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Lévy B, Mouillac F, Quilichini D, Schmitz J, Gaudart J, Gouin F. [Topical methylprednisolone vs lidocaïne for the prevention of postoperative sore throat]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2003; 22:595-9. [PMID: 12946491 DOI: 10.1016/s0750-7658(03)00214-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We assessed the efficacy of topical methylprednisolone or lidocaine for prevention of postoperative sore throat. STUDY DESIGN Randomised, prospective in single blind study. PATIENTS AND METHODS Sixty patients ASA 1 or 2 undergoing tracheal intubation for dental surgery received before intubation either topical lidocaine 5% (15 puffs) or aerosolized methylprednisolone (80 mg). Postoperative pain was assessed by the patients using a VAS and a specific scoring system for sore throat, cough and hoarseness. Evaluations were performed immediately after emergence from anaesthesia, 1 h later, at time of the first postoperative drink, at time of the first postoperative meal and 24 h after surgery. RESULTS Patients receiving methylprednisolone showed slightly better scores for sore throat and cough 1 h after surgery. CONCLUSION Topical methylprednisolone may therefore be a useful adjuvant in the prevention of sore throat after intubation.
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Podbielski A, Beckert S, Schattke R, Leithäuser F, Lestin F, Gossler B, Kreikemeyer B. Epidemiology and virulence gene expression of intracellular group A streptococci in tonsils of recurrently infected adults. Int J Med Microbiol 2003; 293:179-90. [PMID: 12868654 DOI: 10.1078/1438-4221-00253] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Intracellularly persistent group A streptococci (GAS, Streptococcus pyogenes) have been associated with recurrent tonsillopharyngitis and antibiotic treatment failure. As a supplementation of the published in vitro data, conventional bacteriology and molecular epidemiology was performed on material from 29 adult patients of a German army hospital with anamnestic signs of recurrent tonsillopharyngitis. Pre-surgery tonsil swabs and the surgically removed tonsils were examined with respect to growth of aerobic bacteria in absence and presence of antibiotics with exclusively extracellular activity. Under such antibiotic selection, Staphylococcus aureus and GAS were cultured from specimens of 13 and 3 patients, respectively. In every material GAS-positive by culture methods, the intracellular location of the penicillin-susceptible GAS isolates was confirmed by immunohistologic examination of tonsillar sections using a GAS-specific IgG antibody. The three intracellular GAS isolates were typed by emm gene sequencing and could be associated to types M6 and M49 (two isolates). The bacteria were serially passaged on sheep blood agar, and semiquantitative mRNA analysis from virulence genes was performed using bacteria of the 4th and 25th passage after isolation. An M-type-specific pattern of virulence gene expression and different gene expression levels in relation to the passage number were observed.
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Tagg JR, Dierksen KP. Bacterial replacement therapy: adapting 'germ warfare' to infection prevention. Trends Biotechnol 2003; 21:217-23. [PMID: 12727383 DOI: 10.1016/s0167-7799(03)00085-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The individual bacterial members of our indigeneous microbiota are actively engaged in an on-going battle to prevent colonisation and overgrowth of their terrain by competing microbes, some of which might have pathogenic potential for the host. Humans have long attempted to intervene in these bacterial interactions. Ingestion of probiotic bacteria, particularly lactobacilli, is commonly practiced to promote well-balanced intestinal microflora. As bacterial resistance to antimicrobials has increased, so too has research into colonisation of human tissues with specific effector strains capable of out-competing known bacterial pathogens. Recent progress is particularly evident in the application of avirulent Streptococcus mutans to the control of dental caries, alpha hemolytic streptococci to reduction of otitis media recurrences and Streptococcus salivarius to streptococcal pharyngitis prevention.
