1
|
Calabrese M, Arlotta G, Antoniucci ME, Montini L, Giannarelli D, Taccheri T, Corsi F, De Paulis S, Scapigliati A, Bevilacqua F, Vargas J, Corrado M, Pavone N, Bruno P, Massetti M, Cavaliere F. Flurbiprofen in the subglottic space to prevent postoperative sore throat after cardiac surgery: A randomized double-blind study. J Clin Anesth 2024; 95:111418. [PMID: 38430636 DOI: 10.1016/j.jclinane.2024.111418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/29/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024]
Abstract
STUDY OBJECTIVE Postoperative sore throat (POST) and hoarseness are common complications of tracheal intubation. This study aims to evaluate the efficacy of flurbiprofen administered through the subglottic port of tracheal tubes to prevent POST after cardiac surgery. DESIGN Single-center, prospective, randomized, double-blind, placebo-controlled trial. SETTING Tertiary Care Referral University Hospital (Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome). PATIENTS Included 71 patients undergoing for elective cardiac surgery. Inclusion criteria were (a) age between 50 and 75 years, (b) NYHA class I or II, (c) surgery for myocardial revascularization or valve repair or replacement under cardiopulmonary bypass. INTERVENTION Patients were double blind randomized to receive flurbiprofen or saline in the subglottic port of the endotracheal tube (groups F and P). The solution was injected ten minutes after tracheal tube placement, ten minutes after ICU admission and ten minutes before tracheal tube removal. MEASUREMENTS The primary outcome was to assess the effect of topical flurbiprofen administered through the subglottic port of the tracheal tube to prevent post-operative sore throat (POST). The secondary outcomes were the presence of hoarseness safety and patient's subjective satisfaction with their recovery. We did not report any exploratory outcomes. MAIN RESULTS We analyzed 68 patients, 34 patients in each group. In group F, two patients complained of POST and hoarseness (5.9%), while all controls did. The two groups significantly differed in the severity scores (VAS and TPS for sore throat and HOAR for hoarseness) at all time points. In group P, patients reported mild to moderate symptoms that significantly improved or disappeared 36 h after tracheal tube removal. According to the multivariable model, hoarseness affected women less than men, in the control group (p = 0.002). None of the patients in either group reported any adverse effects. CONCLUSIONS Repeated administration of flurbiprofen through the subglottic port of tracheal tubes reduced the incidence of sore throat and hoarseness after cardiac surgery without evidence of complications.
Collapse
Affiliation(s)
- Maria Calabrese
- Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Gabriella Arlotta
- Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Maria Enrica Antoniucci
- Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Luca Montini
- Department of Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
| | - Diana Giannarelli
- Facility Epidemiology and Biostatistics, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Temistocle Taccheri
- Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Filippo Corsi
- Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Stefano De Paulis
- Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Andrea Scapigliati
- Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Francesca Bevilacqua
- Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Joel Vargas
- Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Michele Corrado
- Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Natalia Pavone
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Franco Cavaliere
- Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| |
Collapse
|
2
|
Lin J, Wang WD, Yang QY, Wen YL, Yang JH, Fan WQ, Zuo YB. Effect of intravenous and topical laryngeal lidocaine on sore throat after extubation: a prospective randomized controlled study. Eur Rev Med Pharmacol Sci 2024; 28:2493-2500. [PMID: 38567609 DOI: 10.26355/eurrev_202403_35756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The present study aimed to compare the effect of topical laryngeal lidocaine with intravenous lidocaine before endotracheal intubation on the incidence and severity of postoperative sore throat, hoarseness, and cough. PATIENTS AND METHODS This prospective randomized controlled study enrolled 144 patients undergoing laparoscopic cholecystectomy with endotracheal intubation. The patients were randomized to three groups and received 2% lidocaine by topical laryngeal spray (group T), intravenous 2% lidocaine (group I), and the equivalent volume of intravenous saline (group C) before intubation. The incidence and severity of sore throat, hoarseness, and cough reaction at 0.5, 1, 6, and 24 h after extubation were collected. RESULTS The incidence of sore throat was significantly lower in group T than in groups I and C (6.4% vs. 37.2% and 86.7%, p < 0.001), respectively at 0.5 h after extubation, and it was significantly lower in group I than that in group C (37.2% vs. 86.7%, p < 0.001). Both the incidence of hoarseness and cough were significantly lower in group T than in group I and in group C (14.9% vs. 97.7% and 97.8%, p < 0.001, and 19.1% vs. 72.0% and 93.3%, p < 0.001), respectively. The severity of sore throat, hoarseness and cough in group T was significantly lower than that in group I and that in group C (p < 0.05), and it was significantly lower in group I than in group C (p < 0.05). CONCLUSIONS Both topical laryngeal lidocaine and intravenous lidocaine before intubation have positive effects on preventing sore throat. Topical laryngeal route was superior to intravenous route. Chictr.org.cn ID: ChiCTR2100042442.
Collapse
Affiliation(s)
- J Lin
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
| | | | | | | | | | | | | |
Collapse
|
3
|
Yan W, Cai J, Zhu C, Chen Y, Fang J, Xu H, Zheng X, Zhou Y, Xie Y, Zhang M, Shu S. Effect of thermal softening of double-lumen endobronchial tubes on postoperative sore throat in patients with prior SARS-CoV-2 infection: a randomized controlled trial. BMC Anesthesiol 2023; 23:403. [PMID: 38062363 PMCID: PMC10702112 DOI: 10.1186/s12871-023-02363-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The incidence of postoperative sore throat (POST) after tracheal intubation using double-lumen endobronchial tubes (DLTs) is higher in patients with prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than in the general population. This prospective trial was conducted to determine whether thermal softening of DLTs could decrease the incidence of POST or other airway injuries in patients with prior SARS-CoV-2 infection. METHODS A total of 120 patients with prior SARS-CoV-2 infection undergoing thoracoscopic surgery were randomly assigned to two groups (n = 60 each). In the thermal softening group, the distal portion of the DLT was placed in thermostatic saline (50 °C) for 10 min before endotracheal intubation. In the control group, the distal portion of the DLT was placed in room temperature saline for 10 min before endotracheal intubation. The incidence and severity of POST and hoarseness were assessed at 1, 6 and 24 h postoperatively. The primary outcomes were the incidence and severity of POST at 6 h postoperatively. The secondary outcomes were the incidence and severity of hoarseness, vocal cord and tracheal injuries, and hemodynamic changes in patients at intubation. RESULTS The incidence of POST at 6 h postoperatively was greater in the control group than in the thermal softening group [41 (68%) vs. 22 (37%), P = 0.001]. The overall incidence of POST at 24 h postoperatively was greater in the control group than in the thermal softening group [46 (76%) vs. 24 (40%), P < 0.001]. The overall incidence of tracheal injuries was also greater in the control group than in the thermal softening group (P = 0.016). Vocal cord injuries occurred more frequently in the control group than in the thermal softening group (P = 0.006). CONCLUSION Thermal softening of DLTs before intubation can reduce the incidence of POST and airway injuries in patients with prior SARS-CoV-2 infection undergoing DLT insertion. TRIAL REGISTRATION This trial has been registered at www.chictr.org.cn (registration number: ChiCTR2200066821; registration date: December 19, 2022).
