BACKGROUND:Postoperative sore throat (POST) is one of the more common side effects of tracheal intubation patients under general anesthesia (GA) after extubation using double-lumen endobronchial tubes (DLTs). The internal branches of the superior laryngeal nerve (SLN) block (iSLNB) have been reported to anesthetize the larynx for airway manipulation (such as awake tracheal intubation) and pain treatment efficiently. We hypothesized that ultrasound-guided iSLNB (US-guided iSLNB) combined with GA would ameliorate the incidence and severity of POST and hoarseness. METHODS:Patients (n = 82) undergoing thoracoscopic resection of pulmonary nodules/lobes/segments with one-lung ventilation (OLV) under GA were randomized into 2 groups depending on whether performed with iSLNB (S group, n = 41) or not (C group, n = 41) under GA. Patients in the S group received US-guided iSLNB bilaterally before surgery. POST and hoarseness were assessed at 2, 6, and 24 hours after surgery. The primary outcome of this study was the incidence of POST at 6 hours after surgery between groups. RESULTS:The overall accumulated incidence of POST was lower in the S goup than in the C group (9/41 vs 20/41; 95% CI, 0.30 [0.11-0.77]; P = .011). The incidence and severity of POST was lower in the S group than in the C group at 2 hours (9/41 vs 20/41; 95% CI, 0.30 [0.11-0.77]; P = .008 and P = .004) and 6 hours after (7/41 vs 17/41; 95% CI, 0.29 [0.10-0.81]; P = .012 and P = .015) surgery. The incidence and severity of POST at 24 hours after surgery was nonsignificant. However, the incidence and severity of hoarseness was comparable between the 2 groups at 2, 6, and 24 hours after surgery. CONCLUSIONS:Preoperative US-guided iSLNB could significantly ameliorate the incidence and severity of POST induced by double-lumen bronchial catheter intubation.

BACKGROUND/AIMS:An updated systematic review and meta-analysis was conducted to assess the effect of prophylactic dexamethasone for tracheal intubation of general anesthesia on postoperative sore throat (POST). METHODS:Comprehensive literature search of databases for randomized controlled trials (RCTs), including Embase, PubMed, and Cochrane Library, which evaluate the effect of prophylactic dexamethasone on POST was conducted. RevMan 5.0 and STATA 12.0 software were used to perform meta-analyses. RESULTS:Fourteen RCTs totaling 1,837 patients were included for analysis. Compared with placebo, a significant reduction in the incidence of POST (OR 0.44, 95% CI 0.33-0.58, <0.00001), hoarseness (OR 0.42, 95% CI 0.31-0.58, <0.00001), and postoperative nausea and vomiting (PONV) (OR 0.06, 95% CI 0.03-0.14, <0.00001) and a comparable incidence of cough (OR 0.59, 95% CI 0.19-1.89, =0.38) was described in patients receiving dexamethasone, with or without concomitant drugs. Dexamethasone ≥0.2 mg/kg had a statistically greater impact on reducing the incidence of POST than dexamethasone 0.1-0.2 mg/kg, while dexamethasone ≤0.1 mg/kg did not. Dexamethasone was as effective as other drugs such as ondansetron, magnesium sulfate, ketamine gargle, betamethasone gel, and ketorolac for reducing POST (OR 0.70, 95% CI 0.46-1.07, =0.10). Dexamethasone plus a different drug was more effective than dexamethasone alone for reducing the incidence of POST at 24 hours (OR 0.40, 95% CI 0.21-0.77, =0.006). Compared with controls, a statistically higher blood glucose level was the only adverse event during the immediate postoperative period in patients receiving dexamethasone. CONCLUSIONS:Intravenous dexamethasone ≥0.2 mg/kg within 30 minutes before or after induction of general anesthesia should be recommended as grade 1A evidence with safety and efficacy in reducing the incidence of POST, hoarseness, and PONV in patients without pregnancy, diabetes mellitus, or contraindications for corticosteroids.

INTRODUCTION:Post-Operative Sore Throat (POST) is an undesirable side effect ofendotracheal intubation. Pharmacological and non-pharmacological measures have been utilized for minimizing the morbidity caused by POST. We have tested whether medicated lozenges of Licorice provides efficacy in decreasing POST in smokers presenting for surgery under general anesthesia with endotracheal intubation. METHODS:100 patients, 20 - 65 years, American Society ofAnaesthesiologists (ASA) physical status Grade I & II, of either sex, with history of smoking, and posted for elective surgical procedure lasting more than one hour and requiring general anesthesia with endotracheal intubation were included and randomly divided into two groups (n = 50) to receive Licorice lozenges (Group A) and Sugar Candy (Group B). The patients were assessed for cough, sore throat and hoarseness of voice immediately after extubation and then at 30 min, 12 hrs and 24 hrs after extubation utilizing scoring system of Harding and McVey. RESULTS:Overall incidence of postextubation cough was less in Group A (12 patients, 24%) compared to Group B (26 patients, 52%) (p = 0.002). Magnitude of sore throat (Grades 0/1/2/3) was seen in 48/2/0/0 patients (Group A) and 46/4/0/0 (Group B) at extubation (p = 0.40) and 34/16/0/0 (Group A) and 28/20/2/0 (Group B) at 30 min (p = 0.17). At 12 and 24 hours, the magnitudes of sore throats were 24/25/1/0 (Group A) & 12/38/0/0 (Group B) (p = 0.02) and 26/23/1/0 (Group A) & 15/35/0/0 (Group B) (p = 0.03) respectively. CONCLUSION:Use of licorice lozenges is efficacious for reducing the distressing complaint of POST in postoperative period among smokers.

