Upper Respiratory Symptoms as Long COVID: Insight from a Multicenter Cohort Study

Objective

This study aimed to investigate the clinical features of long COVID cases presenting with upper respiratory symptoms, a topic not yet fully elucidated.

Study Design

Prospective cohort study.

Setting

A multicenter study involving 26 medical facilities in Japan.

Methods

Inclusion criteria were patients aged ≥18 years old with a confirmed COVID-19 diagnosis via severe acute respiratory syndrome coronavirus 2 polymerase chain reaction or antigen testing, who were hospitalized at the participating medical facilities. Analyzing clinical information and patient-reported outcomes from 1009 patients were analyzed. The outcome measured the degree of initial symptoms for taste or olfactory disorders and assessed the likelihood of these symptoms persisting as long COVID, as well as the impact on quality of life if the upper respiratory symptoms persisted as long COVID.

Results

Patients with high albumin, low C-reactive protein, and low lactate dehydrogenase in laboratory tests tended to experience taste or olfactory disorders as part of long COVID. Those with severe initial symptoms had a higher risk of experiencing residual symptoms at 3 months, with an odds ratio of 2.933 (95% confidence interval [CI], 1.282-6.526) for taste disorders and 3.534 (95% CI, 1.382-9.009) for olfactory disorders. Presence of upper respiratory symptoms consistently resulted in lower quality of life scores.

Conclusion

The findings from this cohort study suggest that severe taste or olfactory disorders as early COVID-19 symptoms correlate with an increased likelihood of persistent symptoms in those disorders as long COVID.

Preoperative Ultrasound-Guided Internal Branch Block of Superior Laryngeal Nerve Reduces Postoperative Sore Throat Caused by Double Lumen Endotracheal Intubation: A Randomized Trial

BACKGROUND

Postoperative sore throat (POST) is one of the more common side effects of tracheal intubation patients under general anesthesia (GA) after extubation using double-lumen endobronchial tubes (DLTs). The internal branches of the superior laryngeal nerve (SLN) block (iSLNB) have been reported to anesthetize the larynx for airway manipulation (such as awake tracheal intubation) and pain treatment efficiently. We hypothesized that ultrasound-guided iSLNB (US-guided iSLNB) combined with GA would ameliorate the incidence and severity of POST and hoarseness.

METHODS

Patients (n = 82) undergoing thoracoscopic resection of pulmonary nodules/lobes/segments with one-lung ventilation (OLV) under GA were randomized into 2 groups depending on whether performed with iSLNB (S group, n = 41) or not (C group, n = 41) under GA. Patients in the S group received US-guided iSLNB bilaterally before surgery. POST and hoarseness were assessed at 2, 6, and 24 hours after surgery. The primary outcome of this study was the incidence of POST at 6 hours after surgery between groups.

RESULTS

The overall accumulated incidence of POST was lower in the S goup than in the C group (9/41 vs 20/41; 95% CI, 0.30 [0.11-0.77]; P = .011). The incidence and severity of POST was lower in the S group than in the C group at 2 hours (9/41 vs 20/41; 95% CI, 0.30 [0.11-0.77]; P = .008 and P = .004) and 6 hours after (7/41 vs 17/41; 95% CI, 0.29 [0.10-0.81]; P = .012 and P = .015) surgery. The incidence and severity of POST at 24 hours after surgery was nonsignificant. However, the incidence and severity of hoarseness was comparable between the 2 groups at 2, 6, and 24 hours after surgery.

CONCLUSIONS

Preoperative US-guided iSLNB could significantly ameliorate the incidence and severity of POST induced by double-lumen bronchial catheter intubation.

Effects of ultrasound-guided stellate ganglion block on postoperative sore throat and postoperative sleep disturbance after lumbar spine surgery: a randomized controlled trial

BACKGROUND

Postoperative sore throat and sleep disturbance are prevalent among patients undergoing spinal surgery, and these conditions can substantially impact their postoperative satisfaction and quality of life. The present study aimed to examine the impact of ultrasound-guided stellate ganglion block (SGB) on the occurrence of postoperative sore throat (POST) and postoperative sleep disturbance (PSD) in patients who undergo lumbar spine surgery under general anesthesia.

