Postoperative Sore Throat and Hoarseness following Tracheal Intubation Using Air or Saline to Inflate the Cuff—A Randomized Controlled Trial
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Abstract:
Sore throat and hoarseness following tracheal intubation is common. The aetiology may include high tracheal cuff pressures. We performed a double-blind, randomized controlled trial in 126 intubated patients to compare the incidence and severity of sore throat and hoarseness following inflation of the cuff using air or saline. Intra-cuff pressures were compared to assess any change due to inward diffusion of nitrous oxide. The incidence of significant sore throat and/or hoarseness overall was 15.0%. There was no statistically significant difference between the groups (air 15.9%, saline 14.5%). In the air group mean intra-cuff pressure increased significantly (start 14.0 mmHg, end 40.9 mmHg), while in the saline group there was no significant increase (start 12.7 mmHg, end 14.6 mmHg). The substitution of saline reliably results in sustained low intra-cuff pressures but high tracheal cuff pressure is not an important factor in the development of sore throat or hoarseness postoperatively within the pressure range and duration of operation studied.Keywords:
Sore throat
Cuff
Throat
In order to determine whether patients having pharyngeal packing experience more or less post-operative throat pain when tampons were used, 80 patients were randomized into two groups to receive either gauze or tampon pharyngeal packing. A third control group of 40 patients were intubated but did not have any throat packs. Post-operative throat pain was subjectively rated at both 6 hours and at 24 hours by an independent observer. Thirty-eight per cent of patients had moderate or severe throat pain in the gauze group, whilst in the tampon and control groups these amounted to only 15% and 1% respectively. A significantly higher proportion of patients also had a moderate or severe sore throat at 24 hours in the former group. Intubation alone resulted in a sore throat post-operatively in 50% of patients, but 85% of those had a mild sore throat only. No differences in pain ratings in any group could be shown between men or women or between age groupings. Endotracheal intubation often causes post-operative throat pain which is exacerbated by the use of pharyngeal packing. The results presented suggest that tampons are a safe, effective alternative to gauze and result in less severe post-operative throat pain.
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Introduction: Sore throat is a symptom in which there is painful burning or scratching sensation in the back of throat. Various causative agents for sore throat are mentioned in literature. This study is about the role of commonly consumed spicy food ‘Kurkure’ and other like foods on sore throat. Material and method: this study includes Sixty three Sore throat patients in adolescent age group, who gave history of eating Kurkure and other like food. Examination of all patients was done and advised to stop eating “kurkure” and other like foods. Patient’s symptoms and signs were recorded and follow up was done after 2 days, 4 days and after 7 days. Result: We found that painful burning or scratching sensation in the back of the throat was relieved in 51 out of 63 patients after 2 days and pain on swallowing was relieved in 56 patients out of 63 patients after 2 days. This figure goes up 4 days after stopping eating kukure and other like foods to 56 out of 63 and 58 out of 63 respectively. Similarly, on examination of oropharynx we found that congestion on oropharyngeal structures was absent in 41 out of 63 patients after 2 days and figure goes up to 55 out of 63 patients after 4 days.