BACKGROUND:Postoperative sore throat (POST) contributes to postoperative morbidity. Licorice has been used as an expectorant in cough and cold preparations. In this study, we evaluated the efficacy of licorice gargle for attenuating POST. METHODS:Forty adults (18-60 yr), ASA physical status I and II of either sex, undergoing elective lumber laminectomy were randomized into two groups of 20 each. Group C: received water; Group L: received 0.5 g licorice in water. Both groups received a 30 mL mixture for 30 s, 5 min before anesthesia which was standardized. The incidence and severity of POST at rest and on swallowing and side effects were assessed at 0, 2, 4, and 24 h, postoperatively. Severity of POST was assessed by visual analog scale (between 0 and 100 mm; where 0 means no sore throat and 100 means worst imaginable sore throat). Postextubation cough was assessed immediately after tracheal extubation. Data were analyzed by Z test and Fisher's exact test. P < 0.05 was considered as significant. RESULTS:POST (incidence and severity) was reduced in the Group L compared with Group C at rest and on swallowing for all time points (P < 0.05), except that the severity of POST at rest, at 24 h, was similar in both groups (P > 0.05). Postextubation cough was reduced in Group L compared with Group C (P < 0.05). There was no difference in side effects between groups (P > 0.05). CONCLUSION:Licorice gargle performed 5 min before anesthesia is effective in attenuating the incidence and severity of POST.

BACKGROUND:One small study suggests that gargling with licorice before induction of anesthesia reduces the risk of postoperative sore throat. Double-lumen tubes are large and thus especially likely to provoke sore throats. We therefore tested the hypothesis that preoperative gargling with licorice solution prevents postoperative sore throat and postextubation coughing in patients intubated with double-lumen tubes. METHODS:We enrolled 236 patients having elective thoracic surgery who required intubation with a double-lumen endotracheal tube. Patients were randomly assigned to gargle 5 minutes before induction of anesthesia for 1 minute with: (1) Extractum Liquiritiae Fluidum (licorice 0.5 g); or (2) Sirupus Simplex (sugar 5 g); each diluted in 30 mL water. Sore throat and postextubation coughing were evaluated 30 minutes, 90 minutes, and 4 hours after arrival in the postanesthesia care unit, and the first postoperative morning using an 11-point Likert scale by an investigator blinded to treatment. RESULTS:The incidence of postoperative sore throat was significantly reduced in patients who gargled with licorice rather than sugar-water: 19% and 36% at 30 minutes, 10% and 35% at 1.5 hours, and 21% and 45% at 4 hours, respectively. The corresponding estimated treatment effects (relative risks) were 0.54 (95% CI, 0.30-0.99, licorice versus sugar-water; P = 0.005), 0.31 (0.14-0.68) (P < 0.001), and 0.48 (0.28-0.83) (P < 0.001). CONCLUSION:Licorice gargling halved the incidence of sore throat. Preinduction gargling with licorice appears to be a simple way to prevent a common and bothersome complication.

Study Objective:The aim of this study is to see if there are any clinical differences between using 35 F DLT for all patients versus using patient height regardless of gender to estimate appropriate DLT size. Design:Prospective randomized study. Setting:University Hospital. Patients:50 patients age ≤18 years, undergoing lung or esophageal surgery requiring OLV. Interventions:Patients randomized to two groups (group-35F, group -DLT based on height). Measurements and Main Results:Data collected include demographics, ASA status, airway assessment, number of intubation attempts, Cormack-Lehane grade, number of times DLT repositioned, incidence of sore throat, oxygen saturation at induction and oxygen saturation at 5 minutes and 10 minutes after OLV. There was no statistically significant difference in demographics, ASA classification, Mallampati score, number of intubation attempts, Cormack-Lehane grade, number of times DLT was repositioned, and incidence of sore throat. In height based DLT group the odds were higher for the incidence of sore throat in 37-41 F group. Oxygen saturation at induction, 5 minutes and 10 minutes after OLV are not statistically significant between the two groups. Conclusion: Our findings suggest that the majority of patients receive unnecessarily large DLTs for thoracic surgery, which not only makes intubation inherently more difficult but also increases their risk of postoperative sore throat.

OBJECTIVE:Two types of material are used to manufacture double-lumen endobronchial tubes (DLTs): Polyvinylchloride (PVC) and silicon. PVC DLTs (Broncho-Cath) and silicon DLTs (Silbroncho) not only differ in material, but also subtly differ in structure. The goal of this study was to determine whether the incidences of postoperative sore throat and hoarseness differed between PVC DLTs and silicon DLTs. DESIGN:Prospective, single-blind, balanced (1:1), randomized, controlled trial. SETTING:Single university hospital. PARTICIPANTS:Sixty ASA I-II patients, aged 20 to 65 years, scheduled for thoracoscopic pulmonary lobectomy. INTERVENTIONS:Patients were randomized into the Broncho-cath group (group B, n = 30) and the Silbroncho group (group S, n = 30). Intubation was performed with DLT according to the allocated group by an anesthesiologist. MEASUREMENTS AND MAIN RESULTS:The incidence of sore throat and hoarseness was evaluated at 1 hour and 24 hours after DLT extubation. The intensity of sore throat was assessed by visual analog scale (VAS<0-10) at 1, 2, 4, 12, and 24 hours after DLT extubation. The incidence of sore throat was significantly lower in group S compared with that in group B at 1 h (30% v 66.7%, p = 0.018) and 24 hours (10% v 43.3%, p = 0.014). No significant difference was observed in the incidence of hoarseness between the 2 groups. The VAS scores for sore throat in group B were significantly higher than those in group S throughout the study (p< 0.05). CONCLUSIONS:The use of silicon DLTs resulted in a lower incidence of postoperative sore throat than did the use of PVC DLTs.

