Systematic review of benefits or harms of routine anaesthetist‐inserted throat packs in adults: practice recommendations for inserting and counting throat packs

Abstract

Throat packs are commonly inserted by anaesthetists after induction of anaesthesia for dental, maxillofacial, nasal or upper airway surgery. However, the evidence supporting this practice as routine is unclear, especially in the light of accidentally retained throat packs which constitute 'Never Events' as defined by NHS England. On behalf of three relevant national organisations, we therefore conducted a systematic review and literature search to assess the evidence base for benefit, and also the extent and severity of complications associated with throat pack use. Other than descriptions of how to insert throat packs in many standard texts, we could find no study that sought to assess the benefit of their insertion by anaesthetists. Instead, there were many reports of minor and major complications (the latter including serious postoperative airway obstruction and at least one death), and many descriptions of how to avoid complications. As a result of these findings, the three national organisations no longer recommend the routine insertion of throat packs by anaesthetists but advise caution and careful consideration. Two protocols for pack insertion are presented, should their use be judged necessary.

Airway management for dental clearance in a preschool child: A UK survey

“…The use of an anesthetic throat pack is no longer recommended in adult patients undergoing head and neck surgery due to risk of being retained postoperatively 5 . The use of a surgical throat pack should eliminate the risk of inadvertent retention as it is included in the surgical count.…”

Selective embolization of lingual artery in transoral robotic surgery for the management of recurrent base of tongue carcinomas

“…Routine use of throat packs is not recommended and should be limited to specific surgical indication. 17 However, surgery for the base of the tongue via TORS mandates an excellent exposure, and the placement of a throat pack/swab may compromise visualization. Ligating the primary feeders in the neck is a reasonably safe option, but this requires surgical access to the neck, leading to an increase in overall operating time, a visible scar and may not completely reduce the bleeding.…”

“…Bleeding from the upper airway surgery into the lower airway is a dreaded complication. Routine use of throat packs is not recommended and should be limited to specific surgical indication 17 . However, surgery for the base of the tongue via TORS mandates an excellent exposure, and the placement of a throat pack/swab may compromise visualization.…”

An indication for a throat pack?

“…Likewise, this issue is only briefly touched on in the review article on throat packs by Athanassoglou et al. , which the editorial accompanies.…”