Collapse
Affiliation(s)
- Wenlong Yan
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
| | - Jianyue Cai
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
| | - Chenchen Zhu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
| | - Yu Chen
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
| | - Jun Fang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
| | - Hui Xu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
| | - Xiaojing Zheng
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
| | - Yingting Zhou
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
| | - Yanhu Xie
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
| | - Min Zhang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
| | - Shuhua Shu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China.
| |
Collapse
|
4
|
Chen Z, Jin Y, Lu G, Jin Y, Feng C, Zhao X. Preoperative Ultrasound-Guided Internal Branch Block of Superior Laryngeal Nerve Reduces Postoperative Sore Throat Caused by Double Lumen Endotracheal Intubation: A Randomized Trial. Anesth Analg 2023; 137:1270-1278. [PMID: 37227947 DOI: 10.1213/ane.0000000000006534] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
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.
Collapse
Affiliation(s)
- Zheping Chen
- From the Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yanwu Jin
- From the Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guodong Lu
- From the Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuelong Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Wannan Medical College, Wuhu, China
| | - Chang Feng
- From the Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xin Zhao
- From the Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| |
Collapse
|
5
|
Liang J, Liu J, Qiu Z, Sun G, Xiang P, Hei Z, Li X. Effect of Esketamine Gargle on Postoperative Sore Throat in Patients Undergoing Double-Lumen Endobronchial Intubation: A Randomised Controlled Trial. Drug Des Devel Ther 2023; 17:3139-3149. [PMID: 37876501 PMCID: PMC10591602 DOI: 10.2147/dddt.s430077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Jianfen Liang
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Jun Liu
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Zhuolin Qiu
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Guoliang Sun
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Ping Xiang
- Department of Medical Quality Management, Nanfang Hospital, Southern Medical University, Guangzhou, 510630, People’s Republic of China
| | - Ziqing Hei
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Xiang Li
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| |
Collapse
|
6
|
Talapatra A, Mathew S, Kanakalakshmi ST, Rani R. Effect of fluticasone-impregnated throat packs on postoperative sore throat (POST) and hoarseness of voice: A randomized clinical trial. F1000Res 2023; 12:1352. [PMID: 38434667 PMCID: PMC10905143 DOI: 10.12688/f1000research.139742.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 03/05/2024] Open
Abstract
Background: Post-operative sore throat (POST) is one of the most common complaints post-endotracheal intubation and can be decreased through various interventions. This study aimed to determine the effect of fluticasone-impregnated versus saline throat packs on the occurrence and severity of POST and voice hoarseness. Methods: This prospective, randomized, double-blinded trial was conducted on patients undergoing nasosinus surgeries at Kasturba Medical College and Hospital. Patients were randomized to groups based on a computer-generated table of random numbers post-intubation after placing a definite length of oropharyngeal packs into group F (fluticasone) who received four puffs of fluticasone furoate-soaked throat packs and group C (control) wherein normal saline-soaked throat packs were used. Determining the incidence of POST and voice hoarseness was the primary outcome; severity of POST and voice hoarseness, patient satisfaction scores at 24 hours post-surgery and adverse events were secondary outcomes. Results: Overall, 86 patients were randomized and 43 patients were included in each group. Incidence of POST (%) and voice hoarseness (%) were 55.8, 55.6, 55.8, 53.4 and 30.2, 28, 28, 28 in group C. Incidence of POST (%) and voice hoarseness (%) were 37.2, 37.2, 37.2, 34.8 and 14, 14, 14,14 in group F at 1, 2, 6 and 24 hours, respectively, however, the p values were not found to be significant at any time interval. There was no significant difference in terms of severity of POST and voice hoarseness, patient satisfaction scores between the groups and there were no reported adverse events. Conclusions: In patients undergoing nasosinus surgery under general anesthesia with endotracheal intubation, fluticasone furoate-impregnated throat packs failed to show any significant reduction in the incidence and severity of POST as well as hoarseness of voice, and even though it was not statistically significant, the fluticasone impregnated group had higher patient satisfaction scores. Registration: CTRI ( CTRI/2020/09/027946; 22/09/2020).
Collapse
Affiliation(s)
- Arjun Talapatra
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shaji Mathew
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Sushma Thimmaiah Kanakalakshmi
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Rama Rani
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| |
Collapse
|
7
|
Nakanishi T, Sento Y, Kamimura Y, Nakamura R, Hashimoto H, Okuda K, Nakanishi R, Sobue K. Combined use of the ProSeal laryngeal mask airway and a bronchial blocker vs. a double-lumen endobronchial tube in thoracoscopic surgery: A randomized controlled trial. J Clin Anesth 2023; 88:111136. [PMID: 37137259 DOI: 10.1016/j.jclinane.2023.111136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/16/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
STUDY OBJECTIVE The combined use of the ProSeal laryngeal mask airway and a bronchial blocker may reduce postoperative hoarseness and sore throat. We aimed to test the feasibility and efficacy of this combination technique in thoracoscopic surgery. DESIGN A single-center, patient-assessor blinded, randomized controlled trial. SETTING Nagoya City University Hospital (between November 2020 and April 2022). PATIENTS A total of 100 adult patients undergoing lobectomy or segmentectomy by video- or robotic-assisted thoracoscopic surgery. INTERVENTIONS Patients were randomly assigned to either group using a combination of the ProSeal laryngeal mask airway and a bronchial blocker (pLMA+BB group) or a double-lumen endobronchial tube (DLT group). MEASUREMENTS The primary outcome was the hoarseness incidence on 1-3 postoperative days. Secondary outcomes included sore throat, intraoperative complications (hypoxemia, hypercapnia, surgical interruption, malposition of devices, unintended lung expansion, and ventilatory difficulty), lung collapse, device placement-related outcomes, and coughing during emergence. MAIN RESULTS A total of 100 patients underwent randomization (51 to the pLMA+BB group and 49 to the DLT group). After drop outs, a total of 49 patients in each group were analyzed per-protocol. The incidences of hoarseness in the pLMA+BB and DLT groups were 42.9% and 53.1% (difference, -10.2%; 95% confidence interval, -30.1% to 10.3%; p = 0.419), 18.4% vs. 32.7%, and 20.4% vs. 24.5% on postoperative day 1, 2, and 3, respectively. The incidences of sore throat in the pLMA+BB and DLT groups were 16.3% vs. 34.7% (difference, -18.4%; 95% confidence interval, -35.9% to -0.9%; p = 0.063) on postoperative day 1. In the pLMA+BB group, more intraoperative complications and less coughing during emergence were observed compared to the DLT group. Lung collapse and placement-related outcomes were comparable between the groups. CONCLUSIONS The combination of ProSeal laryngeal mask airway and bronchial blocker did not significantly reduce hoarseness compared to the double-lumen endobronchial tube.
