgery under general anaesthesia. Patients and Methods: The study was done in the Anaesthesiology Department of Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR) Mullana, Ambala, after institutional ethical committee approval and written, informed consent was obtained from the patients from March 2021 to March 2022 with a group size of Group S – 25 patients and Group D – 25 patients. Observation and Results: The results showed that patients in the dexamethasone group had a lower POST rate compared to the control group. Conclusion: We concluded that a low dose of 4 mg dexamethasone was effective in reducing the incidence and severity of POST in patients after anaesthesia, and no side effects compared to 4 mg normal saline.

Effects of preoperative inhaled budesonide combined with intravenous dexamethasone on postoperative sore throat in patients who underwent thyroidectomy: A randomized controlled trial.

This randomized controlled trial aimed to evaluate the efficacy of preoperative inhaled budesonide combined with intravenous dexamethasone on postoperative sore throat (POST) after general anesthesia in patients who underwent thyroidectomy. Patients who underwent elective thyroidectomy were randomly divided into the intravenous dexamethasone group (group A) and budesonide inhalation combined with intravenous dexamethasone group (group B). All patients underwent general anesthesia. The incidence and severity of POST, hoarseness, and cough at 1, 6, 12, and 24 hours after surgery were evaluated and compared between the 2 groups. There were 48 and 49 patients in groups A and B, respectively. The incidence of POST was significantly lower at 6, 12, and 24 hours in group B than that in group A (P < .05). In addition, group B had a significantly lower incidence of coughing at 24 hours (P = .047). Compared with group A, the severity of POST was significantly lower at 6 (P = .027), 12 (P = .004), and 24 (P = .005) hours at rest, and at 6 (P = .002), 12 (P = .038), and 24 (P = .015) hours during swallowing in group B. The incidence and severity of hoarseness were comparable at each time-point between the 2 groups (P > .05). Preoperative inhaled budesonide combined with intravenous dexamethasone reduced the incidence and severity of POST at 6, 12, and 24 hours after extubation compared with intravenous dexamethasone alone in patients who underwent thyroidectomy. Additionally, this combination decreased the incidence of postoperative coughing at 24 hours.

Effect of continuous measurement and adjustment of endotracheal tube cuff pressure on postoperative sore throat in patients undergoing gynecological laparoscopic surgery: a randomized controlled trial.

Postoperative sore throat (POST) is a common complication following endotracheal tube removal, and effective preventive strategies remain elusive. This trial aimed to determine whether actively regulating intraoperative cuff pressure below the tracheal capillary perfusion pressure threshold could effectively reduce POST incidence in patients undergoing gynecological laparoscopic procedures. This single-center, randomized controlled superiority trial allocated 60 patients scheduled for elective gynecological laparoscopic procedures into two groups: one designated for cuff pressure measurement and adjustment (CPMA) group, and a control group where only cuff pressure measurement was conducted without any subsequent adjustments. The primary outcome was POST incidence at rest within 24h post-extubation. Secondary outcomes included cough, hoarseness, postoperative nausea and vomiting (PONV) incidence, and post-extubation pain severity. The incidence of sore throat at rest within 24h after extubation in the CPMA group was lower than in the control group, meeting the criteria for statistically significant superiority based on a one-sided test (3.3% vs. 26.7%, P < 0.025). No statistically significant differences were observed in cough, hoarseness, or pain scores within 24h post-extubation between the two groups. However, the CPMA group had a higher incidence of PONV compared to the control group. Additionally, the control group reported higher sore throat severity scores within 24h post-extubation. Continuous monitoring and maintenance of tracheal tube cuff pressure at 18 mmHg were superior to merely monitoring without adjustment, effectively reducing the incidence of POST during quiet within 24h after tracheal tube removal in gynecological laparoscopic surgery patients. The study was registered at www.chictr.org.cn (ChiCTR2200064792) on 18/10/2022.

