Prevalence, risk factors, and optimized management of moderate-to-severe thirst in the post-anesthesia care unit

The Effect of Thirst, Dry Mouth, Mouth Taste, and Bad Mouth Odor in Laparoscopic Cholecystectomy Patients: A Randomized Controlled Trial

PURPOSE

This study aimed to determine the effect of menthol ice application on thirst, dry mouth, mouth taste, and bad mouth odor in patients who underwent laparoscopic cholecystectomy in the postoperative period.

DESIGN

The study was conducted as a randomized controlled trial with an experimental design.

METHODS

The study sample consisted of 90 patients who underwent laparoscopic cholecystectomy and met the inclusion criteria. Patients were divided into three groups by randomization program. Patients in the menthol ice and ice popsicle (ice prepared with drinking water only) group were administered menthol ice/ice popsicle (10 mL) twice at 20 minutes intervals. Patients in the control group did not receive any intervention. Routine practices of the clinic were performed by the nurses of the general surgery clinic. Postoperative thirst intensity, severity of dry mouth, bad taste, and bad odor in the mouth were evaluated at 0, 20, and 40 minutes.

FINDINGS

No statistically significant difference was found between the sociodemographic and clinical characteristics of the patients in the control group, menthol ice group, and ice popsicle group (P > .05). A statistically significant difference was found between the 3 groups in terms of thirst intensity and severity of dry mouth at times at the 20th and 40th minutes after the application (P < .01). We found a statistically significant difference between the bad taste and bad odor sensation scores of the patients in the control and intervention groups at the 20th and 40th minutes after the application (P < .05).

CONCLUSIONS

The study concluded that menthol ice and ice popsicle application are effective strategies to reduce the intensity of thirst, severity of dry mouth, bad taste, and bad odor in postoperative patients.

Effects of cold spray on thirst, frequency of oral care, and pain of general surgery intensive care unit patients

This study aims to investigate the effects of intraoral cold water spray on thirst, frequency of oral care and postoperative period pain at surgical incision site in patients having abdominal surgery. The study was carried out as a randomized controlled trial, registered under Clinical Trial Number: NCT05940818. The study involved 110 participants, divided equally into two groups (n = 55): the experimental group and the control group. Data were collected using patient information form, NRS, Intensive Care Oral Care Frequency Assessment Scale (ICOCFAS) and Visual Analog Scale (VAS). The severity of thirst at 1st, 8th, 16th h of post-operative period (p < 0.01) and the frequency of oral care application at 16th h were statistically significantly decreased in the experimental group when compared to the control group (p < 0.01).There wasn't statistically significant difference between the patients in the experimental and control groups in terms of pain at surgical incision site (p > 0.05). The patient's thirst and need for frequent oral care in the postoperative period were reduced by the application of a cold water spray. In patients undergoing abdominal surgery, the use of cold water spray application may be recommended to reduce thirst and the need for frequency of oral care application.

Timing of early water intake post-general anaesthesia: a systematic review and meta-analysis

BACKGROUND

Early water intake has gained widespread attention considering enhanced recovery after surgery (ERAS). In the present systematic evaluation and meta-analysis, we assessed the effects of early water intake on the incidence of vomiting and aspiration in adult patients who received general anaesthesia on regaining consciousness during the resuscitation period.

OBJECTIVE

To systematically analyse the results of randomised controlled trials on early postoperative water intake in patients who underwent different types of surgery under general anaesthesia, both at home and abroad, to further explore the safety and application of early water intake and provide an evidence-based foundation for clinical application.

DESIGN

Systematic review and meta-analysis.

METHODS

To perform the systematic evaluation and meta-analysis, we searched the Web of Science, CINAHL, Embase, PubMed, Cochrane Library, Sinomed, China National Knowledge Infrastructure (CNKI), Wanfang, and Vipshop databases to identify randomised controlled trial studies on early water intake in adult patients who received general anaesthesia.

RESULTS

Herein, we included 10 publications with a total sample size of 5131 patients. Based on statistical analysis, there was no statistically significant difference in the incidence of vomiting (odds ratio [OR] = 0.81; 95% confidence interval [CI] [0.58-1.12]; p = 0.20; I-squared [I2] = 0%) and aspiration (OR = 0.78; 95%CI [0.45-1.37]; p = 0.40; I2 = 0%) between the two groups of patients on regaining consciousness post-general anaesthesia.