BACKGROUND:Postoperative sore throat (POST) is one of the main adverse postoperative outcome after tracheal intubation using double-lumen endobronchial tubes (DLTs). The aim of this study was to investigate the effectiveness and safety of ultrasound (US)-guided block of the internal branch of the superior laryngeal nerve (iSLN) for alleviating POST after intubation of DLTs. METHODS:Patients undergoing thoracic surgery between August 2019 and August 2021 were randomized into two groups depending on whether they received US-guided iSLN block immediately after the operation. In the control group, the patients underwent a thoracic surgery under general anesthesia (GA) with DLTs without any special treatment, while the patients in the experimental group received US-guided iSLN block bilaterally with 2 ml of 0.25% ropivacaine on either side immediately after the operation. The primary outcome was the grading of sore throat at three-time points after the operation, i.e., immediate extubation, 2 h after extubation, and 24 h after extubation. Secondary outcomes included the rate of nausea and vomiting, hoarseness, dyspnea, and choking cough after swallowing saliva at 2 h after extubation. RESULTS:The incidence and severity of sore throat were significantly lower in the experimental group than the control group at all time intervals (all P < 0.01). The rate of nausea and vomiting, hoarseness, dyspnea, and choking cough after swallow saliva at 2 h after extubation had no statistical difference (all P > 0.05). CONCLUSIONS:The use of US-guided iSLN block can be effectively and safely applied to relieve POST after intubation of DLTs on thoracic surgery. TRIAL REGISTRATION:The study protocol was registered at the Chinese Clinical Trial Registry ( http://www.chictr.org.cn , NO. ChiCTR2000032188, 22/04/2020).

Background:Postoperative sore throat is a frequent adverse event after double-lumen endobronchial tube (DLT) intubation. The aim of this study was to investigate whether esketamine gargle has a preventive effect on the incidence of postoperative sore throat in patients undergoing DLT intubation. Methods:This trial included 140 patients undergoing elective thoracic surgery at the third affiliated hospital of Sun Yat-Sen University. Patients were randomly allocated into the following two groups of 70 patients each: the control group, gargling with saline of 30 mL, and the esketamine group, gargling with an esketamine solution of 30 mL (2 mL/50 mg esketamine in 28 mL saline), 5 min prior to anaesthesia induction. The primary outcome was the incidence of sore throat 24 h after surgery. The main secondary outcomes included the incidence of sore throat and hoarseness at 1 h and 48 h after surgery, as well as the intraoperative haemodynamic responses. Results:The incidence of sore throat was significantly higher in the control group (47.1%, 33/70 patients) compared with the esketamine group (12.9%, 9/70 patients) at 24 h after surgery (RD, 0.41; 95% confidence interval, 0.26-0.57; p < 0.001). Furthermore, the incidence of sore throat at 1 h (p = 0.027), 24 h (p = 0.019), and seventh day (p = 0.031) as well as hoarseness at 1 h (p = 0.027), 24 h (p = 0.019), and 48 h (p = 0.031) after surgery were reduced in the esketamine group. Significant differences were seen in the peak levels of systolic blood pressure, mean arterial blood pressure, and heart rate between the groups during the intubation (p < 0.05). Besides, no patient developed an adverse reaction to esketamine. Conclusion:Preoperative gargling of esketamine can provide an effect against sore throat after DLT intubation without adverse side effects and effectively inhibit sharp elevations in heart rate and blood pressure during double-lumen intubation procedures.

(Kt), a herbal medicine composed of glycyrrhiza root (Chinese licorice) and Platycodon root extracts (Chinese bellflower), is commonly used in Japan for relief of throat symptoms related to acute upper respiratory tract infection (URTI). Its effectiveness on URTI-associated sore throat pain over 30 min is examined here in comparison with a placebo. Randomized double-blinded multicenter trial. Two local Japanese medical centers with primary care. Patients aged 20-65 years with URTI-related sore throat. Patients were randomized to receive either 2500 mg of Kt, or 2500 mg of placebo (lactose). Randomization was stratified by age (< 45 vs. ≥ 45 years) and baseline sore throat score according to visual analogue scale (VAS) (< 50 vs. ≥ 50). Primary outcome was change to sore throat score according to VAS 30 min after administration of Kt. Perceived impact of the sore throat on daily life at 30 mins after administration was another outcome. Outcomes are analyzed in the intention-to-treat population. Among 70 participants, (Kt group: 36; placebo group: 34), each group contained 34 patients for analysis ( = 68, total). Difference between the groups in the mean change of sore throat score according to VAS at 30 min was without statistical significance (Kt 15.3, placebo 17.2;  = 0.66). Patients reporting that their sore throat had a moderate or greater impact on daily life were also similar in proportion between the groups (Kt 61.8% vs. placebo 55.9%;  = 0.80). Side effects were not reported. Kt did not relieve acute URTI-associated sore throats significantly more than a placebo. (UMIN trial ID: UMIN000035591).