The effect of different endotracheal tube cuff pressure monitoring systems on postoperative sore throat in patients undergoing tracheal intubation: a randomized clinical trial

BackgroundPostoperative sore throat (POST) is an unpleasant outcome that can occur as a result of tracheal intubation in adults. Increased pressure from the endotracheal tube (ETT) cuff often leads to local mucosal injury, resulting in sore throat. The purpose of this study was to compare the effect of two different ETT cuff pressure monitoring systems vs. no cuff pressure monitoring on the incidence and severity of POST in adults.MethodsOne hundred and fourteen ASA I-III patients of either gender, aged 18–65 years, and undergoing surgery requiring endotracheal intubation were included in this study. Patients were randomized into three groups: control (C), cuff pressure gauge (G), and automated cuff controller (A). The ETT cuff pressure was not monitored intraoperatively in group C but was monitored using a cuff pressure gauge and an automated cuff controller in groups G and A, respectively. Postoperatively, patients were assessed at 2, 24, and 48 h for the presence and severity of POST, hoarseness and cough.ResultsOne hundred and eleven patients completed the study. POST occurred in 40.5% of the patients in group G (n = 37) (p = 0.013) and 23.7% of the patients in group A (n = 38) (p < 0.001) within 48 h after surgery, compared to 69.4% in group C (n = 36). There were no significant differences in hoarseness, coughing, and dysphagia across the groups at any time. When comparing groups A and C, individuals in group A exhibited a lower occurrence of significant (grade ≥ 2) POST and hoarseness (10.5% vs. 41.7%, p = 0.002; 26.3% vs. 58.3%, p = 0.005). The incidence of significant cough and dysphagia did not differ substantially across the patient groups within 48 h after surgery. POST scores in group A at 2, 24 h postoperatively were both 0 (0–0), which was significantly lower than those in group C (1 (0–2) at 2 h, p < 0.001 ; 1 (0–1) at 24 h, p = 0.001). POST in group G at 2 h postoperatively was graded as 0 (0–1.5) which was milder than group C (P = 0.024). The severity of hoarseness in group A with scores of 0 (0–2) was superior to that in group C (2 (0–2), p = 0.006) at 2 h postoperatively.ConclusionsIn conclusion, the findings of this study indicated that the occurrence of POST can be reduced by using either the cuff pressure gauge approach or the automated cuff controller method. The automated cuff controller monitoring can potentially decrease the severity of POST and hoarseness.Trial registrationChinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

Non-pharmacological Methods in the Management of Postoperative Sore Throat in Patients Undergoing Endotracheal Intubation: A Systematic Review

Non-pharmacological Methods in the Management of Postoperative Sore Throat in Patients Undergoing Endotracheal Intubation: A Systematic Review

Effect of thermal softening of double-lumen endobronchial tubes on postoperative sore throat in patients with prior SARS-CoV-2 infection: a randomized controlled trial

BackgroundThe incidence of postoperative sore throat (POST) after tracheal intubation using double-lumen endobronchial tubes (DLTs) is higher in patients with prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than in the general population. This prospective trial was conducted to determine whether thermal softening of DLTs could decrease the incidence of POST or other airway injuries in patients with prior SARS-CoV-2 infection.MethodsA total of 120 patients with prior SARS-CoV-2 infection undergoing thoracoscopic surgery were randomly assigned to two groups (n = 60 each). In the thermal softening group, the distal portion of the DLT was placed in thermostatic saline (50 °C) for 10 min before endotracheal intubation. In the control group, the distal portion of the DLT was placed in room temperature saline for 10 min before endotracheal intubation. The incidence and severity of POST and hoarseness were assessed at 1, 6 and 24 h postoperatively. The primary outcomes were the incidence and severity of POST at 6 h postoperatively. The secondary outcomes were the incidence and severity of hoarseness, vocal cord and tracheal injuries, and hemodynamic changes in patients at intubation.ResultsThe incidence of POST at 6 h postoperatively was greater in the control group than in the thermal softening group [41 (68%) vs. 22 (37%), P = 0.001]. The overall incidence of POST at 24 h postoperatively was greater in the control group than in the thermal softening group [46 (76%) vs. 24 (40%), P < 0.001]. The overall incidence of tracheal injuries was also greater in the control group than in the thermal softening group (P = 0.016). Vocal cord injuries occurred more frequently in the control group than in the thermal softening group (P = 0.006).ConclusionThermal softening of DLTs before intubation can reduce the incidence of POST and airway injuries in patients with prior SARS-CoV-2 infection undergoing DLT insertion.Trial registrationThis trial has been registered at www.chictr.org.cn (registration number: ChiCTR2200066821; registration date: December 19, 2022).

