Benefits of the pharyngeal pack

Effects of throat packs in upper airway surgery under intubation anesthesia: a randomized controlled trial

INTRODUCTION

Throat packs (TP) are used in upper airway surgery to avoid accumulation and aspiration of blood, foreign bodies, and fluids. But side effects such as sore throat and TP retention have been reported and challenge the standardized use of TP. The aim of this study is to compare benefits and side effects of TP versus no TP for upper airway procedures in intubation anesthesia.

MATERIAL AND METHODS

One hundred forty-eight patients with surgical interventions at the upper airway under intubation anesthesia were included. Of those, n = 74 each were treated without (A, control) and with (B) TP. Study group B was subdivided whether TP was placed by the surgeon (B1; n = 37) or by the anesthesiologist (B2; n = 37). TP-related side effects such as sore throat, foreign body sensation, hoarseness, dyspnea, difficulty of swallowing, nausea, retching, nausea, aspiration, and pneumonia as well as the influence of TP design and the applicant (surgeon or anesthetist) were analyzed.

RESULTS

A significantly increased rate of difficulty of swallowing (p = 0.045), intensity of sore throat (p = 0.04), and foreign body sensation (p = 0.024) was found in group B when compared to group A. There was no correlation between hoarseness, dyspnea, nausea, retching, and TP. No case of aspiration or pneumonia was seen but one TP was accidentally forgotten in the patient. B2 showed an increased frequency of difficulty swallowing, followed by A and B1. B1 led to the highest incidence of nausea followed by the A and B2.

CONCLUSION

The use of TP led to a high rate of side effects without showing the propagated advantages.

CLINICAL RELEVANCE

The use of TP must be considered critically and cannot generally be recommended without specific reasons, such as high aspiration risk.

A randomized, double-blind study of the ultrasound assessment of the effect of pharyngeal packing on perioperative gastric volume in nasal surgery

Background

Pharyngeal packing (PP) is commonly performed to reduce the incidence of perioperative blood ingestion (PBI) in nasal surgery (NS), and thus the incidence and severity of postoperative nausea and vomiting (PONV). This study examined the effects of PP on the perioperative gastric volume (GV) and PONV in patients undergoing NS, by ultrasound assessment.

Methods

Patients undergoing elective NS [septoplasty, septo-rhinoplasty (SRP) and functional endoscopic sinus surgery (FESS)] were randomised to receive or not receive PP. In the PP group, pharyngeal packs were placed after the orotracheal intubation. Ultrasound assessments were performed for all patients preoperatively (before the anaesthesia induction) and postoperatively (before the extubation). The antero-posterior (AP) and cranio-caudal (CC) antral diameters, antral cross-sectional area (ACSA), and total GV were calculated. PONV incidence and severity were rated. These variables were compared between timepoints and groups, and in the subgroup analyses according to the surgery type. Pearson correlation analysis was performed to assess correlations between the variables.

Results

AP and CC diameters and ACSAs were greater postoperatively than preoperatively in the PP and non-PP groups (n = 44 each; all p < 0.05). Postoperative AP and CC diameters and the ACSA were greater in the non-PP than in the PP group (all p < 0.05). Postoperative AP diameters were greater than preoperatively in patients undergoing SRP and FESS, and the postoperative CC diameter and ACSA were greater than preoperatively in patients undergoing SRP (all p < 0.05). Surgery duration was correlated positively with postoperative AP diameter (r = 0.380, p < 0.05), CC diameter (r = 0.291, p < 0.05), and ACSA (r = 0.369, p < 0.05). Patients who underwent septoplasty surgery, PP was decreased PONV incidence and severity at the first four hours, postoperatively (p < 0.05).

Conclusions

The study findings indicate that PP reduces the increase in the perioperative GV due to PBI in an elective NS. It is therefore a useful and safe means of reducing the risk of perioperative pulmonary aspiration in such surgeries.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCT), ACTRN12619000487112, 25/03/2019, Trial registration retrospectively registered.

The Relationship Between the Preoperative Neutrophil-to-Lymphocyte Ratio and Postoperative Nausea and Vomiting in Patients Undergoing Septorhinoplasty Surgery

BACKGROUND

Postoperative nausea and vomiting (PONV) is one of the most common complications during the postoperative period. In the literature, there are many factors associated with PONV risk, but it is claimed that inflammation increases this risk. The neutrophil-to-lymphocyte ratio (NLR) is a cheap parameter to use in the diagnosis and follow-up of systemic inflammatory diseases. In this study, we aimed to investigate whether the preoperative NLR was a marker for PONV and to determine its relation with antiemetic use.