INTRODUCTION:Ultrasound-guided internal branch of the upper laryngeal nerve block (USG-guided iSLN block) have been used to decrease the perioperative stress response of intubation. It is more likely to be successful than blindly administered superior laryngeal nerve blocks with fewer complications. Here, we evaluated the efficacy of USG-guided iSLN block to treat postoperative sore throat (postoperative sore throat, POST) after extubation. METHODS:100 patients, aged from 18 to 60 years old, ASA I~II who underwent general anesthesia and suffered from the moderate to severe postoperative sore throat after extubation were randomized into two groups(50 cases per group). Patients in group S received USG-guided iSLN block bilaterally (60mg of 2% lidocaine, 1.5ml each side), whereas those in group I received inhalation with 100 mg of 2% lidocaine and 1mg of budesonide suspension diluted with normal saline (oxygen flow 8 L /min, inhalation for 15 minutes). The primary outcome were VAS scores in both groups before treatment (T0), 10 min (T1), 30 min(T2), 1h(T3), 2 h(T4), 4h(T5), 8h(T6), 24h(T7), and 48h(T8) after treatment. The secondary outcome were satisfaction scores after treatment, MAP, HR, and SPO2 fromT0 to T8. The adverse reactions such as postoperative chocking or aspiration, cough, hoarseness, dyspnea were also observed in both groups. RESULTS:Patients in group S had significantly lower VAS score than that in group I at points of T1 ~ T6 (P < 0.01). HR of group S was lower than that of group I at points of T1 ~ T2and T4 (P < 0.05), and MAP was lower than that of group I at points of T1 ~ T3 (P < 0.05). Satisfaction scores of group S were higher than that of group I (P <0.05), In group S, 2 case (4%) needed to intravenous Flurbiprofen Injection 50 mg to relieve pain; in group I, 13 cases (26%) received Flurbiprofen Injection. 2 case of group S appeared throat numbness after treatment for 3 hours; 2 patients have difficult in expectoration after treatment recovered after 3hour. No serious adverse events were observed in both groups. CONCLUSION:Compared with inhalation, USG-guided iSLN block may effectively relieve the postoperative sore throat after extubation under general anesthesia and provided an ideal treatment for POST in clinical work.

STUDY OBJECTIVE:Postoperative sore throat negatively affects patient satisfaction and recovery. It may be related to inflammation of the mucosa caused by injury during intubation. Licorice, derived from the root of Glycyrrhiza glabra, contains active anti-inflammatory ingredients. The efficacy and safety of topical licorice for preventing postoperative sore throat in adults undergoing tracheal intubation for general anesthesia were assessed by a systematic review and meta-analysis. DESIGN:A systematic review and meta-analysis of randomized controlled trials. SETTING:Trials conducted in perioperative settings. MEASUREMENTS:PubMed, EMBASE, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials were searched from inception to April 21, 2018. All randomized, controlled trials (RCTs) that assessed the efficacy and safety of topical licorice in adults undergoing elective surgery under general anesthesia were eligible. The risk of bias was evaluated using the Cochrane risk of bias assessment tool. Data were pooled using a random-effects model. We conducted a trial sequential analysis (TSA) on the incidence of postoperative sore throat. Primary outcomes were the incidence and severity of sore throat 24 h after surgery/extubation and adverse events. MAIN RESULTS:Five randomized controlled trials involving 609 patients were included. Compared with non-analgesic control, topical licorice was associated with a reduced incidence (risk ratio, 0.44; 95% confidence interval (CI), 0.28-0.69; P < 0.001) and severity (standardized mean difference, -0.69; 95% CI, -0.96, -0.43; P < 0.001) of postoperative sore throat. Four trials reported adverse events; there were no significant adverse events related to topical licorice. The findings of sensitivity analyses excluding trials at high or unclear risk of each type of bias were consistent with these findings. TSA confirmed the evidence for postoperative sore throat was adequate. CONCLUSIONS:Preoperative topical application of licorice appears significantly more effective than nonanalgesic methods for preventing postoperative sore throat.

BACKGROUND:The optimal choice of prophylactic drugs to decrease postoperative sore throat is unclear. The objective of this network meta-analysis (NMA) was to compare and rank 11 topical agents used to prevent postoperative sore throat. METHODS:Various databases were searched independently for randomized-controlled trials (RCTs) comparing topical agents used for the prevention of postoperative sore throat. Inclusion criteria were parallel group studies comparing intervention with active or inactive control and reporting postoperative sore throat. The primary outcome was postoperative sore throat at 24 hr. Secondary outcomes were early sore throat at 4-6 hr, cough, and hoarseness at 24 hr. RESULTS:Evidence was synthesized from 70 RCTs reporting 7,141 patients. Topical application of lidocaine, corticosteroids, ketamine, magnesium, benzydamine, water-based lubricant, and liquorice applied along the tracheal tube, to the tracheal tube cuff, gargled or sprayed were compared with intracuff air and each other. Bayesian NMA showed that magnesium (odds ratio [OR], 0.10; 95% credible interval [CrI], 0.03 to 0.26), liquorice (OR, 0.14; 95% CrI, 0.03 to 0.55), and steroid application (OR, 0.11; 95% CrI, 0.06 to 0.22) most effectively prevented postoperative sore throat at 24 hr. Topical lidocaine was the least effective intervention. CONCLUSION:Topical application of magnesium followed by liquorice and corticosteroids most effectively prevented postoperative sore throat 24 hr after endotracheal intubation.

