Preoperative intravenous dexamethasone prevents tracheal intubation-related sore throat in adult surgical patients: a systematic review and meta-analysis

Abstract

Background Postoperative sore throat related to tracheal intubation negatively affects patient recovery and satisfaction. Previous reviews suggested that intravenous dexamethasone diminishes postoperative sore throat. Nevertheless, they comprised a small number of studies with inconsistencies in outcome reporting. We performed a systematic review and meta-analysis to assess the efficacy and safety of preoperative intravenous dexamethasone in preventing postoperative sore throat in adult patients. Methods We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to August 24, 2018. We included randomizedcontrolled trials that assessed the efficacy and safety of intravenous dexamethasone in adult surgical patients who required general anesthesia and endotracheal intubation. Our primary outcomes were the incidence and severity of sore throat at 24 hr after surgery/extubation and adverse events. We pooled the data using a random-effects model. We conducted a trial sequential analysis (TSA) on the incidence of sore throat.Electronic supplementary material The online version of this article (https://doi.

A prospective observational cohort study on the incidence of postoperative sore throat in the pediatric population

“…With regard to the pharmacological prevention or treatment of postoperative sore throat, there is good evidence in adults that 0.1‐0.2mg/kg of intravenous (IV) dexamethasone reduces the incidence and severity of postoperative sore throat . IV lidocaine in addition to IV dexamethasone has been shown to be superior to dexamethasone alone .…”

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

“…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.…”

“…36,37,[39][40][41]44,[46][47][48][49][50]54,56,60,[62][63][64][65][66][67][68][69]72 Topical application of ketamine was associated with decreased incidence of moderate or severe postoperative sore throat compared to non-analgesic methods (20/959 vs 146/912; RR, 0.18; 95% CI, 0.12-0.28; P < .001; I 2 = 0.0%; Figure 3). The number needed to prevent moderate or severe postoperative sore throat was 9 (95% CI, [6][7][8][9][10][11][12][13][14][15][16][17]. There was no evidence of publication bias (P = .53) ( Figure S3).…”

Postoperative sore throat: inevitable side effect or preventable nuisance?

“…Fortunately, several effective strategies to prevent and/or treat sore throat after general anesthesia have been described in the literature, including intraoperative techniques to reduce the incidence and severity. These same authors have recently published several other systematic reviews and meta-analyses summarizing the literature describing other effective treatments of POST, including intravenous dexamethasone (pooled risk ratio [RR], 0.62; 95% confidence interval [CI], 0.51 to 0.75), 7 topical benzydamine (RR, 0.31; 95% CI, 0.20 to 0.47), 8 and topical corticosteroids (RR, 0.39; 95% CI, 0.32 to 0.49). 9 Multiple other treatments have been studied and found to be effective at reducing the incidence and severity of sore throat including lidocaine (either intra-cuff 10 or intravenously administered), 11 ketamine, 12 with even the choice of volatile anesthetic playing a role (desflurane is associated with a higher incidence of POST than sevoflurane).…”

“…Bien que les maux de gorge postopératoires soient souvent considérés comme une complication mineure de l'anesthésie, ils demeurent l'une des plaintes les plus fréquentes après une anesthésie générale, l'incidence étant de l'ordre de 20-40 %. 7 la benzydamine topique (RR, 0,31; IC 95 %, 0,20 à 0,47), 8 et les corticostéroïdes topiques (RR, 0,39; IC 95 %, 0,32 à 0,49). 9 Plusieurs autres traitements ont été étudiés et leur efficacité a été démontrée pour réduire l'incidence et la gravité des maux de gorge, comme par exemple la lidocaïne (à l'intérieur du ballonnet 10 ou par administration intraveineuse), 11 la kétamine, 12 le choix d'agent anesthésique volatile jouant lui-même un rôle (par exemple, le desflurane est associé à une incidence plus élevée de maux de gorge postopératoires que le sévoflurane).…”