Effect of continuous measurement and adjustment of endotracheal tube cuff pressure on postoperative sore throat in patients undergoing gynecological laparoscopic surgery: study protocol for a randomized controlled trial

BackgroundPostoperative sore throat (POST) is a common postoperative complication after endotracheal tube removal. There are still no effective preventive methods for POST. The aim of this trial is to confirm whether maintaining intraoperative cuff pressure below the tracheal capillary perfusion pressure could effectively reduce the incidence of POST among patients undergoing gynecological laparoscopic surgery.MethodsThis study is a single-center, randomized, parallel-controlled, superiority trial with a 1:1 allocation ratio. Sixty patients whose age is between 18 and 65 years and scheduled for gynecological laparoscopic surgery will be randomized to the cuff pressure measurement and adjustment (CPMA) group and the only cuff pressure measurement without adjustment group (control group). The primary endpoint is the incidence of sore throat at rest within 24 h after extubation. The secondary endpoints include the incidence of cough, the incidence of hoarseness, the incidence of postoperative nausea and vomiting (PONV), POST, and pain intensity within 24 h after extubation. Blocked randomization will be conducted with a computer-generated central randomization online service. The blind method will be applied to subjects, data collectors, outcome evaluators, and statisticians. Outcome assessments will be performed at 0 h and 24 h post-extubation.DiscussionThis randomized controlled study hypothesizes that cuff pressure is the primary influencing factor of POST. By continuous monitoring of endotracheal tube cuff pressure and maintaining it within the range of 18–22 mmHg compared with only continuous measurement without adjustment, it aims to prove that continuous measurement and adjustment of endotracheal tube cuff pressure could be effective in reducing the incidence of POST in gynecological laparoscopic surgery patients. The result of this study could be used as a reference for future multicenter studies to confirm the effect of cuff pressure on POST and provides a scientific theoretical basis for preventing POST to further support comfort medicine.Trial registrationChinese Clinical Trial Registry ChiCTR2200064792. Registered on 18 October 2022. This protocol (version 1.0, 16 March 2022) was approved by the Ethics Committee of Beijing Chaoyang Hospital.

High incidence rate of postoperative sore throat in intubated children at Northwest Amhara Comprehensive Specialized Hospitals, Ethiopia. Amulticenter study.

Postoperative sore throat is the most frequent complication in pediatric patients after general anesthesia. This study aimed to investigate the incidence of postoperative sore throat in patients undergoing general anesthesia with tracheal intubation or laryngeal mask airway. A hospital-based multicenter prospective observational cohort study was conducted. Proportional allocation was done with a total of 424 patients from March 1 to June 30, 2022. The information was entered into the Epi-Data software version 4.6 and analyzed with Stata 14. Socio-demographic, surgical, and anesthetic-related characteristics were analyzed using descriptive statistics. A p-value of less than 0.2 was the cutpoint of bivariate logistic regression analysis, and p-values of less than 0.05 were regarded as statistically significant in multivariate logistic regression to determine the presence and strength of association between independent variables and postoperative sore throat. A total of 411 patients were included in this study, with a response rate of 96.9%. The overall proportion of patients who developed postoperative sore throat was 45% (95% CI: 40.18-49.84). Patients who had anesthesia for more than two hours (AOR = 8.23: 95% CI = 4.08-16.5), those who were intubated by undergraduate anesthesia students (AOR = 2.67: 95% CI = 1.53-4.67), and those who had been intubated using tracheal tube (AOR = 2.38: 95% CI = 1.15-4.92) were significantly associated with the level of postoperative sore throat. We concluded that intubated children with ETT have a high incidence of post-operative sore throat. Tracheal tube usage, intubation by undergraduate students, and more than two hours of anesthesia duration were associated factors. The incidence of sore throat can be decreased with the use of a laryngeal mask airway, intubation by a senior anesthetist, and shortening of anesthesia time.