BACKGROUND:Postoperative sore throat is a leading undesirable postoperative outcome. Ketamine is an N-methyl-d-aspartate receptor antagonist and its topical application is used for chronic pain and oral/throat indications. We conducted a systematic review to assess the efficacy of preoperative, topical ketamine application for preventing postoperative sore throat. METHODS:We searched MEDLINE, EMBASE, and CENTRAL through September 23, 2019 for randomized controlled trials in which at least one intervention was topical ketamine to prevent postoperative sore throat in adults undergoing endotracheal intubation. The primary outcome was the incidence of sore throat at 24 hours postoperatively. The comparators were non-analgesic controls (placebo, no treatment, or usual care) or active agents. We pooled the data using a random-effects model. RESULTS:We included 41 randomized controlled trials involving 3784 participants. Topical ketamine was associated with reduced incidence of sore throat at 24 hours postoperatively compared to non-analgesic methods (risk ratio, 0.45; 95% CI, 0.37-0.54; P < .001). We found significant publication bias, but the results remained unchanged with a trim-and-fill analysis. Trial sequential analysis (TSA) suggested that the efficacy of topical ketamine was adequate (TSA-adjusted 95% CI, 0.33-0.56). The GRADE quality for this evidence was moderate. Topical ketamine was inferior to a combination of nebulized ketamine and clonidine in preventing postoperative sore throat. CONCLUSIONS:Preoperative, topical ketamine application may be more effective than non-analgesic methods in preventing postoperative sore throat. The number of studies did not suffice to determine the place of topical ketamine among agents to prevent postoperative sore throat.

Postoperative sore throat is one of the most common complications following endotracheal intubation. Nebulization therapy, a preferable and safety method of drug delivery, has been shown to be effective in postoperative sore throat prevention in many studies. However, the relative efficacy of various nebulized agents remains unknown. In this review, we aimed to quantify and rank order the efficacy of available nebulized agents for various postoperative sore throat-related outcomes. A comprehensive literature search of PubMed, EMBASE, CENTRAL and Google Scholar was conducted to identify eligible studies from inception to 25 May 2020. Incidence of postoperative sore throat 1hour and 24hours postoperatively and severity of postoperative sore throat 24 hours postoperatively were the primary outcomes. We conducted a Bayesian network meta-analysis to combine direct and indirect evidence to estimate the relative effects between treatments as well as the probabilities of ranking for treatments based on their protective effects. We identified 32 trials assessing 6 interventions. Overall inconsistency and heterogeneity were acceptable. Nebulized corticosteroids, magnesium, and ketamine differed from non-analgesic methods on the three primary outcomes. Based on the surface under the cumulative ranking curve, nebulized corticosteroids ranked first in almost all outcomes among the nebulized drugs. Considering only high-quality and 2-arm design studies, nebulized corticosteroids still seemed best. In conclusion, prophylactic use of nebulized corticosteroids, magnesium, and ketamine can effectively prevent postoperative sore throat, and nebulized corticosteroids appears to be the overall best approach.

BACKGROUND:Postoperative sore throat occurs frequently in surgical patients as a result of tracheal intubation. Despite advances in medical and anaesthetic care, the incidence of postoperative sore throat remains high. Our study aimed to assess the efficacy of acupuncture in the prevention of postoperative sore throat following general anaesthesia. METHODS:A non-randomised clinical study (NRS) was carried out in a tertiary care hospital in Tehran, Iran on 228 consecutive patients undergoing elective surgeries under general anaesthesia. Of these, 114 patients were assigned to the acupuncture group and treated with body acupuncture at the PC6 point, while the remaining 114 patients received no preventive care and were treated with routine medical treatment where necessary. The incidence of sore throat within the first 24 h postoperatively was then compared between the two study groups. RESULTS:Of the 114 patients in the acupuncture group, 16 patients (14%) experienced sore throat within the first 24 h postoperatively, which was significantly lower compared to the 34 patients (29.8%) with sore throat in the medical treatment group (p<0.05). However, the frequency of patients with severe sore throat requiring medical treatment did not differ significantly (12.3% vs 16.7%, p>0.05). CONCLUSIONS:Our study suggests that acupuncture could be considered as an option in prevention of postoperative anaesthesia-related sore throat.

Postoperative sore throat (POST) is one of the most reported complications after general anesthesia with an incidence of as high as 60% which may impact patient satisfaction and increase the cost of treatment. The aim of this review is to summarize the currently accepted approaches and new trends intended to reduce the risk and increase the treatment efficacy of POST. Difficult intubation, traumatic intubation, and several other factors contribute to the development of POST. Endotracheal intubation using a stylet-loaded tube exerts excessive pressure on the anterior tracheal wall predisposing to mucosal trauma and contributing to development of POST. Pharmacological interventions are aimed at prevention, amelioration of symptoms, and treatment of POST. Medications suggested for this purpose include corticosteroids, topical sprays and creams, non-steroidal anti-inflammatory drugs (NSAID), and N-methyl-D-aspartate (NMDA) receptor antagonists. The use of video-laryngoscopes (VL) for endotracheal intubation improves the glottic view and increases the success rates with less force required to ensure adequate laryngoscopic view. Nevertheless, despite advances in laryngoscopic devices, the incidence of POST remains high. A novel intubation technique with endotracheal tube (ETT) rotation 180 degrees (ETT 180°) has been suggested to overcome stylet related injury and, possibly, decrease the POST. To date, no clinical trials have been conducted to test the efficacy of ETT 180° in reducing the incidence of POST. Undoubtedly, the suggested method deserves further investigation to determine its role in patient care.

Sore throat is a common postoperative complaint, occurring most often following tracheal intubation. Factors such as tracheal-tube size and cuff design have been shown to be important causative factors. Routine tracheal intubation for elective surgical procedures can result in pathological changes, trauma and nerve damage which may also account for postoperative throat symptoms. Sore throat following the use of a laryngeal mask appears to be related to the technique of insertion but the contribution of intracuff pressure remains to be clarified. It would appear, however, that high intracuff pressure is associated with nerve palsies due to neuropraxia and nerve compression. Careful insertion techniques for both the tracheal tube and laryngeal mask are of paramount importance in the prevention of airway trauma and postoperative sore throat.

