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Min K, Wang Y, Feng D, Jin T, Zhu W, Duan R, Lv X. The Influence of Piriform Recess Instillation with Lidocaine Before Bronchoscopy on Post-General Anesthesia Cough: A Randomized Controlled Trial. Drug Des Devel Ther 2024; 18:2883-2890. [PMID: 39006188 PMCID: PMC11246034 DOI: 10.2147/dddt.s458058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024] Open
Abstract
Background and Importance Postoperative cough is a common complication of general anesthesia after bronchoscopy. The aim of the present study was to determine the safety profile and efficacy of piriform recess instillation with lidocaine in reducing the incidence of coughing. Objective To what extent could piriform recess instillation with lidocaine decrease the incidence of cough at 10min after extubation? Outcome Measures and Analysis Eighty-eight consecutive patients were equally randomized to a lidocaine group receiving piriform recess instillation with 2mL 2% lidocaine, and a normal saline group receiving piriform recess instillation with 2mL saline. The primary outcome was the incidence of cough after extubation, and the secondary outcomes were throat score at 10 min and 6 h after extubation assessed by the numerical rating scale, cough severity at 10 min and 6 h after extubation assessed by the Visual Analog Scale (VAS), 24 h 40-item Quality of Recovery Score (QoR-40), and subject-rated satisfaction score on a VAS. Main Results Compared with saline group, the incidence of cough in lidocaine group was significantly lower (63.6% vs 86.4%, P=0.014). The sore throat score at 10 min after extubation was significantly lower (0[0,0] vs 1[0,2], P<0.001). The subject-rated overall anesthesia satisfaction score was significantly higher (84.8[±6.2] vs 76.6[±8.6], P<0.001). The severity of cough at 10 min after extubation was significantly lower (Mild: 36.4% vs 11.4%, P=0.006; Severe: 9.1% vs 43.2%, P<0.001). There was no significant difference in the sore throat score at 6 h after extubation, severity of cough at 6 h after extubation, or QoR-40 at 24 h after extubation between the two groups. Conclusion Piriform recess instillation with lidocaine before bronchoscopy is a simple and effective method for reducing early cough intensity and alleviating early sore throat. At 6 hours, there were no differences observed between the groups. Clinical Trial Registration Chinese Clinical Trial Registry (identifier: ChiCTR2200067087).
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Affiliation(s)
- Keting Min
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Yu Wang
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Di Feng
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Tian Jin
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Wanli Zhu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Ruowang Duan
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Xin Lv
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
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Malta SM, Bilotta F, Nozari A. Is it Safe to Use Ultrasound-Guided Superior Laryngeal Nerve Block for the Prevention of Postoperative Sore Throat After Double Lumen Endotracheal Intubation? Anesth Analg 2024; 138:e1-e2. [PMID: 38100809 DOI: 10.1213/ane.0000000000006732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
- Stephanie M Malta
- Department of Anesthesiology, Boston Medical Center, Boston, Massachusetts,
| | - Federico Bilotta
- Department of Anesthesiology and Critical Care, Sapienza University of Rome, Rome, Italy
| | - Ala Nozari
- Department of Anesthesiology, Boston Medical Center, Boston, Massachusetts
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Alfaras-Melainis K, Fernando RJ, Boisen ML, Hoffman PJ, Rosenkrans DJ, Teeter E, Cardi AI, Laney J, Reagan A, Rao VK, Anderson M, Luke CB, Subramani S, Schisler T, Ritchie PJ, Gelzinis TA. The Year in Thoracic Anesthesia: Selected Highlights from 2022. J Cardiothorac Vasc Anesth 2024; 38:29-56. [PMID: 37802689 DOI: 10.1053/j.jvca.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
This article reviews research highlights in the field of thoracic anesthesia. The highlights of this year included new developments in the preoperative assessment and prehabilitation of patients requiring thoracic surgery, updates on the use of devices for one-lung ventilation (OLV) in adults and children, updates on the anesthetic and postoperative management of these patients, including protective OLV ventilation, the use of opioid-sparing techniques and regional anesthesia, and outcomes using enhanced recovery after surgery, as well as the use of expanding indications for extracorporeal membrane oxygenation, specialized anesthetic techniques for airway surgery, and nonintubated video-assisted thoracic surgery.
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Affiliation(s)
| | - Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Paul J Hoffman
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Emily Teeter
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Alessandra I Cardi
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Jeremy Laney
- Department of Anesthesiology, University of Southern California, Los Angeles, CA
| | - Aaron Reagan
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Michael Anderson
- Department of Anesthesiology and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Charles B Luke
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Travis Schisler
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia Canada
| | - Peter J Ritchie
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
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Chen Z, Jin Y, Lu G, Jin Y, Feng C, Zhao X. Preoperative Ultrasound-Guided Internal Branch Block of Superior Laryngeal Nerve Reduces Postoperative Sore Throat Caused by Double Lumen Endotracheal Intubation: A Randomized Trial. Anesth Analg 2023; 137:1270-1278. [PMID: 37227947 DOI: 10.1213/ane.0000000000006534] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
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.