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Ratnaraj J, Todorov A, McHugh T, Cheng MA, Lauryssen C. Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery. J Neurosurg 2002; 97:176-9. [PMID: 12296675 DOI: 10.3171/spi.2002.97.2.0176] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors' goal was to determine whether the incidence of postoperative sore throat, hoarseness, and dysphagia associated with anterior spine surgery is reduced by maintaining endotracheal tube cuff pressure (ETCP) at 20 mm Hg during the period of neck retraction. METHODS Fifty-one patients scheduled for anterior cervical spine surgery were enrolled. After intubation, ETCP was adjusted to 20 mm Hg in all patients. Following placement of neck retractors, ETCP was measured. Patients were randomized to a control (no adjustment) or treatment group (ETCP adjusted to 20 mm Hg). A blinded observer questioned the patients about the presence of sore throat, dysphagia, and hoarseness at 1 hour, 24 hours, and 1 week postoperatively. No differences between groups at 1 hour postoperatively were demonstrated. At 24 hours, 51% of patients in the treatment group complained of sore throat compared with 74% of control patients (p < 0.05). Sixty-five percent of the women experienced sore throat compared with 35% of the men (p < 0.05). At 24 hours, longer retraction time correlated with development of dysphagia (p < 0.05, r2 = 0.61). At 24 hours, hoarseness was present in 65% of women and 20% of men (p < 0.05). CONCLUSIONS The results of this study suggest the following three predictors of postoperative throat discomfort following anterior cervical spine surgery in which neck retraction is performed: increased ETCP during neck retraction (sore throat), neck retraction time (dysphagia), and female sex (sore throat and hoarseness). The simple maneuver of decreasing ETCP to 20 mm Hg may be helpful in improving patient comfort following anterior cervical spine surgery.
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O' Brien B, Harmon D, Duggan M, Flynn N. Laryngeal mask cuff inflation at removal does not affect early postoperative laryngopharyngeal morbidity. Can J Anaesth 2002; 49:871-3. [PMID: 12374719 DOI: 10.1007/bf03017423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We assessed the effect of cuff inflation of the laryngeal mask airway at removal on sore throat, pharyngeal morbidity and airway complications. METHODS In a prospective randomized trial, we used a standardized technique of anesthesia and of laryngeal mask insertion in 126 consecutive day-case patients. Postoperatively, on eye opening, the masks were removed either inflated (Group A) or deflated (Group B) and examined for blood by a blinded observer. Episodes of coughing, gagging, laryngospasm, hiccups and retching, and symptoms of sore throat and hoarseness were recorded by the same observer. RESULTS Demographics were similar. Bloodstaining occurred in 21% of patients in Group A (n = 63) vs 13% in Group B (n = 63; P = 0.23); the incidence of sore throat was identical (19%). Group A experienced more hoarseness (22% vs 9%; P = 0.05). Overall airway complications did not differ between groups (19% vs 11%; P = 0.21). CONCLUSION We conclude that removal of the laryngeal mask airway inflated does not reduce the incidence of sore throat, pharyngeal morbidity or airway complications.
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Lindroos R. [On causes of recurrent pharyngitis]. DUODECIM; LAAKETIETEELLINEN AIKAKAUSKIRJA 2002; 116:2557-8; author reply 2258. [PMID: 12053353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Kyokong O, Charuluxananan S, Muangmingsuk V, Rodanant O, Subornsug K, Punyasang W. Efficacy of chamomile-extract spray for prevention of post-operative sore throat. JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND = CHOTMAIHET THANGPHAET 2002; 85 Suppl 1:S180-5. [PMID: 12188410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
A randomized, double-blind study was carried out to assess the effect of 111 mg of Chamomile extract spray compared with normal saline spray (placebo) administered before intubation on post-operative sore throat and hoarseness. One hundred and sixty-one ASA (American Society of Anesthesiologists) physical status I, II elective surgical patients were recruited. Forty-two out of 80 patients (52.5%) in the Chamomile group scored no post-operative sore throat in the post-anesthesia care unit compared with 41 out of 81 patients (50.6%) in the placebo group, p=0.159. Post-operative sore throat and hoarseness both in the post-anesthesia care unit and 24 hour after operation were not statistically different. There was no statistically significant relationship between sore throat or hoarseness and ASA physical status, sex, history of smoking, grade of laryngoscopic view, number of intubation attempts, condition during intubation and condition of extubation. However, there was significant correlation between use of oral airway and sore throat in the post-anesthesia care unit and 24 hours after operation (p=0.031 and 0.002 respectively). Chamomile extract spray administered before intubation, therefore, can not prevent post-operative sore throat and hoarseness.
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Neill RA, Scoville C. Clinical inquiries. What are the indications for tonsillectomy in children? THE JOURNAL OF FAMILY PRACTICE 2002; 51:314. [PMID: 11978252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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109
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Tay JYY, Tan WKS, Chen FG, Koh KF, Ho V. Postoperative sore throat after routine oral surgery: influence of the presence of a pharyngeal pack. Br J Oral Maxillofac Surg 2002; 40:60-3. [PMID: 11883973 DOI: 10.1054/bjom.2001.0753] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A randomized clinical trial was conducted to investigate the effect of the presence of a pharyngeal pack during endotracheal anaesthesia on the incidence of postoperative sore throat. The patients were anaesthetized with fentanyl, thiopentone and atracurium. Thirty-six patients were anaesthetized without placement of pharyngeal packs while 26 patients had pharyngeal packs inserted. There were no significant differences in the incidence or severity of sore throat postoperatively in the two groups (P=0.23). These results contradict previous studies, which showed an increase in the incidence of postoperative sore throat after the use of pharyngeal packs.