Preoperative Nebulisation with Dexmedetomidine to Prevent Postoperative Sore Throat in Patients Undergoing General Anaesthesia

Introduction: Several pharmacological and non-pharmacological ways have been used to prevent Post-Operative Sore Throat (POST). Post-Operative Sore Throat (POST) can be prevented with or without medical management. Dexmedetomidine is a selective alpha 2 adrenergic agonists which can be used for pre-operative nebulization to prevent POST. Dexmedetomidine absorption will be greater through transmucosal route as it is a highly lipid soluble agent. It is a highly lipid soluble agent with good systemic absorption during transmucosal administration. Aim: To assess the efficacy of dexmedetomidine nebulisation in reducing POST in patient who require general anaesthesia with endotracheal intubation. Materials and Methods: This randomized control study was conducted from January 2022 to March 2022. There were 60 patients separated into 2 groups and 30 patients in each. The patients were of age more than 18 years and belonged to American society of Anesthesiology (ASA) grade I and II, posted for elective surgery under general anesthesia. Group D was given dexmedetomidine 50 mcg (1 ml) with 3 ml of saline and made it total volume of 4 ml nebulisation and Group C was given 4 ml of saline nebulisation. Sore throat was evaluated at 0, 2nd,4th,6th,12th and 24th hour after extubation, during the post-operative period. Results: Mean age (SD) of patients in group D was 33.5±12.9 years and that in group C was 36.83±14.5years (P value=0.23). During post operative period, the severeness of sore throat was remarkably lesser in Group D especially from 4th hour upto 24th hour. Severeness of POST was remarkably lesser in group D compared to group C patients over the 4th -24th hours. Conclusion: Dexmedetomidine nebulisation given prior to surgery is beneficial in reducing POST, with minimal haemodynamic disturbance. Dexmedetomidine in nebulised form is therefore a safe option for lowering POST

Effects of postoperative nebulized furosemide and budesonide on postoperative sore throat in patients undergoing maxillofacial surgery: A randomized controlled trial

PurposePostoperative sore throat (POST) is a common complication. We compared postoperative nebulized furosemide, budesonide, and sodium chloride solution for POST in patients undergoing maxillofacial surgery. Methods75 patients were randomly divided into 3 groups. Anesthesia induction and intubation were routinely performed. Following emergence, the patients were randomized to one of three groups. Group F was treated with 40mg of aerosolized furosemide, group B received 2 mg of aerosolized budesonide and Group S was given aerosolized 0.9% sodium chloride solution. Patients were assessed for sore throat,hoarseness, foreign body sensation,dry mouth, cough，nausea and vomiting at 15 min, 1, 2, 4, 6, 8, 12, 24 and 48 h after extubation. ResultsPatients all in three groups had comparable clinical and surgical data.Compared to Group S, POST at rest and during swallowing was significantly lower in Group F and Group B at 2, 4, 6, 8 and 12 h (P < 0.05).Compared to Group S, the incidence of postoperative hoarseness was significantly lower in Group F at 1,2,4,6,8,12 h (P < 0.05)and significantly lower in Group B at 6 h and 8 h (P < 0.05). In particular, the incidence of hoarseness at 1,2,4,24 h in group F was significantly lower than that in group B (P < 0.05). In terms of foreign body sensation, group F was significantly lower than group S at 4 h and 6 h(P < 0.05). ConclusionsPostoperative nebulization of furosemide or budesonide are effective ways to reduce the severity of POST. Nebulized furosemide has more advantages in reducing postoperative hoarseness.

Effects of bevel direction of endotracheal tube on the postoperative sore throat when performing fiberoptic-guided tracheal intubation: A randomized controlled trial.

