Lidocaine for preventing postoperative sore throat

Tanaka, Yuu; Nakayama, Takeo; Nishimori, Mina; Tsujimura, Yuka; Kawaguchi, Masahiko; Sato, Yuki

doi:10.1002/14651858.cd004081.pub3

Cited by 81 publications

(76 citation statements)

References 52 publications

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“…Lignocaine topicalization is commonly used to provide airway anesthesia to facilitate open airway procedures. Other uses include: tracheal intubation in the absence of neuromuscular blockade , reduction of the incidence of coughing and laryngospasm on induction or emergence from general anesthesia , attenuation of the haemodynamic changes to laryngoscopy , attenuation of bronchial hyper‐reactivity , and reduction in the incidence of postoperative sore throat .…”

Section: Indicationsmentioning

confidence: 99%

“…We could find no evidence of the impact of lignocaine on postoperative sore throat in children. A systematic review of the effect of lignocaine on postoperative sore throat in adults concluded that both topical and intravenous lignocaine reduced the incidence and severity of sore throat after anesthesia with a tracheal tube . Only five of the 15 studies reviewed showed a reduction in sore throat and three of the studies demonstrated an increase in sore throat.…”

Section: Indicationsmentioning

confidence: 99%

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Lignocaine topicalization of the pediatric airway

Roberts

Gildersleve

2016

Pediatric Anesthesia

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The application of topical laryngeal lignocaine is a technique used frequently in pediatric anesthesia. It is often used to facilitate open airway procedures, tracheal intubation, or to reduce the incidence of perioperative adverse respiratory events such as coughing and laryngospasm. A number of studies have shown that applying topical lignocaine to the larynx reduces perioperative respiratory adverse events, while others have shown an increased incidence of respiratory complications with lignocaine administration. There is a lack of evidence on the effect of topical lignocaine on the sensitivity of upper airway reflexes and swallowing, the duration of time that airway reflexes are obtunded, and the optimum and safe maximum dose of lignocaine when used by this route. We review the current literature relating to the use of lignocaine to topicalize the pediatric airway. This review concentrates on the indications for use, the maximum safe dose, the effect on swallowing, and risk of aspiration and the complications of the technique.

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Section: Indicationsmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

Lignocaine topicalization of the pediatric airway

Roberts

Gildersleve

2016

Pediatric Anesthesia

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“…We compared ketamine with numerous comparators that have been proven to prevent postoperative sore throat, [15][16][17][18][19][20][21] including topical lidocaine and corticosteroids as well as intravenous dexamethasone. However, comparisons of these treatments were performed in a limited number of small-sized studies, and the non-superiority Ketamine administration is associated with unwanted outcomes such as psychomimetic effects and blood pressure rise.…”

Section: Discussionmentioning

confidence: 99%

Topical application of ketamine to prevent postoperative sore throat in adults: A systematic review and meta‐analysis

Kuriyama

Nakanishi

Kamei

et al. 2020

Acta Anaesthesiol Scand

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Background Postoperative sore throat is a leading undesirable postoperative outcome. Ketamine is an N‐methyl‐d‐aspartate receptor antagonist and its topical application is used for chronic pain and oral/throat indications. We conducted a systematic review to assess the efficacy of preoperative, topical ketamine application for preventing postoperative sore throat. Methods We searched MEDLINE, EMBASE, and CENTRAL through September 23, 2019 for randomized controlled trials in which at least one intervention was topical ketamine to prevent postoperative sore throat in adults undergoing endotracheal intubation. The primary outcome was the incidence of sore throat at 24 hours postoperatively. The comparators were non‐analgesic controls (placebo, no treatment, or usual care) or active agents. We pooled the data using a random‐effects model. Results We included 41 randomized controlled trials involving 3784 participants. Topical ketamine was associated with reduced incidence of sore throat at 24 hours postoperatively compared to non‐analgesic methods (risk ratio, 0.45; 95% CI, 0.37‐0.54; P < .001). We found significant publication bias, but the results remained unchanged with a trim‐and‐fill analysis. Trial sequential analysis (TSA) suggested that the efficacy of topical ketamine was adequate (TSA‐adjusted 95% CI, 0.33‐0.56). The GRADE quality for this evidence was moderate. Topical ketamine was inferior to a combination of nebulized ketamine and clonidine in preventing postoperative sore throat. Conclusions Preoperative, topical ketamine application may be more effective than non‐analgesic methods in preventing postoperative sore throat. The number of studies did not suffice to determine the place of topical ketamine among agents to prevent postoperative sore throat.

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“…The pathologic process has been suggested to involve direct mucosal injury and inflammation related to airway instrumentation and presence of foreign airway objects [5]. Excessive cuff pressures of airway devices have been implicated as a cause of POST [6,7].…”

Section: Introductionmentioning

confidence: 99%

Detrimental Effects of Filling Laryngotracheal Airways To Excessive Pressure (DEFLATE-P): a quality improvement initiative

et al. 2020

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Background: This quality improvement (QI) project was performed at a single center to determine the incidence of postoperative complications associated with use of cuffed airway devices. An educational program was then completed that involved training our anesthesia providers about complications related to excessive cuff pressure and how to utilize a quantitative cuff pressure measurement device (manometer). The impact of this educational initiative was assessed by comparing the incidence of postoperative complications associated with the use of airway devices before and after the training period. Methods: After approval by our institution's Institutional Review Board, a pre-intervention (baseline) survey was obtained from 259 adult patients after having undergone surgery with general anesthesia with the use of an endotracheal tube (ETT) or laryngeal mask airway (LMA). Survey responses were used to determine the baseline incidence of sore throat, hoarseness, and dysphagia. Once these results were obtained, education was provided to the anesthesia department members addressing the complications associated with excessive cuff pressures, appropriate cuff pressures based on manufacturer recommendations, and instructions on the use of a quantitative monitor to determine cuff pressure (manometry). Clinical care was then changed by requiring intraoperative cuff pressure monitoring throughout our institution for all surgical patients. After this educational period, 299 patients completed the same survey describing postoperative airway complications. Results: The use of manometry reduced the incidence of moderate-to-severe postoperative sore throat in the prevs. post-intervention groups (35 patients vs 31 patients, p = 0.045), moderate to severe hoarseness (30 patients vs 13, patients p = 0.0001), and moderate-to-severe dysphagia (13 patients vs 5 patients, p = 0.03). Conclusion: Caring for patients in the perioperative setting frequently entails placement of an airway device. This procedure is associated with several potential complications, including sore throat, coughing, and vocal cord damage. Our quality improvement initiative has shown that intraoperative management of intra-cuff pressure based on manometry is feasible to implement in clinical practice and can reduce postoperative airway complications.

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Lidocaine for preventing postoperative sore throat

Cited by 81 publications

References 52 publications

Lignocaine topicalization of the pediatric airway

Lignocaine topicalization of the pediatric airway

Topical application of ketamine to prevent postoperative sore throat in adults: A systematic review and meta‐analysis

Detrimental Effects of Filling Laryngotracheal Airways To Excessive Pressure (DEFLATE-P): a quality improvement initiative

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