DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20210028

Management of post-operative sore throat in patients undergoing endotracheal intubation: literature review

Ahmed M. El Sharkawy, Mustafa M. Rawas, Amany M. Altoies, Mohammed A. Al Arbash, Abdulaziz A. Alzahrani, Anas M. Alnahari, Khaled S. Alomari, Ziyad H. Hammad, Basel M. Ebrahim, Mansour M. Alqahtani, Ali S. Alshahrani

Abstract


Postoperative sore throat (POST) is a common complaint that is classified as the 8th most undesirable events after general anesthesia. Endotracheal intubation has been estimated to be the commonest factor causing POST. We aim to review the risk factors and preventive measures to reduce the incidence and severity of POST following endotracheal intubation. Although sore throat can be induced by many perioperative factors, endotracheal intubation remains the commonest cause that can induce endothelial injury and a subsequent sore throat. Many risk factors for this association has been reported. The most common risk factors include ages less than 60 years of age, female sex, cough, and asthma, underlying chest diseases, type and timing of the operation, type, and size of the used endotracheal tube. Moreover, the experience of the personnel intubating the patients may have been another risk factor. Medical prevention of POST can be achieved by several agents as steroids, non-steroidal anti-inflammatory drugs (NSAIDS), N-methyl-D-aspartate (NMDA) receptor antagonists, careful monitoring of the tracheal cuff pressure, and licorice application. On the other hand, using lidocaine has been contraindicated according to previous meta-analysis results. Additionally, we recommend that future studies with bigger sample sizes are should be conducted for further validation of the new modalities.


Keywords


Sore throat, Endotracheal, Intubation, Treatment, Prevention, Risk factors

Full Text:

PDF

References


Macario A, Weinger M, Truong P, Lee M. Which Clinical Anesthesia Outcomes Are Both Common and Important to Avoid? The Perspective of a Panel of Expert Anesthesiologists. Anesth Analgesia. 1999;88(5).

Biro P, Seifert B, Pasch T. Complaints of sore throat after tracheal intubation: a prospective evaluation. Eur J Anaesthesiol. 2005;22(4):307-11.

Cho C-K, Kim J-E, Yang H-J, Sung T-Y, Kwon H, Kang P-S. The effect of combining lidocaine with dexamethasone for attenuating postoperative sore throat, cough, and hoarseness. Anesthesia Pain Med. 2016;11:42-8.

Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory surgery. Bri J Anaesth. 2002;88(4):582-4.

Scuderi PE. Postoperative Sore Throat: More Answers Than Questions. Anesth Analgesia. 2010;111(4).

Coelho R, Paiva T, Mathias L. In vitro evaluation of the method effectiveness to limit inflation pressure cuffs of endotracheal tubes. Revista Brasileira de Anestesiologia. 2016;66.

Hu B, Bao R, Wang X. The Size of Endotracheal Tube and Sore Throat after Surgery: A Systematic Review and Meta-Analysis. PloS one. 2013;8:74467.

Al-Qahtani A, Messahel F. Quality improvement in anesthetic practice - Incidence of sore throat after using small tracheal tube. Middle East J Anesthesiol. 2005;18:179-83.

Von Ungern-Sternberg BS, Ramgolam A, Hall GL, Sly PD, Habre W. Peri-operative adverse respiratory events in children. Anaesthesia. 2015;70(4):440-4.

Minamiguchi M, Tanaka Y, Kitagawa K, Inoue S, Kawaguchi M. Evaluation of factors associated with postoperative sore throat. Masui Japanese J Anesthesiol. 2014;63:401-5.

Stout DM, Bishop MJ, Dwersteg JF, Cullen BF. Correlation of endotracheal tube size with sore throat and hoarseness following general anesthesia. Anesthesiology. 1987;67(3):419-21.

Jaensson M, Olowsson L, Nilsson U. Endotracheal tube size and sore throat following surgery: a randomized-controlled study. Acta Anaesthesiologica Scandinavica. 2010;54(2):147-53.

Jung H, Kim H. Dexamethasone contributes to the patient management after ambulatory laryngeal microsurgery by reducing sore throat. Eur Arch Oto-rhino-laryngol. 2013;270.

Hung N-K, Wu C-T, Chan S-M. Effect on Postoperative Sore Throat of Spraying the Endotracheal Tube Cuff with Benzydamine Hydrochloride, 10% Lidocaine, and 2% Lidocaine. Anesth Analgesia. 2010;111(4):882-6.

Agarwal A, Nath SS, Goswami D, Gupta D, Dhiraaj S, Singh PK. An Evaluation of the Efficacy of Aspirin and Benzydamine Hydrochloride Gargle for Attenuating Postoperative Sore Throat: A Prospective, Randomized, Single-Blind Study. Anesth Analgesia. 2006;103(4):1001-3.

Maruyama K, Yamada T, Hara K. Effect of clonidine premedication on postoperative sore throat and hoarseness after total intravenous anesthesia. J Anesth. 2006;20:327-30.

