Efficacy of tonsillectomy in treatment of recurrent group A beta-hemolytic streptococcal pharyngitis

OBJECTIVE

The objective of this study was to determine whether children with tonsillectomies experienced fewer recurrent group A beta-hemolytic streptococcal (GABHS) infections after surgery compared with children who did not receive tonsillectomies.

STUDY DESIGN/METHODS

The authors conducted a retrospective cohort study of 290 children 4 to <16 years who experienced three or more episodes of group A beta-hemolytic streptococcal pharyngitis at least 1 month apart in 12 months.

RESULTS

Children without tonsillectomy were 3.1 times (95% confidence interval, 1.9-4.9; P < .001) more likely to develop a subsequent group A beta-hemolytic streptococcal pharyngitis infection during follow up than children who underwent tonsillectomy after adjusting for the number of group A beta-hemolytic streptococcal pharyngitis infections per patient within the previous year and the presence of preexisting conditions. Among the children who developed a subsequent group A beta-hemolytic streptococcal pharyngitis infection, the children without a tonsillectomy developed a group A beta-hemolytic streptococcal pharyngeal infection sooner (median, 0.6 vs. 1.1 years).

CONCLUSIONS

Tonsillectomy is associated with a decrease in the number of group A beta-hemolytic streptococcal pharyngitis infections in children with a history of recurrent groups A beta-hemolytic streptococcal pharyngitis infection. Tonsillectomy also increased the amount of time before development of further GABHS pharyngitis.

Efficacy of sucralfate in the postoperative management of uvulopalatopharyngoplasty: a double-blind, randomized, controlled study

OBJECTIVE

To evaluate the effectiveness of sucralfate in influencing throat pain, otalgia, analgesic requirement, bleeding, mucosal recovery, and incidence of postoperative bleeding in patients undergoing uvulopalatopharyngoplasty.

DESIGN

A prospective double-blind randomized study.

SETTING

University-affiliated tertiary referral hospital.

PARTICIPANTS

Eighty adult patients with obstructive sleep apnea syndrome requiring uvulopalatopharyngoplasty were recruited and randomly allocated into either a sucralfate treatment group or a control group.

INTERVENTIONS

All patients underwent uvulopalatopharyngoplasty. Patients enrolled in the sucralfate group (n=40) were instructed to gargle the sucralfate suspension and then to swallow. Patients enrolled in the control group (n=40) were instructed to gargle placebo suspension at the same doses and schedule.

MAIN OUTCOME MEASURES

Postoperative throat pain, otalgia, amount of analgesic required, degree of strength (defined as patients' general well-being and return to regular daily activities), percentage of mucosal covering, and postoperative bleeding.

RESULTS

Throat pain and otalgia occurred significantly less often in sucralfate group, with less analgesic requirement and with rapid mucosal healing and early return to regular daily activities. There was no significant difference in episodes of postoperative bleeding between the 2 groups (P=.37).

CONCLUSIONS

Although sucralfate therapy may not provide complete analgesia after uvulopalatopharyngoplasty, it may reduce the amount of analgesic required, thus preventing dose-related adverse effects from the analgesic agent. It can also significantly reduce the total number of days needed to return to normal daily activities (P=.41).

An evaluation of the efficacy of aspirin and benzydamine hydrochloride gargle for attenuating postoperative sore throat: a prospective, randomized, single-blind study

Postoperative sore throat (POST), although a minor complication, remains a source of postoperative morbidity. We compared the efficacy of dispersible aspirin gargle to benzydamine hydrochloride (a topical nonsteroidal anti inflammatory drug) gargles for prevention of POST. We enrolled 60 consecutive female patients, 16-60 yr of age, ASA physical status I or II, undergoing elective modified radical mastectomy under general anesthesia in this prospective, randomized, placebo-controlled, single-blind study. Patients were randomly divided into 3 groups of 20 subjects each: Group 1 (C) mineral water; Group 2 (AS) tab aspirin 350 mg; and Group 3 (BH) 15 mL of benzydamine hydrochloride (0.15%). All the medications were made into 30 mL of solution. Patients were asked to gargle this mixture for 30 s, 5 min before induction of anesthesia. Grading of POST was done at 0, 2, 4, and 24 h postoperatively on a 4-point scale (0-3). Aspirin gargles reduced the incidence of POST for 4 h whereas benzydamine hydrochloride gargles reduced POST for 24 h. POST was more severe in the control group at 0 and 2 h (P < 0.05). Aspirin and benzydamine hydrochloride gargles significantly reduced the incidence and severity of POST (P < 0.05).