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Soltani HA, Aghadavoudi O. The effect of different lidocaine application methods on postoperative cough and sore throat. J Clin Anesth 2002; 14:15-8. [PMID: 11880016 DOI: 10.1016/s0952-8180(01)00344-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To evaluate the efficacy of various ways of lidocaine application in reducing postoperative cough and sore throat. DESIGN Double-blind, randomized study. SETTING University-affiliated hospital. PATIENTS 204 ASA physical status I and II patients scheduled for cataract surgery with general anesthesia. INTERVENTIONS Patients were randomized to six groups (G1, G2, G3, G4, G5, and G6), according to lidocaine application method. Before endotracheal intubation, in the G1 and G2 groups, 10% lidocaine was sprayed on the distal end of the endotracheal tubes (ETTs; G1) and laryngopharyngeal structures (G2). In the G3 group, the distal ends of the ETTs were lubricated with 2% lidocaine jelly. Intravenous (IV) lidocaine was administered to the G4 group at the conclusion of surgery. Intracuff lidocaine was used in the G5 group; in the G6 group, the terminal end of the ETTs were lubricated with normal saline. MEASUREMENTS At the end of surgery and after extubation, patients were observed to record the number of coughs. At 1 hour and at 24 hours following extubation, sore throat was evaluated. MAIN RESULTS In the recovery room, 64.4% of the patients experienced cough, with greatest frequency in the G3, G6, and G2 groups, and the least in the G5 and G4 groups. The frequency of sore throat was significantly different among the six groups at 1 hour and at 24 hours, with greater frequency in the G3, G2, and G6 groups. CONCLUSIONS Using lidocaine to inflate the ETT cuff or IV lidocaine at the end of surgery decreases the frequency of postoperative cough and sore throat and would provide better outcome for patients and the physician.
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Estebe JP, Dollo G, Le Corre P, Le Naoures A, Chevanne F, Le Verge R, Ecoffey C. Alkalinization of intracuff lidocaine improves endotracheal tube-induced emergence phenomena. Anesth Analg 2002; 94:227-30, table of contents. [PMID: 11772834 DOI: 10.1097/00000539-200201000-00044] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNLABELLED We sought to evaluate the effect of filling an endotracheal tube cuff with 40 mg lidocaine alone (Group L) or alkalinized lidocaine (Group LB) in comparison to an Air Control group (Group C) on adverse emergence phenomena in a randomized controlled study (n = 25 in each group). The incidence of sore throat was decreased for Group LB in comparison to Group L during the 24 postextubation hours. The difference between Group L and Group C remained significant in the two postextubation hours only. Plasma lidocaine levels increased when lidocaine was alkalinized (C(max) were 62.5 +/- 34.0 ng/mL and 3.2 +/- 1.0 ng/mL for Groups LB and L, respectively). Cough and restlessness before tracheal extubation were decreased in Group LB compared with Group L and in Group L compared with Group C. Nausea, postoperative vomiting, dysphonia, and hoarseness were increased after extubation in Group C compared with the liquid groups, and a better tolerance was recorded with Group LB compared with Group L. The increase of arterial blood pressure and cardiac frequencies during the extubation period was less in the liquid groups than in the control group and less in Group LB compared with Group L. We concluded that use of intracuff alkalinized lidocaine is an effective adjunct to endotracheal intubation. IMPLICATIONS Use of 40 mg of alkalinized lidocaine, rather than lidocaine or air, to fill the endotracheal tube cuff reduces the incidence of sore throat in the postoperative period. This approach also decreases hemodynamic effects, restlessness, dysphonia, and hoarseness.