METHODS

Sixty patients were randomly assigned to either the experimental group (SGB group) or the control group (CG). Both groups received the same induction and maintenance drugs. However, the SGB group received a right SGB under ultrasound guidance 15 min before anesthesia induction, while the CG did not receive any block anesthesia intervention before anesthesia induction. We monitored the incidence and severity of POST at 1, 6, 24, and 48 h after surgery in both groups. Additionally, we evaluated the deep sleep quality score on the first, second, and fifth days after surgery in both groups.

RESULTS

The incidence of POST at 1 h and 6 h after surgery was significantly lower in the SGB group (10.0% and 13.3%) than in the CG (43.3% and 36.7%) (P < 0.05). The postoperative sore throat scores of the SGB group (0.10 ± 0.31 and 0.17 ± 0.46) at 1 h and 6 h after surgery were lower than those of the CG (0.57 ± 0.73 and 0.50 ± 0.77) (P < 0.05). Moreover, the deep sleep quality score on the first, second, and fifth days after surgery were significantly higher in the CG (5.40 ± 3.37, 4.70 ± 3.19, 4.53 ± 3.44) than in the SGB group (3.87 ± 2.30, 3.13 ± 1.77, 3.03 ± 1.84) (P < 0.05).

CONCLUSION

Ultrasound-guided SGB can reduce the incidence and severity of POST and improve PSD in patients undergoing lumbar spine surgery.

TRIAL REGISTRATION

This study was registered on Chinese Clinical Trial Registry, (ChiCTR2200065279) on 01/11/2022.

Hoarseness and arytenoid dislocation: A rare complication after facial bony contouring surgery

BACKGROUND

Arytenoid dislocation is a rare complication after endotracheal intubation and may result in permanent hoarseness, which cannot be tolerated during cosmetic surgeries, such as facial bony contouring surgery. This study aimed to identify the clinical characteristics of this patient subgroup and share the process of diagnosis and treatment.

METHODS

We retrospectively collected the medical records of patients who underwent facial bony contouring surgery under general anesthesia with endotracheal intubation from September 2017 to July 2022. We divided the patients into a nondislocation group and a dislocation group. Demographic, anesthetic, and surgical characteristics were collected and compared.

RESULTS

441 patients were enrolled, and 5 (1.1%) were diagnosed with arytenoid dislocation. The patients in the dislocation group were more likely to be intubated with the video laryngoscope (P = 0.049), and head-neck movement during surgery may predispose patients to arytenoid dislocation (P = 0.019). The patients in the dislocation group were diagnosed around 5-37 days after surgery. Three of them regained their normal voice after close reduction, and two recovered with speech therapy.

CONCLUSION

Arytenoid dislocation may result from multiple factors instead of one high-risk factor. Head-neck movement, the skills and experience of anesthetists, the time of intubation, and the use of intubation tools may all predispose patients to arytenoid dislocation. To acquire timely diagnosis and treatment, patients should be fully informed of this complication before surgery and observed closely afterward. Any postoperative voice or laryngeal symptoms lasting more than 7 days need a specialist evaluation.

Identifying the Risk Factors for Postoperative Sore Throat After Endotracheal Intubation for Oral and Maxillofacial Surgery

Objective

To identify risk factors for postoperative sore throat (POST) after general anesthesia in oral and maxillOfacial surgery.

Material and Methods

This study is a retrospective cohort design study. We enrolled patients with oral and maxillofacial surgery who underwent endotracheal intubation under general anesthesia in the Stomatology Hospital, Zhejiang University School Of Medicine between April 2020 and April 2021. They were divided into the POST group and the without POST group. The distribution Of various characteristics in the two groups was firstly analyzed. Then, logistic regression analysis was performed to explore the independent predictors for POST occurrence. Following this, logistic regression and random forest models were constructed and their performance was evaluated to predict POST occurrence.

Results

A total of 891 participants were enrolled in the study. Female gender and cough during extubation were significantly associated with increased POST occurrence in multivariate analysis (all P <0.05). Stratified logistic regression analysis results showed that the female gender was an independent predictor for POST occurrence in the 4≤age≤14 and 14<age≤60 groups after adjusting all the covariates, while cough during extubation independently predicted POST in the age>60 group after adjusting American Society of Anesthesiologists status and throat and lung disease (all P <0.05). The logistic regression model had a similar effect to the random forest model in predicting POST occurrence. Interestingly, the female gender had a higher important weight compared to the cough during extubation.

Conclusion

This research reveals female gender and cough during extubation as potential risk factors for POST occurrence, which may provide guidance for the effective prevention of POST in oral and maxillofacial surgery.

