Effects of benzydamine hydrochloride on postoperative sore throat after extubation in children: a randomized controlled trial

The present and the future of benzydamine: expert opinion paper

Objectives

Benzydamine is a compound indicated in the treatment of symptoms of irritation/inflammation of the oropharyngeal cavity, including those associated with pain. Objectives of this expert opinion narrative review is to summarize current indicated benzydamine applications and elicit further ones to be explored.

Materials and methods

In this expert opinion paper, evidences underlying the mechanism of action and clinical application of benzydamine are reviewed. Insights are also provided on possible new clinical applications of the drug and new formulations.

Results

Current recognized indications of benzydamine include: relief of symptoms associated with inflammatory conditions of the mouth and oropharynx, symptomatic treatment of gingivitis and stomatitis, oral mucositis induced by chemotherapy and/or radiotherapy and post operative sore throat. In addition, among new applications that need to be explored experts embed: oral lichen planus, burning mouth syndrome, post intubation sore throat, antifungal action and new anticancer target agents induced mucositis.

Conclusions

Benzydamine is a very versatile compound able to play an auxiliary and adjuvant role in the prevention and treatment of oral cavity/oropharynx disorders. According to experts' opinion there is the need to design clinical trials to highlight novel possible applications of benzydamine and implemented translational analyses to fine-tune patients' selection and open future research scenarios.

The role of local inflammation in complications associated with intubation in pediatric patients: A narrative review

Although the most important primary local inflammatory response factor to intubation is not yet clear, it is known that it may be directly attributed to the presence of trauma during intubation or the response of oral bacterial flora present in the trachea. It is known that prolonged intubation is associated with worse outcomes, but other underlying systemic issues, such as sepsis and trauma, are also associated with this result. Likewise, patients who require advanced airway management and excessive manipulation are more likely to experience complications. There are various inflammatory mediators that are generated during orotracheal intubation, many of which can be considered targets for therapies to help reduce inflammation caused by intubation. However, there is little evidence on the management of the inflammatory response induced by orotracheal intubation in pediatric patients. Therefore, the aim of this narrative review is to highlight the intubation associated complications that can arise from poorly controlled inflammation in intubated pediatric patients, review the proposed pathophysiology behind this, and discuss the current treatments that exist. Finally, taking into account the discussion on pathophysiology, we describe the current therapies being developed and future directions that can be taken in order to create more treatment options within this patient population.

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

Background

Postoperative sore throat is the most frequent complication in pediatric patients after general anesthesia. This study aimed to investigate the incidence of postoperative sore throat in patients undergoing general anesthesia with tracheal intubation or laryngeal mask airway.

Methods

A hospital-based multicenter prospective observational cohort study was conducted. Proportional allocation was done with a total of 424 patients from March 1 to June 30, 2022. The information was entered into the Epi-Data software version 4.6 and analyzed with Stata 14. Socio-demographic, surgical, and anesthetic-related characteristics were analyzed using descriptive statistics. A p-value of less than 0.2 was the cutpoint of bivariate logistic regression analysis, and p-values of less than 0.05 were regarded as statistically significant in multivariate logistic regression to determine the presence and strength of association between independent variables and postoperative sore throat.

Results

A total of 411 patients were included in this study, with a response rate of 96.9%. The overall proportion of patients who developed postoperative sore throat was 45% (95% CI: 40.18-49.84). Patients who had anesthesia for more than two hours (AOR = 8.23: 95% CI = 4.08-16.5), those who were intubated by undergraduate anesthesia students (AOR = 2.67: 95% CI = 1.53-4.67), and those who had been intubated using tracheal tube (AOR = 2.38: 95% CI = 1.15-4.92) were significantly associated with the level of postoperative sore throat.

Conclusions and recommendations

We concluded that intubated children with ETT have a high incidence of post-operative sore throat. Tracheal tube usage, intubation by undergraduate students, and more than two hours of anesthesia duration were associated factors. The incidence of sore throat can be decreased with the use of a laryngeal mask airway, intubation by a senior anesthetist, and shortening of anesthesia time.

