Nebulized pharmacological agents for preventing postoperative sore throat: A systematic review and network meta-analysis

Yu, Jian; Ren, Li; Min, Su; You, Yang; Lv, Feng

doi:10.1371/journal.pone.0237174

Cited by 8 publications

(4 citation statements)

References 46 publications

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“…Anaesthetist experience was not associated with the rate of sore throat, consistent with another study [21]. We think that tracheal intubation with smaller tubes is an easier intervention than others tested to reduce postoperative sore throat, such as drugs or laryngeal nerve block [22][23][24][25][26][27].…”

Section: Discussionsupporting

confidence: 85%

A randomised controlled trial of 7.5‐mm and 7.0‐mm tracheal tubes vs. 6.5‐mm and 6.0‐mm tracheal tubes for men and women during laparoscopic surgery

et al. 2021

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Sore throat after tracheal intubation impairs postoperative recovery. We randomly allocated 172 ASA physical status 1-2 participants, scheduled for laparoscopic lower abdominal surgery, to tracheal intubation with larger tubes (n = 88) or smaller tubes (n = 84), with internal diameters 7.5-mm vs. 6.5-mm for men and 7.0-mm vs. 6.0-mm for women. Primary outcome was the rates of no, mild, moderate or severe sore throat 1 h after surgery, which were 60, 10, 17 and 1 with larger tracheal tubes and 79, 5, 0 and 0 with smaller tubes, p < 0.001. The equivalent rates 24 h after surgery were 64, 16, 8 and 0 vs. 74, 6, 3 and 1, p = 0.037. Intra-operative ventilatory variables were unaffected by tube diameter, including peak inspiratory pressure, plateau pressure and endtidal carbon dioxide partial pressure. In summary, smaller tracheal tubes benefitted patients having laparoscopic operations.

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Section: Discussionsupporting

confidence: 85%

A randomised controlled trial of 7.5‐mm and 7.0‐mm tracheal tubes vs. 6.5‐mm and 6.0‐mm tracheal tubes for men and women during laparoscopic surgery

et al. 2021

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“…4 The pharmacological methods include topical drug application over the ETT cuffs or filling the cuffs with drugs, using oral gargles, inhaled nebulization, and intravenous (IV) injections. [3][4][5][6][7] The drugs studied to reduce POST include steroids, [5][6][7] local anesthetics (LA), 8 benzydamine, 9 aspirin, 2 magnesium, 10 ketamine, 3,11 zinc, 12 and licorice gargle. 13 Eutectic mixture of LA (EMLA) is a 1:1 mixture of lidocaine 2.5% and prilocaine 2.5%, which has a melting point below room temperature.…”

Section: Glossarymentioning

confidence: 99%

Effect of 5% EMLA Cream on Postoperative Sore Throat in Adults Following General Endotracheal Anesthesia: A Randomized Placebo-Controlled Study

Murugaiyan

Sahoo

Rao

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Postoperative sore throat (POST) is a distressing complaint in adults after endotracheal intubation. This study aimed to evaluate the effect of topical application of a eutectic mixture of local anesthetics (EMLA) cream over the endotracheal tube (ETT) cuff on the incidence and severity of POST, cough, and hoarseness of voice in adults after surgery. METHODS: In this randomized, placebo-controlled study, adult patients 18 to 65 years old, in American Society of Anesthesiologists (ASA) physical status I and II, and of either sex were scheduled to receive 5% EMLA cream (intervention arm) or lubricant gel (placebo-controlled arm) applied over the ETT cuff. POST was graded as none (0), mild (1), moderate (2), or severe (3). A score of ≥2 was considered as significant POST. The incidence of POST at the sixth postoperative hour was the primary outcome. Secondary outcomes included the incidence of POST at 0, second, and 24 hours, and the incidence of significant POST (score ≥2). The incidence and severity of postoperative cough and hoarseness of voice were recorded simultaneously. RESULTS: Two hundred and four patients completed the study. The incidence of POST was significantly lower in the EMLA group versus placebo at the sixth postoperative hour (4.9% vs 40.1%; relative risk [RR], 0.12; 95% confidence interval [CI], 0.05-0.29; P < .001); and at 0 hour (74.5% vs 93.1%; RR, 0.8; 95% CI, 0.7-0.9; P < .001) and second hour (51.9% vs 84.3%; RR, 0.61; 95% CI, 0.5-0.75; P < .001) but comparable at 24 hours (1.9% vs 3.9%; RR, 0.5; 95% CI, 0.09-2.67; P = .4). The number needed to treat to prevent POST with EMLA cream application was 5 at 0 hour and 3 at the second and sixth hour. The proportion of patients with significant POST over 24 hours were less in the EMLA group (9.8% vs 43.1%; P < .001). The incidence of postoperative cough and hoarseness of voice was significantly less at the 0, second, and sixth hours in the EMLA group, but comparable at 24 hours. The incidence of severe cough (8.8% vs 31.4%; P < .001) and hoarseness of voice (2% vs 7.4%; P < .001) over 24 hours was less in the EMLA group. CONCLUSIONS: The application of EMLA cream over ETT cuff reduces the incidence and severity of POST, cough, and hoarseness of voice in adults after general anesthesia in the early postoperative period compared to lubricant gel.