Background:During fiberoptic-guided tracheal intubation, impingement between the distal tip of the endotracheal tube and the airway tissue can cause difficulties in tube insertion or tissue damage during the tube advancement over the bronchoscope. This randomized controlled study aimed to investigate the effects of the endotracheal tube’s bevel direction on the complications associated with airway injury when performing fiberoptic-guided tracheal intubation.Methods:The study subjects were divided into 2 groups: L (control) and D (study). When advancing the tube over the bronchoscope, the tube’s bevel was facing the patients’ left in Group L and the dorsal direction in Group D. According to the degree of resistance at the time of tube advancement, the insertion score was graded in 3 stages; the severity of the patients’ sore throat and hoarseness was evaluated and recorded postoperatively.Results:The severity of postoperative sore throat was higher in Group L than in Group D 3 hours and 24 hours after surgery. (P = .008, P = .023, respectively). The tube insertion score was comparable between the groups. The severity of postoperative hoarseness did not vary significantly between the groups.Conclusion:Endotracheal tube insertion with the bevel facing the dorsal direction of the patient during fiberoptic-guided tracheal intubation reduced the severity of postoperative sore throat in patients undergoing laparoscopic gynecologic surgery.

Implementation of Evidence in Preventing Postoperative Sore Throat of Patients Undergoing General Anesthesia Intubation Using the i-PARIHS Framework.

Objective The aim of the study was to assess the effectiveness of the implementation of the best evidence in preventing postoperative sore throat in patients undergoing general anesthesia intubation. Methods The related topics of the postoperative sore throat of patients undergoing general anesthesia intubation were systematically searched in the database and evaluated using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Combined with clinical needs and evidence-based professional judgment, 20 pieces of evidence and 6 examination standards on the management process and evidence implementation plan for the prevention of postoperative sore throat in patients with general anesthesia intubation are summarized, implementing the best evidence into clinical practice in anesthesiology, general surgery, orthopedics, thoracic surgery, and gynecology. Results Nurses' knowledge scores and evidence compliance significantly improved after the implementation of the best evidence (P < 0.05); the incidence of the postoperative sore throat in patients undergoing general anesthesia intubation decreased from 41.7% to 28.1%. Conclusion The i-PARIHS framework effectively prevents postoperative sore throat in patients, providing an effective case for translating evidence into practice based on the i-PARIHS framework.

Development of a nomogram for prediction of postoperative sore throat in patients under general anaesthesia: a single-centre, prospective, observational study

ObjectivesPostoperative sore throat (POST) is very common in patients under general anaesthesia. However, there is no effective clinical predictive model for reducing its occurrence. The objective of this study was...

Gargling with ketamine preoperatively decreases postoperative sore throat after endotracheal intubation in middle ear surgeries: A prospective randomized control study.

Postoperative sore throat (POST) is the eighth most common side effect in the postoperative period. Though it is considered as a minor side effect, it can lead to significant discomfort for the patient. Increased morbidity due to postoperative sore throat could have a big impact on outcomes with an increased economic burden to the nation. To determine the efficacy of ketamine gargle on a postoperative sore throat, we compared ketamine gargle with a normal saline gargle. Furthermore, we studied their efficacy on postoperative cough and hoarseness of voice. We randomly allocated 60 patients of ASA-I and II into two groups equally in patients posted for middle ear surgeries under general anaesthesia. Patients of the group- K were asked to gargle with 40mg ketamine mixed with 29ml normal saline preoperatively. Group- C patients were given 30ml normal saline to gargle. Airway manipulation in all patients was done by senior anesthesiologists in the operating room. Patients were observed and interviewed at 1h, 6h, and 24h after extubation for postoperative sore throat, cough, and hoarseness of voice. In the control group, the incidence of postoperative sore throat at 1h, 6h, and 24h was 50%, 43.3%, and 36.7% respectively. When we compared the incidence in the ketaminegroup (Group-K) with the control group it showed that they were significantly lower (p-value ≤ 0.05) at all three observation points. On the other hand, ketamine gargle has no significant protective effect on the severity of postoperative sore throat, cough, and hoarseness of voice. Ketamine gargle in this study, showed significantly effective in attenuating postoperative sore throat in patients undergoing tracheal intubation for elective surgeries.

