How Does Tube Size Affect Patients’ Experiences of Postoperative Sore Throat and Hoarseness? A Randomised Controlled Blinded Study

Sore throat (POST) and hoarseness (PH) are common complaints after endotracheal intubation (EI). The aim of this study was to investigate whether tube size impacts the experiences of POST and PH after EI in patients undergoing elective surgery, as well as to document a possible role of gender. This randomised, controlled, blinded study was conducted at Aalborg University Hospital, Thisted, Denmark or North Denmark Regional Hospital, Denmark. A total of 236 patients (53.4% female, mean age 50.9 years (SD 14.0)) were enrolled from the departments of gynaecology, parenchyma and orthopaedics. The patients were randomised to a tube size of 8.0 or 7.0 for males and 7.0 or 6.0 for females. Tube sizes were known to the anaesthesia staff but blinded for patients, researchers and staff at the postoperative care unit. POST and/or PH was reported 30–60 min before anaesthesia, at 30 min and at 2, 5, 12, 24, 48, 72 and 96 h after anaesthesia. Both female and male patients experienced significantly lower levels of POST and PH after intubation with the smallest tube size. This study demonstrates that a smaller size of tube results in a reduction in POST and PH after EI for both male and female patients.

To compare the frequency of postoperative sore throat with I-gel versus laryngeal mask airway in patients

Background: In case of general anesthesia, airway maintenance along with least complications is the most important goal of team of anesthesiologists. In case of clinical practice, the laryngeal mask airway (LMA) devices have superiority in managing supraglottic airway. Recently i-gel airway has been introduced as supraglottic airway equipment (disposable). Aim: To make comparison between laryngeal mask and I-gel with respect to postoperative complication of sore throat in case of patients who were given general anesthesia. Study design: Randomized trial Setting: Anesthesia Department Study duration: 6 after synopsis approval in total 6months of duration Methods: Candidates were divided randomly divided into two groups. In case of members of group A, patients were given i-gel where as members of group B, disposable LMA was given. General anesthesia was administered according to the standardized protocols. A day after operation, candidates were check post operatively for 24 hours, for sore throat and information was documented on Performa. Results: The candidates mean age was 44.23±15.11years in case of i-gel group members whereas 46.10±15.56 years in case of LMA group. In case of i-gel group, there were about twenty five males members and thirty five were females members . In case of LMA group members, there were about twenty six males and thirty four female members . In present case research, sore throat postoperatively was seen in case of 17(14.2%) cases, i.e. 4 (6.7%) in i-gel group while 13(21.7%) in case of LMA group. The significant difference was witnessed between members of both groups (p<0.05). Conclusion: Thus i-gel is better than LMA for general anesthesia as it has fewer chances of side effects like postoperative sore throat. Keywords: Postoperative sore throat, I-gel, laryngeal mask airway, general anesthesia

A COMPARISON OF EFFECT OF NEBULISED KETAMINE AND NEBULISED MAGNESIUM SULPHATE IN REDUCTION OF INCIDENCE AND SEVERITY OF POSTOPERATIVE SORE THROAT - A PROSPECTIVE RANDOMIZED DOUBLE BLINDED STUDY

Introduction: Postoperative sore throat (POST) is a common occurrence following general anesthesia with endotracheal intubation. The incidence of POST is estimated to be 21%-65% in various studies. Irritation and inammation of the air way are considered to be the cause of POST. Although considered a minor and self limiting complication, it may cause a signicant patient morbidity, dissatisfaction and increased the length of duration of hospital stay. Various pharmacological and non pharmacological methods have been tried to decrease POST with varying success rates. Among the interventions, the use of ketamine gargle or lozenges has highest success rates, but the problem with this is the bitter taste of the drug and the risk of aspiration, so aerosol route of drug administration gained popularity among the anesthesiologists with good acceptance from the patients. It is known that N-methyl-D-aspartate (NMDA) receptors have a role in nociception and inammation. Hence, this study is aimed at using the aerosol route of magnesium sulphate and ketamine and to nd it effectiveness in preventing POST. Aim Of The Study: To evaluate the effect of nebulized ketamine and nebulized magnesium sulphate for attenuation of postoperative sore throat in patients undergoing surgeries under general anesthesia with tracheal intubation. Materials And Methods: This study was done in the Department of Anesthesiology in collaboration with the Department of Surgery in Kanyakumari Government Medical College from January 2019 to December 2019. Patient planned for surgery under general anesthesia except head, neck & ENT surgeries were selected and randomized into two groups (35 each). Each group received nebulisation for 15 min before induction of general anaesthesia. Group M: Nebulization with 500mg magnesium sulphate in 5ml NS. Group K: Nebulization with 50mg ketamine in 5ml NS. The Parameters related to the study such as duration of laryngoscopy, time taken to intubate, duration of surgery, number of attempts to intubate were recorded. Incidence and severity of sore throat were assessed by four point scale. Incidence of sore throat is assessed for 24 hours. Complication were recorded. Results: We found that the demographic parameters were comparable and statistically insignicant. The mean duration of laryngoscopy difference between the two groups Group M - 24.54± 1.12 seconds and Group K - 24.49 ±1.15 seconds was not statistically signicant P= 0.834 (P>0.05). The mean time taken to intubate in Group M - 27.54± 1.12 seconds and Group K - 27.54± 1.12 seconds was not statistically signicant with P=1.000 respectively (P>0.05). The mean duration of surgery in Group M - 90.71±15.67 minutes and the Group K - 88.20 ±16.53 minutes between the two groups was not statistically signicant P= 0.516 (P>0.05). The mean difference of number of attempts taken to intubate between the two groups was statistically insignicant P=0.771 (P>0.05). The overall incidence of sore throat in Group M was 91% and in Group B was 34%. The severity of sore throat between Group M and Group K is statistically signicant at 2, 4, 6 hrs at grade 1 and grade 2. Conclusion: On the basis of our result, we can suggest that the use of perioperative ketamine nebulization when compared magnesium sulphate nebulization reduces the incidence and severity of post-operative sore throat at 4th and 6th hour during postoperative period in patients who had received general anesthesia with tracheal intubation.

