Postoperative sore throat: cause, prevention and treatment

Abstract

SummarySore throat is a common postoperative complaint, occurring most often following tracheal intubation. Factors such as tracheal-tube size and cuff design have been shown to be important causative factors. Routine tracheal intubation for elective surgical procedures can result in pathological changes, trauma and nerve damage which may also account for postoperative throat symptoms. Sore throat following the use of a laryngeal mask appears to be related to the technique of insertion but the contribution of intracuff pressure remains to be clarified. It would appear, however, that high intracuff pressure is associated with nerve palsies due to neuropraxia and nerve compression. Careful insertion techniques for both the tracheal tube and laryngeal mask are of paramount importance in the prevention of airway trauma and postoperative sore throat.

Tracheal intubation and sore throat: a mechanical explanation

“…One wonders if tracheal or laryngeal inflammation is experienced as sore throat or just described as such? A recent review [16] leaves this question open, discussing instead`the factors that may cause postoperative throat symptoms such as pain, dysphagia and hoarseness'. The current study suggests that the site of most applied force is different in kind for the two modes of airway management.…”

Assessment of the efficacy of dexamethasone, lignocaine or placebo in the prevention of post intubation sore throat

“…All these studies give conflicting results. Local anaesthetic spray used before intubation has been said to decrease sore throat [22]. El.…”

“…A local anaesthetic sprayed into the larynx did not appear to alleviate sore throat [7,12]. The application of lignocaine spray before intubation appeared to increase the incidence of sore throat as a result of either mucosal irritation or repeated laryngoscopy [22] but it did make for smoother anaesthesia as it prevented coughing, movements during intubation…”

“…The high volume low pressure cuff can be converted into high volume high pressure cuff by over inflation or during nitrous oxide: oxygen anaesthesia. But these changes did not occur when cuffs were inflated with anaesthetic gas mixture [22]. Seegobin & Hasselt [25] have found evidence of obstruction to mucosal blood flow at a lateral wall pressure above 30 cmH20 with total occlusion of flow to the mucosa over the tracheal rings and posterior tracheal wall a lateral wall pressure of 50 cmH20 (37mmHg).…”

“…When intracuff pressure in the low volume high pressure cuffed tubes was high and allowed to increase the advantage of decreased incidence of sore throat is lost [2]. Although the high volume cuffs caused a greater area of damage to the tracheal mucosa, the damage was more superficial than that caused by the high pressure cuffs [22]. Edward Loeser's study [23] showed that the foam filled cuffs had the highest cuff-tracheal contact area of any of the cuffs studied, and it was associated with the highest incidence and severity of postoperative sore throat.…”