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Stollerman GH. Rheumatic fever in the 21st century. Clin Infect Dis 2001; 33:806-14. [PMID: 11512086 DOI: 10.1086/322665] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2000] [Revised: 02/02/2001] [Indexed: 11/04/2022] Open
Abstract
In the first half of the twentieth century, the group A streptococcus (GAS) was established as the sole etiologic agent of acute rheumatic fever (ARF). In the century's latter half, the clinical importance of variation in the virulence of strains of GAS has become clearer. Although still obscure, the pathogenesis of ARF requires primary infection of the throat by highly virulent GAS strains. These contain very large hyaluronate capsules and M protein molecules. The latter contain epitopes that are cross-reactive with host tissues and also contain superantigenic toxic moieties. In settings where ARF has become rare, GAS pharyngitis continues to be common, although it is caused by GAS strains of relatively lower virulence. These strains, however, colonize the throat avidly and stubbornly. Molecularly distinct pyoderma strains may cause acute glomerulonephritis, but they are not rheumatogenic, even though they may secondarily colonize and infect the throat. Guidelines for the diagnosis, treatment, and prevention of GAS pharyngitis and ARF are reviewed with particular reference to the prevalence of the latter in the community.
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Dollo G, Estebe JP, Le Corre P, Chevanne F, Ecoffey C, Le Verge R. Endotracheal tube cuffs filled with lidocaine as a drug delivery system: in vitro and in vivo investigations. Eur J Pharm Sci 2001; 13:319-23. [PMID: 11384855 DOI: 10.1016/s0928-0987(01)00119-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to examine if lidocaine diffusion across an endotracheal tube cuff could improve post-operative tolerance, especially sore throat. The in vitro release of lidocaine from tube cuffs filled with different lidocaine formulations (base form, hydrochloride form or alkalinized lidocaine hydrochloride) was investigated. A preliminary pilot clinical study in anaesthesia for spine surgery in smoker patients was carried out to examine the pharmacokinetic (i.e. systemic uptake) and pharmacodynamic effects (i.e. incidence of sore throat) obtained with the endotracheal tube cuff filled with lidocaine solution, compared to cuffs inflated only with air. From our in vitro experiment, only the hydrophobic neutral base form of lidocaine was able to diffuse (65.1+/-1.1% released after 6 h), while for the charged hydrochloride form, only a permeation phenomenon occurred concerning only 1% of the total drug. Alkalinization of lidocaine hydrochloride (the only form available as a drug) allows smaller amounts to be used compared to previous published studies (20-40 mg vs. 200-500 mg) and no lag time for diffusion. Such a system could provide a controlled release reservoir for lidocaine to adjacent tracheal tissue. This was shown in our pilot study with sustained plasmatic profiles and improved tolerance (decreased pain scores) in the rank order: air group<<lidocaine hydrochloride group<alkalinized lidocaine group.
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Karchmer TB, Anglim AM, Durbin LJ, Farr BM. Pseudoepidemic of streptococcal pharyngitis in a hospital pharmacy. Am J Infect Control 2001; 29:104-8. [PMID: 11287878 DOI: 10.1067/mic.2001.112749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
CONTEXT Streptococcus pyogenes has recently re-emerged as a significant pathogen causing disease ranging from pharyngitis to lethal systemic infection. Six hospital pharmacy employees were diagnosed as having streptococcal pharyngitis during 1 week, and antibiotic prophylaxis was requested to halt the outbreak. OBJECTIVE Outbreak investigation. DESIGN Review of initial cases and prospective evaluation of the remaining pharmacy employees and the antigen detection test being used. SETTING Pharmacy and occupational health department of a university hospital. POPULATION Sixteen employees of the hospital pharmacy and 19 other employees of the hospital. RESULTS The 6 pharmacy employees who had positive streptococcal antigen detection tests did not have symptoms suggesting streptococcal pharyngitis. Of the 10 remaining pharmacy employees, none had a positive throat culture for S pyogenes. Specificity of the antigen detection test being used was 53% (95% CI, 30%-75%) in prospective evaluation. CONCLUSIONS This was believed to represent a pseudoepidemic because none of the 6 cases had signs or symptoms typical of streptococcal pharyngitis, none of the remaining 10 pharmacy employees had positive throat cultures, and prospective evaluation found low specificity of the antigen detection test. Whereas use of an accurate test in such a low prevalence setting could have resulted in a higher percentage of results being false-positive, the low specificity of the antigen detection test being used also contributed to the pseudoepidemic.