Collapse
Affiliation(s)
- Toshiyuki Nakanishi
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
| | - Yoshiki Sento
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Yuji Kamimura
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Ryuji Nakamura
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Hiroya Hashimoto
- Clinical Research Management Center, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Katsuhiro Okuda
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Ryoichi Nakanishi
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Kazuya Sobue
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| |
Collapse
|
8
|
Jabbar ML, Mahboba JH, Meazher N. Comparing the effectiveness of topical dexamethasone emollient, lidocaine gel, and glycerin emollient on the endotracheal tube for postoperative hoarseness of voice, sore throat, and laryngospasm. J Med Life 2023; 16:904-907. [PMID: 37675167 PMCID: PMC10478659 DOI: 10.25122/jml-2022-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/14/2022] [Indexed: 09/08/2023] Open
Abstract
During general anesthesia, inserting a relatively stiff endotracheal tube using a metallic laryngoscope through the soft tissues of the pharynx and larynx, along with applying a pressured cuff, can result in varying degrees of tissue trauma and adverse outcomes. Anesthesiologists commonly encounter post-operative issues such as hoarseness, sore throat, and laryngospasm. This study aimed to compare the effectiveness of topical applications of dexamethasone emollient, lidocaine gel, and glycerin emollient in reducing these complications. One hundred patients were randomly assigned to four groups of 25 patients each: the control group (Group C), lidocaine gel group (Group L), glycerin emollient group (Group G), and dexamethasone emollient group (Group D). The assigned medication was topically applied to the endotracheal tube, and patients were monitored for postoperative laryngospasm, hoarseness, and sore throat within the first 24 hours. No statistically significant differences were found among the four groups in terms of demographic characteristics, postoperative sore throat, hoarseness, or laryngospasm (p>0.05). Lidocaine gel was an effective drug that can be used to attenuate the incidence rate of post-operative sore throat.
Collapse
Affiliation(s)
| | | | - Nasser Meazher
- Department of Surgery, Medical College, Kufa University, Kufa, Iraq
| |
Collapse
|
9
|
In 't Veld BA, Rettig TCD, de Heij N, de Vries J, Wolfs JFC, Arts MP. Maintaining endotracheal tube cuff pressure at 20 mmHg during anterior cervical spine surgery to prevent dysphagia: a double-blind randomized controlled trial. Eur Spine J 2018; 28:353-361. [PMID: 30361759 DOI: 10.1007/s00586-018-5798-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/14/2018] [Accepted: 10/14/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Anterior cervical spine surgery is associated with postoperative dysphagia, sore throat and dysphonia. It is unclear, whether this is caused by increased endotracheal tube (ETT) cuff pressure after retractor placement. This study aims to assess the effect of ETT cuff pressure adjustment on postoperative dysphagia, sore throat and dysphonia. METHODS In this, single-centre, observer and patient-blinded randomized controlled trial patients treated with anterior cervical spine surgery were randomized to adjustment of the ETT cuff pressure to 20 mmHg after placement of the retractor versus no adjustment. Primary outcome was the incidence and severity of postoperative dysphagia. Secondary outcomes were sore throat and dysphonia. Outcomes were evaluated on day one and 2 months after the operation. RESULTS Of 177 enrolled patients, 162 patients (92.5%) could be evaluated. The incidence of dysphagia was 75.9% on day one and 34.6% 2 months after surgery. Dysphagia in the intervention and control group was present in 77.8% versus 74.1% of patients on day one (odds ratio (OR) 1.2, 95% confidence interval (CI) (0.6-2.5)) and 28.4% versus 40.7% of patients after 2 months (OR 0.6, 95% CI 0.3-1.1), respectively. Severity of dysphagia, sore throat and dysphonia was similar in both groups. CONCLUSIONS Anterior cervical spine surgery is accompanied by a high incidence of postoperative dysphagia, lasting until at least 2 months after surgery in over a third of our patients. Adjusting ETT cuff pressure to 20 mmHg after retractor placement, as compared to controls, did not lower the risk for both short- and long-term dysphagia. Netherlands National Trial Registry Number: NTR 3542. These slides can be retrieved under electronic supplementary material.
Collapse
Affiliation(s)
- Bastiaan A In 't Veld
- Department of Anaesthesiology, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands.
| | - Thijs C D Rettig
- Department of Anaesthesiology, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
| | - Naomi de Heij
- Department of Anaesthesiology, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
| | - Jessica de Vries
- Department of Anaesthesiology, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
| | - Jasper F C Wolfs
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Mark P Arts
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
| |
Collapse
|
10
|
Yu W, Wang Z, Gao D, Zhang W, Jin W, Ma X, Qi S. A method for addressing right upper lobe obstruction with right-sided double-lumen endobronchial tubes during surgery: a randomized controlled trial. BMC Anesthesiol 2018; 18:130. [PMID: 30223773 PMCID: PMC6142378 DOI: 10.1186/s12871-018-0596-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/10/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A right-sided double-lumen tube (R-DLT) tends to obstruct the right upper lobe intraoperatively due to anatomical distortion during surgery. If the R-DLT is poorly matched with the patient's airway anatomy, it will not be possible to correctly replace the tube with a fiberoptic bronchoscope (FOB). In our study, we aimed to explore an efficient method for difficult repositioning caused by right upper lobe occlusion during surgery: repositioning the R-DLT from the right main bronchus into the left main bronchus. The current study was designed to assess the efficacy and safety of this method. METHODS Sixty adult patients scheduled to undergo left-sided thoracic surgery were randomly assigned to two groups. With the patient in the right lateral position during surgery, the R-DLT was pulled back to the trachea while being rotated 90° clockwise; it was then either rotated 90° clockwise for placement into the left main bronchus (Group L) or rotated 90° anticlockwise and returned to the right main bronchus (Group R) using FOB guidance. The primary outcomes included clinical performance, which was measured by intubation time, and the quality of lung collapse. A secondary outcome was safety, which was determined according to bronchial injury and vocal cord injury. RESULTS The median intubation time (IQR [range]) required for placement of a R-DLT into the left main bronchus was shorter than the time required for placement into the right main bronchus (15.0 s [IQR, 12.0 to 20.0 s]) vs 23.5 s [IQR, 14.5 to 65.8 s], P = 0.005). The groups showed comparable overall results for the quality of lung collapse during the total period of one-lung ventilation (P = 1.000). The numbers of patients with bronchial injuries or vocal cord injuries were also comparable between groups (Group R, 11/30 vs. Group L 8/30, P = 0.580 for bronchus injuries; Group R, 15/30 vs. Group L 13/30, P = 0.796 for vocal cord injuries). CONCLUSIONS Repositioning a R-DLT from the right main bronchus into the left main bronchus had good clinical performance without causing additional injury. This may be an efficient method for the difficult repositioning of a R-DLT due to right upper lobe occlusion during surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IPR-15006933 , registered on 15 August 2015.