CONCLUSION

Based on the available evidence, early water intake after regaining consciousness post-anaesthesia did not increase the incidence of adverse complications when compared with traditional postoperative water abstinence. Early water intake could effectively improve patient thirst and facilitate the recovery of gastrointestinal function.

Effect of modified endotracheal intubation protocol combined with early oral intake on postoperative recovery quality in thyroid and parathyroid surgery at a tertiary hospital in China: a 2x2 factorial randomised controlled trial protocol

INTRODUCTION

Early oral intake (EOI) is supposed to be safe and beneficial to patients' recovery. However, the optimal timing of resuming oral intake has not been validated in thyroid and parathyroid surgery. On the other hand, a modified electromyography (EMG) endotracheal intubation protocol with real-time EMG monitoring during video laryngoscope/fibrescope-guided intubation was presented in 2022, which was regarded as an effective way to shorten the intubation time. We aimed to use Quality of Recovery-15 (QoR-15) questionnaire to compare the efficacy and safety of different EMG endotracheal intubation protocols combined with different postoperative oral intake strategy in thyroid and parathyroid surgery.

METHODS AND ANALYSIS

This prospective, single-centre, 2×2 factorial, randomised controlled trial will be conducted in the Peking Union Medical College Hospital (PUMCH), China. We plan to recruit 200 adult patients who will receive thyroid or parathyroid surgery under intraoperative nerve monitoring. Eligible patients will be randomly divided into two groups, which will receive either the modified intubation protocol (M group) or conventional intubation process (C group). After patients enter postanaesthesia care unit and Steward scores ≥4, they will be randomly divided into two groups again, which will receive early resumption of oral intake (E group) or delayed resumption of oral intake (D group). Patients will be followed up during hospitalisation and the QoR-15 questionnaire will be administered to compare the quality of recovery on the day before surgery (T0), the first day after surgery (T1) and the day of discharge (T2). The primary outcome is the QoR-15 scores at T1.

ETHICS AND DISSEMINATION

The study protocol has been approved by the Research Ethics Committee of Peking Union Medical College Hospital (IRB K-2501). All participants will give written informed consent before participation. The results from this study will be shared at conferences and disseminated in international journals.

TRIAL REGISTRATION NUMBER

NCT05624463.

Origins of thirstiness sensation and current food solutions

The sensation of thirstiness is the desire to drink water. In certain situations, the ingestion of liquid water can be restricted. As a result, thirstiness is not relieved, resulting in an uncomfortable and distressing situation. The present review describes thirstiness and hydration, the food products and beverages that cause thirstiness, and the beverages and food products currently available to quench thirstiness in individuals with restricted access to liquid ingestion. It also discusses how to measure the effectiveness of calming thirstiness. To diminish thirstiness distress, different alternatives to liquids are proposed. Individuals with swallowing disorders are given thickened water, individuals with restricted water ingestion are given ice cubes or ice popsicles of different flavors, and sportspeople are given energy gels. However, current beverage solutions seem not to relieve thirst fully, although some stimuli like iced water, flavors (especially lemon and mint), or acids seem to work better than plain stimuli and could be added to existing products. Therefore, there is still a need to incorporate these strategies into beverage and food formulations and to test their effectiveness.

Effects of menthol on thirst during surgery patients fasting: A systematic review and meta-analysis of randomized controlled studies

AIMS

We aim to analyse the effect of menthol on thirst intensity and thirst comfort in surgical patients.

BACKGROUND

Menthol has achieved good results in quenching thirst in patients in intensive care units, but its safety and reliability in perioperative fasting patients are unknown.

DESIGN

A systematic review with meta-analysis of intervention studies was performed.

DATA SOURCES

We used Chinese and English databases from their dates of inception to May 2022. Literature was retrieved from PubMed, Web of Science, Cochrane Library, Embase, CINHAL, SinoMed, CNKI, Wanfang and VIP database.

REVIEW METHODS

Two reviewers independently examined the records according to the eligibility criteria and extracted the data of each included study.

RESULTS

A total of seven studies were identified in this review, which included 537 surgical patients. Overall, menthol reduced thirst intensity in surgical patients and decreased thirst discomfort. Further subgroup analysis revealed that the menthol intervention significantly improved thirst intensity in surgical patients during preoperative and postoperative fasting periods. The Egger's tests showed no significant bias (p = 0.113 and 0.553, thirst intensity and thirst discomfort, respectively).

