Effect of Throat Pack Placement on the Incidence of Sore Throat and Postoperative Nausea and Vomiting in Septorhinoplasty Patients: A Randomized Controlled Trial

Background Advances in surgical and anesthetic techniques have led to a growing interest in performing procedures at ambulatory surgery centers. However, procedures involving the oropharyngeal or nasopharyngeal region may lead to the ingestion of blood which can lead to postoperative nausea and vomiting (PONV). To date, limited studies have largely failed to demonstrate the benefits of oropharyngeal throat packing. Objectives This study aims to investigate whether throat packing during elective septorhinoplasty increases the incidence of postoperative throat pain and assess its effects on PONV. Methods A randomized, prospective, single-blinded study was performed on 101 patients undergoing elective septorhinoplasty who received oropharyngeal throat packing versus no packing to compare the incidence of PONV and throat pain in the immediate postoperative period in addition to postoperative day (POD) 1 and 2. Results The incidence and severity of postoperative throat pain were significantly greater in patients receiving throat packs in the immediate postoperative period and on POD 1. Significant differences in throat pain and incidence between the two groups diminished by POD 2. Patients having received throat packs also demonstrated a higher usage of opioids in post anesthesia care unit (PACU). The incidence of PONV was not significantly different between the two cohorts at any point of observations. Conclusions This study demonstrates results that largely agree with previous data that throat packs may contribute to postoperative throat pain while not significantly altering the incidence of PONV. Considering this data, we do not recommend routine use of throat packing during elective septorhinoplasty.

The Throat Pack Debate: A Review of Current Practice in UK and Ireland Cleft Centers

Introduction: The use of throat packs during oropharyngeal surgery has long been a topic of debate among cleft surgeons. The advantage of inserting an absorbent tulle within the pharynx must be weighed against the risk of unintended retention postoperatively. Despite safety check mechanisms in place, retention may occur with potentially life-threatening consequences. We present a comprehensive review of throat pack use in all cleft units within the United Kingdom and Ireland. Methods: All 20 cleft surgery units in the United Kingdom and Ireland were surveyed on their use of throat packs in children aged 6 months to 2 years undergoing elective cleft palate surgery. Results: The response rate to the survey was 100%. Seventy-five percent of units currently use throat packs; in 40%, they are used in addition to cuffed endotracheal tubes (ETTs). Inclusion of the throat pack in the surgical swab count was perceived as the safest mechanism employed to avoid retention. 26.1% of respondents were aware of at least 1 incident of pack retention in their unit. Discussion/Conclusion: The reported UK and Irish experience demonstrates that three-quarters of units routinely use packs. Notably, a quarter of respondents to the survey have experience of an incident of throat pack retention. Nevertheless, the majority of respondents considered the perceived risk of retaining a pack to be low. The growing use of microcuffed ETTs in UK cleft units paired with a low incidence of perioperative complications when a throat pack is not introduced might prompt cleft surgeons to review routine pharyngeal packing.

Principles of Anesthesia and Airway Management in Head and Neck Surgery

This topic aims to discuss key aspects of anesthetic and airway management for head and neck surgery. Airway management is a central part of patient care and management in Head and Neck Surgery. Common challenges in Head and Neck surgery are shared airway, distorted airway anatomy due to existing pathology; risk of airway obstruction, disconnection or loss of airway intra-operatively; risk of soiling of the airway due to bleeding and surgical debris; and the potential for airway compromise post-operatively. The option for airway management technique is influenced by patient’s factors, anesthetic needs, and surgical requirements. Intubation technique necessitating either a small or large cuffed tracheal tube with a throat pack provides the highest level of airway protection Non-intubation or open airway techniques involve mask ventilation, apneic techniques, and insufflation techniques, or the use of a laryngeal mask airway. Lastly, jet ventilation techniques may be conducted via a supraglottic, subglottic or transtracheal routes. It is essential to have clear airway management plans including rescue airway strategies that should be communicated with the surgeons and patients at the earliest opportunity.

The incidental finding of a retained ‘throat pack’

A postoperative radiograph demonstrated a folded radio-opaque structure in the nasopharynx, resembling a retained throat pack, despite her not having any respiratory symptoms. Retention of a throat pack is a never event.

Impact of Subglottic Saline Irrigation on Reducing Bacterial Contamination for Oral Surgery Patients

This study investigated the effectiveness of subglottic irrigation (SI) with 100 mL of saline on reducing bacterial contamination in the subglottic space during oral surgery procedures without the use of throat packs. Subglottic lavage and irrigation were performed through the suction lumen located on specialized endotracheal tubes (ETTs) with capabilities of permitting evacuation from the subglottic space. Fifty-three patients who were scheduled for oral surgery procedures under general anesthesia while intubated with specialized ETTs at Kyushu Dental University Hospital were enrolled in this study. Subglottic irrigation was performed, and the sample fluid was collected through the ETT suction lumen for smear and culture bacterial examinations after 3 points in time: immediately after intubation, after completing the surgical procedure, and again after SI. Oral surgery without a throat pack significantly increased bacterial contamination in the subglottic lavage (p < .001), and SI decreased bacterial contamination (p < .001) similarly to levels found after tracheal intubation. Subglottic irrigation with 100 mL of saline was effective in reducing bacterial load in the subglottic space to levels similarly noted immediately after intubation for patients undergoing intraoral surgical procedures without the use of a throat pack.