Effect of 5% EMLA Cream on Postoperative Sore Throat in Adults Following General Endotracheal Anesthesia: A Randomized Placebo-Controlled Study

BACKGROUND

Postoperative sore throat (POST) is a distressing complaint in adults after endotracheal intubation. This study aimed to evaluate the effect of topical application of a eutectic mixture of local anesthetics (EMLA) cream over the endotracheal tube (ETT) cuff on the incidence and severity of POST, cough, and hoarseness of voice in adults after surgery.

METHODS

In this randomized, placebo-controlled study, adult patients 18 to 65 years old, in American Society of Anesthesiologists (ASA) physical status I and II, and of either sex were scheduled to receive 5% EMLA cream (intervention arm) or lubricant gel (placebo-controlled arm) applied over the ETT cuff. POST was graded as none (0), mild (1), moderate (2), or severe (3). A score of ≥2 was considered as significant POST. The incidence of POST at the sixth postoperative hour was the primary outcome. Secondary outcomes included the incidence of POST at 0, second, and 24 hours, and the incidence of significant POST (score ≥2). The incidence and severity of postoperative cough and hoarseness of voice were recorded simultaneously.

RESULTS

Two hundred and four patients completed the study. The incidence of POST was significantly lower in the EMLA group versus placebo at the sixth postoperative hour (4.9% vs 40.1%; relative risk [RR], 0.12; 95% confidence interval [CI], 0.05-0.29; P < .001); and at 0 hour (74.5% vs 93.1%; RR, 0.8; 95% CI, 0.7-0.9; P < .001) and second hour (51.9% vs 84.3%; RR, 0.61; 95% CI, 0.5-0.75; P < .001) but comparable at 24 hours (1.9% vs 3.9%; RR, 0.5; 95% CI, 0.09-2.67; P = .4). The number needed to treat to prevent POST with EMLA cream application was 5 at 0 hour and 3 at the second and sixth hour. The proportion of patients with significant POST over 24 hours were less in the EMLA group (9.8% vs 43.1%; P < .001). The incidence of postoperative cough and hoarseness of voice was significantly less at the 0, second, and sixth hours in the EMLA group, but comparable at 24 hours. The incidence of severe cough (8.8% vs 31.4%; P < .001) and hoarseness of voice (2% vs 7.4%; P < .001) over 24 hours was less in the EMLA group.

CONCLUSIONS

The application of EMLA cream over ETT cuff reduces the incidence and severity of POST, cough, and hoarseness of voice in adults after general anesthesia in the early postoperative period compared to lubricant gel.

Internal branch of superior laryngeal nerve block by dexamethasone alleviates sore throat after thyroidectomy: a randomized controlled trial

PURPOSE

Postoperative sore throat (POST) is a common complaint following thyroidectomy. Dexamethasone was reported to alleviate POST when administered via different routes. This study aimed to compare the effects of local spray and perineural injection surrounding the internal branch of superior laryngeal nerve (iSLN) in preventing POST and alleviating postoperative impaired voice function.

METHODS

A randomized, double-blinded, controlled trial was performed to test the efficacy of the iSLN block in inhibiting of POST. A total of 161 patients who underwent elective thyroidectomy were randomly allocated to two groups. Group Spray: 4 mg dexamethasone was sprayed on to the vocal cord; Group iSLN: bilateral perineural injection with 4 mg dexamethasone around the iSLN. The incidence and severity of POST, swallowing pain, and its side effects were evaluated. Postoperative acoustic analysis, including jitter and shimmer, was also performed.

RESULTS

Group iSLN exhibited a significantly less incidence and intensity of POST at 6 h and 24 h (P < 0.001). The patients experienced less swallowing pain at 6 h (P < 0.001) after the surgery, compared with Group Spray. When compared with Group Spray, Group iSLN improved postoperative voice function, which was characterized by lower jitter and lower shimmer value at 6 h and 24 h (P < 0.001) after the surgery. The severity of postoperative cough is higher in Group Spray (P < 0.001).

CONCLUSIONS

Among patients undergoing elective thyroidectomy, those who received perineural injection surrounding iSLN with dexamethasone had improved voice function and presented with more excellence in the inhibition of POST and cough, in comparison with the local spray.

REGISTER INFORMATION

This trial was registered in the Chinese Clinical Trial Registry on 4th Jan, 2021 (ChiCTR2100042145). The trial is registered at http://www.chictr.org.cn/showproj.aspx?proj=120142 .