CONCLUSION

Menthol intervention effectively improved thirst intensity and thirst discomfort during fasting in surgical patients, but more large-scale, multicentre randomized controlled trials are required to confirm these findings further.

Incidence and Associated Factors of Postoperative Undesirable Anesthetic Outcomes Among Surgical Patients at Referral Hospitals in Amhara Region, Ethiopia: A Multi-Center Study

Background

Patients undergoing surgery frequently experience unfavorable anesthetic outcomes. They may have an impact on body systems and result in more serious postoperative morbidities. This study was conducted to determine the incidence of postoperative undesirable anesthetic outcomes among surgical patients at referral hospitals in Amhara region, Ethiopia.

Methods

A total of 412 patients, who underwent surgical procedures between August 1 and October 30 of 2022, were included in this study. The Leiden Perioperative Care Patient Satisfaction Questionnaire's (LPPSq) dimension "discomfort and needs" was used to collect data on the first postoperative day. Data entry and analysis were performed using SPSS version 20. To assess how risk factors affected the outcome variable, logistic regression analysis was utilized. In multivariable logistic regression analysis, a variable with a P-value of less than 0.05 was statistically considered as significant.

Results

The proportion of those who had "at least a little bit" of unfavorable outcomes was calculated to estimate their overall prevalence, and the prevalence of those who had "more than moderate" levels of unfavorable outcomes was determined to appreciate how severe these outcomes were. The percentages of postoperative pain, the most common undesired result, for "at least a little bit" and "more than moderate" were 87.7% and 32.3%, respectively. In this study, postoperative cold was the least prevalent (51.4%) undesirable anesthetic outcome. The remaining undesirable postoperative outcomes were reported less frequently.

Conclusion and Recommendation

Undesirable postoperative anesthetic outcomes were still common. The most frequent unfavorable result was postoperative pain. Adequate postoperative patient follow-up and quality service are paramount.

Penehyclidine hydrochloride for treating postoperative nausea and vomiting after laparoscopic bariatric surgery: a double-blinded randomized controlled trial

BACKGROUND

Postoperative nausea and vomiting (PONV) is a common and distressing complication of laparoscopic bariatric surgery (LBS). Penehyclidine hydrochloride has been reported to be effective in preventing PONV. Considering the potential preventive effects of penehyclidine against PONV, we hypothesized that intravenous infusion of penehyclidine may alleviate PONV within the first 48 h in patients scheduled for LBS.

METHODS

Patients who underwent LBS were randomly assigned (1:2) to receive saline (Control group, n = 113) or a single intravenous dose of penehyclidine 0.5 mg (PHC group, n = 221). The primary outcome was incidence of PONV within the first 48 h postoperatively. Secondary endpoints included severity of PONV, need for rescue antiemetic therapy, volume of water intake, and time to first flatus.

RESULTS

PONV occurred in 159 (48%) patients within the first 48 h postoperatively, including 51% in the Control group and 46% in the PHC group. There was no significant difference in the incidence or severity of PONV between the two groups (P > 0.05). Within the first 24 h and 24-48 h, no significant difference was found in incidence or severity of PONV, postoperative nausea, postoperative vomiting, need for rescue antiemetic therapy, or volume of water intake (P > 0.05). Kaplan-Meier curves showed that penehyclidine was significantly associated with a prolonged time to first flatus (median onset time: 22 h vs. 21 h, P = 0.036).

CONCLUSIONS

Penehyclidine did not decrease incidence and severity of PONV in patients undergoing LBS. However, a single intravenous dose of penehyclidine (0.5 mg) was associated with a slightly prolonged time to first flatus.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2100052418, http://www.chictr.org.cn/showprojen.aspx?proj=134893 , date of registration: 25/10/2021).

The effectiveness of cold oral stimuli in quenching postoperative thirst: A systematic review and meta-analysis

OBJECTIVE

To examine the effectiveness of cold oral stimuli in quenching postoperative thirst in patients undergoing surgery.

DESIGN

A systematic review and meta-analysis of interventional studies.

SETTING

Postoperative care units.

METHODS

Seven electronic databases (Medline, Scopus, Web of Science, PubMed, CINHAL, PsycInfo, and EMBASE) were systematically searched from their inception to January 12, 2022. The Cochrane Handbook for Systematic Reviews of Interventions was followed. Two researchers examined the study quality using the Cochrane risk of bias tools. A meta-analysis with a subgroup analysis was performed. Sensitivity analysis, funnel plots and Egger's test were used to examine publication bias.