Ahuja V, Mitra S, Sarna R. Nebulized ketamine decreases incidence and severity of post-operative sore throat. Indian J Anaesth. 2015;59(1):37-42.

Lee JY, Sim WS, Kim ES. Incidence and risk factors of postoperative sore throat after endotracheal intubation in Korean patients. J Int Med Res. 2017;45(2):744-52.

Inoue S, Abe R, Tanaka Y, Kawaguchi M. Tracheal intubation by trainees does not alter the incidence or duration of postoperative sore throat and hoarseness: a teaching hospital-based propensity score analysis†. Br J Anaesth. 2015;115(3):463-9.

Jaensson M, Gupta A, Nilsson U. Risk factors for development of postoperative sore throat and hoarseness after endotracheal intubation in women: A secondary analysis. AANA J. 2012;80:67-73.

Myles PS, Hunt JO, Moloney JT. Postoperative ‘minor’ complications. Anaesthesia. 1997;52(4):300-6.

Jaensson M, Gupta A, Nilsson UG. Gender differences in risk factors for airway symptoms following tracheal intubation. Acta Anaesthesiologica Scandinavica. 2012;56(10):1306-13.

Hu B, Bao R, Wang X. The size of endotracheal tube and sore throat after surgery: a systematic review and meta-analysis. PLoS One. 2013;8(10):74467.

Jaensson M, Gupta A, Nilsson U. Gender differences in sore throat and hoarseness following endotracheal tube or laryngeal mask airway: a prospective study. BMC Anesthesiol. 2014;14(1):56.

Maruyama K, Nakagawa H, Imanishi H, Kitamura A, Hayashida M. Comparison of postoperative pharyngeal morbidity using the Macintosh laryngoscope or AirWay Scope after mastectomy. J Anesth. 2011;25(5):773.

Najafi A, Imani F, Makarem J. Postoperative sore throat after laryngoscopy with macintosh or glide scope video laryngoscope blade in normal airway patients. Anesth Pain Med. 2014;4(1):15136.

Clayton-Smith A, Bennett K, Alston R. A Comparison of the Efficacy and Adverse Effects of Double-Lumen Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Cardiothorac Vasc Anesth. 2014;29.

Turkstra TP, Smitheram AK, Alabdulhadi O, Youssef H, Jones PM. The Flex-Tip™ tracheal tube does not reduce the incidence of postoperative sore throat: a randomized controlled trial. Canad J Anesth J. 2011;58(12):1090-6.

Seo JH, Kwon TK, Jeon Y, Hong DM, Kim HJ, Bahk JH. Comparison of techniques for double-lumen endobronchial intubation: 90° or 180° rotation during advancement through the glottis. Br Jf Anaesth. 2013;111(5):812-7.

Zhong T, Wang W, Chen J, Ran L, Story DA. Sore Throat or Hoarse Voice with Bronchial Blockers or Double-Lumen Tubes for Lung Isolation: A Randomised, Prospective Trial. Anaesth Intensive Care. 2008;36(6):441-6.

Kuriyama A, Maeda H, Sun R, Aga M. Topical application of corticosteroids to tracheal tubes to prevent postoperative sore throat in adults undergoing tracheal intubation: a systematic review and meta-analysis. Anaesthesia. 2018;73(12):1546-56.

Sun L, Guo R. Dexamethasone for preventing postoperative sore throat: A meta-analysis of randomized controlled trials. Irish J Med Sci. 2013;183.

Park SY, Kim SH, Lee SJ. Application of triamcinolone acetonide paste to the endotracheal tube reduces postoperative sore throat: a randomized controlled trial. Canad J Anesth. 2011;58(5):436-42.

Tazeh-Kand NF, Eslami B, Mohammadian K. Inhaled fluticasone propionate reduces postoperative sore throat, cough, and hoarseness. Anesth Analg. 2010;111(4):895-8.

Sumathi PA, Shenoy T, Ambareesha M, Krishna HM. Controlled comparison between betamethasone gel and lidocaine jelly applied over tracheal tube to reduce postoperative sore throat, cough, and hoarseness of voice. Br J Anaesth. 2007;100(2):215-8.

Singh NP, Makkar JK, Cappellani RB, Sinha A, Lakshminarasimhachar A, Singh PM. Efficacy of topical agents for prevention of postoperative sore throat after single lumen tracheal intubation: a Bayesian network meta-analysis. Canad J Anesth. 2020;67(11):1624-42.

Kuriyama A, Maeda H. Topical application of licorice for prevention of postoperative sore throat in adults: A systematic review and meta-analysis. J Clin Anesth. 2019;54:25-32.

Agarwal A, Gupta D, Yadav G, Goyal P, Singh PK, Singh U. An evaluation of the efficacy of licorice gargle for attenuating postoperative sore throat: a prospective, randomized, single-blind study. Anesth Analg. 2009;109(1):77-81.

Ruetzler K, Fleck M, Nabecker S. A Randomized, Double-Blind Comparison of Licorice Versus Sugar-Water Gargle for Prevention of Postoperative Sore Throat and Postextubation Coughing. Anesth Analgesia. 2013;117(3):614-21.