Postoperative sore throat can occur as a complication in patients who have undergone surgery under general anesthesia. The incidence of postoperative sore throat ranges from 12.1% to 70%, and its effects include damage to the epithelium and mucosal cells caused by airway securement, damage to the vocal cords, congestion, blood clots, and factors such as an inappropriately large tube, cuff shape, cuff pressure, and airway securement. Notably, there are individual differences in pain thresholds, and the sensation of pain is affected by mental states, such as anxiety, and varies from person to person. Therefore, we conducted a literature review using PubMed to clarify patient factors related to the development of postoperative sore throat. The extracted keywords were "postoperative sore throat," "anesthesia," and "patient factors." We found 16 articles that met our search criteria. We expanded the search period and retrieved 19 cases from 1990 to 2020. We also included references that were judged to be closely related to the list of citations of the retrieved references. The study designs included were randomized controlled trials, clinical trials, meta-analyses, reviews, and systematic reviews. The results showed that female sex, smoking, and age were the most common patient factors. However, we could not find any literature that studied the relationship between postoperative sore throat and mental states such as anxiety.

BACKGROUND:Sore throat is a common complication of anaesthesia that affects patient satisfaction after surgery. METHODS:We studied 5264 ambulatory surgical patients prospectively to determine the patient, anaesthetic, and surgical factors associated with sore throat. RESULTS:In 5264 patients, 12.1% reported a sore throat. Patients with tracheal tube had the greatest incidence, 45.4%, followed by patients with laryngeal mask airway, 17.5%, while patients with a facemask had a lower incidence of sore throat, 3.3%. Female patients had more sore throats than male patients (13.4 vs 9.1%). Airway management had the strongest influence on the incidence of sore throat. Sore throat in ambulatory surgical patients was associated with female sex, younger patients, use of succinylcholine, and gynaecological surgery. CONCLUSION:Airway management, female sex, younger patients, surgery for gynaecological procedure, and succinylcholine predicts postoperative sore throat. Increased awareness of the predictive factors can help to avoid this combination and improve patient satisfaction.

BACKGROUND:Sore throat is a common side-effect of general anaesthesia and is reported by between 30% and 70% of patients after tracheal intubation. The likelihood of a sore throat varies with the type, diameter, and cuff pressure of the endotracheal tube used. If intubation is essential, it may be helpful to give drugs prophylactically to alleviate postoperative sore throat. Local anaesthetics and steroids have been used for this purpose. This review was originally published in 2009 and was updated in 2015. OBJECTIVES:The objective of this review was to evaluate the efficacy and any harm caused by topical and systemic lidocaine used prophylactically to prevent postoperative sore throat in adults undergoing general anaesthesia with endotracheal intubation. SEARCH METHODS:We searched CENTRAL (The Cochrane Library 2013, Issue 9), MEDLINE (January 1966 to October 2013), and EMBASE (1980 to October 2013). We also contacted manufacturers and researchers in the field. The original search was undertaken in June 2007. We reran the search in February 2015 and found four studies of interest. We will deal with those studies when we next update the review. SELECTION CRITERIA:We included randomized controlled trials (RCTs) of topical and systemic prophylactic lidocaine therapy versus control (using air or saline) that reported on the risk and severity of postoperative sore throat as an outcome. DATA COLLECTION AND ANALYSIS:Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information, such as the risk of any adverse effects. MAIN RESULTS:We included 19 studies involving 1940 participants in this updated review. Of those 1940 participants, 952 received topical or systemic lidocaine therapy and 795 were allocated to the control groups. Topical and systemic lidocaine therapy appeared to reduce the risk of postoperative sore throat (16 studies, 1774 participants, risk ratio (RR) was 0.64 (95% confidence interval (CI) 0.48 to 0.85), the quality of the evidence was low), although when only high-quality trials were included (eight studies, 814 participants) the effect was no longer significant (RR 0.71, 95% CI 0.47 to 1.09). Lidocaine given systemically in two studies (320 participants) did not reveal evidence of an effect (RR 0.44, 95% CI 0.19 to 1.05 ). The severity of sore throat as measured on a visual-analogue scale (VAS) was reduced by lidocaine therapy (six trials, 611 participants, (mean difference (MD) -10.80, 95% CI -14.63 to -6.98). The adverse effects of lidocaine were not reported in these studies, though toxicity is generally rare. AUTHORS' CONCLUSIONS:In our revised systematic review, although the results of included studies show generally positive results, they should be interpreted carefully. The effect size of lidocaine appeared to be affected by study quality; drug concentration; route of administration; management of cuff pressure during anaesthesia; the included population; and the type of outcome measured.

PURPOSE:Postoperative sore throat (POST) is a relatively common morbidity. Topical lidocaine lubricants have been proposed to prevent POST; however, their effectiveness remains uncertain. This meta-analysis aimed to evaluate the prophylactic effect of lidocaine lubrications against POST, cough, and hoarseness in adult patients after surgery. METHODS:Randomized-controlled trials from PubMed, Embase, the Cochrane Library, and the ClinicalTrials.gov registry that were published from inception until 26 March 2018 were included that compared the effectiveness of lidocaine lubricants with that of controls in preventing the incidence of overall POST and moderate to severe POST (POSTMS) at the first and 24th postoperative hour (POST-1h, POST-24h, POSTMS-1h, and POSTMS-24h). Postoperative cough and hoarseness at the 24th postoperative hour were also studied. Bias assessment and subgroup, sensitivity, and trial sequential analyses were also performed. RESULTS:Fourteen randomized-controlled trials (n = 2146) were selected. The incidences of POST-1h and POST-24h were 41.1 % and 22.6 % for the lidocaine group, and 41.9% and 23.5% for the control group, respectively. No effect was found on any of the outcome measurements. The overall risk ratios were 1.11 (95% confidence interval [CI], 0.82 to 1.51) and 1.06 (95% CI, 0.37 to 3.02) for the incidence of POST-1h and POSTMS-1h, respectively; 0.99 (95% CI, 0.83 to 1.17) and 0.49 (95% CI, 0.16 to 1.50) for POST-24h and POSTMS-24h, respectively; and, 1.09 (95% CI, 0.71 to 1.66) and 0.91 (95% CI, 0.66 to1.24) for postoperative cough (PC)-24h and postoperative hoarseness (PH)-24h, respectively. CONCLUSION:Lidocaine lubricants applied on the tips of endotracheal tube are not effective against the morbidities of POST, PC, and PH. TRIAL REGISTRATION:PROSPERO (CRD42017073259); registered 26 October, 2017.

