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Senol Celik S, Chalkias A, Sariköse S, Nur Arslan H, Bahramifar A, Rahimi-Bashar F, Ait Hssain A, Hashemi S, Vahedian-Azimi A. Effect of peri-intubation non-pharmacological interventions on postoperative laryngeal symptoms: A systematic review with meta-analysis and meta-regression. Intensive Crit Care Nurs 2024; 84:103728. [PMID: 38861781 DOI: 10.1016/j.iccn.2024.103728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/27/2024] [Accepted: 05/22/2024] [Indexed: 06/13/2024]
Abstract
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).
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Affiliation(s)
| | - Athanasios Chalkias
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Outcomes Research Consortium, Cleveland, OH 44195, USA; Department of Intensive Care Medicine, Tzaneio General Hospital, Piraeus, Greece.
| | - Seda Sariköse
- Koç University, School of Nursing, İstanbul, Turkey.
| | | | - Ali Bahramifar
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Farshid Rahimi-Bashar
- Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Ait Hssain
- Medical Intensive Care Unit, Hamad General Hospital, PO BOX 3050, Doha, Qatar; Department of Medicine, Weill Cornell Medicine, New York, Doha, Qatar
| | - Saeed Hashemi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Ishida K, Maruyama Y, Yoshiyama Y, Ito M, Tanaka S, Shen D, Kawamata M. Alkalized lidocaine in a tapered cuff suppresses endotracheal tube-induced hemodynamic changes: a randomized controlled trial. J Anesth 2023; 37:726-733. [PMID: 37452145 DOI: 10.1007/s00540-023-03224-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
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.
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Affiliation(s)
- Kumiko Ishida
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Nagano, 390-8621, Japan.
| | - Yuki Maruyama
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Nagano, 390-8621, Japan
| | - Yuki Yoshiyama
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Nagano, 390-8621, Japan
| | - Mariko Ito
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Nagano, 390-8621, Japan
| | - Satoshi Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Nagano, 390-8621, Japan
| | - Dandan Shen
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Nagano, 390-8621, Japan
| | - Mikito Kawamata
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Nagano, 390-8621, Japan
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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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Bi X, Wen J, Chen Q, Zhang X. Effects of thermal softening of double-lumen endobrochial tubes on prevention of postoperative sore throat in smokers: a randomized controlled trial. J Cardiothorac Vasc Anesth 2022; 36:3109-3113. [DOI: 10.1053/j.jvca.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 11/11/2022]
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Ali S, Khan A, Ashfaq AD. Comparison of Two Different Sizes of Endotracheal Tracheal Tube for Postoperative Sore Throat in Breast Cancer Patients Undergoing Surgeries. Cureus 2021; 13:e12896. [PMID: 33643740 PMCID: PMC7903537 DOI: 10.7759/cureus.12896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Sadia Ali
- Anesthesia and Critical Care, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Ahsun Khan
- Anesthesia and Critical Care, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Allah Ditta Ashfaq
- Anesthesia and Critical Care, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Fenta E, Teshome D, Melaku D, Tesfaw A. Incidence and factors associated with postoperative sore throat for patients undergoing surgery under general anesthesia with endotracheal intubation at Debre Tabor General Hospital, North central Ethiopia: A cross-sectional study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sachdeva K, Asthana V, Gupta D, Bist SS. Post Extubation Airway Conditions after Direct Laryngoscopic Biopsy: A Comparative Evaluation between Lignocaine Nebulization and Lignocaine Lozenges - A Randomized Trial. Anesth Essays Res 2019; 13:158-162. [PMID: 31031498 PMCID: PMC6444958 DOI: 10.4103/aer.aer_195_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Kanika Sachdeva
- Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Veena Asthana
- Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Divya Gupta
- Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Sampan S Bist
- Department of ENT, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
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El-Boghdadly K, Bailey CR, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia 2016; 71:706-17. [DOI: 10.1111/anae.13438] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 12/14/2022]
Affiliation(s)
- K. El-Boghdadly
- Department of Anesthesia; Toronto Western Hospital; Toronto Ontario Canada
| | - C. R. Bailey
- Department of Anaesthetics; Evelina London Children's Hospital; Guys and St. Thomas’ NHS Foundation Trust; London UK
| | - M. D. Wiles
- Department of Anaesthetics; Sheffield Teaching Hospital NHS Foundation Trust; Sheffield UK
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