METHODS

Eighty patients who were planned to undergo elective septorhinoplasty and were in ASA I-II were prospectively included in the study. The NLR value was calculated by dividing the number of neutrophils by the number of lymphocytes obtained from the preoperative complete blood count. The patients were divided into two groups of 40 patients: patients with an NLR < 2 (group 1) and patients with an NLR > 2 (group 2). Nausea and vomiting during the first 24 h in the recovery room and in the related clinic and antiemetic requirement were recorded.

RESULTS

The rate of nausea-vomiting in the recovery room and in the postoperative 24-h period in group 1 was significantly lower than in group 2 (p < 0.05). The rate of use of antiemetics in the recovery room and in the postoperative 24-h period in group 1 was significantly lower than in group 2 (p < 0.05).

CONCLUSION

NLR values above 2 calculated in the preoperative period may be an indicator of PONV risk. Antiemetic prophylaxis may be given according to this value.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The use of throat packs in pediatric cleft lip/palate surgery: a retrospective study

OBJECTIVES

Throat packs are commonly used to prevent ingestion or aspiration of blood and other debris during cleft lip/palate surgery. However, dislodgement or (partial) retainment after extubation could have serious consequences. The aim of the present study was to investigate the effect of omitting pharyngeal packing during cleft lip/palate surgery on the incidence of early postoperative complications in children.

MATERIALS AND METHODS

A retrospective study was performed on all children who underwent cleft lip/palate surgery at the Wilhelmina Children's Hospital. This study compared the period January 2010 through December 2012 when pharyngeal packing was applied according to local protocol (group A) with the period January 2013 till December 2015 when pharyngeal packing was no longer applied after removal from the protocol (group B). Data were collected for sex, age at operation, cleft lip/palate type, type of repair, lateral incisions, length of hospital stay, and complications in the first 6 weeks after surgery. Early complications included wound dehiscence, postoperative bleeding, infection, fever, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI).

RESULTS

This study included 489 cleft lip/palate operations (group A n = 246, group B n = 243). A total of 39 (15.9%) early complications were recorded in group A and a total of 40 (16.5%) in group B. There were no significant differences (P = 0.902) in complications between the two groups; however, there was a significant difference (P < 0.001) in length of hospital stay between the two groups (group A 3.6 days vs group B 3.2 days).

CONCLUSION

Omitting routine placement of throat packs in cleft lip/palate surgery was not associated with an increased early postoperative complication rate. Therefore, the traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned.

CLINICAL RELEVANCE

The traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned.

Effects of different types of pharyngeal packing in patients undergoing nasal surgery: A comparative study

Context:

Postoperative throat complaints such as postoperative sore throat (POST), dysphagia, and hoarseness frequently arises after tracheal intubation and throat packing for patient undergoing general anesthesia. This condition is very disturbing to patient. Avoiding POST is a major priority for these patients because preventing postoperative complications contributes to patient satisfaction.

Aims:

To describe and analyze the postoperative throat effects of nasopharyngeal packing and oropharyngeal packing in patients undergoing nasal surgery.

Settings and Design:

A randomized comparative study.

Subjects and Methods:

After obtaining approval of Ethical Committee 40 patients were included in study. After this patient were randomly allocated into two groups of 20 each. Group A - in which the oropharynx was packed and Group B - inwhich the nasopharynx was packed. General anesthesia were given and throat packing was done and patients were interviewed postoperatively for any throat complications such as sore throat, difficulty in swallowing (dysphagia), hoarseness of voice, throat irritation, and any other symptom pertaining to the study were noted and data were analyzed.

Statistical Analysis Used:

T-test to compare the age, while Chi-square test and Fisher's exact test were used to compare sex distribution, sore throat, dysphagia, hoarseness, and throat irritation.

Results:

Results showed statistically significant difference in incidence and severity of POST in Group A patients when compared to Group B patients to be more. Patients in Group A had a higher incidence of dysphagia when compared to their Group B counterparts. With respect to the incidence of hoarseness and throat irritation, there was no statistical significance between the groups.

Conclusion:

We concluded that the site of pharyngeal packing influences the incidence and severity of POST and as well as the incidence of dysphagia after general anesthesia. The use of nasopharyngeal packing in the patients undergoing nasal surgeries might lead to a reduction of the same.