Collapse
Affiliation(s)
- Wei Yu
- Department of Anaesthesiology, Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Road, Harbin, 150001 Heilongjiang Province China
| | - Zijian Wang
- Department of Anaesthesiology, Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Road, Harbin, 150001 Heilongjiang Province China
| | - Dapeng Gao
- Department of Anaesthesiology, Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Road, Harbin, 150001 Heilongjiang Province China
| | - Wei Zhang
- Department of Anaesthesiology, Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Road, Harbin, 150001 Heilongjiang Province China
| | - Wen Jin
- Department of Anaesthesiology, Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Road, Harbin, 150001 Heilongjiang Province China
| | - Xuesong Ma
- Department of Anaesthesiology, Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Road, Harbin, 150001 Heilongjiang Province China
| | - Sihua Qi
- Department of Anaesthesiology, Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Road, Harbin, 150001 Heilongjiang Province China
| |
Collapse
|
11
|
Yun YS, Kim MB, Son YI. The effect of vocal hygiene education for patients with vocal polyp. Otolaryngol Head Neck Surg 2016; 137:569-75. [PMID: 17903572 DOI: 10.1016/j.otohns.2007.03.043] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Accepted: 03/29/2007] [Indexed: 10/22/2022]
Abstract
Objective The authors aimed to assess the effect of vocal hygiene education for patients suffering with vocal polyp and to discover the meaningful factors that can predict better outcomes with performing vocal hygiene. Study Design and Setting Voice evaluation and vocal hygiene education were provided to 340 consecutive patients with vocal polyp. Three months later, 175 of the 340 patients completed a follow-up evaluation. According to the change in polyp size, these patients were divided into two groups: the “improvement” and the “no improvement.” The effect of vocal hygiene was assessed. Eight parameters were compared between these two groups. Results The “improvement” group was composed of 20% of the 340 patients and 38% of the 175 patients. Multivariate analyses demonstrated that nonsmokers with a small polyp had the greatest possibility of improvement with vocal hygiene and so avoid unnecessary surgery. Conclusion Patients who do not smoke and who have a polyp that is small in size have a much better chance to improve their voice by performing vocal hygiene.
Collapse
Affiliation(s)
- Young-Sun Yun
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea
| | | | | |
Collapse
|
12
|
Zhao X, Cao X, Li Q. Dexamethasone for the prevention of postoperative sore throat: a systematic review and meta-analysis. J Clin Anesth 2014; 27:45-50. [PMID: 25468585 DOI: 10.1016/j.jclinane.2014.06.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 06/03/2014] [Accepted: 06/09/2014] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To determine the antiemetic efficacy of dexamethasone in the prevention of postoperative sore throat (POST) and postoperative hoarseness (PH). DESIGN Meta-analysis. SETTING Metropolitan university medical center. MEASUREMENTS This systematic review and meta-analysis was conducted and reported in agreement with the PRISMA guideline. We searched online databases of MEDLINE (from 1966 to August 2013), EMBASE (from 1982 to August 2013), Google Scholar, and the Cochrane Database of Systematic Review. Relative ratios (RRs) and 95% confidence interval (CI) were calculated. RESULTS Four trials with a total of 480 patients were included for the analysis: 283 received prophylactic dexamethasone and 197 received placebo. Pooled result by random-effects model showed that dexamethasone significantly decreased the incidence of POST at 1 hour (RR = 0.51, 95% CI 0.27-0.94, P = .03; P for heterogeneity = .0005, I(2) = 83%) and at 24 hour postextubation (RR = 0.46, 95% CI 0.26-0.79, P < .05; P for heterogeneity = .01, I(2) = 72%). Our analysis indicated that dexamethasone significantly decreased the incidence of PH at 1 hour (RR = 0.22, 95% CI 0.11-0.46, P < .01; P for heterogeneity = .48, I(2) = 0%), but did not affect the incidence of PH at 24 hours postextubation (RR = 0.67, 95% CI 0.37-1.20, P > .1; P for heterogeneity = .12, I(2) = 59%). CONCLUSION Our meta-analysis suggested that intravenous dexamethasone can effectively reduce the incidence of POST both at 1 and at 24 hours postextubation. In addition, the present study showed that prophylactic dexamethasone reduced the incidence of PH at 1 hours but not at 24 hours postextubation.
Collapse
Affiliation(s)
- Xiang Zhao
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiuhong Cao
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Quan Li
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| |
Collapse
|
13
|
Gupta D, Agrawal S, Sharma JP. Effect of preoperative licorice lozenges on incidence of postextubation cough and sore throat in smokers undergoing general anesthesia and endotracheal intubation. Middle East J Anaesthesiol 2013; 22:173-178. [PMID: 24180166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
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.
Collapse
Affiliation(s)
- Diyva Gupta
- Department of Anesthesia, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun, India
| | | | | |
Collapse
|
14
|
Suda K, Ishida Y, Kawamura Y, Inaba K, Kanaya S, Teramukai S, Satoh S, Uyama I. Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg 2012; 36:1608-16. [PMID: 22392356 DOI: 10.1007/s00268-012-1538-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Meticulous mediastinal lymphadenectomy frequently induces recurrent laryngeal nerve palsy (RLNP). Surgical robots with impressive dexterity and precise dissection skills have been developed to help surgeons perform operations. The objective of this study was to determine the impact on short-term outcomes of robot-assisted thoracoscopic radical esophagectomy performed on patients in the prone position for the treatment of esophageal squamous cell carcinoma, including its impact on RLNP. METHODS A single-institution nonrandomized prospective study was performed. The patients (n = 36) with resectable esophageal squamous cell carcinoma were divided into two groups: patients who agreed to robot-assisted thoracoscopic esophagectomy with total mediastinal lymphadenectomy performed in the prone position (n = 16, robot-assisted group) without insurance reimbursement, and those who agreed to undergo the same operation without robot assistance but with health insurance coverage (n = 20, control group). These patients were observed for 30 days following surgery to assess short-term surgical outcomes, including the incidence of vocal cord palsy, hoarseness, and aspiration. RESULTS Robot assistance significantly reduced the incidence of vocal cord palsy (p = 0.018) and hoarseness (p = 0.015) and the time on the ventilator (p = 0.025). There was no in-hospital mortality in either group. There were no significant differences between the two groups with respect to patient background, except for the use of preoperative therapy (robot-assisted group <control, p = 0.003). There were no significant differences in estimated blood loss, operating time, number of dissected lymph nodes, completeness of resection, or the incidence of the other complications, except for anastomotic leakage (p = 0.038). CONCLUSION Robot-assisted thoracoscopic esophagectomy with total mediastinal lymphadenectomy is feasible and safe. This method shows promise in preventing RLNP.
