Postoperative throat complaints after tracheal intubation

Christensen, Anders Mark; Willemoes-Larsen, H.; Lundby, Lilli; Jakobsen, Karina

doi:10.1093/bja/73.6.786

Cited by 221 publications

(190 citation statements)

References 14 publications

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“…22 This factor may also explain our somewhat lower incidence of postoperative laryngeal symptoms, recorded 24 hr after anesthesia, than reported by Combes et al, 6 although female gender, gynecological surgery, and duration of intubation are well known risk factors for complaints of laryngeal symptoms after anesthesia. 2,3 Finally, the selected doses of remifentanil and propofol ensured acceptable intubating conditions in more than 95% of patients. However, within acceptable conditions, the distribution of excellent and good conditions was unequal in the two groups.…”

Section: Discussionmentioning

confidence: 99%

“…First, since the primary outcome of our study was the incidence of SLI, use of a depolarizing agent was avoided, because the role of succinylcholine in the etiology of postoperative sore throat and hoarseness remains unclear. 2,3,23 Second, cisatracurium is reported to produce less histamine release and fewer allergic reactions compared to other nondepolarizing NMBDs, such as rocuronium, 7,24 even though reports of anaphylactic reactions after cisatracurium administration were published since its introduction into clinical anesthesia. 7 The mean onset of action of cisatracurium was > six minutes, inducing a mean delay of three minutes of the first attempt to intubate the trachea compared to the patients in group Placebo.…”

Section: Discussionmentioning

confidence: 99%

“…However, female gender and gynecological surgery are well known factors of complaints of laryngeal symptoms after general anesthesia. 2,3 It would be of interest to pursue further investigations with the inclusion of male patients. This study was performed on otherwise healthy and relatively young patients with no known risk-factors for difficult intubation.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas some authors report similar frequencies of laryngeal morbidity in patients with either excellent or good intubating conditions, [1][2][3][4] others have shown that excellent intubating conditions, provided by the administration of neuromuscular blocking drugs (NMBDs) at induction of anesthesia, are associated with fewer postoperative laryngeal symptoms and less tissue damage than are associated with non-excellent conditions. 5,6 Hence, optimizing intubating conditions by using NMBDs would be required to minimize airway symptoms and injuries related to tracheal intubation.…”

Section: Conclusion : à La Suite D'une Induction De L'anesthésie à L'mentioning

confidence: 99%

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Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study

Bouvet

Stoian

Jacquot-Laperrière

et al. 2008

Can J Anesth/J Can Anesth

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Purpose:The need for muscular relaxation to improve intubating conditions and to reduce the incidence of laryngeal morbidity is still controversial. The aim of this study was to determine the incidence of symptomatic laryngeal injuries (SLI) and of acceptable intubating conditions (including both good and excellent conditions), both with and without cisatracurium during induction of anesthesia, along with moderate doses of remifentanil and propofol. Methods:In this prospective, randomized double-blind equivalence trial, the intubating conditions were compared in 130 ASA I or II female patients. All subjects received remifentanil 2 µg·kg -1 iv and propofol 2.5 mg·kg -1 iv, with either cisatracurium 0.15 mg·kg -1 iv (group Cisatracturium), or saline (group Placebo). Tracheal intubating conditions were assessed with the Copenhagen Score. A systematic screening for postoperative hoarseness and sore throat was performed 24 and 48 hr after anesthesia, followed by a nasofibroscopic examination when laryngeal symptoms persisted at 48 hr.Results: Twenty-four hr after anesthesia, the incidence of postoperative hoarseness and sore throat in the Cisatracurium and Placebo groups was 26.5% and 21.5%, respectively, and 48 hr after anesthesia, the incidence was 7.8% and 6.1%, respectively (P = 0.32 and P = 0.50 between groups, respectively). In the clinically evaluable population, the incidence of SLI, assessed at 48 hr by nasofibroscopy, was equivalent in both groups, 1.6% vs 1.5% in group Placebo and group Cisatracurium, respectively (P < 0.001 for equivalence test), as was the occurrence of acceptable intubating conditions (95.4% vs 100%, P < 0.05 for equivalence test). However, the occurrence of excellent intubating conditions was more frequent in group Cisatracurium than in group Placebo (P = 0.0003). Conclusion:Following induction of anesthesia with propofol and moderate-dose remifentanil, cisatracurium did not confer a higher rate of good-to-excellent conditions for tracheal intubation, nor did muscle relaxation with cisatracurium decrease the rate of SLI after tracheal intubation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Conclusion : à La Suite D'une Induction De L'anesthésie à L'mentioning

confidence: 99%

See 2 more Smart Citations

Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study

Bouvet

Stoian

Jacquot-Laperrière

et al. 2008

Can J Anesth/J Can Anesth

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show abstract

“…However, such pressure trauma is not necessarily associated with sore throat, a common if usually minor complication of tracheal intubation. Sore throat has been associated with younger patients undergoing short procedures [5]; Christensen et al found no association with length of procedure and a 50% incidence of hoarseness after intubation [6]. An explanation for this may be that trauma arises during the process of intubation and not only from the presence of a tracheal tube.…”

mentioning

confidence: 99%

Tracheal intubation and sore throat: a mechanical explanation

Chandler¹

2002

Anaesthesia

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SummaryAlthough tracheal intubation remains a valuable tool, it may result in pressure trauma and sore throat. The evidence for an association between these sequelae is not conclusive and sore throat may be caused at the time of intubation. This hypothesis was tested in a mechanical model and the results from tracheal intubation compared with those from insertion of a laryngeal mask airway, which is associated with a lower incidence of sore throat. Use of the model suggests that the tracheal tube and laryngeal mask airway impinge on the pharyngeal wall in different manners and involve different mechanisms for their conformation to the upper airway, but that in a static situation, the forces exerted on the pharyngeal wall are low with both devices. It also suggests that the incidence of sore throat should be lower for softer and smaller tracheal tubes and that the standard`Magill' curve (radius of curvature 140^20 mm) is about optimum for the average airway.

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