Gupta D, Agrawal S, Sharma J. Effect of preoperative licorice lozenges on incidence of postextubation cough and sore throat in smokers undergoing general anesthesia and endotracheal intubation. Middle East J Anesthesiol. 2013;22:173-8.

Kuriyama A, Aga M, Maeda H. Topical benzydamine hydrochloride for prevention of postoperative sore throat in adults undergoing tracheal intubation for elective surgery: a systematic review and meta-analysis. Anaesthesia. 2018;73(7):889-900.

Chen C-y, Kuo C-J, Lee Y-W, Lam F, Tam K-W. Benzydamine hydrochloride on postoperative sore throat: A meta-analysis of randomized controlled trials. Canad J Anaesth. 2013;61.

An Evaluation of the Efficacy of Aspirin and Benzydamine Hydrochloride Gargle for Attenuating Postoperative Sore Throat: A Prospective, Randomized, Single-Blind Study. Survey Anesthesiol. 2007;51(5):269.

Thang'a P, Kamya D, Mung'ayi V. Effects of intravenous diclofenac on postoperative sore throat in patients undergoing laparoscopic surgery at Aga Khan University Hospital, Nairobi: a prospective, randomized, double blind controlled trial. Afr Health Sci. 2013;13(4):999-1006.

Rahimi M, Makarem J. Effects of Diclofenac Epolamine Patch on Postoperative Sore Throat in Parturients After Cesarean Delivery Under Endotracheal General Anesthesia. Acta Anaesthesiologica Taiwanica. 2009;47(1):17-21.

Tanaka Y, Nakayama T, Nishimori M, Tsujimura Y, Kawaguchi M, Sato Y. Lidocaine for preventing postoperative sore throat. Cochrane Database Systematic Rev. 2015(7).

Mekhemar NA, El-agwany AS, Radi WK, El-Hady SM. Comparative study between benzydamine hydrochloride gel, lidocaine 5% gel and lidocaine 10% spray on endotracheal tube cuff as regards postoperative sore throat. Braz J Anesthesiol. 2016;66(3):242-8.

Singh NP, Makkar JK, Wourms V, Zorrilla-Vaca A, Cappellani RB, Singh PM. Role of topical magnesium in post-operative sore throat: A systematic review and meta-analysis of randomised controlled trials. Indian J Anaesth. 2019;63(7):520-9.

Kuriyama A, Maeda H, Sun R. Topical application of magnesium to prevent intubation-related sore throat in adult surgical patients: a systematic review and meta-analysis. Canad J Anesth. 2019;66(9):1082-94.

Kuriyama A, Nakanishi M, Kamei J, Sun R, Ninomiya K, Hino M. Topical application of ketamine to prevent postoperative sore throat in adults: A systematic review and meta-analysis. Acta Anaesth Scand. 2020;64(5):579-591.

Liu J, Zhang X, Gong W. Correlations Between Controlled Endotracheal Tube Cuff Pressure and Postprocedural Complications: A Multicenter Study. Anesthe Analgesia. 2010;111(5):1133-7.

Ansari L, Bohluli B, Mahaseni H, Valaei N, Sadr-Eshkevari P, Rashad A. The effect of endotracheal tube cuff pressure control on postextubation throat pain in orthognathic surgeries: A randomized double-blind controlled clinical trial. Br J Oral Maxillofacial Surg. 2013;52.

Koo C-H, Sohn H-M, Choi E-S. The Effect of Adjustment of Endotracheal Tube Cuff Pressure during Scarless Remote Access Endoscopic and Robotic Thyroidectomy on Laryngo-Pharyngeal Complications: Prospective Randomized and Controlled Trial. J Clin Med. 2019;8(11):1787.

Ryu J-H, Han S-S, Do S-H, Lee J-M, Lee S-C, Choi E-S. Effect of Adjusted Cuff Pressure of Endotracheal Tube During Thyroidectomy on Postoperative Airway Complications: Prospective, Randomized, and Controlled Trial. World J Surg. 2013;37(4):786-91.

Ebneshahidi A, Mohseni M. Strepsils® tablets reduce sore throat and hoarseness after tracheal intubation. Anesth Analg. 2010;111(4):892-4.

Gulhas N, Canpolat H, Cicek M. Dexpanthenol pastille and benzydamine hydrochloride spray for the prevention of post-operative sore throat. Acta anaesth Scand. 2007;51:239-43.

Gupta D, Agrawal S, Sharma JP. Evaluation of preoperative Strepsils lozenges on incidence of postextubation cough and sore throat in smokers undergoing anesthesia with endotracheal intubation. Saudi J Anaesth. 2014;8(2):244-8.

Ogata J, Minami K, Horishita T. Gargling with Sodium Azulene Sulfonate Reduces the Postoperative Sore Throat After Intubation of the Trachea. Anesth Analgesia. 2005;101(1):290-3.

Cook T, Howes B. Supraglottic airway devices: recent advances. Cont Educ Anaesth Crit Care Pain. 2010;11(2):56-61.