From a sore throat to the intensive care unit: the Lemierre syndrome

Lemierre syndrome is characterized by an acute oropharyngeal infection, suppurative thrombophlebitis of the internal jugular vein and metastatic infections. The infection is usually caused by Fusobacterium necrophorum. We report on a 19-year-old male patient who was admitted with a five-day history of fever, sore throat and progressive dyspnea. Computed tomography of the neck and chest revealed a parapharyngeal abscess, jugular vein thrombosis, descending necrotizing mediastinitis and multiple areas of bilateral consolidation and cavitations within the lungs. Fusobacterium necrophorum was identified in the blood culture. Early combined abscess drainage with neck and chest incisions, together with broad spectrum intravenous antibiotic treatment and medical management in an intensive care unit resulted in a good clinical outcome.

Effects of intravenous lidocaine prior to intubation on postoperative airway symptoms

We investigated whether intravenous lidocaine prior to endotracheal intubation influences the postoperative airway symptoms of sore throat, cough, and sputum. After ethics committee approval, 80 patients undergoing elective operations were studied. A total of 20 patients were given lidocaine 1.0 mg.kg(-1) (group L1), 20 patients were given lidocaine 1.5 mg.kg(-1) (group L2), and 40 patients received normal saline (group C). The sore throat incidence was 20% in group L1, 0 in group L2, and 40% in group C. Cough incidence was 0 in group L1, 20% in group L2, and 40% in group C. Sputum incidence was 35% in group L1, 25% in group L2, and 47.5% in group C. There were significant differences in the incidences (P < 0.01) and severity (P < 0.01) of sore throat and cough in groups C and L (groups L1 + L2). There were no significant differences between groups in terms of the incidence or severity of sputum. In conclusion, intravenous lidocaine prior to endotracheal intubation decreased the incidence of postoperative sore throat and cough.

Gargling with Sodium Azulene Sulfonate Reduces the Postoperative Sore Throat After Intubation of the Trachea

Postoperative sore throat (POST) is a complication that remains to be resolved in patients undergoing endotracheal intubation. In this study, we investigated whether preoperative gargling with sodium 1,4-dimethyl-7-isopropylazulene-3-sulfonate monohydrate (sodium azulene sulfonate, Azunol) reduces POST after endotracheal intubation. Forty patients scheduled for elective surgery under general anesthesia were randomized into Azunol and control groups. In the Azunol group, patients gargled with 4 mg Azunol diluted with 100 mL tap water (40 microg/mL). In the control group, patients gargled with 100 mL of tap water. After emergence from general anesthesia, the patients with POST were counted and POST was evaluated using a verbal analog pain scale. There were no significant differences between the two groups by age, height, body weight, gender distribution, or duration of anesthesia and surgery. In the control group, 13 patients (65%) complained of POST, which remained 24 h later in nine patients (45%). In the Azunol group, five patients (25%) also complained of POST, which completely disappeared by 24 h later. The incidence of POST and verbal analog pain scale scores in the Azunol group decreased significantly compared with the control group. We demonstrated that gargling with Azunol effectively attenuated POST with no adverse reactions.