Effect of postoperative ultrasound-guided internal superior laryngeal nerve block on sore throat after intubation of double-lumen bronchial tube: a randomized controlled double-blind trial

Background

Postoperative sore throat (POST) is one of the main adverse postoperative outcome after tracheal intubation using double-lumen endobronchial tubes (DLTs). The aim of this study was to investigate the effectiveness and safety of ultrasound (US)-guided block of the internal branch of the superior laryngeal nerve (iSLN) for alleviating POST after intubation of DLTs.

Methods

Patients undergoing thoracic surgery between August 2019 and August 2021 were randomized into two groups depending on whether they received US-guided iSLN block immediately after the operation. In the control group, the patients underwent a thoracic surgery under general anesthesia (GA) with DLTs without any special treatment, while the patients in the experimental group received US-guided iSLN block bilaterally with 2 ml of 0.25% ropivacaine on either side immediately after the operation. The primary outcome was the grading of sore throat at three-time points after the operation, i.e., immediate extubation, 2 h after extubation, and 24 h after extubation. Secondary outcomes included the rate of nausea and vomiting, hoarseness, dyspnea, and choking cough after swallowing saliva at 2 h after extubation.

Results

The incidence and severity of sore throat were significantly lower in the experimental group than the control group at all time intervals (all P < 0.01). The rate of nausea and vomiting, hoarseness, dyspnea, and choking cough after swallow saliva at 2 h after extubation had no statistical difference (all P > 0.05).

Conclusions

The use of US-guided iSLN block can be effectively and safely applied to relieve POST after intubation of DLTs on thoracic surgery.

Trial registration

The study protocol was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn, NO. ChiCTR2000032188, 22/04/2020).

A randomised controlled trial of 7.5-mm and 7.0-mm tracheal tubes vs. 6.5-mm and 6.0-mm tracheal tubes for men and women during laparoscopic surgery

Sore throat after tracheal intubation impairs postoperative recovery. We randomly allocated 172 ASA physical status 1-2 participants, scheduled for laparoscopic lower abdominal surgery, to tracheal intubation with larger tubes (n = 88) or smaller tubes (n = 84), with internal diameters 7.5-mm vs. 6.5-mm for men and 7.0-mm vs. 6.0-mm for women. Primary outcome was the rates of no, mild, moderate or severe sore throat 1 h after surgery, which were 60, 10, 17 and 1 with larger tracheal tubes and 79, 5, 0 and 0 with smaller tubes, p < 0.001. The equivalent rates 24 h after surgery were 64, 16, 8 and 0 vs. 74, 6, 3 and 1, p = 0.037. Intra-operative ventilatory variables were unaffected by tube diameter, including peak inspiratory pressure, plateau pressure and end-tidal carbon dioxide partial pressure. In summary, smaller tracheal tubes benefitted patients having laparoscopic operations.

Efficacy of perioperative intravenous dexmedetomidine administration for the prevention of postoperative sore throat: a meta-analysis

Objective

Postoperative sore throat (POST) is an undesirable intubation-related complication after surgery. Several studies have investigated the efficacy of perioperative intravenous dexmedetomidine administration for the prevention of POST, but the results have been inconsistent. We aimed to summarize all existing evidence and draw a more precise conclusion to guide future clinical work.

Methods

PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure databases were comprehensively searched for all randomized controlled trials published before 1 February 2021 that investigated the efficacy of dexmedetomidine for the prevention of POST.

Results

Nine studies involving 400 patients were included in our meta-analysis. Compared with the control groups (i.e., saline and anesthetic drugs), perioperative intravenous use of dexmedetomidine significantly reduced the incidence of POST [risk ratio (RR): 0.56; 95% confidence interval (CI): 0.40–0.77; I² = 0%) and coughing on the tube during extubation (RR: 0.58; 95% CI: 0.41–0.82; I² = 0%). Additionally, patients in the dexmedetomidine group were more likely to develop bradycardia (RR: 2.46; 95% CI: 1.28–4.71; I² = 0%) and hypotension (RR: 3.26; 95% CI: 1.14–9.33; I² = 0%) during the administration of dexmedetomidine than those in the control group.

Conclusion

Perioperative intravenous administration of dexmedetomidine has a positive effect on the prevention of POST.

