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

Effect of peri-intubation non-pharmacological interventions on postoperative laryngeal symptoms: A systematic review with meta-analysis and meta-regression

OBJECTIVES

To evaluate the effectiveness of peri-intubation non-pharmacological interventions in reducing postoperative sore throat (POST), cough (PEC), and hoarseness in surgical patients.

DESIGN

A systematic review with meta-analysis and meta-regression.

SETTING

Elective surgery under general anesthesia in operating rooms.

MAIN OUTCOME MEASURES

Evaluate the impact of non-pharmacological interventions, including pre-intubation (gargling with Sodium Azulene Sulfonate, licorice, or using Strepsils tablets of honey and lemon lozenge), during-intubation (inflating the TT cuff with normal saline and softening the ETT cuff with warm normal saline), and post-intubation (cold vapor therapy, gargling with honey lemon water, and using green tea gargle), on the occurrence of POST, PEC, and hoarseness.

RESULTS

Nineteen trials with 2,136 participants were included. Pre-intubation intervention significantly reduced POST immediately after extubation (n = 861; OR: 0.28, 95 % CI: 0.20-0.38, P < 0.001), and 24 h post-extubation (n = 1006; OR: 0.21, 95 % CI: 0.16-0.28, P < 0.001). During-intubation intervention did not show significant effects on POST. Pre-intubation intervention also reduced POST-associated pain score at 24 h post-extubation (n = 440; MD: -0.50, 95 % CI: -0.81 to -0.18, P < 0.001). Post-intubation interventions were effective in reducing POST-associated pain scores at different time points post-extubation (P < 0.05). Pre-intubation intervention significantly reduced PEC (OR: 0.13, 95 % CI: 0.02-0.70, P = 0.02) and hoarseness (OR: 0.36, 95 %CI: 0.15-0.86, P = 0.02) at 24 h post-extubation. However, during-intubation interventions did not reduce hoarseness at 24 h post-extubation.

CONCLUSION

Pre-intubation non-pharmacological interventions were found to be the most effective in reducing the incidence and severity of POST, PEC, and hoarseness.

IMPLICATIONS FOR CLINICAL PRACTICE

Implementing pre-intubation non-pharmacological interventions can be beneficial for bedside nurses and healthcare professionals in reducing postoperative complications and nurses can contribute to improving patient comfort and recovery outcomes following surgery.

SYSTEMATIC REVIEW PROTOCOL

The protocol was registered in the PROSPERO international prospective register of systematic reviews on 2 January 2024 (CRD42023492813).

Alkalized lidocaine in a tapered cuff suppresses endotracheal tube-induced hemodynamic changes: a randomized controlled trial

PURPOSE

The use of an endotracheal tube (ET) cuff filled with alkalized lidocaine (AL) can suppress ET-induced emergence phenomena, such as hypertension, tachycardia and coughing, and postoperative sore throat (POST) and hoarseness (PH). The efficacy of intracuff lidocaine may vary depending on the cuff shape, but there has been no study on the effects of a tapered cuff filled with AL. We examined whether intracuff AL suppresses ET-induced emergence phenomena, POST and PH.

METHODS

Sixty-two patients were enrolled in this study and the patients were randomly allocated to a group in which the tapered cuff was filled with AL (Group AL) and a group in which the tapered cuff was filled with normal saline (Group S). The primary outcomes of this study were changes in mean blood pressure (MBP) and heart rate (HR) at extubation. MBP, HR and the number of coughs were recorded before and up to 10 min after extubation. The degree of POST and the incidences of POST and PH were recorded at 15 min, 2 h and 24 h after extubation.

RESULTS

Changes in MBP before extubation and HR before and after extubation were significantly lower in Group AL than in Group S (p < 0.025). The number of coughs at extubation and the incidence of PH at 2 h after extubation were significantly lower in Group AL than in Group S (p < 0.0001 and p = 0.014, respectively).

CONCLUSION

AL in a tapered cuff significantly suppresses ET-induced cardiovascular changes in MBP and HR.