Effect of sodium azulene sulfonate on capsaicin-induced pharyngitis in rats

Abstract: Sodium azulene sulfonate is a water‐soluble derivative of azulene which is an antiinflammatory component of chamomile of the family of Asteraceae. Sodium azulene sulfonate is clinically used as a therapeutic agent in the treatment of pharyngitis as well as other inflammatory diseases such as tonsillitis, stomatitis and conjunctivitis. There has been no documentation on the effect of sodium azulene sulfonate on pharyngitis in laboratory models, probably because of no availability of such models. We recently established a pharyngitis model using capsaicin application on pharyngeal mucosa in rats. The present study investigated the antipharyngitis activity of sodium azulene sulfonate comparing with those of ruthenium red (vanilloid receptor antagonist, 8.5 and 85 mg/ml), ascorbic acid (antioxidative compound, 100 μg/ml), povidone iodine (gargle as disinfectant, oxidative compound, 5 and 20 mg/ml) and diclofenac sodium (cyclooxygenase inhibitor, 0.1 and 1 mg/ml). As an antipharyngeal effect, the capsaicin‐induced plasma exudation in the pharyngeal mucosa of the rat was evaluated. The capsaicin‐induced plasma exudation in the pharyngeal mucosa was inhibited by sodium azulene sulfonate (100 and 200 μg/ml) as well as ruthenium red and ascorbic acid, but not by povidone iodine and dicrofenac sodium; povidone iodine rather promoted the plasma exudation. In conclusion, the antipharyngitis effect of sodium azulene sulfonate was demonstrated for the first time in a laboratory model. Although the mechanism by which sodium azulene sulfonate inhibited the capsaicin‐induced pharyngitis is not yet unraveled, antioxidative effect, but not inhibitory effect on cyclooxygenase pathway, might be involved.

Adenotonsillectomy for upper respiratory infections: evidence based?

BACKGROUND

Despite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician little support in deciding which child might benefit from the operation.

METHODS

A literature search was performed to identify randomised trials and non-randomised controlled studies into the efficacy of tonsillectomy with or without adenoidectomy in children under 18 years. For the outcomes sore throat episodes, sore throat associated school absence, and upper respiratory infections, pooled estimates of the incidence rate ratios and rate differences with 95% confidence intervals were calculated, assuming a Poisson distribution.

RESULTS

Six randomised trials and seven non-randomised controlled studies on the efficacy of adenotonsillectomy in children were evaluated. For sore throat episodes data for 2483 person-years were available. The pooled risk difference was -1.2 episodes per person-year (95% CI -1.3 to -1.1). For sore throat associated school absence 1669 person-years were analysed. The pooled risk difference was -2.8 days per person-year (95% CI -3.9 to -1.6). For upper respiratory infections 1596 person-years were available. The pooled risk difference was -0.5 episodes per person-year (95% CI -0.7 to -0.3).

CONCLUSIONS

All available randomised trials and non-randomised controlled studies into the efficacy of (adeno)tonsillectomy had important limitations. The frequency of sore throat episodes and upper respiratory infections reduces with time whether (adeno)tonsillectomy has been performed or not. (Adeno)tonsillectomy gives an additional, but small, reduction of sore throat episodes, days of sore throat associated school absence, and upper respiratory infections compared to watchful waiting.

Effectiveness of lubrication of endotracheal tube cuff with chamomile-extract for prevention of postoperative sore throat and hoarseness

PURPOSE OF THE STUDY

To determine the efficacy of lubrication of the endotracheal tube cuff with Chamomile extract (Kamillosan M) before intubation on postoperative sore throat and hoarseness.

MATERIAL AND METHOD

The authors randomly assigned 161 patients ASA (American Society of Anesthesiologists) physical status I, II elective surgical, orthopedic, gynecological or urological into 2 groups. The study group received 10 puffs of total 370 mg of Chamomile extract (Kamillosan M spray) lubricated at cuff of endotracheal tube while the control group did not receive any lubrication before intubation. Standard general anesthesia with tracheal intubation was given in both groups. Sore throat and hoarseness were recorded in post anesthetic care unit and at 24 h after operation.

