Efficacy of topical agents for prevention of postoperative sore throat after single lumen tracheal intubation: a Bayesian network meta-analysis.

BACKGROUND: The optimal choice of prophylactic drugs to decrease postoperative sore throat is unclear. The objective of this network meta-analysis (NMA) was to compare and rank 11 topical agents used to prevent postoperative sore throat. METHODS: Various databases were searched independently for randomized-controlled trials (RCTs) comparing topical agents used for the prevention of postoperative sore throat. Inclusion criteria were parallel group studies comparing intervention with active or inactive control and reporting postoperative sore throat. The primary outcome was postoperative sore throat at 24 hr. Secondary outcomes were early sore throat at 4-6 hr, cough, and hoarseness at 24 hr. RESULTS: Evidence was synthesized from 70 RCTs reporting 7,141 patients. Topical application of lidocaine, corticosteroids, ketamine, magnesium, benzydamine, water-based lubricant, and liquorice applied along the tracheal tube, to the tracheal tube cuff, gargled or sprayed were compared with intracuff air and each other. Bayesian NMA showed that magnesium (odds ratio [OR], 0.10; 95% credible interval [CrI], 0.03 to 0.26), liquorice (OR, 0.14; 95% CrI, 0.03 to 0.55), and steroid application (OR, 0.11; 95% CrI, 0.06 to 0.22) most effectively prevented postoperative sore throat at 24 hr. Topical lidocaine was the least effective intervention. CONCLUSION: Topical application of magnesium followed by liquorice and corticosteroids most effectively prevented postoperative sore throat 24 hr after endotracheal intubation.

RéSUMé: CONTEXTE: Le choix optimal des médicaments prophylactiques pour réduire les maux de gorge postopératoires n'est pas clair. L'objectif de cette méta-analyse en réseau (NMA) était de comparer et classifier 11 agents topiques utilisés pour prévenir les maux de gorge postopératoires. MéTHODE: Des recherches ont été réalisées dans plusieurs bases de données de façon indépendante afin d'en extraire les études randomisées contrôlées (ERC) comparant des agents topiques utilisés pour la prévention des maux de gorge postopératoires. Nos critères d'inclusion étaient des études de groupes parallèles comparant une intervention à un témoin actif ou inactif sur des résultats de maux de gorge postopératoires. Le critère d'évaluation principal était les maux de gorge postopératoires à 24 h. Les critères d'évaluation secondaires comprenaient les maux de gorge précoces à 4-6 h, la toux et l'enrouement à 24 h. RéSULTATS: Les données probantes ont été synthétisées à partir de 70 ERC portant sur 7141 patients. L'application topique de lidocaïne, de corticostéroïdes, de kétamine, de magnésium, de benzydamine, d'un lubrifiant à base d'eau et de la réglisse, appliqués le long du tube endotrachéal, sur le ballonnet du tube endotrachéal, en gargarisme ou en vaporisation, ont été comparées à l'air intra-ballonnet et entre les divers agents. La NMA bayésienne a démontré que l'application de magnésium (rapport de cotes [RC], 0,10; intervalle de crédibilité [CrI] 95 %, 0,03 à 0,26), de réglisse (RC, 0,14; CrI 95 %, 0,03 à 0,55) et de stéroïdes (RC, 0,11; CrI 95 %, 0,06 à 0,22) étaient les méthodes plus efficaces pour prévenir les maux de gorge postopératoires à 24 h. La lidocaïne topique était l'intervention la moins efficace à 24 h. CONCLUSION: L'application topique de magnésium, suivie de celle de réglisse et de corticostéroïdes, est l'approche qui prévient le plus efficacement les maux de gorge postopératoires 24 h après une intubation endotrachéale.

Liver Transplantation Followed by Renal Transplantation on Extracorporeal Membrane Oxygenation: A Case Report.

We report the case of a 68-year-old woman with end-stage liver disease and end-stage renal disease scheduled for simultaneous liver and kidney transplant. Intraoperatively, she became hemodynamically unstable during her liver transplant surgery, and her renal transplant had to be postponed. On the following day, she required extracorporeal membrane oxygenation and ABIOMED Impella support for managing her severe cardiovascular decompensation. At the same time, the renal transplant was conducted to use the donor kidney already allocated for this patient. The patient was successfully managed postoperatively in the cardiothoracic intensive care unit and was discharged after 2 months. This case is unique because there are no similar cases previously reported in which renal transplantation was performed with extracorporeal membrane oxygenation and Impella support following cardiogenic shock after a liver transplant.

Preoperative Evaluation: Estimation of Pulmonary Risk.

Postoperative pulmonary complications (PPCs) are common after major non-thoracic surgery and associated with significant morbidity and high cost of care. A number of risk factors are strong predictors of PPCs. The overall goal of the preoperative pulmonary evaluation is to identify these potential, patient and procedure-related risks and optimize the health of the patients before surgery. A thorough clinical examination supported by appropriate laboratory tests will help guide the clinician to provide optimal perioperative care.

Pharmacology and clinical applications of human recombinant antithrombin.

IMPORTANCE OF THE FIELD: Antithrombin therapy (AT) has been tested in various medical applications. With advances in genetics and biotechnology, large-scale production of human recombinant antithrombin (rhAT) is now feasible. The prospect of administering a recombinant protein rather than a pooled blood component, has rekindled interest in antithrombin therapy. However, many known properties of human pooled antithrombin (hpAT) still need to be investigated and established for rhAT. AREAS COVERED IN THIS REVIEW: The manufacture and clinical pharmacology of antithrombin. The literature, evidence and our own views about the future of this drug and its potential clinical applications. WHAT THE READER WILL GAIN: The reader will appreciate the biological rationale underpinning antithrombin administration in various clinical settings. The potential benefits and harms of the intervention are addressed. Novel future applications of recombinant antithrombin are broached. TAKE HOME MESSAGE: rhAT has been approved for its use in congenital antithrombin deficiency. rhAT has also been used off-label to treat heparin-resistance in cardiac surgery and sepsis. It is a promising adjuvant for immunosuppression in organ transplantation, and may have role as an anti-angiogenic, anti-tumor and anti-viral agent. rhAT has clear safety advantages over phAT, such as the avoidance of infection transmission.

Anatomic distortion of the right coronary artery as a complication of lung transplantation.

Lung transplantation for end-stage chronic obstructive lung disease is now considered the standard of care. We report a case of perioperative myocardial ischemia and cardiovascular compromise in a single lung transplant recipient due to right coronary artery occlusion from mediastinal shift and repositioning of the heart.