Postoperative laringo-pharyngeal symptoms in elective surgery - Incidence and related factors
Introduction: To determine cumulative incidence of sore throat complaints (STCs) which occur with the insertion of the laryngeal mask (LM) and endotracheal tube (ETT) during the first hour and 24 hours after elective surgery. In addition, to establish risk factors associated with its occurrence.
Methods: In a cohort study, a total of 451 patients scheduled for elective non-cardiac surgery were included consecutively for 6 months (ASA I-II-III, >18 years old) who underwent LM or ETT airway management for general anesthesia. Through a questionnaire with indirect and direct questions the presence of sore throat, hoarseness, dysphagia and the composite endpoint STCs were assessed one and 24 hours after surgery. Marginal models were used to identify risk factors.
Results: We found an incidence of STCs of 26.8% and 13.5% at first and 24 postoperative hours respectively. At first hour, they were classified as sore throat (23.9%), hoarseness (6.7%) and dysphagia (6.4%). Each compound was not mutually exclusive. At 24 hours of follow up, incidence of STCs and its compounds decreases significantly but differently to ETT and LM. STCs were associated with female gender (OR=1.53 95%CI 1.00-2.37, p=0.05), ETT intubation (OR=4.20 95%CI 2.19-8.04, p<0.01) and bloodstain on airway device at extubation (OR=2.00 95%CI 1.18-3.36, p<0.01).
Conclusions: The incidence of STCs remains important. There are differences in the pattern of reduction between ETT and LM over time and this study confirms risk factors for postoperative STCs like use of ETT, presence of blood during the airway device extraction and female gender.
2. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999;89:652-8.
3. Rieger A, Brunne B, Hass I, Brummer G, Spies C, Striebel H. Laryngo-pharyngeal complaints following laryngeal mask airway and endotracheal intubation. J Clin Anesth. 1997;9:42-7.
4. Harding CJ, McVey FK. Interview method affects incidence of postoperative sore throat. Anaesthesia. 1987;42:1104-7.
5. Biro P, Seifert B, Pasch T. Complaints of sore throat after tracheal intubation: A prospective evaluation. Eur J Anaesthesiol. 2005;22:307-11.
6. McHardy FE, Chung F. Postoperative sore throat: Cause, prevention and treatment. Anaesthesia. 1999;54:444-53.
7. Keijzer C, Buitelaar DR, Efthymiou KM, Srámek M, Cate J, ten Ronday M, et al. A comparison of postoperative throat and neck complaints after the use of the i-gel and the La Premiere disposable laryngeal mask: A double-blinded, randomized, controlled trial. Anesth Analg. 2009;109:1092-5.
8. Fitzmaurice G, Laird N, Ware J. Marginal Models: Generalized Estimating Equations (GEE). En: Fitzmaurice G, Laird N, Ware J, editores. Applied Longitudinal Analysis. United States of America: Wiley Interscience; 2004. p. 291-324.
9. The [PROC GENMOD] for this paper was generated using [SAS] software, Version [9.2] of the SAS System for [Windows]. Copyright [2002-2007] SAS Institute Inc., Cary, NC, USA.
10. Scuderi PE. Postoperative sore throat: More answers than questions. Anesth Analg. 2010;111:831-2.
11. Christensen AM, Willemoes-Larsen H, Lundby L, Jakobsen KB. Postoperative throat complaints after tracheal intubation. Br J Anaesth. 1994;73:786-7.
12. Joshi GP, Inagaki Y, White PF, Taylor-Kennedy L, Wat LI, Gevirtz C, et al. Use of the laryngeal mask airway as an alternative to the tracheal tube during ambulatory anesthesia. Anesth Analg. 1997;85:573-7.
13. Stout DM, Bishop MJ, Dwersteg JF, Cullen BF. Correlation of endotracheal tube size with sore throat and hoarseness following general anesthesia. Anesthesiology. 1987;67:419-21.
14. Tanaka Y, Nakayama T, Nishimori M, Sato Y, Furuya H. Lidocaine for preventing postoperative sore throat. Cochrane database of systematic reviews (online). 2009:CD004081.
15. Dingley J, Whitehead MJ, Wareham K. A comparative study of the incidence of sore throat with the laryngeal mask airway. Anaesthesia. 1994;49:251-4.
16. Wakeling HG, Butler PJ, Baxter PJ. The laryngeal mask airway: A comparison between two insertion techniques. Anesth Analg. 1997;85:687-90.
17. O'Kelly SW, Heath KJ, Lawes EG. A study of laryngeal mask inflation. Pressures exerted on the pharynx. Anaesthesia. 1993;48:1075-8.
18. Huang YS, Hung NK, Lee MS, Kuo CP, Yu JC, Huang GS, et al. The effectiveness of benzydamine hydrochloride spraying on the endotracheal tube cuff or oral mucosa for postoperative sore throat. Anesth Analg. 2010;111:887-91.
19. Hung NK, Wu CT, Chan SM, Lu CH, Huang YS, Yeh CC, et al. Effect on postoperative sore throat of spraying the endotracheal tube cuff with benzydamine hydrochloride, 10% lidocaine, and 2% lidocaine. Anesth Analg. 2010;111:882-6.
20. Ebneshahidi A, Mohseni M. Strepsils® tablets reduce sore throat and hoarseness after tracheal intubation. Anesth Analg. 2010;111:892-4.
21. Tazeh-Kand NF, Eslami B, Mohammadian K. Inhaled fluticasone propionate reduces postoperative sore throat, cough, and hoarseness. Anesth Analg. 2010;111:895-8.
The publisher (Sociedad Colombiana de Anestesiología y Reanimación S.C.A.R.E.) retains copyright for the published articles.
Creative Commons License
Articles published by Colombian Journal of Anesthesiology are licensed under the Creative Commons 4.0 license: Attribution-NonCommercial-NoDerivs: CC BY-NC-ND.