Postoperative upper airway problems

Incidence of Postoperative Sore Throat and Associated Factors Among Pediatric Patients Undergoing Surgery Under General Anesthesia at Hawassa University Comprehensive Specialized Hospital, a Prospective Cohort Study

Background

Postoperative sore throat is one of the common postoperative complications following general anesthesia. Postoperative sore throat causes decreased patient satisfaction, and it affects patients' well-being after surgery, thus identifying its incidence and predictors helps to distinguish the preventable causes of postoperative sore throat. This study aimed to assess the incidence and associated factors of postoperative sore throat among pediatric patients undergoing surgery under general anesthesia at Hawassa university comprehensive specialized hospital.

Methods

A prospective cohort study was conducted among children in the age range 6-16 years old who underwent emergency and elective surgical procedures under general anesthesia. Data were entered and analyzed using SPSS version 26 software packages. Univariate and multivariate analyses were performed to investigate the independent predictors. The presence and severity of postoperative sore throat were assessed by using a four-point categorical pain scale at the 2nd, 6th, 12th, and 24th-hour postoperative time.

Results

A total of 102 children were recruited in this study, from which 27 children (26.5%) complained of sore throat postoperatively. This study found that endotracheal intubation (P value: 0.030; AOR: 3.155; 95% CI [1.114-8.933]) and several attempts greater than one (P value: 0.027 and AOR: 4.890; 95% CI: [1.203-19.883]) had statistically significant association with a postoperative sore throat.

Conclusion

The overall incidence of postoperative sore throat was 26.5%. Endotracheal intubation and the number of attempts greater than one were independent factors that were significantly associated with the occurrence of postoperative sore throat in this study.

Comparison Between Lidocaine Inhalation and Intravenous Dexamethasone in Reducing Postoperative Sore Throat Frequency After Laryngeal Mask Insertion

Background

The frequency of postoperative sore throat (POST) after laryngeal mask airway insertion (LMA) was relatively high. Lidocaine might reduce the pain and inflammatory response. Additionally, inhalation form might result in a better distribution, which results in a better airway analgesia and minimal systemic effect.

Objectives

To compare the incidence of sore throat post LMA insertion after 1.5 mg/kg of lidocaine inhalation and 10 mg of intravenous dexamethasone.

Methods

This was a single-blinded randomized clinical trial, which included 128 patients who underwent ophthalmic surgery under general anesthesia with LMA insertion. Inclusion criteria were individuals 18 - 65 years old, ASA 1 or 2, Mallampati class I or II, and no sore throat before surgery. After University of Indonesia Research Ethical Committee approval and informed consent, all subjects were randomly divided into two groups: lidocaine inhalation group, which would receive lidocaine inhalation 2% 1.5 mg/kg (additional NaCl 0.9% until total 6 mL volume) and intravenous 2 mL NaCl 0.9%, and dexamethasone group, which would received NaCl 0.9% inhalation (6 mL volume) and dexamethasone 10 mg intravenously 10 minutes before LMA insertion. POST incidence and pain severity assessment were done 2 hours postoperatively. Statistical analysis were done with SPSS version 21.

Results

There were 10.9% of subjects in the lidocaine inhalation group and 9.4% subjects in the dexamethasone group who suffer from POST postoperatively (P > 0.05). The median of POST pain in the lidocaine inhalation group was 0 (0 - 1), whereas in dexamethasone group it was 0 (0 - 3). This study did not find any side effects on both groups.

Conclusions

Lidocaine inhalation 1.5 mg/kg was proportional to intravenous dexamethasone 10 mg in reducing the incidence and severity of POST after LMA insertion.

Achieving the Recommended Endotracheal Tube Cuff Pressure: A Randomized Control Study Comparing Loss of Resistance Syringe to Pilot Balloon Palpation

BACKGROUND

Both under- and overinflation of endotracheal tube cuffs can result in significant harm to the patient. The optimal technique for establishing and maintaining safe cuff pressures (20-30 cmH2O) is the cuff pressure manometer, but this is not widely available, especially in resource-limited settings where its use is limited by cost of acquisition and maintenance. Therefore, anesthesia providers commonly rely on subjective methods to estimate safe endotracheal cuff pressure. This study set out to determine the efficacy of the loss of resistance syringe method at estimating endotracheal cuff pressures.

METHODS

This was a randomized clinical trial. We enrolled adult patients scheduled to undergo general anesthesia for elective surgery at Mulago Hospital, Uganda. Study participants were randomized to have their endotracheal cuff pressures estimated by either loss of resistance syringe or pilot balloon palpation. The pressures measured were recorded.

RESULTS

One hundred seventy-eight patients were analyzed. 66.3% (59/89) of patients in the loss of resistance group had cuff pressures in the recommended range compared with 22.5% (20/89) from the pilot balloon palpation method. This was statistically significant.

CONCLUSION

The loss of resistance syringe method was superior to pilot balloon palpation at administering pressures in the recommended range. This method provides a viable option to cuff inflation.

The Effect of Cold Vapor Applied for Sore Throat in the Early Postoperative Period

PURPOSE

This study was conducted for the purpose of determining the effect of cold vapor applied for sore throat in the early postoperative stage.

DESIGN

A quasi-experimental design was used.

METHODS

The study sample consisted of 60 patients who underwent lumbar disc herniation surgery in the Neurosurgery Clinic of Gazi University Health Research and Practice Center in Ankara, Turkey. The study involved two intervention groups and one control group. The study data were collected through questionnaire and observation forms.

FINDINGS

65% (n = 39) of patients experienced sore throat. There were no statistical differences between the groups in terms of sore throat and hoarseness (P > .05); however, a significant difference was determined in the group to whom oxygen together with cold vapor was applied for dry throat (4th and 8th hours) and swallowing difficulties(8th and 12th hours) (P < .05).

CONCLUSIONS

Cold vapor did not have an effect on sore throat on its own; however, it decreased hoarseness and swallowing difficulties when applied together with oxygen.

Evaluation of preoperative Strepsils lozenges on incidence of postextubation cough and sore throat in smokers undergoing anesthesia with endotracheal intubation

Post-operative sore throat (POST) is an undesirable side effect of endotracheal intubation. Pharmacological and non-pharmacological measures have been utilized for minimizing the morbidity caused by POST. We have tested use of Strepsils lozenges in providing efficacy for decreasing POST in smokers presenting for surgery under general anesthesia with endotracheal intubation.

Transient unilateral combined paresis of the hypoglossal nerve and lingual nerve following intubation anesthesia

Nerve damage may occur in the pharyngolaryngeal region during general anesthesia. The most frequently injured nerves are the hypoglossal, lingual and recurrent laryngeal. These injuries may arise in association with several factors, such as laryngoscopy, endotracheal intubation and tube insertion, cuff pressure, mask ventilation, the triple airway maneuver, the oropharyngeal airway, manner of intubation tube insertion, head and neck position and aspiration. Nerve injuries in this region may take the form of an isolated single nerve or of paresis of two nerves together in the form of hypoglossal and recurrent laryngeal nerve palsy (Tapia's syndrome). However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. The risk of this damage can be reduced with precautionary measures. We describe a case of combined unilateral nervus hypoglossus and nervus lingualis paresis developing after intubation anesthesia.