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Affiliation(s)
- Zheping Chen
- From the Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yanwu Jin
- From the Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guodong Lu
- From the Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuelong Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Wannan Medical College, Wuhu, China
| | - Chang Feng
- From the Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xin Zhao
- From the Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Lv Z, Huang X, Cai J, Zhou Z, Gao L, Wang W, Sun J, Pan Y. Effect of superior laryngeal nerve block in alleviating sore throat after application of i-gel supraglottic airway: a randomized controlled trial. BMC Anesthesiol 2023; 23:333. [PMID: 37798734 PMCID: PMC10552282 DOI: 10.1186/s12871-023-02287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/17/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Postoperative sore throat (POST) is a common complaint after supraglottic airway device (SAD) application. Internal branch of the superior laryngeal nerve (iSLN) block has the potential to alleviate POST. The aim of this trial was to explore the effect of iSLN block in alleviating sore throat, as well as to identify the potential risk factors for POST after SAD insertion. METHODS One hundred thirty-four patients scheduled for elective gynecological surgery were randomized to either group T: tetracaine syrup (1%) for local lubrication on i-gel supraglottic device (n = 67) or group B: i-gel insertion with water based lubricant on it and followed by bilateral iSLN block (ropivacaine, 0.375%, 2 ml for each side) (n = 67). Under ultrasound guidance, iSLN was exposed below thyrohyoid membrane. The primary outcome was the intensity of sore throat at 6 h after surgery. In addition, POST score at 0.5 h and 24 h, the severity of postoperative swallowing discomfort, acoustic analysis and complications were measured. RESULTS Compared with tetracaine syrup for local lubrication, iSLN block resulted in a reduced intensity of POST at 0.5 h (P = 0.044, OR = 1.99, 95%CI 1.02 to 3.88) and 6 h (P < 0.001, OR = 5.07, 95%CI 2.53 to 10.14) after surgery, as well as less severity of swallowing discomfort (P < 0.001, OR = 2.21, 95%CI 1.63 to 2.99) and cough (P = 0.039, OR = 1.97, 95%CI 1.04 to 3.73). The patients after iSLN block presented lower jitter and shimmer value in acoustic analysis at 6 h after surgery (P < 0.001). CONCLUSIONS iSLN block was effective in alleviating POST, improving voice function, as well as reducing postoperative swallowing discomfort and coughing. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2000037974) on 8th Sept 2020.
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Affiliation(s)
- Zhu Lv
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinyi Huang
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinxia Cai
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zijun Zhou
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Linglin Gao
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Weijian Wang
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Jiehao Sun
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Yizhao Pan
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Zheng ZP, Tang SL, Fu SL, Wang Q, Jin LW, Zhang YL, Huang RR. Identifying the Risk Factors for Postoperative Sore Throat After Endotracheal Intubation for Oral and Maxillofacial Surgery. Ther Clin Risk Manag 2023; 19:163-170. [PMID: 36798751 PMCID: PMC9926977 DOI: 10.2147/tcrm.s396687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
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.
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Affiliation(s)
- Zhou-peng Zheng
- Department of Anesthesiology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, 310,000People’s Republic of China,Zhejiang Provincial Clinical Research Center for Oral Diseases, Hangzhou, 310,000People’s Republic of China,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, 310,000People’s Republic of China,Cancer Center of Zhejiang University, Hangzhou, 310,000People’s Republic of China
| | - Su-lin Tang
- Department of Anesthesiology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, 310,000People’s Republic of China,Zhejiang Provincial Clinical Research Center for Oral Diseases, Hangzhou, 310,000People’s Republic of China,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, 310,000People’s Republic of China,Cancer Center of Zhejiang University, Hangzhou, 310,000People’s Republic of China
| | - Shao-lan Fu
- Department of Anesthesiology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, 310,000People’s Republic of China,Zhejiang Provincial Clinical Research Center for Oral Diseases, Hangzhou, 310,000People’s Republic of China,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, 310,000People’s Republic of China,Cancer Center of Zhejiang University, Hangzhou, 310,000People’s Republic of China
| | - Qian Wang
- Department of Anesthesiology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, 310,000People’s Republic of China,Zhejiang Provincial Clinical Research Center for Oral Diseases, Hangzhou, 310,000People’s Republic of China,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, 310,000People’s Republic of China,Cancer Center of Zhejiang University, Hangzhou, 310,000People’s Republic of China
| | - Li-wei Jin
- Department of Anesthesiology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, 310,000People’s Republic of China,Zhejiang Provincial Clinical Research Center for Oral Diseases, Hangzhou, 310,000People’s Republic of China,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, 310,000People’s Republic of China,Cancer Center of Zhejiang University, Hangzhou, 310,000People’s Republic of China
| | - Yan-li Zhang
- Department of Anesthesiology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, 310,000People’s Republic of China,Zhejiang Provincial Clinical Research Center for Oral Diseases, Hangzhou, 310,000People’s Republic of China,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, 310,000People’s Republic of China,Cancer Center of Zhejiang University, Hangzhou, 310,000People’s Republic of China
| | - Rong-rong Huang
- Department of Anesthesiology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, 310,000People’s Republic of China,Zhejiang Provincial Clinical Research Center for Oral Diseases, Hangzhou, 310,000People’s Republic of China,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, 310,000People’s Republic of China,Cancer Center of Zhejiang University, Hangzhou, 310,000People’s Republic of China,Correspondence: Rong-rong Huang, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, No. 166, Qiutao North Road, Shangcheng District, Hangzhou, People’s Republic of China, Email
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