Comparison of adding magnesium sulfate, dexmedetomidine and ondansetron to lidocaine for gargling before laryngoscopy and endotracheal intubation to prevent sore throat: a randomized clinical trial

Preoperative nebulised lidocaine for children with mild symptoms of upper respiratory tract infections: A randomised controlled trial

Nebulised lidocaine was previously used in infants and children undergoing flexible bronchoscopy and was safe and beneficial. The aim of this randomised controlled trial was to assess the impact of preoperative nebulised lidocaine on the incidence of perioperative respiratory adverse events in children aged one to five years proposed for ilioinguinal ambulatory surgery while having mild symptoms of upper respiratory tract infection. Patients were randomly allocated to one of the two groups of the study: Group L (lidocaine) received 4 mg/kg of nebulised lidocaine 2% (0.2 ml/kg), and Group P (placebo) received 0.2 ml/kg of normal saline nebulisation, 30 minutes before anaesthesia. Nebulised lidocaine reduced the risk of bronchospasm, with p = 0.003 and a risk ratio (RR) = 0.326 [0.140-0.760], and prolonged oxygen support postoperatively, with p = 0.004 and RR = 0.222 [0.067-0.732]. It also reduced the risk of hospitalisation, with p = 0.001 and RR = 0.138 [0.033-0.577]. No side effects for nebulised lidocaine 2% were noted. Preoperative nebulised lidocaine seems to be a safe and efficient premedication for children with upper respiratory tract infections.

Postoperative Sore Throat After Tracheal Intubation: An Updated Narrative Review and Call for Action

Background

Postoperative sore throat (POST) represents a common airway complication closely related to endotracheal tube (ETT), exhibiting a higher incidence following tracheal intubation compared to other airway apparatuses. Nevertheless, considering its mild and self-limiting character, POST is often overlooked. This study provides an updated narrative review on the latest perspectives regarding POST, including a comprehensive summary of its mechanisms, risk factors, clinical assessment methods, prevention and treatment strategies. Additionally, directions for future research are proposed.

Methods

A comprehensive search was conducted using keywords such as "postoperative sore throat" and "tracheal intubation" in PubMed, Web of Science, and Cochrane databases from their inception to October 2024. Two groups of reviewers independently performed data search and cleaning after standard training. To address gaps in knowledge or potential biases, the literature was thoroughly screened based on established criteria, and a comprehensive synthesis, analysis, and summary of the relevant findings was conducted.

Results

The precise cause of POST remains unknown, and its potential mechanism is believed to involve secondary inflammation triggered by irritation, mechanical trauma, tracheal intubation, and cuff inflation. The risk factors for POST encompass preoperative, intraoperative, and postoperative factors. Currently, effective prevention methods for POST consist of pharmacological interventions, non-pharmacological interventions, and traditional Chinese medicine (TCM) therapy. In terms of pharmacological interventions, non-steroidal anti-inflammatory drugs (NSAIDs) and steroid can effectively prevent the occurrence of POST through their anti-inflammatory properties. However, given the unavoidable side effects of medications, non-pharmacological interventions and non-invasive methods may offer greater benefits for POST and related hoarseness. For example, proficient and gentle intubation techniques can prevent mechanical injury caused by repeated intubation attempts. Currently, several studies have demonstrated the potential role of TCM in managing POST. Nonetheless, the precise mechanisms underlying its effects remain to be elucidated, and the available clinical evidence is still limited.

Conclusion

Given that POST is prevalent following tracheal intubation but frequently overlooked, we advocate heightened awareness of its occurrence and progression, and recommend integrating the prevention and management of POST into routine clinical practice.

Comparison of Preoperative Topical Magnesium Sulfate Spraying and Magnesium Sulfate Gargling for the Prevention of Postoperative Sore Throat after Tracheal Intubation: A Randomized, Double-Blind, Non-Inferiority Trial

Background and Aim

Postoperative sore throat is a common complication following endotracheal intubation, which can significantly affect patient comfort and recovery. The purpose of this study is that compares the efficacy of preoperative topical magnesium sulfate spraying with that of magnesium sulfate gargling aimed at preventing postoperative sore throat.

Patients and Methods

236 Participants were randomly allocated to either the magnesium sulfate spray group (Group A) or the magnesium sulfate gargle group (Group B), with 118 patients in each group. In Group A, during intubation under direct laryngoscopy, 15 mg/kg of magnesium sulfate was sprayed using a single-use otorhinolaryngology anesthesia sprayer onto the pharyngeal mucosa and posterior pharyngeal wall near the glottis. In Group B, gargling with 20 mg/kg of magnesium sulfate for 30 seconds 15 minutes before surgery. The primary outcome measure was the total incidence of postoperative sore throat within 48 hours, with a non-inferiority margin of 0.15.

Results

The upper limit of the 95% confidence interval (CI) for the difference in the total incidence of POST between Group A and Group B was below the non-inferiority margin (0.15) (non-inferiority P<0.001). The upper limits of the 95% CI for the differences in the incidence rates of POST between Group A and Group B at time points T1- T6 were all below the non-inferiority margin (all non-inferiority P<0.001). The total incidence of POST (P=0.046) and the incidence of POST at T2-T4 (all P<0.001) in group A were lower than those in group B. The analysis of the individual effects between groups indicated significant differences in POST NRS scores at T1 (P=0.034) and T2-T4 (all P<0.001).

Conclusion

The local spray of magnesium sulfate on the throat before surgery to prevent postoperative sore throat is not inferior to, and may even be superior to, gargling with magnesium sulfate.

Magnesium Sulfate and Its Versatility in Anesthesia: A Comprehensive Review

In the field of general anesthesia, magnesium sulfate (MgSO4) has become a valuable adjunct because it provides a range of benefits that enhance and optimize conventional aesthetic procedures. This review highlights the various intra-anesthetic benefits of MgSO4 while examining its complex function in the treatment using anesthesia. Magnesium inhibits the release of acetylcholine at the motor endplate and blocks calcium channels at presynaptic nerve terminals. This reduces the amplitude of endplate potential and the excitability of muscle fibers, which increases the potency of a neuromuscular blockade by nondepolarizing neuromuscular blockers. This activity may lessen the need for primary muscle relaxants. Moreover, its capacity to potentially reduce the total amount of main aesthetic agents needed emphasizes its function in maximizing anesthesia dosage, ensuring sufficient depth while perhaps potentially reducing adverse effects linked with increased dosages. MgSO4's adaptable qualities present a viable path for improving anesthetic outcomes, possibly improving patient safety and improving surgical results.