Topical application of corticosteroids to tracheal tubes to prevent postoperative sore throat in adults undergoing tracheal intubation: a systematic review and meta‐analysis

Abstract

Postoperative sore throat negatively affects patient satisfaction and recovery. Numerous randomised trials have tested the efficacy of corticosteroids applied to tracheal tubes to prevent postoperative sore throat. We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Wanfang Database, and the China Academic Journal Network Publishing Database from inception to 7 December 2017. We included randomised controlled trials that assessed the efficacy and safety of corticosteroids applied to tracheal tubes, compared either with non-analgesic controls and analgesic agents, in adults undergoing elective surgery under general anaesthesia. We pooled the data using a random-effects model and assessed the risk of random error by applying trial sequential analysis. Our primary outcomes were postoperative sore throat 24 h after surgery/extubation, and adverse events. The evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We included 20 randomised controlled trials involving 2200 patients. Compared with non-analgesic controls, corticosteroids applied to tracheal tubes were associated with a reduced incidence of postoperative sore throat, risk ratio (95%CI) 0.39 (0.32-0.49) (18 trials, 1506 patients). Two randomised trials reported no adverse events. Compared with lidocaine, corticosteroids applied to tracheal tubes were associated with reduced incidence of postoperative sore throat, risk ratio (95%CI) 0.42 (0.35-0.51) (nine trials, 706 patients). Trial sequential analyses suggested the presence of firm evidence that corticosteroids applied to tracheal tubes were superior both to non-analgesic controls and lidocaine, in preventing postoperative sore throat. Evidence for postoperative sore throat for both comparisons was assessed as high quality. Only two trials sought adverse events; none were recorded.

Preoperative intravenous dexamethasone prevents tracheal intubation-related sore throat in adult surgical patients: a systematic review and meta-analysis

“…Previous studies have suggested that topical application of ketamine and corticosteroids help to prevent postoperative sore throat. 17,47 Our study suggests that intravenous dexamethasone is superior to topical ketamine, while topical corticosteroids and most analgesic agents combined with intravenous dexamethasone are no better than intravenous dexamethasone alone. Nevertheless, most of these comparisons were performed in single, small-sized trials and we believe that additional studies of this nature are warranted.…”

“…The presumed etiology underlying postoperative sore throat is mucosal inflammation around the tracheal tube cuff. 12 Previous studies suggest that topical and intravenous anti-inflammatory agents prevent postoperative sore throat in surgical patients, [16][17][18]45 thus supporting this explanation. Furthermore, intravenous corticosteroids administered to critical care patients prior to elective extubation decrease laryngeal edema and reduce post-extubation airway complications.…”

Topical application of ketamine to prevent postoperative sore throat in adults: A systematic review and meta‐analysis

“…We compared ketamine with numerous comparators that have been proven to prevent postoperative sore throat, [15][16][17][18][19][20][21] including topical lidocaine and corticosteroids as well as intravenous dexamethasone. However, comparisons of these treatments were performed in a limited number of small-sized studies, and the non-superiority Ketamine administration is associated with unwanted outcomes such as psychomimetic effects and blood pressure rise.…”

Postoperative sore throat: inevitable side effect or preventable nuisance?

“…These same authors have recently published several other systematic reviews and meta-analyses summarizing the literature describing other effective treatments of POST, including intravenous dexamethasone (pooled risk ratio [RR], 0.62; 95% confidence interval [CI], 0.51 to 0.75), 7 topical benzydamine (RR, 0.31; 95% CI, 0.20 to 0.47), 8 and topical corticosteroids (RR, 0.39; 95% CI, 0.32 to 0.49). 9 Multiple other treatments have been studied and found to be effective at reducing the incidence and severity of sore throat including lidocaine (either intra-cuff 10 or intravenously administered), 11 ketamine, 12 with even the choice of volatile anesthetic playing a role (desflurane is associated with a higher incidence of POST than sevoflurane). 13 The current systematic review and meta-analysis by Kuriyama et al provides an opportunity to consolidate the literature supporting topical magnesium as a highly effective treatment for POST.…”

“…7 la benzydamine topique (RR, 0,31; IC 95 %, 0,20 à 0,47), 8 et les corticostéroïdes topiques (RR, 0,39; IC 95 %, 0,32 à 0,49). 9 Plusieurs autres traitements ont été étudiés et leur efficacité a été démontrée pour réduire l'incidence et la gravité des maux de gorge, comme par exemple la lidocaïne (à l'intérieur du ballonnet 10 ou par administration intraveineuse), 11 la kétamine, 12 le choix d'agent anesthésique volatile jouant lui-même un rôle (par exemple, le desflurane est associé à une incidence plus élevée de maux de gorge postopératoires que le sévoflurane). 13 La revue systématique et la méta-analyse de Kuriyama et coll.…”