Risk Factors for Postoperative Sore Throat After Nasotracheal Intubation.

OBJECTIVE: Postoperative sore throat is relatively frequent complication after orotracheal intubation. However, there are few reports about postoperative sore throat in nasotracheal intubation. In this retrospective study, we investigated the risk factors of postoperative sore throat in nasotracheal intubation. METHODS: Anesthesia records of patients 16 to 80 years of age who underwent nasotracheal intubation were included. Patients underwent oral and maxillofacial surgery from February 2015 until September 2018. Airway device (Macintosh laryngoscope, Pentax-AWS, or McGRATH video laryngoscope, or fiberoptic scope), sex, age, height, weight, American Society of Anesthesiologists classification, intubation attempts, duration of intubation, intubation time, tube size, and fentanyl and remifentanil dose were investigated. Fisher exact test, Wilcoxon rank sum test, Welch t test, and Steel-Dwass multiple test were used, and a multivariable analysis was performed using stepwise logistic regression to determine the risk factors of postoperative sore throat. RESULTS: A total of 169 cases were analyzed, and 126 patients (74.6%) had a postoperative sore throat. Based on the univariate analysis of the data, 12 factors were determined to be potentially related to the occurrence of a postoperative sore throat. However, after evaluation using stepwise logistic regression analysis, the 2 remaining variables that correlated with postoperative sore throat were airway device (P < .05) and intubation attempts (P = .04). In the model using logistic regression analysis, the fiberoptic scope had the strongest influence on the incidence of sore throat with reference to Pentax-AWS (odds ratio = 5.25; 95% CI = 1.54-17.92; P < .05). CONCLUSION: Use of a fiberoptic scope was identified as an independent risk factor for postoperative throat discomfort. Compared with direct laryngoscopy and other video laryngoscopes, the use of a fiberoptic scope had a significantly higher incidence of sore throat.

A Comparison of Two Stool Positions for Stabilizing a Dental Chair During CPR.

OBJECTIVE: Most dental chairs lack sufficient stability to perform effective manual chest compression (MCC) during cardiopulmonary resuscitation (CPR). A stabilizing stool can significantly reduce backrest vertical displacement in all chair types; however, a severely curved exterior backrest may negatively impact the stool's effectiveness. This study evaluated the efficacy of 2 stool positions for stabilizing a dental chair during MCC. METHODS: Chest compressions were performed on a manikin positioned in a dental chair while vertical displacement of the chair backrest during MCC was recorded using video and measured. Vertical displacement data were captured with no stool and with a stabilizing stool in 2 different positions. Reduction ratios were calculated to evaluate the effectiveness of the 2 stool positions. RESULTS: With no stool, the backrest median (interquartile range) vertical displacement during chest compressions was 16.5 (2.5) mm as compared with 12.0 (1.5) mm for the stabilizing stool positioned under the area of MCC and 8.5 (1.0) mm under the shoulders. The stool positioned under the shoulders produced a significantly increased calculated reduction ratio of 48% (14%) compared with 27% (20%) under the area of MCC (P < .001). CONCLUSIONS: Positioning a stabilizing stool under the shoulders was more effective at reducing vertical displacement of the dental chair backrest during chest compressions than positioning the stool under the area of MCC.

Usefulness of a stool to stabilize dental chairs for cardiopulmonary resuscitation (CPR).

BACKGROUND: Cardiopulmonary resuscitation (CPR) requires immediate start of manual chest compression (MCC) and defibrillation as soon as possible. During dental surgery, CPR could be started in the dental chair considering difficulty to move the patient from the dental chair to the floor. However, all types of dental chairs are not stable for MCC. We previously developed a procedure to stabilize a dental chair by using a stool. EUROPEAN RESUSCITATION COUNCIL (ERC) guideline 2015 adopted our procedure when cardiac arrest during dental surgery. The objective of this study was to verify the efficacy of a stool as a stabilizer in different types of dental chairs. METHODS: Three health care providers participated in this study, and 8 kinds of dental chairs were examined. MCC were performed on a manikin that was laid on the backrest of a dental chair. A stool was placed under the backrest to stabilize the dental chair. The vertical displacement of the backrest by MCC was recorded by a camcorder and measured by millimeter. Next, the vertical displacement of the backrest by MCC were compared between with and without a stool. RESULTS: In all 8 dental chairs, the method by using a stool significantly reduced the vertical displacements of the backrest by during MCC. The reduction ratio (mean [interquartile range]) varied between nearly 27 [20] and 87 [5] %. In the largest stabilization case, the displacement was 3.5 [0.5] mm with a stool versus 26 [5.5] mm without a stool (p <  0.001). CONCLUSIONS: Our procedure to stabilize dental chairs by using a stool reduced the displacement of a backrest against MCC in all chairs. CLINICAL RELEVANCE: Effective MCC could be performed in dental chairs by using a stool when sudden cardiac arrest occurs during dental surgery.