Effectiveness of Ketamine Gargles in Prevention of Post-Operative Sore Throat in Patients Undergoing Endotracheal Intubation

Objective: To compare the efficacy of ketamine gargles versus placebo in prevention of post-operative sore throat in patients undergoing endotracheal intubation. Study design: Randomized controlled trial. Place and Duration of Study: Department of Anesthesiology and Critical Care, National Institute of Cardiovascular Diseases, Karachi from 13th April 2018 to 12th October 2018. Methodology: Eighty six patients undergoing elective pelvic or abdominal surgery under general anaesthesia of age between 18–50 years of either gender were included. Patients with preoperative sore throat in addition to asthma who require more than single attempt for tracheal-tube passage were excluded from the study. Patients were allocated into two groups (Group K and Group P). All patients were premedicated with alprazolam 0.25 mg orally 3 hours before surgery. Patients in group K was given preservative free ketamine 1 ml (50 mg) in 29 ml of drinking water whereas group P was given 30 ml drinking water on entering the operation theater and was asked to gargle with the preparation for 40 seconds. At the end of 24 hours of surgery patients were asked to mark the severity of POST pain on the scale. A score of 0-3 was considered as effectiveness. Results: The mean age of women in group K was 38.58±7.57 years and in group P was 38.21±7.33 years. Fifty nine (68.60%) were males and 27 (31.40%) were females. The efficacy (in terms of prevention of postoperative sore throat) was seen in 36 (83.72%) patients in group K (ketamine gargles) and in 22 (51.16%) patients in group P (placebo) with p-value of 0.001. Conclusion: Ketamine gargle is very effective in prevention of post-operative sore throat in patients undergoing endotracheal intubation. Keywords: Endotracheal intubation, Ketamine gargles, Post-operative sore throat

Comparison of the incidence of postoperative sore throat between patients undergoing videolaryngoscope-guided versus Macintosh laryngoscope-guided double-lumen intubation: a systematic review and meta-analysis

Postoperative sore throat is a common complication of tracheal intubation, especially double-lumen tube intubation, after general anesthesia. Several studies have been conducted to compare the incidence of postoperative sore throat among patients un-dergoing videolaryngoscope-guided double-lumen intubation with that among patients undergoing Macintosh laryngoscope-guided double-lumen intubation. We purported to summarize all the existing evidences to explore the effect of videolaryngoscope and Macintosh laryngoscope on postoperative sore throat in patients with double-lumen intubation. PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure databases were searched for all randomized controlled trials published before 01 June 2021 that compared videolaryngoscopy with Macintosh laryngoscopy for prevention of postoperative sore throat among patients undergoing double-lumen intubation. The results showed that, 9 studies involving 695 patients were included in our meta-analysis. There was no significant difference about the incidence of postoperative hoarseness (risk ratio: 0.80; 95% confidence interval: 0.49–1.32; p-value = 0.38; I2 = 83%), tube malposition (risk ratio: 0.75; 95% confidence interval: 0.07–7.60; p-value = 0.80; I2 = 71%) and the success rate at the first attempt (risk ratio: 1.03; 95% confidence interval: 0.96–1.10; p-value = 0.42; I2 = 70%) between the two groups. We found that the videolaryngoscopy provided much lower incidence of oral injury (risk ratio: 0.49; 95% confidence interval: 0.27–0.89; p-value = 0.02; I2 = 7%) compared with Macintosh laryngoscopy. There was no significant difference in the incidence of postoperative sore throat (risk ratio: 0.74; 95% confidence interval: 0.42–1.32; p-value = 0.31; I2 = 87%) between the two groups. The sensitivity analysis excluding one study suggested that the incidence of postoperative sore throat was lower in the videolaryngoscopy group (risk ratio: 0.64; 95% confidence interval: 0.46–0.89; p-value = 0.008; I2 = 19%). The subgroup analysis suggested that the incidence of postoperative sore throat was lower in the videolaryngoscopy group in studies performed by experienced anesthetists (risk ratio: 0.62; 95% confidence interval: 0.45–0.87; p-value = 0.005; I2 = 5%). The current evidence demonstrates that, experienced anesthetist under the guidance of videolaryngoscope can significantly reduce the risk of postoperative sore throat in patients with double-lumen intubation. Using the videolaryngoscope resulted in a lower incidence of oral injury-related complications. However, there was no advantage in using a videolaryngoscope over Macintosh laryngoscope in the reduction of postoperative hoarseness, tube malposition and the success rate at first attempt.

