Background Postoperative sore throat is a common, uncomfortable, stressful sequel of tracheal intubation that contributes to postoperative mortality and morbidity following general anesthesia. Therefore, reducing risks of post-operative sore throat is important to improve patient outcome. Objectives The objective of this systematic review and meta-analysis was to evaluate the incidence and risk factors of postoperative sore throat among patients who underwent surgery. Methods Studies were retrieved from PubMed, Cochrane Database, Cinahl, Scopus, Mednar, Hinari and Google Scholar by employing a combination of search terms with Boolean operators. Heterogeneity across studies was assessed using the Cochrane Q test. Funnel plot was used for visual assessment of publication bias. Subgroup analyses by country and meta-regression was performed to explore the possible causes of heterogeneity. Egger’s weighted regression test at a p-value < 0.05 was used to assess the presence of publication bias. Sensitivity analysis was performed to judge whether the pooled effect size was influenced by individual study. Stata v14.0 (Statacorp, College Station, Texas, USA) software was used for all statistical analyses. STATA software version 14 was used for all statistical analyses. Result A total of 11 studies with 5885 total sample size were included. The total number of patients who developed Post-operative sore throat was 2252. The pooled prevalence of Post-operative sore throat was 40.48% (95% CI: 35.16, 45.79). The visual inspection of the funnel plot showed the symmetrical distribution. Patients who had number of a single attempts were about 42.5% less likely to develop POST than patients who had multiple intubation attempts (OR: 0.58(0.38–0.88), P = 010, I2: 86.6%. Additionally, duration of tube in place less than 1 h was about 18.7% more likely to develop POST than who were not (OR: 1.19(0.29–4.79), P = 0.028, I2: 0.0%). The other independent predictors of POST were OR: 3.01(0.57–15.84), P = 0.19, I2: 92.3%) and OR: 1.56(0.97–2.58), P = 0.080, I2: 0.0%) respectively. Conclusions Patients’ age and sex, size of ETT and LMA, duration of ETT in trachea, experience of anesthetists’, number of attempts, induction agent, and smoking were revealed more common causes of sore throat. The number of attempts and the length of tube in place were both linked to the occurrence of postoperative sore throat. Research Registry Our unique identifying number is reviewregistry1416. Highlights
Introduction: Coughing during extubation after thyroid surgery can increase venous pressure and release the vessel ligation which leads to active bleeding, and form hematoma which can be a life threatening due to airway obstruction. Lidocaine before extubation may reduce cough and hemodynamic instability. The aim of this study was to compare effect of intra-tracheal and intravenous lidocaine on airway and hemodynamic responses during extubation. Method: A hospital based prospective cohort study was conducted on 74 patients who underwent thyroid surgery. A Systematic random sampling technique was employed. Data recording was made after Anesthetists gave 1.5 mg/kg 2% lidocaine either intravenous (control group) or intra-tracheal (exposed group) before extubation. The episode and grade of coughs were recorded. Heart rate and blood pressure were also recorded at the time of lidocaine administration, and at 1,2,3,4 and 5 minutes post extubation. Independent two sample t-test and chi-square were computed. P-value < 0.05 considered as statistically significant. Result: The two groups were comparable with respect to socio -demographic and clinical characteristics. The incidence of coughing after intravenous and intratracheal lidocaine was 11% and 15%, p-value, 0.425, respectively. The sedation score after extubation also was comparable between the two groups. Even though the difference between the two groups was statistically insignificant, the mean heart rates and blood pressure after lidocaine in intravenous and intratracheal lidocaine groups were higher at 1 min post extubation and then decline to baseline mean heart rate at 5 munities post extubation. Conclusion: Intravenous and intratracheal lidocaine have comparable effects on airway and hemodynamic response during extubation after thyroid surgery. The sedation score after lidocaine was also similar among the two groups. Therefore lidocaine can be used either intra tracheal or intravenously before extubation. Highlights
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