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“…The incidence of POST is correlated with age, sex, tracheal tube size, endotracheal tube cuff pressure and other factors [ 4 ]. Various methods have been applied to reduce the incidence and severity of POST, including IV administration of lidocaine or dexamethasone [ 5 , 6 ]; replacement of a double-lumen tube with an endobronchial blocker [ 7 ]; and prophylactic use of nebulised ketamine, magnesium, or corticosteroids [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of intratracheal dexmedetomidine combined with ropivacaine on postoperative sore throat: a prospective randomised double-blinded controlled trial

Niu

Yang

et al. 2022

BMC Anesthesiol

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Background The present study aimed to investigate whether intratracheal dexmedetomidine combined with ropivacaine reduces the severity and incidence of postoperative sore throat after tracheal intubation under general anaesthesia. Methods Two hundred patients with American Society of Anaesthesiologists physical status I-II who were subjected to general anaesthesia were randomly divided into four groups, namely, Group D, Group R, Group DR and Group S; these groups received intratracheal dexmedetomidine (1 µg/kg), 0.8% ropivacaine (40 mg), dexmedetomidine (1 µg/kg) combined with 0.8% ropivacaine (40 mg) and normal saline before endotracheal intubation, respectively. The primary outcomes were the incidence and grade of sore throat and hoarseness at 2 h and 24 h after surgery. Moreover, the modified Observer's Assessment of Alertness/Sedation Scale results were recorded at each time point. The secondary outcomes were intraoperative haemodynamic fluctuations, intraoperative anaesthetic drug requirements, and adverse reactions during and after surgery. The patients’ vital signs before induction, before superficial anaesthesia, after superficial anaesthesia, before intubation, after intubation, and 1 min after intubation were recorded. The use of anaesthetic drugs and occurrence of adverse effects were also recorded. Results The incidence and severity of sore throat were significantly lower in Group DR than in the other three groups 2 h after the operation, but they were only significantly lower in Group DR than in the control group 24 h after the operation. Moreover, compared with Group S and Group D, Group DR exhibited more stable haemodynamics during intubation. The doses of remifentanil and propofol were significantly lower in Group DR than in the other groups. Conclusion The combined use of dexmedetomidine and ropivacaine for surface anaesthesia before intubation significantly reduced the incidence and severity of postoperative sore throat. This treatment also decreased anaesthetic drug requirements and intraoperative haemodynamic fluctuations and caused no adverse effects. Trial registration This clinical research was registered at the Chinese Clinical Trial Registry (ChiCTR1900022907, Registration date 30/04/2019).

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Nebulized pharmacological agents for preventing postoperative sore throat: A systematic review and network meta-analysis

Cited by 8 publications

References 46 publications

A randomised controlled trial of 7.5‐mm and 7.0‐mm tracheal tubes vs. 6.5‐mm and 6.0‐mm tracheal tubes for men and women during laparoscopic surgery

A randomised controlled trial of 7.5‐mm and 7.0‐mm tracheal tubes vs. 6.5‐mm and 6.0‐mm tracheal tubes for men and women during laparoscopic surgery

Effect of 5% EMLA Cream on Postoperative Sore Throat in Adults Following General Endotracheal Anesthesia: A Randomized Placebo-Controlled Study

Effect of intratracheal dexmedetomidine combined with ropivacaine on postoperative sore throat: a prospective randomised double-blinded controlled trial

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