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Sore throat: when is it serious? THE JOHNS HOPKINS MEDICAL LETTER HEALTH AFTER 50 2000; 12:4-5. [PMID: 10932944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
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117
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Little P, Williamson I, Warner G. Length of penicillin treatment of streptococcal infections. Care must be taken when extrapolating data. BMJ (CLINICAL RESEARCH ED.) 2000; 320:1666; author reply 1666-7. [PMID: 10905831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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118
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Falck G, Grahn-Håkansson E, Holm SE, Roos K, Lagergren L. Tolerance and efficacy of interfering alpha-streptococci in recurrence of streptococcal pharyngotonsillitis: a placebo-controlled study. Acta Otolaryngol 2000; 119:944-8. [PMID: 10728939 DOI: 10.1080/00016489950180333] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
A total of 342 patients with clinical signs of tonsillitis and suspected group A beta-haemolytic streptococci (GAS) aetiology, verified with rapid test and GAS culture, were enrolled in a randomized, placebo-controlled, double-blind, multicentre study. They received antibiotic treatment for 10 days, followed by 10 days of alpha-streptococcal or placebo spray treatment in the ratio of 2 : 1. Pharyngeal status, throat culture and adverse events were investigated up to 75 days after treatment. The frequency of bacteriologically verified clinical recurrence was 13% in the alpha-streptococcal group and 15% in the placebo group at the follow-up on day 22. The corresponding figures at the last valid visit after 45-75 days were 19% and 30%, respectively, a statistically significant difference (p = 0.037). Furthermore, at the last valid visit 5% of subjects in the alpha-streptococcal and 12% in the placebo group were healthy carriers, bacteriological treatment failures, of GAS (p = 0.029). Treatment with alpha-streptococci and placebo spray were equally well tolerated. Thus, re-colonization with alpha-streptococci seem to hinder late recurrences of GAS pharyngotonsillitis.
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119
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Wong ML, Chan RK, Koh D, Wee S. Factors associated with condom use for oral sex among female brothel-based sex workers in Singapore. Sex Transm Dis 2000; 27:39-45. [PMID: 10654867 DOI: 10.1097/00007435-200001000-00008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The prevalence of oral sex increased from 27.1% in 1992 to 81.1% in 1997, with a concomitant increase in pharyngeal gonorrhea, among female sex workers in Singapore. The extent of condom use for oral sex among them is unknown. GOAL To determine the prevalence of and factors associated with consistent condom use during oral sex. STUDY DESIGN A cross-sectional study of 225 women randomly selected from the surveillance scheme register of female brothel-based sex workers with a history of oral sex documented in their medical records. RESULTS Slightly more than half (56.9%) consistently used condoms for oral sex compared to 97% for vaginal sex. Condom use was significantly higher among middle than high class sex workers (adjusted rate ratio: 1.52, 95% CI: 1.01-2.29) and those with negotiation skills (adjusted rate ratio: 1.95, 95% CI: 1.32-2.07). CONCLUSION Sex workers should be taught skills to negotiate condom use for oral sex.
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Saeki H, Morimoto Y, Yamashita A, Nagusa Y, Shimizu K, Oka H, Miyauchi Y. [Postoperative sore throat and intracuff pressure: comparison among endotracheal intubation, laryngeal mask airway and cuffed oropharyngeal airway]. MASUI. THE JAPANESE JOURNAL OF ANESTHESIOLOGY 1999; 48:1328-31. [PMID: 10658413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
We studied which device is most useful to reduce postoperative sore-throat. We investigated the relationship between intracuff pressure and postoperative sore-throat in using endotracheal intubation (ET), the laryngeal mask airway (LMA) and the cuffed oropharyngeal airway (COPA) in adult patients. We classified sore-throat into categories; pain at rest, hoarseness and dysphasia. We evaluated pain at rest by the score (0: no pain, 1: mild discomfort, 2: mild pain, 3: severe pain). Pain at rest (scores 1, 2, 3) was complained by 10 patients in ET group, 3 in LMA group, 5 in COPA group on the day of operation, showing significantly lower incidence of pain at rest in LMA group than in ET group. Hoarseness was complained by 15 patients in ET group, 2 in LMA group and 4 in COPA group, showing significantly lower incidence of hoarseness in LMA and COPA groups than in ET group. Dysphasia was complained by 3 in ET group, 1 in LMA group and 2 in COPA group, showing no significant difference. These results suggest that LMA is most appropriate to reduce postoperative sore-throat.
