Postoperative sore throat related to tracheal tube cuff design

Abstract

Recent reports of the incidence of postoperative sore throat following anaesthesia with tracheal intubation have claimed that low volume high pressure cuffs are preferable to those with high volume and low pressure. In this study similar methods were used for evaluating postoperative sore throat. Randomly selected tracheal tubes were used in 56 patients undergoing elective abdominal surgery, followed by direct questioning about sore throat on the first postoperative day. The incidence of postoperative sore throat was 41 per cent with high volume low pressure cuffed tubes and 55 per cent with low volume high pressure cuffed tubes. This difference is not statistically significant, but the tendency of the results is contradictory to those published earlier. The incidence of postoperative sore throat varies greatly if direct or indirect questioning is used and also varies between studies using the same method of questioning. Therefore the validity of this method for evaluating the influence of cuff design must be questioned. Postoperative sore throat is a symptom caused by many factors, such as the intubation procedure and the use of stylets or lubricants. The incidence of postoperative sore throat does not necessarily reflect damage caused by the tracheal tube cuff.KEY WORDS: COMPLICATIONS, postoperative sore throat; EQUIPMENT, tracheal tube cuff design.TRACHEAL DAMAGE after long term intubation with permanent severe damage to a small number of patients, led to improvement in cuff design. Interest has then been focused on short term intubation 2-4 and postoperative sore throat 7-9. Postoperative sore throat (PST) is a quantitatively large problem -little but reversible damage to a large number of patients. PST has been evaluated by interviewing patients the day after operation. Wolfson 5 reported an incidence of PST of 18.4 per cent using direct questioning, Hartsell and Stephen 6 5.7 per cent using indirect questioning, while Loeser, et al. 7 had a PST incidence of 24 per cent with low volume cuffs and 58 per cent with high volume cuffs using direct questioning. Loeser, have investigated the relation between PST and cuff pressure, lubricant and cuff-tracheal contact area. They conclude that lubricant and high volume cuffs result in a higher frequency of PST, the best results being achieved with unlubricated low volume high pressure cuffs. These findings are in opposition with

Comparison of nebulized ketamine and ketamine with clonidine in postoperative sore throat

“…Among the various reasons of POST airway inflammation following airway mucosal injury, airway smooth muscle contraction contributed to the problem significantly. 4,6,8 The analgesia due to ketamine was achieved through topical action of ketamine via NMDA antagonistic action and antiinflammatory action. 14,[23][24][25][26] Experimental animal studies have shown that ketamine has protective effect on airway inflammatory injury and also relaxes airway smooth muscles probably via interference with Ca+.…”

“…with a low intracuff pressure. 8 Use of topical lidocaine, 9 steroid coated tubes, 10 gargling with azulene sulphonate ketamine and licorice. [8][9][10][11][12][13] Ketamine is N-methyl daspartate (NMDA) receptor antagonist and has been used as gargle or nebulization.…”

“…8 Use of topical lidocaine, 9 steroid coated tubes, 10 gargling with azulene sulphonate ketamine and licorice. [8][9][10][11][12][13] Ketamine is N-methyl daspartate (NMDA) receptor antagonist and has been used as gargle or nebulization. [13][14][15] Various preclinical and clinical studies have reported that clonidine produces antinociception regardless of the route of administration (central or peripheral).…”

Dexamethasone reduces the severity of postoperative sore throat

“…Factors contributing to the development of sore throat include trauma to pharyngolaryngeal mucosa from laryngoscopy, placement of a nasogastric tube, or oral suctioning, 2 cuff design, pressure affecting tracheal mucosal capillary perfusion 3,4 and contact of the tracheal tube with the vocal cords and posterior pharyngeal wall resulting in edema or mucosal lesions. 5 The common measures for the prevention of postoperative sore throat include the use of endotracheal tubes with a low intracuff pressure, 4,6 smaller-sized endotracheal tubes, 5 topical lidocaine, 7 steroid coated endotracheal tubes, 8 and inhalation of steroids. 9 Dexamethasone is a potent corticosteroid with analgesic, anti-inflammatory and antiemetic action.…”

Le kétoprofène transdermique réduit le mal de gorge postopératoire

“…12 Although usually not crucial, the pain from sore throat can be the main complaint when incisional pain is well controlled, particularly by epidural analgesia. To prevent trauma to the pharynx, larynx, and trachea, various measures have been recommended, such as the use of endotracheal tubes with a low intracuff pressure, 11,13 smaller endotracheal tubes, 1 2 steroid coated endotracheal tubes, 14 inhalation of steroids, 1 5 or topical use of lidocaine. 1 6 Ketoprofen {2-(3-benzoylphenyl) propionic acid} belongs to the propionic acid derivatives, which represent a group of analgesic, anti-inflammatory, and antipyretic nonsteroidal anti-inflammatory drugs (NSAIDs).…”