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.

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).

Usefulness of bispectral index and patient state index during sevoflurane anesthesia in children: A prospective observational study

Cortical electroencephalography-based devices are used to monitor the depth of anesthesia. In this study, we evaluated the values of bispectral index (BIS) and patient state index (PSI) during sevoflurane anesthesia in children. The ability/accuracy of BIS and PSI to predict the maintenance and recovery state of anesthesia was evaluated based on prediction probability (Pk) values and the secondary outcomes were agreement and correlation of 2 monitors. Fifty children (3-12 years old) were enrolled and the patients received sevoflurane anesthesia with remifentanil followed by propofol administration. Before the induction of anesthesia, BIS and PSI sensors were simultaneously placed on the forehead, and data were collected until the end of anesthesia. Maintenance state was defined as the period following intubation until the cessation of sevoflurane, while recovery state was defined as the period following the cessation of sevoflurane until awake. Pk, agreement or correlation of BIS and PSI in different anesthesia state were calculated. Anesthesia reduced mean BIS and PSI values. Pk of BIS (95% confidential interval [CI]: 0.78-0.91) and PSI (95% CI: 0.82-0.91) for anesthesia were 0.85 and 0.87, respectively. Agreement was 0.79 for recovery state and 0.73 for maintenance state. Pk values were comparable for BIS and PSI. Agreement between BIS and PSI measurements in the same state was relatively good. Therefore, these monitors are appropriate for monitoring for different state of anesthesia in pediatric population.

Casein Microgels as Benzydamine Hydrochloride Carriers for Prolonged Release

This research aims to investigate the properties of nano- and micro-sized casein hydrogels crosslinked by sodium tripolyphosphate as drug delivery systems. Benzydamine hydrochloride was chosen as a model hydrophilic drug. The gels were synthesized by varying different parameters: casein concentration, casein/crosslinking ratio, and addition of ethanol as a co-solvent. The electrostatic attractive interactions between the casein and the sodium tripolyphosphate were confirmed by FTIR spectroscopy. The particle sizes was determined by dynamic light scattering and varied in the range between several hundred nanometers and several microns. The yield of the gelation process was high for all investigated samples and varied between 55.3% and 78.3%. The encapsulation efficiency of the particles was strongly influenced by the casein concentration and casein/crosslinker ratio and its values were between 4.6% and 22.4%. The release study confirmed that casein particles are useful as benzydamine carriers and ensured prolonged release over 72 h.

Model for Taking Care of Patients with Early Childhood Caries during the SARS-Cov-2 Pandemic

Pending the availability of vaccines to contain the SARS-CoV-2 pandemic, the current solution is "social distancing" with a reduction of dental treatments to those assessed as urgent and emergency cases. These treatments also involve Early Childhood Caries (ECC) due to the fact that this disease affects preschool children (a vulnerable population) and, in addition, shows a propensity to evolve into more serious complications (dental pain, infections). A narrative review was carried out to support a protocol for treating ECC with efficacious and safe (in terms of SARS-CoV-2 transmission) procedures. Protocol involves criteria for patients' selection remotely (telemedicine), and well-detailed criteria/equipment and hygiene procedures to combat against SARS-CoV-2 transmission. Moreover, the protocol proposes innovative caries treatments, named Minimally Invasive Treatments (MITs), well known in pedodontics for their high level of children's acceptance during dental care. MITs allow for caries removal (particularly in primary teeth) without any high-speed rotating instrument cooled with nebulized air-water spray (with high risk of virus environmental diffusion), usually adopted during traditional treatments. For evaluating MITs effectiveness in caries management, only Systematic Review and Randomized Controlled Trials (RCTs) were included in our study, without any risk of bias assessment. The indications proposed in this protocol could support clinicians for the temporary management of ECC until the SARS-CoV-2 pandemic ends.