Effect of Magnesium Sulphate Nebulization on the Incidence of Postoperative Sore Throat in Patients Requiring Endotracheal Intubation for General Anesthesia

Background: Post-operative sore throat (POST) is one of the most common anesthesia related complication. It is one of the undesirable post-operative events. Several Non pharmacological and pharmacological methods tried to reduce POST. we planned to study the efficacy of magnsesium sulphate nebulization in reduction of post operative sore throat.&#x0D; Study Design: Prospective, comparative observational study.&#x0D; Place and Duration of Study: Department of anesthesiology, AVBRH, from June 2020 to November 2020.&#x0D; Materials and Methods: observational study of 60 cases divided into two equal groups. Patients included in the study were of either gender belonging to American Society of Anesthesiologists (ASA) status 1 or 2 undergoing elective surgery of approximately 2 h or more duration requiring tracheal intubation. Patients in Group N were nebulized with 3 ml of normal saline and the patients in Group M were nebulized with 3 ml of 225 mg isotonic nebulized magnesium sulfate for 15 min. The incidence of POST at rest and on swallowing at 0, 2, 4,12 and 24 h in the postoperative period were evaluated.&#x0D; Results: No significant difference in postoperative sorethroat was observed on swallowing in between magnesium sulphate and normal saline at zero and 2nd hour. significant difference was observed at 4th,12th and 24th hour between magnesium sulphate and normal saline in reducing the incidence of post-operative sore throat.&#x0D; Conclusion: MgSO4 significantly reduces the incidence of POST compared to normal saline.

A COMPARISON OF EFFECT OF NEBULISED KETAMINE AND NEBULISED MAGNESIUM SULPHATE IN REDUCTION OF INCIDENCE AND SEVERITY OF POSTOPERATIVE SORE THROAT - A PROSPECTIVE RANDOMIZED DOUBLE BLINDED STUDY