Effects of the anesthesiologist's experience on postoperative hoarseness after double-lumen endotracheal tube intubation: a single-center propensity score-matched analysis

Background

Postoperative hoarseness after general anesthesia is associated with patient discomfort and dissatisfaction. A recent large retrospective study showed that single-lumen endotracheal tube intubation by a trainee did not alter the incidence of postoperative pharyngeal symptoms compared with intubation by a senior anesthesiologist. However, there is limited information about the relationship between the anesthesiologist’s experience and hoarseness after double-lumen endotracheal tube intubation. We tested the hypothesis that double-lumen endotracheal tube intubation performed by a trainee increases the incidence of postoperative hoarseness compared to intubation by a senior anesthesiologist.

Methods

This retrospective observational study included patients who underwent lung resection between April 2015 and March 2018 at a university hospital. Double-lumen endotracheal tube intubation was carried out with a Macintosh laryngoscope. We divided the patients into 2 groups - one group comprised of patients who were intubated by a trainee anesthesiologist with < 2 years of experience, and the other group comprised of those who underwent intubation by a senior anesthesiologist with ≥2 years of experience. The primary outcome was the incidence of postoperative hoarseness 24 h after surgery and we collected data on postoperative hoarseness using a checklist of postanesthetic adverse events. One-to-one propensity score matching was conducted and P values < 0.05 were considered statistically significant.

Results

There was a total of 256 eligible patients, of which 153 underwent intubation by trainee anesthesiologists, and the remaining 103 patients were intubated by a senior anesthesiologist. The one-to-one propensity score matching resulted in 96 pairs of patients for the groups. The incidence of postoperative hoarseness 24 h after surgery was significantly higher in patients who were intubated by a trainee anesthesiologist than in patients who were intubated by a senior anesthesiologist (9.4% vs. 2.1%, respectively; P = 0.03).

Conclusions

Double-lumen endotracheal tube intubation by trainee anesthesiologists with < 2 years of experience increased the incidence of postoperative hoarseness 24 h after surgery compared to intubation by senior anesthesiologists with ≥2 years of experience.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-020-01198-1.

Current management of arytenoid sub-luxation and dislocation

PURPOSE

To review the current management of arytenoid subluxation/dislocation (AS/AD) focusing on diagnostic, therapeutic, and prognostic controversies.

METHODS

The international literature of the last 20 years has been considered. After the application of inclusion criteria, 20 studies were selected (471 AS/AD cases in total).

RESULTS

All the included investigations were retrospective case series. AS/AD was often iatrogenic occurring at least in 0.01% of patients undergone endo-tracheal intubation. The most common symptom was persistent hoarseness. The diagnosis was made by video-laryngoscopy and neck computed tomography in most reports, while some used also laryngeal electromyography. Laryngeal electromyography was fundamental to rule out unilateral vocal fold paralysis, the main differential diagnosis. The surgical relocation of AS/AD under general or local anesthesia was achieved in about 80% of patients.

CONCLUSION

AS/AD is a mechanical disorder of the larynx that can be successfully treated if promptly diagnosed. Clinical trials and multi-centric studies are necessary to set management guidelines.

Topical application of ketamine to prevent postoperative sore throat in adults: A systematic review and meta-analysis

BACKGROUND

Postoperative sore throat is a leading undesirable postoperative outcome. Ketamine is an N-methyl-d-aspartate receptor antagonist and its topical application is used for chronic pain and oral/throat indications. We conducted a systematic review to assess the efficacy of preoperative, topical ketamine application for preventing postoperative sore throat.

METHODS

We searched MEDLINE, EMBASE, and CENTRAL through September 23, 2019 for randomized controlled trials in which at least one intervention was topical ketamine to prevent postoperative sore throat in adults undergoing endotracheal intubation. The primary outcome was the incidence of sore throat at 24 hours postoperatively. The comparators were non-analgesic controls (placebo, no treatment, or usual care) or active agents. We pooled the data using a random-effects model.

RESULTS

We included 41 randomized controlled trials involving 3784 participants. Topical ketamine was associated with reduced incidence of sore throat at 24 hours postoperatively compared to non-analgesic methods (risk ratio, 0.45; 95% CI, 0.37-0.54; P < .001). We found significant publication bias, but the results remained unchanged with a trim-and-fill analysis. Trial sequential analysis (TSA) suggested that the efficacy of topical ketamine was adequate (TSA-adjusted 95% CI, 0.33-0.56). The GRADE quality for this evidence was moderate. Topical ketamine was inferior to a combination of nebulized ketamine and clonidine in preventing postoperative sore throat.