BACKGROUND:In surgical patients undergoing general anaesthesia, coughing at the time of extubation is common and can result in potentially dangerous complications. We performed a systematic review and meta-analysis to assess the efficacy and safety of i.v. lidocaine administration during the perioperative period to prevent cough and other airway complications. METHODS:We searched Medical Literature Analysis and Retrieval System, Excerpta Medica database, and Cochrane Central Register of Controlled Trials for RCTs comparing the perioperative use of i.v. lidocaine with a control group in adult patients undergoing surgery under general anaesthesia. The RCTs were assessed using risk-of-bias assessment, and the quality of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RESULTS:In 16 trials (n=1516), the administration of i.v. lidocaine compared with placebo or no treatment led to large reductions in post-extubation cough (risk ratio [RR]: 0.64; 95% confidence interval [CI]: 0.48-0.86) and in postoperative sore throat at 1 h (RR: 0.46; 95% CI: 0.32-0.67). There was no difference in incidence of laryngospasm (risk difference [RD]: 0.02; 95% CI: -0.07 to 0.03) or incidence of adverse events related to the use of lidocaine. CONCLUSIONS:The use of i.v. lidocaine perioperatively decreased airway complications, including coughing and sore throat. There was no associated increased risk of harm.

Postoperative sore throat has a reported incidence of up to 62% following general anaesthesia. In adults undergoing tracheal intubation, female sex, younger age, pre-existing lung disease, prolonged duration of anaesthesia and the presence of a blood-stained tracheal tube on extubation are associated with the greatest risk. Tracheal intubation without neuromuscular blockade, use of double-lumen tubes, as well as high tracheal tube cuff pressures may also increase the risk of postoperative sore throat. The expertise of the anaesthetist performing tracheal intubation appears to have no influence on the incidence in adults, although it may in children. In adults, the i-gel(™) supraglottic airway device results in a lower incidence of postoperative sore throat. Cuffed supraglottic airway devices should be inflated sufficiently to obtain an adequate seal and intracuff pressure should be monitored. Children with respiratory tract disease are at increased risk. The use of supraglottic airway devices, oral, rather than nasal, tracheal intubation and cuffed, rather than uncuffed, tracheal tubes have benefit in reducing the incidence of postoperative sore throat in children. Limiting both tracheal tube and supraglottic airway device cuff pressure may also reduce the incidence.

Postoperative sore throat (POST) is usually self-limiting but was rated by patients as one of the top 10 most undesirable anesthetic outcomes. Pharmacologic interventions that have been suggested to decrease the incidence of POST include application of local anesthetics and corticosteroids to the cuff of the endotracheal tube. These interventions often require extra steps during induction of general anesthesia. We sought evidence for using nonsteroidal, nonlocal anesthetic, topical pharmacologic interventions conveniently implemented preoperatively to decrease the incidence of POST. One hundred seventeen potential evidence sources were located, with 11 randomized controlled trials meeting inclusion criteria. The evidence examined ketamine, aspirin, and azulene gargle; benzydamine gargle or oral spray; dexpanthenol pastilles; and lozenges containing amyl-m-cresol or magnesium. Although there were methodologic concerns with the studies, the evidence suggested that all the treatment medications decreased the incidence of POST at early and late intervals. The severity of POST was also typically reduced. Preoperative ketamine and aspirin gargle are probably the most promising for providers practicing in the United States. However, before these agents are recommended for general use, large multicenter trials should be done exploring not only efficacy but also dose-response relationships and side effects.

Although fiberoptic-guided tracheal intubation is a gentler method than using a direct laryngoscope, injury may occur owing to impingement between the distal edge of the endotracheal tube and the glottis. This study aimed to investigate the effects of endotracheal tube advancement speed during fiberoptic-guided intubation on airway symptoms postoperatively. We randomized patients scheduled for laparoscopic gynecological surgery to either Group C or S. When advancing the tube over the bronchoscope, the operator advanced the tube at a normal speed in Group C and at a slower speed in Group S. The speed in Group S was approximately half that in Group C. The target outcomes were the severity of postoperative sore throat, hoarseness, and cough. Patients in Group C experienced a more severe sore throat than those in Group S at 3 and 24 h postoperatively (p = 0.001 and p = 0.012, respectively). However, the severity of hoarseness and cough postoperatively were not significantly different between the groups. In conclusion, the slow advancement of the endotracheal tube during fiberoptic-guided intubation can reduce sore throat severity.

