The effectiveness of acupuncture point stimulation for the prevention of postoperative sore throat: A meta-analysis.

BACKGROUND: Enhanced recovery pathways can be further improved for postoperative sore throat (POST) that occurs after surgery under general anesthesia. Medications have shown some effectiveness in preventing POST, but acupuncture or related techniques with better safety and lower cost can be used as an alternative or adjuvant therapy to treat perioperative symptoms by stimulating acupuncture point (acupoint). Therefore, we aimed to conduct a meta-analysis to assess whether acupoint stimulation helps patients prevent POST in adults undergoing tracheal intubation for general anesthesia. METHODS: Publications in PubMed, the Cochrane Central Register, ScienceDirect, and ClinicalTrial.gov were surveyed from January 2000 through August 2020. Studies that compared interventions between true acupoint stimulation and no or sham acupoint stimulation were included. The primary outcomes were the incidence and severity of POST at 24h. RESULTS: Four randomized control trials and 1 comparative study involving 1478 participants were included. Compared with the no or sham acupoint stimulation, the true acupoint stimulation was associated with a reduced incidence (risk ratio, 0.32; 95% confidence interval (CI), 0.18-0.55; P < .001) and decreased severity (standardized mean difference, -2.79; 95% CI, -4.59 to - 0.99; P = .002) of POST. There were no significant adverse events related to acupoint stimulation. The finding for POST was assured by subgroup, sensitivity, and trial sequential analyses. CONCLUSIONS: Acupoint stimulation may reduce the occurrence of POST. It can be considered as one of nonpharmacological methods to prevent POST in enhanced recovery pathways. Further rigorous studies are needed to determine the effectiveness of acupoint stimulation.

Topical application of licorice for prevention of postoperative sore throat in adults: A systematic review and meta-analysis.

STUDY OBJECTIVE: Postoperative sore throat negatively affects patient satisfaction and recovery. It may be related to inflammation of the mucosa caused by injury during intubation. Licorice, derived from the root of Glycyrrhiza glabra, contains active anti-inflammatory ingredients. The efficacy and safety of topical licorice for preventing postoperative sore throat in adults undergoing tracheal intubation for general anesthesia were assessed by a systematic review and meta-analysis. DESIGN: A systematic review and meta-analysis of randomized controlled trials. SETTING: Trials conducted in perioperative settings. MEASUREMENTS: PubMed, EMBASE, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials were searched from inception to April 21, 2018. All randomized, controlled trials (RCTs) that assessed the efficacy and safety of topical licorice in adults undergoing elective surgery under general anesthesia were eligible. The risk of bias was evaluated using the Cochrane risk of bias assessment tool. Data were pooled using a random-effects model. We conducted a trial sequential analysis (TSA) on the incidence of postoperative sore throat. Primary outcomes were the incidence and severity of sore throat 24 h after surgery/extubation and adverse events. MAIN RESULTS: Five randomized controlled trials involving 609 patients were included. Compared with non-analgesic control, topical licorice was associated with a reduced incidence (risk ratio, 0.44; 95% confidence interval (CI), 0.28-0.69; P < 0.001) and severity (standardized mean difference, -0.69; 95% CI, -0.96, -0.43; P < 0.001) of postoperative sore throat. Four trials reported adverse events; there were no significant adverse events related to topical licorice. The findings of sensitivity analyses excluding trials at high or unclear risk of each type of bias were consistent with these findings. TSA confirmed the evidence for postoperative sore throat was adequate. CONCLUSIONS: Preoperative topical application of licorice appears significantly more effective than nonanalgesic methods for preventing postoperative sore throat.

Clinical Research on Prevention and Treatment of Respiratory Tract Complications With Acupoint Application After Operation Under General Anesthesia.

There are various respiratory tract complications in patients undergoing general anesthesia, with postoperative sore throat (POST) being the most commonly seen. Although measures have been taken to prevent and treat POST in clinical practice, the control of POST is still not satisfactory. In this study, 880 ASA patients with grade I to II general anesthesia were randomly assigned into control group and experimental group. After patients entered into the operating room, the plasters were applied to the designated points (Tianzhu, Lianquan, Dazhui, etc), and the clinical efficacy of acupoint application in prevention and treatment of respiratory tract complications after general anesthesia was observed. The results showed that patients starting using acupoint application before operation could significantly reduce the incidence of postoperative respiratory tract complications, and the effects lasted for up to 24 hours. In this study, acupoint application was used, providing a simple, safe, efficient, and durable approach to prevent and treat respiratory tract complications after operation under general anesthesia.

[Effects of transcutaneous electrical acupoint stimulation on treatment and prevention of postoperative sore throat after tracheal intubation under general anesthesia].