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.

Comparison of Two Different Sizes of Endotracheal Tracheal Tube for Postoperative Sore Throat in Breast Cancer Patients Undergoing Surgeries

Objective The purpose of this study was to compare two different sizes of an endotracheal tube (ETT), with inner diameters (ID) of 6.5 mm and 7.5 mm, for the frequency of postoperative sore throat in patients undergoing elective breast cancer surgery. Methodology This study was a randomized controlled trial conducted in the Shaukat Khanum Memorial Cancer Hospital and Research Center from December 3, 2016, to February 3, 2017. This study included 110 patients, 55 from each group, who were selected from the elective surgery list fulfilling the inclusion criteria. Group A patients were intubated with 6.5-mm ID ETTs and group B patients with 7.5-mm ID ETTs. All patients were carefully extubated in the operating room when fulfilling extubation criteria. Any concerns of sore throat were recorded 24 hours postoperatively. All relevant data were recorded on a pro forma. Results In this study, the mean age was 46.6 ± 13.2 years (range: 18-65 years). The mean body mass index (BMI) was 29.50 ± 07.12 kg/m², with a minimum and maximum of 19 kg/m² and 38 kg/m², respectively. The mean four-point scale was 2.98 ± 1.3, with a minimum and maximum of 1.0 and 4.0, respectively. Of the 110 patients, 47 patients reported a sore throat at 24 hours after surgery, whereas 63 patients did not report a sore throat. In this study, 14 patients in group A were diagnosed with a postoperative sore throat, whereas 33 patients in group B were diagnosed with a sore throat at 24 hours. A chi-square test was significant, and a poststratification chi-square test was applied to compare sore throat at 24 hours postoperative between the groups with respect to age and BMI. Conclusions ETT sizes produced a significant difference in the frequency of postoperative sore throat in patients undergoing breast surgery. Physicians should consider this impact on clinical practice to optimize patient outcomes. Additional studies with a larger sample size are warranted to further explore this impact.

Post Extubation Airway Conditions after Direct Laryngoscopic Biopsy: A Comparative Evaluation between Lignocaine Nebulization and Lignocaine Lozenges - A Randomized Trial

Context:

Postextubation airway complications are one of the most undesired side effects of airway manipulation. Pharmacological and nonpharmacological measures have been utilized for minimizing the morbidity. Lignocaine lozenges, a new modality, used to reduce post-extubation airway complications is an area yet to be explored.

Aims:

The aim of this study is to evaluate and compare the effects of lignocaine nebulization versus lignocaine lozenges in decreasing immediate postextubation airway complications in patients presenting for direct laryngoscopic biopsy.

Settings and Design:

This randomized study was conducted at tertiary care teaching hospital in northern state of India.

Subjects and Methods:

A total of 90 patients, 40–70 years, the American Society of Anesthesiologists (ASA) physical status Classes I, II, and III of either sex, posted for elective direct laryngoscopic biopsy, requiring general anesthesia with endotracheal intubation were included and randomly divided into groups (n = 30) to receive lignocaine nebulization (Group A), lignocaine lozenge (Group B), control (Group C). The patients were assessed for a cough after extubation after 5 min then every 10 min up to 30 min postextubation.

Statistical Analysis Used:

Categorical variables were compared using the Chi-square test or Fisher's exact test and continuous variables by using one-way Analysis of variance and Kruskal–Wallis test, respectively.

Results:

Comparison of a cough at various time intervals starting from extubation up to 30 min in post-extubation period was highly significant in between groups. Among Group A (lignocaine nebulization) 33% of patients had a decrease in the severity of a cough within the first 5 min; although among Group B (Lignocaine Lozenges), the decrease in the severity of a cough (40%) was more as compared to that of Group A. Similar decrease in the severity of a cough was observed through various time interval from 10 min to 30 min postextubation. After 30 min, 73% of patients in Group A and 76% of patients in Group B had an incidence of a decrease in the severity of cough.

Conclusions:

Lignocaine Lozenges have been found to have a better result.