RESULTS

One hundred and sixty-one ASA physical status I, II elective surgical patients were recruited. Forty one out of 81 patients (50.6%) in the Chamomile group, scored no postoperative sore throat in the post-anesthesia care unit compared with 45 out of 80 patients (56.3%) in the control group p=0.386. Postoperative sore throat and hoarseness both in the postanesthesia care unit and at 24 h postoperation were not statistically different. There was no statistically significant relationship between sore throat or hoarseness and postoperative nausea or vomiting, ASA physical status, gender, history of smoking, grade of laryngoscopic view, number of intubation attempts, condition during intubation, use of oral airway and couching during extubation.

CONCLUSION

Lubrication of endotracheal tube cuff with Chamomile extract spray before intubation can not prevent post operative sore throat and hoarseness.

Does sealing endotracheal tube cuff pressure diminish the frequency of postoperative laryngotracheal complaints after nitrous oxide anesthesia?

STUDY OBJECTIVES

To study endotracheal tube (ETT) cuff pressures during nitrous oxide (N2O) anesthesia when the cuffs are inflated with air to achieve sealing pressure, and to evaluate the frequency of postoperative laryngotracheal complaints.

DESIGN

Prospective, randomized, blind study.

SETTING

Metropolitan teaching hospital.

PATIENTS

50 ASA physical status I and II patients scheduled for elective abdominal surgery.

INTERVENTIONS

Patients received standard general anesthesia with 66% N2O in oxygen. In 25 patients, the ETT cuff was inflated with air to achieve a sealing pressure (Pseal group). In 25 patients, the ETT cuff was inflated with air to achieve a pressure of 25 cm H2O (P25 group).

MEASUREMENTS AND MAIN RESULTS

ETT intracuff pressures were recorded before (control) and at 30, 60, 90, 120, and 150 minutes during N2O administration. We investigated the frequency and intensity of sore throat, hoarseness, and dysphagia in patients in the Post-Anesthesia Care Unit (PACU) and 24 hours following tracheal extubation. The cuff pressures in the Pseal group were significantly lower than in the P25 group at all time points studied (p < 0.001), with a significant increase with time in both groups (p < 0.001). The cuff pressures exceeded the critical pressure of 30 cm H2O only after 90 minutes in the Pseal group and already by 30 minutes in the P25 group. The frequency and intensity of sore throat, hoarseness, and dysphagia were similar in both groups in the PACU and 24 hours after tracheal extubation (p > 0.05).

CONCLUSIONS

Minimum ETT sealing cuff pressure during N2O anesthesia did not prevent, but instead attenuated, the increase in cuff pressure and did not decrease postoperative laryngotracheal complaints.

Prevention of postoperative sore throat using capsicum plaster applied at the Korean hand acupuncture point

In a randomised, double-blind, sham-controlled study, we compared the efficacy of capsicum plaster (PAS) applied at the Korean hand acupuncture point for the prevention of postoperative sore throat in 150 patients scheduled to undergo abdominal hysterectomy. The K group had PAS applied at the K-A20 of both hands and placebo tape at both non-acupoints. The PAS was applied prior to induction of anaesthesia and removed 8 h postoperatively. The sore throat scores of Group K were significantly lower than those of other groups at 24 h following surgery (p = 0.00027). The prevalence of moderate to severe sore throat at 24 h was lower for Group K (0%) than for sham and placebo controls (16%[p = 0.038] and 19%[p = 0.032], respectively). There were no differences in the recovery room of the sore throat scores for all groups. We found that the PAS applied at the K-A20 was an alternative method for reducing postoperative sore throat.

Mucosal vaccine made from live, recombinant Lactococcus lactis protects mice against pharyngeal infection with Streptococcus pyogenes