Collapse
Affiliation(s)
- Koichi Suda
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Aichi, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Shaaban AR, Kamal SM. Comparison between betamethasone gel applied over endotracheal tube and ketamine gargle for attenuating postoperative sore throat, cough and hoarseness of voice. Middle East J Anaesthesiol 2012; 21:513-519. [PMID: 23327023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Tracheal intubation for general anesthesia often leads to trauma of the airway mucosa resulting in postoperative sore throat, hoarseness of voice and cough. The aim of this study was to evaluate two different methods as regard their efficacy for controlling the postoperative pharyngo-laryngo-tracheal sequelae (sore throat, cough, hoarseness of voice) after general anesthesia with laryngoscopy and tracheal intubation. We compared between the effects of betamethasone gel applied over the endotracheal tube and gargling with ketamine solution in reducing these complications during the first 24 postoperative hours after elective surgical procedures in a prospective randomized controlled single blind clinical trial. METHODS Seventy five patients ASA physical status I and II, undergoing elective surgery under general anesthesia using endotracheal intubation were enrolled in this prospective, randomized, single-blind study. Patients were randomly divided into 3 groups of 25 patients each: Group (K): (n: 25) Patients in this group were asked to gargle with ketamine 40 mg in 30 ml saline for 60 seconds as repeated smaller attempts, 5 minutes before induction of anesthesia. Group (B) (n: 25): Endotracheal tubes were lubricated with 0.05% betamethasone gel. Group (C) (n: 25): CONTROL GROUP patients did not receive ketamine gargle nor betamethasone gel. The incidence and the severity of Postoperative sore throat, cough, and hoarseness of voice were graded at 0, 2, 4, and 24 h after operation by a blinded investigator. RESULTS The incidence and severity of sore throat were significantly lower in group (K) and group (B) than group (C) (p < 0.05) at all time intervals. While there was no significant difference between group (K) and group (B) (p > 0.05). The incidence and severity of cough and hoarseness of voice were significantly lower in group (B) than group (C) and group (k) (p < 0.05) at all time intervals. CONCLUSION Gargling with ketamine before induction of anesthesia is comparable with application of 0.05% betamethasone gel over the Endotracheal tubes in decreasing postoperative sore throat. In addition, Betmethasone application decreased the incidence and severity of postoperative cough and hoarsness of voice.
Collapse
Affiliation(s)
- Ahmad R Shaaban
- Department of anesthesia and intensive care, Faculty of medecine, Ain Shams university, Cairo, Egypt.
| | | |
Collapse
|
16
|
Zhao J, Xu H, Li W, Chen L, Zhong D, Zhou Y. Intraoperative recurrent laryngeal nerve monitoring during surgery for left lung cancer. J Thorac Cardiovasc Surg 2010; 140:578-82. [PMID: 20478574 DOI: 10.1016/j.jtcvs.2010.01.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 01/01/2010] [Accepted: 01/18/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study evaluated the safety and efficacy of intraoperative recurrent laryngeal nerve monitoring during surgery for left lung cancer. METHODS From April 2008 to April 2009, a total of 25 patients at high risk for left recurrent laryngeal nerve injury agreed to and underwent intraoperative recurrent laryngeal nerve monitoring during surgery for left lung cancer in our hospital. Results and clinical records were reviewed. RESULTS All the patients' left recurrent laryngeal nerves were identified during operation by intraoperative recurrent laryngeal nerve monitoring. Twenty-four patients retained normal left recurrent laryngeal nerves after the operation. One patient, in whom part of the left recurrent laryngeal nerve was found to be invaded, underwent single-stage nerve anastomosis under recurrent laryngeal nerve monitoring after the invaded nerve was resected. There were no significant intraoperative or postoperative complications among the other patients. CONCLUSIONS Intraoperative recurrent laryngeal nerve monitoring during thoracotomy is a safe and effective way of identifying the nerve. It may help surgeons to avoid injuring the recurrent laryngeal nerve during some thoracic procedures.
Collapse
Affiliation(s)
- Jinbo Zhao
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | | | | | | | | | | |
Collapse
|
17
|
Robb-Nicholson C. By the way, doctor. I developed a hoarse voice and annoying phlegm in my throat and was surprised to learn that the cause was acid reflux. I've never had heartburn, so I don't know how this could have happened. Can you explain? Harv Womens Health Watch 2009; 17:8. [PMID: 20088090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
18
|
Uerpairojkit K, Charuluxananan S, Werawatganon T, Poomseetong T. Profile Soft-Seal Cuff for general anesthesia under ambulatory gynecologic laparoscopy. J Med Assoc Thai 2009; 92:1184-1190. [PMID: 19772178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To compare the severity of throat discomfort in terms of sore throat, dysphagia, and dysphonia caused by LMA-ProSeal (PLMA) and Profile Soft-Seal Cuff (PSSC) in early (2 hour) and late (24 hour) postoperative period after ambulatory gynecologic laparoscopy. DESIGN Randomized double-blind controlled trial. MATERIAL AND METHOD One hundred and thirty eight patients undergoing ambulatory gynecologic laparoscopy in Chulalongkorn Memorial Hospital were randomly allocated into two groups. One group was intubated with Profile-Soft-Seal Cuff (PSSC), while the other with ProSeal LMA (PLMA). Four-leveled score of sore throat, dysphagia, dysphonia, nausea, or vomiting symptoms at 2 and 24 hours and 5-leveled satisfaction score to both techniques at 24 hours postoperatively were evaluated. RESULTS The patients in the PLMA group had less severe symptoms of sore throat (p = 0.016) and dysphonia (p = 0.003) than those in the PSSC group at 2 hour. No difference was detected for dysphagia, nausea, vomiting, and satisfaction scores at 24 hour postoperatively. CONCLUSION PLMA caused less sore throat and dysphonia in the early postoperative period than PSSC did PLMA can be used as an alternative airway device for anesthesia in ambulatory gynecologic laparoscopy.