Success Rate of Insertion and Postoperative Sore Throat: I-Gel Versus Laryngeal Mask Airway Classic

Introduction: Supraglottic devices are a useful advent in airway management filling a gap between the facemask and tracheal tube in terms of both anatomical position and degree of invasiveness. Laryngeal mask airway classic (LMA-C) being first of its kind and I-gel is second generation non-inflatable supraglottic device. The objective of our study was to compare the two supraglottic devices, Laryngeal mask airway classic (LMA-C) and I-gel for a success rate of insertion and postoperative sore throat. Materials and Methods: A total of 80 patients scheduled for elective surgical procedures were studied in a prospective, randomly assigned, comparative and interventional manner. Patients were randomly allocated into two groups with forty patients in each group. I-gel and LMA-C were used in Groups 1 and 2 respectively. After achieving adequate depth of anesthesia the supraglottic device of appropriate size was inserted. The success rate of insertion of the device was represented by the number of insertion attempts. In the postoperative ward within 24 hours after surgery patient was asked whether a sore throat was present. Results: There was a statistically significant difference between the two supraglottic devices in terms of successful attempts of insertion (p-value 0.02).In group 1(I-gel)34 out of 40 patients had first attempt insertion success,6 patients in the second attempt, and no patient had third insertion attempt. In group 2 (LMA-C) first-time insertion success was in 14 patients, 23 patients in the second attempt, and 3 patients in the third attempt. The incidence of postoperative sore throat was higher in the LMA-C group than the I-gel group(17.5% vs 5% respectively) with a p-value of 0.154. Conclusion: Compared to the laryngeal mask airway classic, I-gel was inserted with less number of attempts and had a lower incidence of postoperative sore throat.

A COMPARATIVE STUDY BETWEEN LIGNOCAINE NEBULISATION AND MAGNESIUM SULPHATE NEBULISATION FOR ATTENUATION OF POSTOPERATIVE SORE THROAT

BACKGROUND: Postoperative sore throat (POST) is a common complication following general anaesthesia (GA) with orotracheal intubation. Both magnesium sulphate nebulisation and lignocaine nebulisation have been reported to be used successfully to reduce the incidence and severity of POST. Till date, no study has been reported comparing the efcacy of these two drugs for attenuation of POST. Therefore, the aim of this study was to compare the efcacy of preoperative lignocaine nebulisation and magnesium sulphate nebulisation in reducing the incidence and severity of POSTin patients undergoing GAwith orotracheal intubation. METHODS:Aprospective, double blind, parallel group, randomised, controlled study was conducted on 96 patients, aged between 18-50 years, ASAphysical status I and II, undergoing elective surgery under GAwith orotracheal intubation. Patients were randomly allocated into two groups, group L and group M. The patients in group L (n=48) received 4% lignocaine nebulisation (3 ml) and those in group M (n=48) received isotonic magnesium sulphate nebulisation (3 ml) over 15 minutes ending 5 minutes prior to induction of GA. The patients were assessed for incidence and severity of POST, cough, hoarseness of voice and dysphagia at 5 minutes and thereafter at 1, 4, 12, 24 and 48 hours in the postoperative period. All data were compared using appropriate statistical tests. RESULTS: POST four-point scale was found to be signicantly lower in group M in comparison to group L at 5 minutes and 1 hour in the postoperative period. Hoarseness severity score and dysphagia severity score were also signicantly lower in group M at 1 hour postoperatively. CONCLUSION: In comparison to lignocaine nebulisation; magnesium sulphate nebulisation was found to be more effective to reduce the incidence and severity of POST, hoarseness of voice, and dysphagia particularly in the early postoperative period.

Efficacy of perioperative intravenous dexmedetomidine administration for the prevention of postoperative sore throat: a meta-analysis

Objective Postoperative sore throat (POST) is an undesirable intubation-related complication after surgery. Several studies have investigated the efficacy of perioperative intravenous dexmedetomidine administration for the prevention of POST, but the results have been inconsistent. We aimed to summarize all existing evidence and draw a more precise conclusion to guide future clinical work. Methods PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure databases were comprehensively searched for all randomized controlled trials published before 1 February 2021 that investigated the efficacy of dexmedetomidine for the prevention of POST. Results Nine studies involving 400 patients were included in our meta-analysis. Compared with the control groups (i.e., saline and anesthetic drugs), perioperative intravenous use of dexmedetomidine significantly reduced the incidence of POST [risk ratio (RR): 0.56; 95% confidence interval (CI): 0.40–0.77; I2 = 0%) and coughing on the tube during extubation (RR: 0.58; 95% CI: 0.41–0.82; I2 = 0%). Additionally, patients in the dexmedetomidine group were more likely to develop bradycardia (RR: 2.46; 95% CI: 1.28–4.71; I2 = 0%) and hypotension (RR: 3.26; 95% CI: 1.14–9.33; I2 = 0%) during the administration of dexmedetomidine than those in the control group. Conclusion Perioperative intravenous administration of dexmedetomidine has a positive effect on the prevention of POST.