A novel vaccine (LL-CRR) made from live, nonpathogenic Lactococcus lactis that expresses the conserved C-repeat region (CRR) of M protein from Streptococcus pyogenes serotype 6 was tested in mice. Nasally vaccinated mice produced CRR-specific salivary immunoglobulin A (IgA) and serum IgG. Subcutaneously vaccinated mice produced CRR-specific serum IgG but not salivary IgA. A combined regimen produced responses similar to the salivary IgA of nasally vaccinated mice and serum IgG of subcutaneously vaccinated mice. Mice vaccinated nasally or with the combined regimen were significantly protected against pharyngeal infection following a nasal challenge with S. pyogenes M serotype 14. Mice vaccinated subcutaneously were not protected against pharyngeal infection. Mice in all three LL-CRR vaccination groups were significantly protected against the lethal effects of S. pyogenes. Only 1 of 77 challenged mice that were vaccinated with LL-CRR died, whereas 60 of 118 challenged mice that were vaccinated with a control strain or phosphate-buffered saline died. In conclusion, mucosal vaccination with LL-CRR produced CRR-specific salivary IgA and serum IgG, prevented pharyngeal infection with S. pyogenes, and promoted survival.

Prevention of streptococcal pharyngitis by anti-Streptococcus pyogenes bacteriocin-like inhibitory substances (BLIS) produced by Streptococcus salivarius

BACKGROUND & OBJECTIVES

Streptococcus salivarius is a numerically prominent member of the human oral microbiota that produces a variety of bacteriocin-like inhibitory substances (BLIS) having in vitro inhibitory activity against S. pyogenes. Our previous studies of S. salivarius isolates from children using a deferred antagonism BLIS production (P)-typing scheme showed that the 9 per cent of children having large populations of P-type 677 S. salivarius experienced fewer S. pyogenes acquisitions than either the 11 per cent of children having predominant P-type 226 populations or the 60 per cent of children with largely non-inhibitory (P-type 000) S. salivarius. Amongst the other BLIS P-types detected were a number of strongly-inhibitory (P-type 777) S. salivarius. In the present study the inhibitory agents produced by prototype strains of P-types 226, 677 and 777 S. salivarius are compared.

METHODS

The prototype BLIS-producing S. salivarius strains SN, 20P3, and K12 were isolated from tongue swabbings. BLIS P-typing was done using standard procedures. The BLIS molecules were purified and characterized.

RESULTS

S. salivarius SN (P-type 226) produces a heat-labile muramidase. S. salivarius 20P3 (P-type 677) produces the 2315 Da lantibiotic salivaricin A and S. salivarius K12 (P-type 777) produces two lantibiotics; salivaricin A2 (2368 Da) and salivaricin B (2733 Da).

INTERPRETATION & CONCLUSION

The P-type 777 S. salivarius strain produced salivaricin A2 and salivaricin B. The combined production of two anti-S. pyogenes BLIS activities by this strain indicates that it could be adopted as a colonizing strain in bacterial interference trials.

Alkalinization of intra-cuff lidocaine and use of gel lubrication protect against tracheal tube-induced emergence phenomena

BACKGROUND

We sought to determine the benefits of using alkalinized lidocaine 40 mg to fill the cuff of a tracheal tube (ETT) in combination with water-soluble gel lubrication to prevent post-intubation sore throat.

METHODS

The work included an in vitro study of the diffusion of alkalinized lidocaine solution through the low-pressure, high-volume cuff of an ETT. We also performed a randomized controlled study (n=20 patients in each group) that included a group who received an alkalinized lidocaine-filled ETT cuff with lubrication of the tube using water-soluble gel (Group G), and two control groups who received an alkalinized lidocaine-filled cuff with ETT lubrication with water (Group W) or an air-filled cuff with ETT lubrication with water (Group C).

RESULTS

Water-soluble gel lubrication (Group G) produced a lower incidence of sore throat during the 24-h post-extubation period than lubrication with water alone in the cuffs filled with alkalinized lidocaine (Group W), and compared with the air control group. The ability of lidocaine to pass through the cuff of an ETT when water-soluble gel and/or water alone was used as a lubricant was similar, as determined by lidocaine plasma concentrations (C(max) 45 ng x ml(-1)). Cough and restlessness before tracheal extubation were decreased in patients with the alkalinized lidocaine-filled cuffs compared with the air-filled cuffs. After extubation, nausea, vomiting, dysphonia and hoarseness were greater for patients with air-filled cuffs compared with the lidocaine-filled cuffs. No significant difference between the groups was recorded in arterial blood pressure and heart rate. In vitro data suggest that the lower the NaHCO(3) injection volume, the greater the release of lidocaine across a low-pressure, high-volume cuff.