CONCLUSIONS

Preoperative, topical ketamine application may be more effective than non-analgesic methods in preventing postoperative sore throat. The number of studies did not suffice to determine the place of topical ketamine among agents to prevent postoperative sore throat.

Effect of Intravenous Lidocaine, Dexamethasone, and Their Combination on Postoperative Sore Throat: A Randomized Controlled Trial

BACKGROUND

Postoperative sore throat (POST), hoarseness, and cough after tracheal intubation are not uncommon. Although both lidocaine and dexamethasone have been used independently to reduce these events, there is no study assessing the combined effects of lidocaine and dexamethasone.

METHODS

This prospective, double-blind, randomized controlled study enrolled 180 patients requiring general anesthesia with endotracheal intubation for >90 minutes. They received 1 of the 4 intravenous agents just before induction of anesthesia: lidocaine (1.5 mg/kg) in group L, dexamethasone (8 mg) in group D, lidocaine (1.5 mg/kg) with dexamethasone (8 mg) in group DL, and placebo as normal saline in group NS. Standard anesthesia protocol was followed. Incidence and severity of a sore throat, cough, and hoarseness of voice were assessed up to 24 hours postoperatively. The primary outcome was the incidence of POST, and the main effects of dexamethasone and lidocaine were the primary interest.

RESULTS

Data of 45 patients in D, 44 in L, 44 in DL, and 43 in NS groups were analyzed. The incidence of a sore throat was 36%, 43%, 25%, and 56% in group D, L, DL, and NS, respectively (P = .02). Dexamethasone with or without lidocaine reduced the incidence of the POST (odds ratio, 0.44; 95% confidence interval, 0.24-0.82; P < .01). However, lidocaine was not effective in reducing POST (odds ratio, 0.62; 95% confidence interval, 0.33-1.14; P = .12). No difference was observed in the severity of a sore throat, incidence and severity of a cough, and hoarseness among the groups.

CONCLUSIONS

Dexamethasone, with or without lidocaine, was effective in reducing the incidence of POST in patients requiring prolonged tracheal intubation.

Aerosolized corticosteroids to prevent postoperative sore throat in adults: A systematic review and meta-analysis

BACKGROUND

Postoperative sore throat negatively affects patient recovery and satisfaction levels. We conducted a systematic review and meta-analysis to assess the efficacy and safety of aerosolized corticosteroids in the prevention of postoperative sore throat in adults undergoing tracheal intubation for surgery.

METHODS

We searched Medline, EMBASE, China National Knowledge Infrastructure, and the Cochrane Central Register of Controlled Trials for eligible studies from inception to 13 May 2018. We included randomized controlled trials that assessed the efficacy and safety of aerosolized corticosteroids, compared either with non-analgesic or analgesic controls, in adults undergoing tracheal intubation for surgery. Incidence and severity of sore throat 24 hours postoperatively and adverse events were the primary outcomes.

RESULTS

Nine randomized controlled trials involving 984 patients were included. Compared with non-analgesic control, aerosolized corticosteroids were associated with a reduced incidence (risk ratio [RR], 0.39; 95% confidence interval [CI], 0.26-0.58) and were likely associated with decreased severity (standardized mean difference [SMD], -0.96; 95% CI, -2.52, 0.59) of postoperative sore throat. Among these, four trials reported that there were no adverse events. Trial sequential analysis (TSA) suggested that the evidence on the incidence of postoperative sore throat, in comparison with the non-analgesic control, was not definitive (TSA-adjusted CI, 0.07-1.98). The GRADE quality of evidence on each outcome was very low.

CONCLUSIONS

Aerosolized corticosteroids may be superior to non-analgesic methods in preventing postoperative sore throat, but the evidence for efficacy and safety is still limited and not definitive.

Preoperative intravenous dexamethasone prevents tracheal intubation-related sore throat in adult surgical patients: a systematic review and meta-analysis

BACKGROUND

Postoperative sore throat related to tracheal intubation negatively affects patient recovery and satisfaction. Previous reviews suggested that intravenous dexamethasone diminishes postoperative sore throat. Nevertheless, they comprised a small number of studies with inconsistencies in outcome reporting. We performed a systematic review and meta-analysis to assess the efficacy and safety of preoperative intravenous dexamethasone in preventing postoperative sore throat in adult patients.

