Postoperative sore throat: influence of tracheal tube lubrication versus cuff design

Abstract

The incidence and severity of postoperative sore throat was evaluated in six groups of 20 patients each after elective orthopedic surgery. Groups I to V had tracheal intubalion with Portex disposable polyvinylchloride tracheal tubes and group VI had mask anaesthesia. All groups were exposed to heated humidified gases. Tracheal tubes in groups l-Ill were uncuffed and lubricated with four per cent lidocaine jelly (group I), four per cent lidocaine hydrochloride anaesthetic solution(group I1)or normal saline (group Ill). Patients in group IV had unlubricated tubes with large residual volume cuffs, patients in group V unlubricated tubes with small residual volume cuffs and patients in group VI (mask anaesthesia) had the lowest incidence and severity of postoperative sore throat while those in group I had the highest incidence and most severe postoperative sore throats. Patients in group V had a lower incidence and severity of postoperative sore throat than patients in all other groups, except group VI. Postoperative sore throat was equally common and severe in patients in groups II. III, and IV. The data indicate that, with the use of heated humidified gases, tracheal intubation with either cuffed or uncuffed tubes produces a greater incidence and severity of postoperative sore throat than mask anaesthesia. In addition, our findings suggest that lubrication of tracheal tubes provides no advantage in terms of reducing postoperative sore throat and, depending on the lubricant, can increase the incidence and severity, Finally, our results demonstrate that the tracheal tube causing the least incidence and severity of postoperative sore throat is one with an unlubricated low residual volume cuff.

Lidocaine spray 10 min prior to intubation: effects on postoperative sore throat

“…Clearly, there are conflicting reports about the effects of using lidocaine jelly as an ETT lubricant and other methods of lidocaine application. In our study, lidocaine spray alone showed a tendency to decrease POST, and lidocaine jelly increased the incidence of sore throat, consistent with the results of Loeser et al [6] and Klemola et al [12]. Fujita et al [13] reported that methylparaben specifically activated the transient receptor potential (TRP) AT channels and can cause pain sensations, especially when applied to the mouth or skin.…”

“…After tracheal intubation, the incidence of POST varies from 14.4% to 50% [4].The main causes of POST are thought to involve traumatic laryngoscopy or contact with the tracheal tube cuff, which may result in edema or erosion of the pharyngeal or tracheal mucosa [5][6][7][8]. Previous studies of the effects of ETT lubricants and lidocaine spray on the incidence of POST have generated inconsistent results [6][7][8][9][10][11][12]. Loeser et al [6] and Jones et al [7] reported that both lignocaine jelly and ointment increased the incidence of sore throat compared with water-soluble jelly or no lubrication.…”

“…Previous studies of the effects of ETT lubricants and lidocaine spray on the incidence of POST have generated inconsistent results [6][7][8][9][10][11][12]. Loeser et al [6] and Jones et al [7] reported that both lignocaine jelly and ointment increased the incidence of sore throat compared with water-soluble jelly or no lubrication. However, Basaranoglu et al [8] found that there was no relationship between lidocaine jelly and POST.…”

Postoperative sore throat related to tracheal tube cuff design

“…However, if the Chisquare test is applied to the incidence of PST expressed as per cent of the total material, which seems to be the method used by Loeser,et al ,9 there is a significant difference (p < 0.05), with high volume cuffs causing less PST in our study. It should be emphasized that using incidence figures expressed inper cent has the effect that, if the actual material is less than 100, it is increased to 100 in the calculation, i.e.…”

“…This was not the case in our investigation. There are probably several explanations of the contradictory results compared with those of Loeser, et al 9 The interview technique may be too blunt an instrument to evaluate and differentiate the pathogenetic factors in PST. This is indicated by the wide variations in results by other authors.…”