CONCLUSIONS

These data show benefits of using an alkalinized lidocaine-filled ETT cuff in combination with water-soluble gel lubrication in preventing post-intubation sore throat.

Efficacy of cefpodoxime in the prophylaxis of recurrent pharyngotonsillitis

BACKGROUND

Recurrent acute pharyngotonsillitis remains a common illness in children and young adults and can lead to serious complications if not treated. cefpodoxime proxetil is a second-generation oral cephalosporin, which shows potent antibacterial activity against both Gram-positive and Gram-negative bacteria and high stability in the presence of beta-lactamases.

OBJECTIVE

We aimed to evaluate the efficacy of second-generation cephalosporins in the prophylaxis of recurrent pharyngotonsillitis in children.

METHODS

A total of 180 children aged between 4 and 14 years with recurrent pharyngotonsillitis were randomized to receive either cefpodoxime proxetil (100 mg twice a day, 6 days a month for 6 months) or placebo (at the same dosage).

RESULTS AND CONCLUSIONS

Our results show that treatment with cefpodoxime proxetil may be effective in reducing symptoms of recurrent pharyngotonsillitis and preventing recurrences without causing side effects or developing bacterial resistance.

Immune response to group A streptococcal C5a peptidase in children: implications for vaccine development

The group A streptococcal C5a peptidase (SCPA) is a major surface virulence protein that facilitates the establishment of local infection by group A streptococci (GAS). We measured the human immune response to SCPA, using a standardized indirect enzyme-linked immunosorbent assay. Paired acute and convalescent serum samples from children with GAS-associated pharyngitis were assayed, and a strong immune response to SCPA was demonstrated that was independent of the infecting M type and the age of the patient. Western blot analysis of bacterial extracts revealed that all tested M types expressed SCPA. The immune response to SCPA correlated with the anti-streptolysin O and anti-DNase B responses. These data confirm the immunogenicity of SCPA in humans. Previous knowledge of SPCA's role in virulence, its highly conserved nature, and the results of mouse protection studies make SCPA an ideal vaccine candidate for the prevention of GAS disease.

[Topical methylprednisolone vs lidocaïne for the prevention of postoperative sore throat]

OBJECTIVE

We assessed the efficacy of topical methylprednisolone or lidocaine for prevention of postoperative sore throat.

STUDY DESIGN

Randomised, prospective in single blind study.

PATIENTS AND METHODS

Sixty patients ASA 1 or 2 undergoing tracheal intubation for dental surgery received before intubation either topical lidocaine 5% (15 puffs) or aerosolized methylprednisolone (80 mg). Postoperative pain was assessed by the patients using a VAS and a specific scoring system for sore throat, cough and hoarseness. Evaluations were performed immediately after emergence from anaesthesia, 1 h later, at time of the first postoperative drink, at time of the first postoperative meal and 24 h after surgery.

RESULTS

Patients receiving methylprednisolone showed slightly better scores for sore throat and cough 1 h after surgery.

CONCLUSION

Topical methylprednisolone may therefore be a useful adjuvant in the prevention of sore throat after intubation.

Epidemiology and virulence gene expression of intracellular group A streptococci in tonsils of recurrently infected adults

Intracellularly persistent group A streptococci (GAS, Streptococcus pyogenes) have been associated with recurrent tonsillopharyngitis and antibiotic treatment failure. As a supplementation of the published in vitro data, conventional bacteriology and molecular epidemiology was performed on material from 29 adult patients of a German army hospital with anamnestic signs of recurrent tonsillopharyngitis. Pre-surgery tonsil swabs and the surgically removed tonsils were examined with respect to growth of aerobic bacteria in absence and presence of antibiotics with exclusively extracellular activity. Under such antibiotic selection, Staphylococcus aureus and GAS were cultured from specimens of 13 and 3 patients, respectively. In every material GAS-positive by culture methods, the intracellular location of the penicillin-susceptible GAS isolates was confirmed by immunohistologic examination of tonsillar sections using a GAS-specific IgG antibody. The three intracellular GAS isolates were typed by emm gene sequencing and could be associated to types M6 and M49 (two isolates). The bacteria were serially passaged on sheep blood agar, and semiquantitative mRNA analysis from virulence genes was performed using bacteria of the 4th and 25th passage after isolation. An M-type-specific pattern of virulence gene expression and different gene expression levels in relation to the passage number were observed.