MAIN OUTCOME MEASURE

A thirst intensity score was used to rate postoperative thirst.

RESULTS

Data were collected from 11 interventional studies for this systematic review. Eight studies underwent a meta-analysis with a total of 1504 patients. Our meta-analysis showed that the thirst intensity scores decreased in the experimental groups by 1.42 points (95% confidence interval: -2.162 to -0.684) more than those of the control groups. Subgroup analysis indicated that Asian patients and age were two factors that moderated the thirst intensity score after applying cold oral stimuli.

CONCLUSION

Cold oral stimuli were effective in mitigating postoperative thirst. Ice products such as ice cubes, or ice chips are easily available in postoperative units. When applying cold oral stimuli, health professionals should be aware of that in Asian and older patients. Cultural acceptance and physiological degeneration, respectively, may influence the thirst ratings. Future research should investigate various factors underlying the perioperative period. Network meta-analysis can be used to examine multiple strategies for thirst management.

Use of Transcutaneous Electrical Nerve Stimulation to Alleviate Thirst After Surgery: A Randomized Controlled Trial

PURPOSE

This prospective study investigated the preventive effect of transcutaneous electrical nerve stimulation (TENS) for postoperative thirst.

DESIGN

This experimental study was conducted with the CONSORT checklist.

METHODS

A total of 105 surgical patients who received general anesthesia were recruited from a medical center. Each patient was randomly assigned to the experimental group (n = 53; 20 min of TENS) or the control group (n = 52; routine care). In each group, oral moisture wetness was measured at 1 min, 20 min, and 50 min post-surgery. Descriptive and inferential statistics (Chi-square test, t test, one-way ANOVA, and generalized estimating equation (GEE) regression analysis) were performed to assess the proposed relationships.

FINDINGS

The two groups showed similar characteristics at baseline. The oral moisture wetness was significantly higher in the experimental group than the control group at each post-surgery assessment time (all P < .001). The GEE results showed that patients in the experimental group reported more oral moisture wetness than patients in the control group.

CONCLUSIONS

This study demonstrated that TENS can reduce thirst reported by patients after general anesthesia. Thus, this method may have clinical applications for managing postoperative thirst.

Effect of high-flow nasal cannula therapy on thirst sensation and dry mouth after extubation: A single-centre prospective cohort study

OBJECTIVES

Little is known regarding the association between the type of oxygen therapy and thirst sensation after extubation. This study aimed to assess the effect of post-extubation high-flow nasal cannula on thirst.

RESEARCH METHODOLOGY/DESIGN AND SETTING

This single-centre prospective cohort study included 100 ventilated patients. After extubation, patients received either high-flow nasal cannula (n = 19) or conventional oxygen therapy (n = 81). Thirst intensity was evaluated by a self-reporting numeric rating scale, and dry mouth was defined objectively using an oral moisture checking device.

MAIN OUTCOME MEASURES

The primary outcome was thirst intensity 24 hours post-extubation. Secondary outcomes were thirst intensity at 4 hours post-extubation and prevalence of dry mouth at 4 hours and 24 hours post-extubation.

RESULTS

At 24 hours post-extubation, the median (interquartile range) thirst intensity was 5 (1, 7) in the high-flow nasal cannula group and 5 (4, 6) in the conventional oxygen group. After adjustment, high-flow nasal cannula therapy was significantly associated with lower thirst intensity (adjusted odds ratio, 0.14; 95 % confidence interval (CI) 0.04-0.49; P = 0.002). At 4 hours post-extubation, high-flow nasal cannula was also associated with lower thirst intensity (adjusted odds ratio, 0.19; 95 % CI, 0.06-0.60; P = 0.005). The number of patients with dry mouth was not significantly different between the two groups (high-flow vs conventional oxygen therapy, 42.1 % vs 30.9 % [4 hours after extubation]; 47.4 % vs 34.6 % [24 hours after extubation]).

CONCLUSIONS

High-flow nasal cannula therapy was associated with lower thirst intensity than conventional oxygen therapy following extubation. However, there was no significant difference in the prevalence of dry mouth.