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BACKGROUND: Hyperinflation of laryngeal mask airway cuffs can cause harm to the upper airway mainly by exerting high pressures on pharyngeal and laryngeal structures thus impairing mucosal perfusion. Although cuff manometers can be used to guide the monitoring of cuff pressures, their use is not routine in many institutions. In a prospective audit, we assessed the incidence of sore throat following day-case-surgery in relation to the intracuff pressure within the laryngeal mask airway.METHODS: Four hundred children (3-21 years) were consecutively included in this study. The laryngeal mask airway was inflated as deemed necessary by the attending anesthetist. Cuff pressures were measured using a calibrated cuff manometer (Portex Limited, Hythe, Kent, UK, 0-120 cm H2O, pressures exceeding the measurement range were set at 140 cm H2O for statistical purposes) at induction of anesthesia.RESULTS: Forty-five children (11.25%) developed sore throat, 32 (8%) sore neck and 17 (4.25%) sore jaw. Of those that developed sore throat, 56.5% had cuff pressures exceeding >100 cm H2O. In contrast, when cuff pressures were <40 cm H2O, there were no episodes of sore throat, whilst there was only a 4.6% occurrence of sore throat if cuff pressures were between 40-60 cm H2O.CONCLUSION: We have demonstrated that intra cuff pressure in laryngeal mask airways is closely related to the development of sore throat with higher pressures increasing its likelihood. Hence, cuff pressures should be measured routinely using a manometer to minimize the incidence of sore throat. PMID: 19281479
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Abstract In a 750-bed community-teaching hospital with 3,200 employees, throat cultures were routinely done in hospital personnel complaining of a sore throat. During a 3-month period, 323 employees had throat cultures; only 20 (6.2%) of these throat cultures grew group A streptococcus. The prevalence of positive throat cultures was similarly low in employees (6.2%) and adult patients (7.3%). There was no evidence that employees either had higher prevalence of group A streptococcal pharyngitis or that they spread the infection to patients. It is concluded that routine throat cultures are not warranted in employees complaining of a sore throat, and that throat cultures should be done only selectively in hospital personnel with a high probability of group A streptococcal pharyngitis.
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Hyperinflation of laryngeal mask airway cuffs can cause harm to the upper airway mainly by exerting high pressures on pharyngeal and laryngeal structures thus impairing mucosal perfusion. Although cuff manometers can be used to guide the monitoring of cuff pressures, their use is not routine in many institutions. In a prospective audit, we assessed the incidence of sore throat following day-case-surgery in relation to the intracuff pressure within the laryngeal mask airway.Four hundred children (3-21 years) were consecutively included in this study. The laryngeal mask airway was inflated as deemed necessary by the attending anesthetist. Cuff pressures were measured using a calibrated cuff manometer (Portex Limited, Hythe, Kent, UK, 0-120 cm H2O, pressures exceeding the measurement range were set at 140 cm H2O for statistical purposes) at induction of anesthesia.Forty-five children (11.25%) developed sore throat, 32 (8%) sore neck and 17 (4.25%) sore jaw. Of those that developed sore throat, 56.5% had cuff pressures exceeding >100 cm H2O. In contrast, when cuff pressures were <40 cm H2O, there were no episodes of sore throat, whilst there was only a 4.6% occurrence of sore throat if cuff pressures were between 40-60 cm H2O.We have demonstrated that intra cuff pressure in laryngeal mask airways is closely related to the development of sore throat with higher pressures increasing its likelihood. Hence, cuff pressures should be measured routinely using a manometer to minimize the incidence of sore throat.
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Summary We investigated the diagnostic accuracy of a documented previous difficult tracheal intubation as a stand‐alone test for predicting a subsequent difficult intubation. Our assessment included patients from the Danish Anaesthesia Database who were scheduled for tracheal intubation by direct laryngoscopy. We used a four‐point scale to grade the tracheal intubation. A previous difficult intubation was defined according to the presence of a record documenting a difficult penultimate tracheal intubation‐score for the 15 499 patients anaesthetised more than once. Our assessment demonstrates that a documented history of previous difficult or failed intubation using direct laryngoscopy are strong predictors of a subsequent difficult or failed intubation and may identify 30% of these patients. Although previous investigators have reported predictive values that exceed our findings markedly, a documented previous difficult or failed tracheal intubation appears in everyday anaesthetic practice to be a strong predictor of a subsequent difficult tracheal intubation.
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Viable counts of beta-haemolytic streptococci per ml. of saliva were made in the following groups: (1) children with acute streptococcal sore throat, (2) children with acute non-streptococcal sore throat, (3) children who had no sore throat but were streptococcal throat carriers, (4) children who neither had a sore throat nor were streptococcal throat carriers.The mean counts from cases of streptococcal sore throat and from streptococcal carriers were respectively 1.4 x 10(6) and 2.5 x 10(5) per ml.In a comparison of the efficiency of the throat swab, sublingual swab and specimen of saliva in isolating beta-haemolytic streptococci from the upper respiratory tract, culture of saliva produced the best results.
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