Collapse
Affiliation(s)
- Ketchada Uerpairojkit
- Department of Anesthesia, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | | |
Collapse
|
19
|
Kori K, Muratani T, Tatsumi S, Minami T. [Influence of endotracheal tube cuff lubrication on postoperative sore throat and hoarseness]. Masui 2009; 58:342-345. [PMID: 19306635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Sore throat and hoarseness are common postoperative complications in patients who undergo tracheal intubation. In this study, we evaluated the severity of postoperative sore throat and the incidence of hoarseness in 60 patients after tracheal intubation. METHODS 60 patients (ASA PS 1 or 2, 29 males and 31 females) scheduled for general anesthesia with endotracheal intubation were enrolled in this study. They were divided into three groups. Lidocaine 4% was sprayed into the trachea in the sprayed group (n=20). The distal end of the endotracheal tube was lubricated with 2% lidocaine jelly in the lubricated group (n=20). No intervention to the endotracheal tube was carried out in the no-intervention group (n=20). We evaluated the visual analogue scale (VAS) of sore throat and the incidence of hoarseness in each group at the end of general anesthesia and the next day. RESULTS VAS scores of sore throat at the end of anesthesia were 9.2 +/- 3.4 mm in the sprayed group, 27.8 +/- 5.7 mm in the lubricated group, and 11.8 +/- 4.4 mm in the no-intervention group. VAS scores on the next day were 2.5 +/- 1.4 mm in the sprayed group, 14.0 +/- 4.3 mm in the lubricated group, and 2.2 +/- 1.7 mm in the no-intervention group. Both VAS scores at the end of anesthesia and the day after anesthesia were significantly higher in the lubricated group than others (P<0.05). However, there was no significant difference in hoarseness among the three groups. CONCLUSIONS In this study, VAS scores at the end of anesthesia and the next day were both significantly higher in the lubricated group than in others. Furthermore, there is no significant difference in VAS between the sprayed group and the no-intervention group. These data suggest that lidocaine jelly lubrication to the endotracheal tube reinforces the severity of sore throat. On the other hand, there was no significant difference in VAS between the sprayed group and the no-intervention group. This suggests that lidocaine sprayed to the trachea does not reduce postoperative sore throat.
Collapse
Affiliation(s)
- Kazuyoshi Kori
- Department of Anesthesia, Matsushita Memorial Hospital, Osaka 570-8540
| | | | | | | |
Collapse
|
20
|
Abstract
Mouth washing after inhalation of corticosteroids is effective for prevention of local adverse effects. We determined the amounts of drug residues remaining on the oropharyngeal mucosa following inhalation of budesonide (BUD) via a Turbuhaler (BUD-TH) (100 microg). Further, we studied the effects of mouth washing on the removal of drug residues by quantification of BUD in expectorated wash solution using an HPLC method. The amount of BUD recovered after gargling and rinsing for 5 s each was 19.4+/-9.4 microg, as compared to 23.8+/-13.6 microg after rinsing alone for 10 s and 18.3+/-8.9 microg after gargling alone for 10 s, though the differences were not significant. Our results indicated that about 20% of the dose was remaining on the oropharyngeal mucosa after inhalation. In a comparison of washing times, the amounts of BUD recovered were 26.3+/-3.2 microg after gargling and rinsing for 3 s each, and 19.4+/-9.3 microg after those for 5 s each. As for the effect of lag time before beginning mouth washing, the ratio of BUD recovered following mouth washing with a lag time of 1 min was 73.2%, while it was reduced to 27.8% after 10 min, as compared to immediate mouth washing following administration. Our results suggest that the amount of BUD removed by mouth washing is associated with the lag time between inhalation and mouth washing, however, not with the duration of mouth washing. We concluded that immediate mouth washing after inhalation is most useful for the removal of drugs following BUD-TH administration.
Collapse
Affiliation(s)
- Haruko Yokoyama
- School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Japan
| | | | | | | | | |
Collapse
|
21
|
Abstract
Hyalinosis cutis et mucosae is a rare autosomal recessive disorder which is characterized by deposition of hyaline material around the basement membrane of the skin and mucous membranes. Typical clinical symptoms are hoarseness, infiltration of the mucous membranes and papular verrucous skin changes. Mutations within the extracellular matrix protein gene (ECM-1) are the underlying defect. We report on a 24-year-old man, who had first been seen in our department at the age of seven and had undergone the necessary diagnostic procedures and who revisited 17 years later with hoarseness and extensive verrucous skin changes at elbows and knees which were removed by excision. A new mutation of the ECM1 gene was identified.
Collapse
Affiliation(s)
- Bernadette Vago
- Department of Dermatology, University of Heidelberg, Germany.
| | | | | | | | | |
Collapse
|
22
|
Abstract
The main symptom of unilateral vocal fold palsy is hoarseness, which can cause considerable disturbance to the patient depending on its extent and the patient's individual situation. Therapy aims at the restitution of a tuneful and resilient voice, which can be achieved by surgical or conservative means, improving the glottal closure and synchronizing the vocal fold vibrations during phonation. Vocal therapy is a common conservative method that may be supported by psychotherapeutic or physical procedures. In surgical therapy, there is a distinction between techniques of endoscopic augmentation by injecting different materials into the vocal folds and transcutaneous laryngeal framework surgery, i.e., transferring the paralyzed vocal fold to the glottal midline. Particularly apt for injection are biocompatible materials amount and position whose can easily be controlled. However, the inevitable resorption of many materials causes deterioration in voice quality. Furthermore, the change of vocal fold morphology obstructs regular phonatory vibration. On the other hand, medialization thyroplasty leads to permanent voice amelioration without a substantial complication rate when performed by experienced surgeons.
Collapse
Affiliation(s)
- M Schuster
- Abteilung für Phoniatrie und Pädaudiologie, Universitätsklinikum Erlangen.
| | | |
Collapse
|
23
|
Abstract
We report an effective method for mouth washing after inhalation of corticosteroids for the prevention of local adverse effects such as hoarseness and oropharyngeal candidiasis. This method involves gargling and rinsing immediately after inhalation, repeated at least twice. We performed a questionnaire survey on mouth washing after inhalation of corticosteroids of 19 inpatients who used inhaled corticosteroids at the University of Tokyo Hospital. The questions concerned: 1) awareness of local adverse effects of inhaled corticosteroids; 2) gargling and rinsing habits; 3) repeating mouth washing at least twice; and 4) mouth washing immediately after inhalation. The percentage of patients correctly performing the individual maneuvers were: 1) 63.2%; 2) 36.8%; 3) 36.8%; and 4) 63.2%. The percentage of patients performing our recommended method of mouth washing (all four elements) was 11%. These results suggest that patients receiving inhaled corticosteroids poorly comprehend mouth washing procedures after inhalation of corticosteroids. It is important that pharmacists advise patients on the correct method of mouth washing.