BACKGROUND:Postoperative throat pain is an established complication of general anaesthesia with endotracheal intubation. We thus sought to determine the incidence of postoperative throat pain and the efficacy of lidocaine jelly and ketamine gargle in the prevention of postoperative throat pain. MATERIALS AND METHOD:One hundred and fifty ASA I or II, male: female ratio of 1:2 patients, aged18 -64 year, scheduled for elective general surgery requiring general anaesthesia with endotracheal intubation were randomly recruited into two groups, ketamine (K group) and lidocaine (L group). Group K received ketamine gargle (40 mg in 30 ml normal saline) for 30 sec, five minutes before induction of anaesthesia, while Group L received 2% lidocaine jelly applied to the ETT cuff and 30 ml normal saline was gargled for 30 sec, five minutes before induction of anaesthesia. RESULTS:Postoperative throat pain was defined as pain present with swallowing and it was assessed using verbal rating scale. Time from extubation to onset of postoperative throat pain was significantly longer for patients in K group compared to the lidocaine group, P<0.01. Group L patients recorded a higher occurrence of moderate to severe pain (44.1% vs. 23.5%) as against group K with 58.3% no pain and 36.5% mild pain, P< 0.01. The overall incidence of postoperative throat pain for the study was 55.4%. CONCLUSION:The study demonstrated that ketamine gargle has more protection against moderate to severe postoperative pain as compared to topical lidocaine jelly. Patients undergoing surgery under general anaesthesia with endotracheal intubation will benefit from ketamine gargle five minutes before induction of anaesthesia as prophylaxis against postoperative throat pain.

Although tracheal intubation remains a valuable tool, it may result in pressure trauma and sore throat. The evidence for an association between these sequelae is not conclusive and sore throat may be caused at the time of intubation. This hypothesis was tested in a mechanical model and the results from tracheal intubation compared with those from insertion of a laryngeal mask airway, which is associated with a lower incidence of sore throat. Use of the model suggests that the tracheal tube and laryngeal mask airway impinge on the pharyngeal wall in different manners and involve different mechanisms for their conformation to the upper airway, but that in a static situation, the forces exerted on the pharyngeal wall are low with both devices. It also suggests that the incidence of sore throat should be lower for softer and smaller tracheal tubes and that the standard 'Magill' curve (radius of curvature 140 +/- 20 mm) is about optimum for the average airway.

BACKGROUND:Topical pharmacological agents typically used to treat postoperative sore throat (POST) after tracheal intubation include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, lidocaine, Glycyrrhiza (licorice), and N-methyl-d-aspartate (NMDA) receptor antagonists (including ketamine and magnesium). However, the optimal prophylactic drug remains elusive. METHODS:The literature published before September 8, 2019 was searched on the PubMed, the Embase, the Web of Science, and the Cochrane Library. Randomized controlled trials (RCTs) covering topical prophylactic medications for patients with POST were included. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the quality of evidence. The primary outcome is the risk of POST. Combining both direct and indirect evidence, a network meta-analysis was performed to assess odds ratios (ORs) between the topical pharmacological agents and surface under the cumulative ranking (SUCRA) curve for the treatment-based outcomes. This study is registered with PROSPERO, number CRD42020158985. RESULTS:Sixty-two RCTs (at least 73% of which were double blinded) that included a total of 6708 subjects and compared 6 categories of drugs and/or placebos were ultimately enrolled. All preventive interventions except lidocaine were more effective than placebo at the 4 time intervals. Lidocaine (OR: 0.35, 95% credible interval [CrI], 0.16-0.79) has a greater POST preventative intervention effect than the placebo at a time interval of only 2 to 3 hours after surgery. Relative to lidocaine, the risk of POST except 2 to 3 hours was lower for the following treatments: corticosteroids, ketamine, magnesium, NSAIDs, and Glycyrrhiza. The NMDA receptor antagonists studied here included ketamine and magnesium. Magnesium generally demonstrated greater benefit than ketamine at 24 hours postsurgery/extubation (OR: 0.41, 95% CrI, 0.18-0.92). Compared with ketamine, corticosteroids were associated with a reduced risk of POST during the 4 to 6 hours (OR: 0.40, 95% CrI, 0.19-0.83) and 24 hours (OR: 0.34, 95% CrI, 0.16-0.72) time intervals. During the 2 to 3 hours time interval, Glycyrrhiza (OR: 0.38, 95% CrI, 0.15-0.97) was more efficacious than magnesium. CONCLUSIONS:Our analysis shows that, among the 6 topical medications studied, lidocaine is not optimal for topical use to prevent POST. Glycyrrhizin, corticosteroids, NSAIDs, and NMDA receptor antagonists (ketamine and magnesium) are associated with a reduced postoperative pharyngeal pain across the 4 postsurgical time intervals studied, all of which can be chosen according to the clinical experience of the anesthesiologists and the patient preferences and are recommended for the reduction of postoperative throat pain.

Postoperative sore throat is one well-recognized complication, occurring most frequently following tracheal intubation. Effective prevention of postoperative sore throat has been recognized as a top priority, bringing pleasant feelings and satisfaction to patients. This study aimed to assess the efficacy of magnesium sulfate, dexmedetomidine and ondansetron gargle with lidocaine administrated prior to laryngoscopy and tracheal intubation for postoperative sore throat prevention alongside hemodynamic management. This double-blind randomized clinical trial enrolled 105 general anesthesia-administered patients who had undergone laryngoscopy and endotracheal intubation, and they were equally randomized into three groups: magnesium sulfate, dexmedetomidine, and ondansetron groups. No significant intergroup difference was seen in oxygen saturation, non-invasive blood pressure, heart rate, duration of surgery, postoperative complications, analgesic consumption, and incidence of cough and hoarseness. The results showed statistically significant intergroup differences in pain scores and average pain intensity in the dexmedetomidine group was significantly lower than the other groups. Results suggest that dexmedetomidine gargle with lidocaine before general anesthesia induction could be recommended as an option depending on the patient's general condition and the anesthesiologist's discretion.