METHODS

We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to August 24, 2018. We included randomized-controlled trials that assessed the efficacy and safety of intravenous dexamethasone in adult surgical patients who required general anesthesia and endotracheal intubation. Our primary outcomes were the incidence and severity of sore throat at 24 hr after surgery/extubation and adverse events. We pooled the data using a random-effects model. We conducted a trial sequential analysis (TSA) on the incidence of sore throat.

RESULTS

We included 15 randomized-controlled trials involving 1,849 patients. In comparison with non-analgesic methods, intravenous dexamethasone was associated with a reduced incidence (risk ratio, 0.62; 95% confidence interval [CI], 0.51 to 0.75) and severity (standardized mean difference, - 1.06; 95% CI, - 1.80 to - 0.33) of postoperative sore throat. Serious adverse events were not associated with intravenous dexamethasone administration in the four studies where this was assessed. The TSA indicated that the evidence regarding the incidence of postoperative sore throat is adequate.

CONCLUSIONS

Our study indicates that preoperative intravenous administration of dexamethasone alleviates postoperative sore throat more effectively than non-analgesic methods.

TRIAL REGISTRATION

PROSPERO (CRD42018086697); registered 29 January, 2018.

A comparison of the transillumination-assisted technique versus midline approach technique in novices: a prospective randomized controlled trial about the Bonfils intubation fiberscope

Background

The present study aimed to compare the safety and efficacy for novices to conduct intubation with the Bonfils intubation fiberscope (BIF) using the transillumination-assisted or midline approach technique in patients with normal airways.

Methods

In this prospective randomized control study, 10 trainees were assigned to the transillumination-assisted technique group (T group) or the midline approach technique group (R group). Each trainee was required to conduct intubation in 50 patients. The primary outcome was intubation time. The secondary outcomes were success rate (%), number of attempts, and complications.

Results

Among the cases of successful intubation, the intubation time was not significantly different between the two groups (P > 0.05). The overall success rate of intubation was not significantly different between the two groups (P > 0.05). The intubation success rates at the first, second, and third attempts as well as the average intubation times were similar between the two groups (P > 0.05), but in patients receiving successful intubation at the second attempt, the intubation time was longer in the T group (P = 0.0006). The incidences of dry throat, sore throat, and hoarseness were higher in the T group (all P < 0.05).

Conclusions

For patients with a normal airway, the transillumination-assisted technique was unlikely to increase the success rate of intubation with the BIF compared with the midline approach technique, but led to more complications.

Trial registration

ChiCTR-INR-16009967, retrospectively registered on November 22, 2016

Electronic supplementary material

The online version of this article (doi:10.1186/s12871-017-0322-6) contains supplementary material, which is available to authorized users.

The effects of water lubrication of tracheal tubes on post-intubation airway complications: study protocol for a randomized controlled trial

Background

Water is known to have lubricating properties, thus it is used for lubrication of tracheal tubes to reduce airway injuries caused by intubation. However, there is no definite evidence to substantiate the beneficial effects of lubricating tracheal tubes using water for attenuating airway injuries. Moreover, the lubrication pretreatment may cause contamination of the tube, leading to respiratory infections. Therefore, this trial aims to assess whether no pretreatment of tracheal tubes does not increase post-intubation airway complications as compared with water lubrication of tubes.

Methods/design

This is a prospective, double-blind, single-center, parallel-arm, noninferiority, randomized controlled trial to be conducted in participants aged 20–80 years who are undergoing elective surgery under general anesthesia with orotracheal intubation. Participants are randomly assigned into one of two groups depending on whether intubation is performed using a tracheal tube lubricated with water (n = 150) or without any pretreatment (n = 150). The primary outcome is the incidence of sore throat at 0, 2, 4, and 24 h after surgery, which is analyzed with a noninferiority test. The secondary outcomes are the incidence and severity of postoperative hoarseness, oropharyngeal injuries, and respiratory infections.

Discussion

Because we hypothesized that lubricating tracheal tubes using water has no advantage in reducing airway injuries associated with intubation, we will compare the incidence of sore throat, which is the most common complaint after intubation, in a noninferiority manner. This is the first randomized controlled trial to investigate the possibly beneficial or harmful effects of lubricating tracheal tubes using water before intubation. We expect that this trial will provide useful evidence to formulate a protocol for preparing tracheal tubes before intubation.

Trial registration

This trial is registered at ClinicalTrials.gov on 1 July 2015 (NCT02492646)

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1699-0) contains supplementary material, which is available to authorized users.