Collapse
Affiliation(s)
- Haruko Yokoyama
- Department of Clinical Drug Evaluation, School of Pharmacy, Tokyo University of Pharmacy and Life Science, 1432-1 Horinouchi, Hachioji 192-0392, Japan.
| | | | | | | | | |
Collapse
|
24
|
Charuluxananan S, Sumethawattana P, Kosawiboonpol R, Somboonviboon W, Werawataganon T. Effectiveness of lubrication of endotracheal tube cuff with chamomile-extract for prevention of postoperative sore throat and hoarseness. J Med Assoc Thai 2004; 87 Suppl 2:S185-9. [PMID: 16083185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
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.
Collapse
Affiliation(s)
- Somrat Charuluxananan
- Department of Anesthesiology and Clinical Epidemiology Unit, Faculty of Medicine, Chulalongkorn University, Rama IV Rd., Pathumwan, Bangkok 10330, Thailand
| | | | | | | | | |
Collapse
|
25
|
Braz JRC, Volney A, Navarro LHC, Braz LG, Nakamura G. Does sealing endotracheal tube cuff pressure diminish the frequency of postoperative laryngotracheal complaints after nitrous oxide anesthesia? J Clin Anesth 2004; 16:320-5. [PMID: 15374551 DOI: 10.1016/j.jclinane.2004.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/15/2004] [Accepted: 03/15/2004] [Indexed: 10/26/2022]
Abstract
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.
Collapse
|
26
|
Lévy B, Mouillac F, Quilichini D, Schmitz J, Gaudart J, Gouin F. [Topical methylprednisolone vs lidocaïne for the prevention of postoperative sore throat]. Ann Fr Anesth Reanim 2003; 22:595-9. [PMID: 12946491 DOI: 10.1016/s0750-7658(03)00214-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
Collapse
Affiliation(s)
- B Lévy
- Département d'anesthésie-réanimation, CHU La Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
| | | | | | | | | | | |
Collapse
|
27
|
Wang HS, Wang ZY, Li DS. [How to avoid hoarseness for operation of schwannoma of the cervical vagus nerve]. Zhonghua Er Bi Yan Hou Ke Za Zhi 2003; 38:57-9. [PMID: 12778771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To avoid hoarseness for operation of schwannoma of the cervical vagus nerve (SVN). METHODS From Jan. 1997 to Sept. 2001, ten cases of SVN were operated. The procedures were as follows: Exposing the tumor and the vagus nerve, confirming its origin from the fascicle of recurrent laryngeal nerve (RLN) or the fascicle of non-RLN, making an small incision on the posterolateral surface of the tumor, usually posterior to the internal jugular vein, and then tearing and enlarging the small incision to enucleate the tumor. RESULTS Two of the four cases of SVN originated from the fascicle of RLN happened temporary hoarseness and other two without hoarseness. All six cases of SVN originated from the fascicle of non-RLN, but one, happened no hoarseness. CONCLUSION Above-mentioned technique is a good and reliable method to avoid hoarseness in the operation of SVN.
Collapse
Affiliation(s)
- Hong-shi Wang
- Department of Head & Neck Surgery, Cancer Hospital, Fudan University, Shanghai 200032, China.
| | | | | |
Collapse
|
28
|
Ratnaraj J, Todorov A, McHugh T, Cheng MA, Lauryssen C. Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery. J Neurosurg 2002; 97:176-9. [PMID: 12296675 DOI: 10.3171/spi.2002.97.2.0176] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
Collapse
Affiliation(s)
- Jebadurai Ratnaraj
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | | | | | | | | |
Collapse
|
29
|
Kyokong O, Charuluxananan S, Muangmingsuk V, Rodanant O, Subornsug K, Punyasang W. Efficacy of chamomile-extract spray for prevention of post-operative sore throat. J Med Assoc Thai 2002; 85 Suppl 1:S180-5. [PMID: 12188410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
A randomized, double-blind study was carried out to assess the effect of 111 mg of Chamomile extract spray compared with normal saline spray (placebo) administered before intubation on post-operative sore throat and hoarseness. One hundred and sixty-one ASA (American Society of Anesthesiologists) physical status I, II elective surgical patients were recruited. Forty-two out of 80 patients (52.5%) in the Chamomile group scored no post-operative sore throat in the post-anesthesia care unit compared with 41 out of 81 patients (50.6%) in the placebo group, p=0.159. Post-operative sore throat and hoarseness both in the post-anesthesia care unit and 24 hour after operation were not statistically different. There was no statistically significant relationship between sore throat or hoarseness and ASA physical status, sex, history of smoking, grade of laryngoscopic view, number of intubation attempts, condition during intubation and condition of extubation. However, there was significant correlation between use of oral airway and sore throat in the post-anesthesia care unit and 24 hours after operation (p=0.031 and 0.002 respectively). Chamomile extract spray administered before intubation, therefore, can not prevent post-operative sore throat and hoarseness.
Collapse
Affiliation(s)
- Oranuch Kyokong
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | | | | | | |
Collapse
|
30
|
Onoguchi K, Hachiya T, Sasaki T, Hashimoto K, Takakura H, Hanai M. A technique for the prevention of hoarseness during surgery for distal aortic arch aneurysm. Ann Thorac Cardiovasc Surg 2002; 8:193-5. [PMID: 12472406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
Hoarseness occurs frequently after surgery to repair distal aortic arch aneurysms when using only a median sternotomy approach. We describe a useful technique which protects the left recurrent laryngeal nerve during this procedure and reduces the incidence of postoperative hoarseness.
Collapse
Affiliation(s)
- Katsuhisa Onoguchi
- Department of Cardiovascular Surgery, Saitama Cardiovascular and Respiratory Center, Japan
| | | | | | | | | | | |
Collapse
|
31
|
Saeki H, Morimoto Y, Yamashita A, Nagusa Y, Shimizu K, Oka H, Miyauchi Y. [Postoperative sore throat and intracuff pressure: comparison among endotracheal intubation, laryngeal mask airway and cuffed oropharyngeal airway]. Masui 1999; 48:1328-31. [PMID: 10658413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
We studied which device is most useful to reduce postoperative sore-throat. We investigated the relationship between intracuff pressure and postoperative sore-throat in using endotracheal intubation (ET), the laryngeal mask airway (LMA) and the cuffed oropharyngeal airway (COPA) in adult patients. We classified sore-throat into categories; pain at rest, hoarseness and dysphasia. We evaluated pain at rest by the score (0: no pain, 1: mild discomfort, 2: mild pain, 3: severe pain). Pain at rest (scores 1, 2, 3) was complained by 10 patients in ET group, 3 in LMA group, 5 in COPA group on the day of operation, showing significantly lower incidence of pain at rest in LMA group than in ET group. Hoarseness was complained by 15 patients in ET group, 2 in LMA group and 4 in COPA group, showing significantly lower incidence of hoarseness in LMA and COPA groups than in ET group. Dysphasia was complained by 3 in ET group, 1 in LMA group and 2 in COPA group, showing no significant difference. These results suggest that LMA is most appropriate to reduce postoperative sore-throat.