Bacterial replacement therapy: adapting 'germ warfare' to infection prevention

The individual bacterial members of our indigeneous microbiota are actively engaged in an on-going battle to prevent colonisation and overgrowth of their terrain by competing microbes, some of which might have pathogenic potential for the host. Humans have long attempted to intervene in these bacterial interactions. Ingestion of probiotic bacteria, particularly lactobacilli, is commonly practiced to promote well-balanced intestinal microflora. As bacterial resistance to antimicrobials has increased, so too has research into colonisation of human tissues with specific effector strains capable of out-competing known bacterial pathogens. Recent progress is particularly evident in the application of avirulent Streptococcus mutans to the control of dental caries, alpha hemolytic streptococci to reduction of otitis media recurrences and Streptococcus salivarius to streptococcal pharyngitis prevention.

Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery

OBJECT

The authors' goal was to determine whether the incidence of postoperative sore throat, hoarseness, and dysphagia associated with anterior spine surgery is reduced by maintaining endotracheal tube cuff pressure (ETCP) at 20 mm Hg during the period of neck retraction.

METHODS

Fifty-one patients scheduled for anterior cervical spine surgery were enrolled. After intubation, ETCP was adjusted to 20 mm Hg in all patients. Following placement of neck retractors, ETCP was measured. Patients were randomized to a control (no adjustment) or treatment group (ETCP adjusted to 20 mm Hg). A blinded observer questioned the patients about the presence of sore throat, dysphagia, and hoarseness at 1 hour, 24 hours, and 1 week postoperatively. No differences between groups at 1 hour postoperatively were demonstrated. At 24 hours, 51% of patients in the treatment group complained of sore throat compared with 74% of control patients (p < 0.05). Sixty-five percent of the women experienced sore throat compared with 35% of the men (p < 0.05). At 24 hours, longer retraction time correlated with development of dysphagia (p < 0.05, r2 = 0.61). At 24 hours, hoarseness was present in 65% of women and 20% of men (p < 0.05).

CONCLUSIONS

The results of this study suggest the following three predictors of postoperative throat discomfort following anterior cervical spine surgery in which neck retraction is performed: increased ETCP during neck retraction (sore throat), neck retraction time (dysphagia), and female sex (sore throat and hoarseness). The simple maneuver of decreasing ETCP to 20 mm Hg may be helpful in improving patient comfort following anterior cervical spine surgery.

Laryngeal mask cuff inflation at removal does not affect early postoperative laryngopharyngeal morbidity

PURPOSE

We assessed the effect of cuff inflation of the laryngeal mask airway at removal on sore throat, pharyngeal morbidity and airway complications.

METHODS

In a prospective randomized trial, we used a standardized technique of anesthesia and of laryngeal mask insertion in 126 consecutive day-case patients. Postoperatively, on eye opening, the masks were removed either inflated (Group A) or deflated (Group B) and examined for blood by a blinded observer. Episodes of coughing, gagging, laryngospasm, hiccups and retching, and symptoms of sore throat and hoarseness were recorded by the same observer.

RESULTS

Demographics were similar. Bloodstaining occurred in 21% of patients in Group A (n = 63) vs 13% in Group B (n = 63; P = 0.23); the incidence of sore throat was identical (19%). Group A experienced more hoarseness (22% vs 9%; P = 0.05). Overall airway complications did not differ between groups (19% vs 11%; P = 0.21).

CONCLUSION

We conclude that removal of the laryngeal mask airway inflated does not reduce the incidence of sore throat, pharyngeal morbidity or airway complications.