Introduction: Postoperative sore throat (POST) is a common occurrence following general anesthesia with endotracheal intubation. The incidence of POST is estimated to be 21%-65% in various studies. Irritation and inammation of the air way are considered to be the cause of POST. Although considered a minor and self limiting complication, it may cause a signicant patient morbidity, dissatisfaction and increased the length of duration of hospital stay. Various pharmacological and non pharmacological methods have been tried to decrease POST with varying success rates. Among the interventions, the use of ketamine gargle or lozenges has highest success rates, but the problem with this is the bitter taste of the drug and the risk of aspiration, so aerosol route of drug administration gained popularity among the anesthesiologists with good acceptance from the patients. It is known that N-methyl-D-aspartate (NMDA) receptors have a role in nociception and inammation. Hence, this study is aimed at using the aerosol route of magnesium sulphate and ketamine and to nd it effectiveness in preventing POST. Aim Of The Study: To evaluate the effect of nebulized ketamine and nebulized magnesium sulphate for attenuation of postoperative sore throat in patients undergoing surgeries under general anesthesia with tracheal intubation. Materials And Methods: This study was done in the Department of Anesthesiology in collaboration with the Department of Surgery in Kanyakumari Government Medical College from January 2019 to December 2019. Patient planned for surgery under general anesthesia except head, neck &amp; ENT surgeries were selected and randomized into two groups (35 each). Each group received nebulisation for 15 min before induction of general anaesthesia. Group M: Nebulization with 500mg magnesium sulphate in 5ml NS. Group K: Nebulization with 50mg ketamine in 5ml NS. The Parameters related to the study such as duration of laryngoscopy, time taken to intubate, duration of surgery, number of attempts to intubate were recorded. Incidence and severity of sore throat were assessed by four point scale. Incidence of sore throat is assessed for 24 hours. Complication were recorded. Results: We found that the demographic parameters were comparable and statistically insignicant. The mean duration of laryngoscopy difference between the two groups Group M - 24.54± 1.12 seconds and Group K - 24.49 ±1.15 seconds was not statistically signicant P= 0.834 (P&gt;0.05). The mean time taken to intubate in Group M - 27.54± 1.12 seconds and Group K - 27.54± 1.12 seconds was not statistically signicant with P=1.000 respectively (P&gt;0.05). The mean duration of surgery in Group M - 90.71±15.67 minutes and the Group K - 88.20 ±16.53 minutes between the two groups was not statistically signicant P= 0.516 (P&gt;0.05). The mean difference of number of attempts taken to intubate between the two groups was statistically insignicant P=0.771 (P&gt;0.05). The overall incidence of sore throat in Group M was 91% and in Group B was 34%. The severity of sore throat between Group M and Group K is statistically signicant at 2, 4, 6 hrs at grade 1 and grade 2. Conclusion: On the basis of our result, we can suggest that the use of perioperative ketamine nebulization when compared magnesium sulphate nebulization reduces the incidence and severity of post-operative sore throat at 4th and 6th hour during postoperative period in patients who had received general anesthesia with tracheal intubation.

Influence of two-handed jaw thrust during tracheal intubation on postoperative sore throat: a prospective randomised study.

ObjectiveGeneral anaesthesia with tracheal intubation results in sore throat. We evaluated the influence of the two-handed jaw thrust on postoperative sore throat in patients who require tracheal intubation.MethodsIn this prospective, double-blind, single-centre, parallel-arm, and randomised trial, 92 patients who were scheduled for general anaesthesia for total hip arthroplasty were allocated to one of two groups. In the jaw thrust group (n = 46), the two-handed jaw thrust manoeuvre was applied at intubation. In the control group (n = 46), conventional intubation with sham jaw thrust was performed. Incidences of airway morbidities including sore throat, hoarseness, and cough at 2, 4, and 24 hours postoperatively were compared.ResultsDuring the postoperative 24 hours, the incidence of sore throat (8 [17%] vs. 20 [44%]) and hoarseness were lower in the jaw thrust group (8 [17%] vs. 18 [39%]) compared with the control group. The incidence of cough during the postoperative 24 hours was similar between the groups.ConclusionsThe jaw thrust manoeuvre significantly reduced sore throat and hoarseness in patients after general anaesthesia using tracheal intubation.Clinical trial registration: NCT 03568279.

Management of post-operative sore throat in patients undergoing endotracheal intubation: literature review

Postoperative sore throat (POST) is a common complaint that is classified as the 8th most undesirable events after general anesthesia. Endotracheal intubation has been estimated to be the commonest factor causing POST. We aim to review the risk factors and preventive measures to reduce the incidence and severity of POST following endotracheal intubation. Although sore throat can be induced by many perioperative factors, endotracheal intubation remains the commonest cause that can induce endothelial injury and a subsequent sore throat. Many risk factors for this association has been reported. The most common risk factors include ages less than 60 years of age, female sex, cough, and asthma, underlying chest diseases, type and timing of the operation, type, and size of the used endotracheal tube. Moreover, the experience of the personnel intubating the patients may have been another risk factor. Medical prevention of POST can be achieved by several agents as steroids, non-steroidal anti-inflammatory drugs (NSAIDS), N-methyl-D-aspartate (NMDA) receptor antagonists, careful monitoring of the tracheal cuff pressure, and licorice application. On the other hand, using lidocaine has been contraindicated according to previous meta-analysis results. Additionally, we recommend that future studies with bigger sample sizes are should be conducted for further validation of the new modalities.