Collapse
Affiliation(s)
- H Saeki
- Department of Anesthesiology and Critical Care, Tokuyama Central Hospital
| | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
The pressure within latex balloons remains constant despite the balloons being inflated to more than 40 times their initial volume. We used this property to enable improved tracheal cuff pressure control. A latex balloon with an initial volume of 5 ml was connected via a vinyl duct attached with a roller clamp and three-way stopcock to a standard tracheal tube cuff. The 5 ml latex balloon was then inflated with 250 ml of air. The pressure within the tracheal tube cuff was monitored throughout anaesthesia with the inflated latex balloon acting as a pressure controller. Throat symptoms were recorded on the first four postoperative days. The controller kept the tracheal tube cuff pressures constant, and reduced the incidence of postoperative throat symptoms. Variations in cuff pressures with and without the controller were investigated in an altitude chamber to simulate flight. In the altitude chamber, cuff pressure reached over 200 cmH2O at 10 000 feet without the controller, whereas such variations were practically eliminated when the controller was used.
Collapse
Affiliation(s)
- I Yoneda
- Division of Behavioural Sciences, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | | | | | | | | |
Collapse
|
33
|
Moley JF, Lairmore TC, Doherty GM, Brunt LM, DeBenedetti MK. Preservation of the recurrent laryngeal nerves in thyroid and parathyroid reoperations. Surgery 1999; 126:673-7; discussion 677-9. [PMID: 10520914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND The recurrent laryngeal nerve (RLN) is vulnerable to injury in thyroid and parathyroid reoperations because of the presence of scar tissue and displacement of the nerve from its normal position. METHODS Since 1993, we have performed 132 reoperations for recurrence of thyroid or parathyroid carcinoma (102 cases), persistent hyperparathyroidism (21 cases), and recurrent goiter (9 cases). One or both RLNs were identified in all cases (208 nerves). Exposure of the nerve was accomplished by a lateral approach (159 nerves), a low anterior approach (41 nerves), or the identification of the nerve between the larynx and the upper pole of the thyroid, in parathyroid reoperations (8 nerves). Dissection was then done while the nerve was kept in view at all times. RESULTS Preoperatively, unilateral vocal cord paralysis was noted in 6 patients. Resection of a functioning RLN encased with a tumor was intentionally carried out in 5 patients. The RLNs were identified and preserved in all other cases. Among these 121 patients, transient hoarseness lasting up to a month occurred in 12 patients. CONCLUSIONS Careful identification and exposure of the RLN through a previously undissected area can be done safely in thyroid and parathyroid reoperations and resulted in no permanent recurrent nerve injuries in our experience.
Collapse
Affiliation(s)
- J F Moley
- Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
| | | | | | | | | |
Collapse
|
34
|
Schubert TT. Gastroesophageal reflux disease and pulmonary disease. Am J Gastroenterol 1996; 91:1690-1. [PMID: 8792682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
35
|
Yamanda T, Haniuda M, Aoki T, Kaneko K, Miyazawa M, Yoshida K. [Postoperative early complication of primary lung cancer]. Kyobu Geka 1996; 49:721-4. [PMID: 8741450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We analyzed postoperative early complications of primary lung cancer in 321 cases during 1982 to 1993 in our hospital, and assessed the prevention and the treatment against these complications. In order of frequency the complications are, paroxymal supraventricular tachcarida (10.6%), atelectasis due to sputum (6.9%), pulmonary fistula for more than seven days (4.7%), hoarseness of voice due to recurrent nerve palsy (4.0%), chylothorax (2.5%), gastrointestinal tract complications (2.2%), reoperation due to massive bleeding (1.2%), wound dehiscence (0.9%), bronchial fistula (0.6%), rupture of ascending aorta (0.3%) and myocardial infarction (0.3%). The two cases of bronchial fistula after pneumonectomy, and one of myocardial infarction after lobectomy through the median approach died of early complications. The operative indication for primary lung cancer is extended to the patients with higher age and lower pulmonary function; so we should be careful for the pre and postoperative prevention and the rapid and appropriate treatment against these postoperative early complications.
Collapse
Affiliation(s)
- T Yamanda
- Second Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | | | | | | | | | | |
Collapse
|
36
|
Waring JP, Lacayo L, Hunter J, Katz E, Suwak B. Chronic cough and hoarseness in patients with severe gastroesophageal reflux disease. Diagnosis and response to therapy. Dig Dis Sci 1995; 40:1093-7. [PMID: 7729270 DOI: 10.1007/bf02064205] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Gastroesophageal reflux may be responsible for atypical symptoms such as chronic cough and hoarseness. Our aim was to evaluate and treat patients with severe gastroesophageal reflux and chronic cough or hoarseness with intensive antireflux therapy. Twenty-seven patients with typical heartburn symptoms in addition to significant cough or hoarseness were treated with aggressive antireflux therapy. We recorded the response of each symptom to the antireflux therapy. Two patients were lost to follow-up. Twenty of the 25 (80%) patients showed some improvement in cough or hoarseness, nine (36%) had no atypical symptoms at follow-up. The response of heartburn to therapy was strongly predictive of successful therapy for the atypical symptoms. Cough and hoarseness improved in only two of the five patients with residual heartburn symptoms compared to 18 of 20 patients with no heartburn (P < 0.04). Only patients with no heartburn symptoms at follow-up had complete resolution of atypical symptoms. There were no important differences on ambulatory pH monitoring between partial and complete responders. Improvement in atypical reflux symptoms, such as chronic cough and hoarseness, is common with aggressive antireflux therapy. There are no findings on ambulatory esophageal pH monitoring that uniquely identify patients who are likely to respond to antireflux therapy.
Collapse
Affiliation(s)
- J P Waring
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA
| | | | | | | | | |
Collapse
|
37
|
|
38
|
Henry RL. Inhaled corticosteroid agents and dysphonia. Med J Aust 1987; 147:365. [PMID: 3657668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
39
|
Mikhaĭlova GD. [Causes and various aspects of the treatment of dysphonia in children based on mass screening data]. Vestn Otorinolaringol 1987:66-70. [PMID: 3590499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
40
|
Bishop MJ, Weymuller EA, Fink BR. Laryngeal effects of prolonged intubation. Anesth Analg 1984; 63:335-42. [PMID: 6367543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
41
|
|