Endoscopic removal of throat-packing gauze swallowed during general anesthesia

Throat packing is commonly placed in the pharynx before starting oral and maxillofacial surgery under general anesthesia to protect the airway from aspiration of blood and surgical debris. Complications such as airway obstruction may arise if any of the throat packing is retained after extubation, and less commonly, swallowing of the throat packing has been reported. We report endoscopic removal of throat packing gauze swallowed during general anesthesia.

Effect of pharyngeal packing during nasal surgery on postoperative nausea and vomiting

OBJECTIVE

The aim of this study was to evaluate the efficacy of pharyngeal packing in reducing postoperative nausea and vomiting (PONV) after nasal surgery by taking into consideration the surgery types.

STUDY DESIGN

A prospective, randomized, controlled trial.

SETTING

A tertiary referral center.

SUBJECTS AND METHODS

After the study was approved by the local ethics committee, this study was conducted in the Otorhinolaryngology clinic with the collaboration of the Anesthesiology clinic. The development of PONV within 24 hours after surgery was evaluated in patients who were applied a pharyngeal pack (Group 1) or not (Group 2) during nasal surgery.

RESULTS

There were 104 adult patients for routine nasal surgery included in the current study, yielding 100 (group 1, n = 50; group 2, n = 50) evaluable subjects. No significant difference was found in the incidence of PONV between the two groups at two (P = 0.41), four (P = 0.54), eight (P = 0.51), and 24 hours. According to surgery type, the incidence of PONV after two hours was 71 percent in septorhinoplasty, 68 percent in endoscopic sinus surgery, and 50 percent in septoplasty; after four hours it was 59 percent in septorhinoplasty, 53 percent in endoscopic sinus surgery, and 37 percent in septoplasty; and after eight hours it was 35 percent in septorhinoplasty, 39 percent in endoscopic sinus surgery, and 21 percent in septoplasty. PONV was not seen at 24 hours. Compared to the septoplasty group for which pharyngeal packing was used, significantly lower rates of PONV at four and eight hours were found in the septoplasty group in which pharyngeal packing was not used (P = 0.02).

CONCLUSION

Pharyngeal packing in nasal surgery has no impact on PONV.

Pharyngeal packing is a predisposing factor for postoperative aphthous stomatitis in nasal surgery

OBJECTIVE

To evaluate whether pharyngeal packing is a predisposing factor for the development of postoperative aphthous stomatitis in nasal surgery.

STUDY DESIGN

A prospective, randomized, controlled trial.

SETTING

A tertiary referral center.

SUBJECTS AND METHODS

After the study was approved by the local ethics committee, 100 adult patients scheduled for routine nasal surgery were enrolled. The development of postoperative aphthous lesions within three days after surgery was evaluated in patients in whom a pharyngeal pack was (Group 1) or was not (Group 2) applied during nasal surgery.

RESULTS

In Group 1, the presence of pharyngeal pack increased the risk for postoperative oral mucosal aphthae development by 4.64 times (P = 0.02, RR = 4.64, 95% CI = 1.22-17.91). No significant associations were found between postoperative oral mucosal aphthae development and sex (P = 1), age (P = 0.69), height (P = 0.73), weight (P = 0.22), or duration of surgery (P = 0.47) in Group 1.

CONCLUSION

Pharyngeal packing during nasal surgery increases postoperative morbidity by leading to the development of painful oral aphthous lesions.

The efficacy of pharyngeal packing during routine nasal surgery--a prospective randomised controlled study

The efficacy of pharyngeal packing in the prevention of postoperative nausea and vomiting (PONV) in patients undergoing nasal surgery was evaluated in a prospective randomised controlled study. The effect of the presence of the pharyngeal pack on the incidence of postoperative sore throat was also assessed. One hundred patients were randomly allocated to one of two groups; the first had packing and the second received no packing. The placement of a pharyngeal pack was found to have no effect on the incidence of PONV but was associated with a significantly increased incidence of sore throat. The absence of a pharyngeal pack was not associated with an increase in postoperative aspiration or vomiting. We conclude that the routine placement of pharyngeal packs during uncomplicated nasal surgery has no effect on the incidence of PONV and will increase the incidence of postoperative sore throat.

Postoperative sore throat after routine oral surgery: influence of the presence of a pharyngeal pack

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.