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Yoneda I, Watanabe K, Hayashida S, Kanno M, Sato T. A simple method to control tracheal cuff pressure in anaesthesia and in air evacuation. Anaesthesia 1999; 54:975-80. [PMID: 10540063 DOI: 10.1046/j.1365-2044.1999.01008.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The pressure within latex balloons remains constant despite the balloons being inflated to more than 40 times their initial volume. We used this property to enable improved tracheal cuff pressure control. A latex balloon with an initial volume of 5 ml was connected via a vinyl duct attached with a roller clamp and three-way stopcock to a standard tracheal tube cuff. The 5 ml latex balloon was then inflated with 250 ml of air. The pressure within the tracheal tube cuff was monitored throughout anaesthesia with the inflated latex balloon acting as a pressure controller. Throat symptoms were recorded on the first four postoperative days. The controller kept the tracheal tube cuff pressures constant, and reduced the incidence of postoperative throat symptoms. Variations in cuff pressures with and without the controller were investigated in an altitude chamber to simulate flight. In the altitude chamber, cuff pressure reached over 200 cmH2O at 10 000 feet without the controller, whereas such variations were practically eliminated when the controller was used.
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Abstract
Sore throat is a common postoperative complaint, occurring most often following tracheal intubation. Factors such as tracheal-tube size and cuff design have been shown to be important causative factors. Routine tracheal intubation for elective surgical procedures can result in pathological changes, trauma and nerve damage which may also account for postoperative throat symptoms. Sore throat following the use of a laryngeal mask appears to be related to the technique of insertion but the contribution of intracuff pressure remains to be clarified. It would appear, however, that high intracuff pressure is associated with nerve palsies due to neuropraxia and nerve compression. Careful insertion techniques for both the tracheal tube and laryngeal mask are of paramount importance in the prevention of airway trauma and postoperative sore throat.
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Nicoteri JA. Rising above 'soar' throats. Take a common-sense approach to assessing young adults with sore throats. Am J Nurs 1999; 99:18-20. [PMID: 10091559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Cengiz M, Ozyar E, Oztürk D, Akyol F, Atahan IL, Hayran M. Sucralfate in the prevention of radiation-induced oral mucositis. J Clin Gastroenterol 1999; 28:40-3. [PMID: 9916664 DOI: 10.1097/00004836-199901000-00009] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Radiotherapy-induced mucositis decreases the quality of life by impairing eating, swallowing, and talking and by disturbing sleep. Mucositis may also predispose to local and systemic infections and may cause interruption of radiotherapy course. We studied the efficacy of sucralfate suspension in the prevention and management of oral mucositis and pain during radiotherapy in a double-blind, placebo-controlled, randomized, prospective trial. Twenty-eight patients with head and neck cancer were included in the study. The patients were randomized to use either sucralfate mouth washing (n = 18) or placebo washing (n = 10) during irradiation. Oral mucositis and symptoms were assessed by the same physician using Radiation Therapy Oncology Group Acute Radiation Morbidity Scoring criteria. All patients developed varying degrees of radiation-induced mucositis. Grade 4 mucositis was not encountered in any patient. One patient had grade 1, seven patients grade 2, and two patients grade 3 mucositis in placebo group. In sucralfate group, nine patients each had grade 1 and grade 2 with no grade 3 mucositis. Patients in the sucralfate group experienced significantly lower degree of mucositis than placebo group (p < 0.05). Sucralfate mouth washing is beneficial in decreasing the intensity of radiation-induced mucositis and oral discomfort. It is cheap, easy to administer with no serious side effect, and may be routinely used in patients receiving head and neck radiotherapy.
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Tamura H, Matayoshi Y, Nakamura K, Itaya M, Fujita F, Kondou K, Ono H. [Propofol-air-oxygen anesthesia reduces the incidence of sore throat after laryngeal mask anesthesia]. MASUI. THE JAPANESE JOURNAL OF ANESTHESIOLOGY 1998; 47:1217-20. [PMID: 9834594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We investigated the effects of the presence or absence of N2O in propofol anesthesia using a laryngeal mask on the incidence of postoperative sore throat. In the N2O-combined anesthesia group (n = 25), score 0 (no sore throat) was observed in 11 patients; score 1 (slight pain and discomfort that improved on the next day of operation) in 9; and score 2 (persistent pain on the next day) in 5. In the non-N2O-combined anesthesia group (n = 25), score 0 was observed in 21 patients, score 1 in 3; and score 2 in 1, showing a significantly lower incidence of sore throat and milder sore throat than in the N2O-combined anesthesia group. These results suggest that propofol anesthesia using a laryngeal mask not combined with N2O reduces the incidence of postoperative sore throat.
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