The Practical Effect of Action Intervention Strategy Combined Based on Surgical and Psychological Factors

This study mainly analyzes the related surgical and psychological factors that cause the change of thirst degree after gastrointestinal surgery, and observes the practical effect of action intervention strategy combined with the two factors on reducing postoperative thirst degree. Based on this, the clinical data of 87 patients who underwent gastrointestinal tumor resection in our hospital from January 2020 to January 2021 is retrospectively analyzed. The degree of thirst is evaluated by the visual analogue scale (VAS) and the subjects are divided into three groups: a mild group (n = 29), a moderate group (n = 35), and a severe group (n = 23), and their psychological and surgical indicators are compared and analyzed. The results show that the thirst degree and light comfort of mouth in the study group are better than those in the control group at 2 h after surgery, and there is no significant difference when compared to 6 h after surgery, but the thirst degree and oral discomfort in the control group at 6 h after surgery are significantly higher than those in the study group at 2 h after surgery. It is suggested that an action research intervention strategy with a high practical effect can effectively reduce postoperative thirst and oral discomfort.

Thirst Relief Effect of 0.75% Citric Acid Spray During the Anesthesia Recovery Period: A Randomized Controlled Trial

PURPOSE

Postoperative thirst is a common clinical issue. The discomfort caused by thirst during the perioperative period is strong and significant. Postoperative thirst is associated with emotional changes, giving rise to a series of adverse psychological and physical problems to patients. This study aimed to explore the effect of 0.75% citric acid spray on thirst relief during the anesthesia recovery period in China.

DESIGN

A randomized controlled trial was conducted on subjects immediately after the removal of the endotracheal tube in a postanesthesia care unit.

METHODS

A total of 112 patients with TI scores ≥3 on 0-10 numeric rating scale were randomized to the intervention group (0.75% citric acid spray group; n = 56) or control group (cool water spray; n = 56) by computerized randomization. Thirst assessment was performed before and 5 minutes after the intervention. Five minutes after the intervention, if the TI score was still ≥3 points, the spray would be added and the thirst assessment would be performed again until the TI score was <3 points. The onset time, duration time, and the number of additional sprays within 20 minutes was recorded.

FINDINGS

Five minutes after the intervention, the thirst intensity score of the 0.75% citric acid spray group decreased from 5.57 ± 1.35 to 3.09 ± 1.20. The onset and duration times were 0.77 ± 0.47 min and 4.41 ± 2.59 min, respectively, and the number of spray additions in 20 min was 1.09 ± 0.92. The thirst intensity score of the cool water spray group decreased from 5.29 ± 1.52 to 3.73 ± 1.54. The onset and duration time were 0.84 ± 0.42 min and 2.77 ± 1.80 min, respectively, and the number of spray additions was 1.91 ± 1.24. No incidence of adverse events, including choking, aspiration, and allergies occurred.

CONCLUSION

For thirsty patients during the anesthesia recovery period, the spray method is safe and has fewer side effects, including choking, aspiration, and allergies. Thus, 0.75% citric acid spray and cool water spray are both safe and effective; however, the 0.75% citric acid spray has a better thirst relief effect that lasts longer than the cool water spray.

Development and validation of a new nursing diagnosis: Perioperative thirst

PURPOSE

To develop and validate the content of the nursing diagnosis proposal for perioperative thirst.

METHODS

A content analysis by 34 judges. An online Delphi panel was used in one round, evaluating criteria of relevance, clarity and precision. Wilcoxon's one-tailed test was used and the content validity index to maintain the item was set to 0.80.

FINDINGS

The content validity index in relation to the evaluated items reached levels between 0.87-1.00. The final components of the diagnosis proposal included the following items as defining characteristics: dry mouth, dry throat, dry lips, thick saliva, thick tongue, constant swallowing of saliva, desire to drink water, bad taste in the mouth, and caregiver's report. Related factors are as follows: pre- and postoperative fasting, oral breathing, dehydration, hypovolemia, insensitive loss of hydration by breathing, dry mouth, habit of drinking water, high room temperature. Associated conditions: intubation, use of muscarinic and nicotinic anticholinergics and water restriction.

CONCLUSIONS

All components of the nursing diagnosis were validated in relation to relevance, clarity, and accuracy, demonstrating high levels of agreement between experts. Qualitative observations were found to be fundamental for both combining and excluding some items.

IMPLICATIONS FOR NURSING PRACTICE

Improvement of refinement and clarity levels of this nursing diagnosis proposal aiding its inclusion in the NANDA International taxonomy and thus enabling greater understanding of the phenomenon of thirst in surgical patients. This study helps to explain and facilitate the identification of defining characteristics, related factors, and associated conditions for nurses, nursing students, and researchers on this subject.