OBJECTIVE: To observe the clinical efficacy of transcutaneous electrical acupoint stimulation (TEAS) at Hegu (LI 4) and Neiguan (PC 6) on treatment and prevention of postoperative sore throat (POST) after tracheal intubation under general anesthesia. METHODS: One hundred patients who received elective thyroid gland lobectomy with gradeⅠand Ⅱ of American Society of Anesthesiologists criteria were randomly assigned into a TEAS group and an anesthesia group according to random number table method, 50 cases in each group. All the patients were treated with tracheal intubation under general anesthesia. Patients in the TEAS group were treated with TEAS (2 Hz/100 Hz, 8 to 12 mA) at Hegu (LI 4) and Neiguan (PC 6) from 30 min before anesthesia induction to the end of operation. Patients in the anesthesia group were treated with TEAS at the same acupoints but no electrical stimulation was given. The incidence rate, severity and visual analogue scale (VAS) of POST were recorded 1h, 6h, 12h and 24h after tracheal extubation, respectively. RESULTS: The incidence rate of POST was 12.0% (6/50), 22.0% (11/50) and 18.0% (9/50) 1h, 6h, 12h after tracheal extubation respectively in the TEAS group, which was significantly lower than 30.0% (15/50), 42.0% (21/50) and 36.0% (18/50) in the anesthesia group (all P<0.05). However, the incidence rate was not significantly different between the two groups 24h after extubation[14.0% (7/50) vs 28.0% (14/50), P>0.05]. Moreover, the VAS scores of the patients with POST in the TEAS group at each time point were lower than those in the anesthesia group (all P<0.05). CONCLUSIONS: TEAS at Hegu (LI 4) and Neiguan (PC 6) can effectively reduce the incidence rate and severity of POST induced by tracheal intubation under general anesthesia.

In vitro assessment of the ability of probiotics, blueberry and food carbohydrates to prevent S. pyogenes adhesion on pharyngeal epithelium and modulate immune responses.

Group A streptococci (GAS) cause 20-30% of pediatric pharyngitis episodes, which are a major cause of ambulatory care visits. Therefore, a strategy to prevent GAS dissemination in children could significantly benefit public healthcare. Contextually, we assessed the possibility of employing alternative food-grade strategies to be used with the oral probiotic L. helveticus MIMLh5 for the prevention of pharyngeal infections. First, we demonstrated through an antagonism-by-exclusion assay that guaran may potentially prevent S. pyogenes adhesion on pharyngeal cells. Subsequently, we showed that an anthocyanin-rich fraction extracted from wild blueberry (BbE) exerts anti-inflammatory effects on the human macrophage cell line U937. Finally, we showed that BbE reduces interferon-ß expression in MIMLh5-stimulated murine dendritic cells, resulting in a reduction in the pro-inflammatory cytokines IL-12 and TNF-α. In conclusion, this proof-of-concept study indicates that different food-grade strategies may be concomitantly adopted to potentially prevent GAS colonization and modulate local immune defences.

Does topical use of autologous serum help to reduce post-tonsillectomy morbidity? A prospective, controlled preliminary study.

BACKGROUND: To evaluate the effects of autologous serum usage on throat pain, haemorrhage and tonsillar fossa epithelisation in patients after tonsillectomy. METHODS: Thirty-two patients (aged 4-15 years) were included in the study. Tonsillectomy was performed and autologous serum was administered topically to the right tonsillar fossa during the operation, and at 8 and 24 hours post-operatively. The left side served as the control. A visual analogue scale was used to record the patient's pain every day. Each patient's oropharynx was observed on the 5th and 10th post-operative days to examine bleeding and epithelisation. RESULTS: The pain scores for the side administered autologous serum were significantly lower than those for the control side, on the night following the operation and on the 1st, 2nd, 5th and 6th post-operative days. Tonsillar fossa epithelisation was significantly accelerated on the study side compared with the control side on the 5th and 10th post-operative days. CONCLUSION: In tonsillectomy patients, topically administered autologous serum contributed to throat pain relief and tonsillar fossa epithelisation during the post-operative period.

Preventive Effect of Preoperative Administration of Hange-Shashin-To on Postoperative Sore Throat: A Prospective, Double-Blind, Randomized Trial.

OBJECTIVES: The present study aimed to determine the efficacy of Hange-Shashin-To (HST), a Kampo medicine, in treating postoperative sore throat and nausea. DESIGN: This randomized, controlled, double-blind study was conducted among two groups of adult female patients who were scheduled to undergo benign laparoscopic surgery under general anesthesia. All patients in each group had a physical status of either 1 (normal, healthy patient) or 2 (patient with a mild systemic disease), according to the American Society of Anesthesiologists. Patients were randomly assigned to either the HST group or the placebo (control) group. INTERVENTION: Before surgery, the HST group received HST (5.0 g) mixed with jelly, while the placebo group received only jelly. Patients and the evaluator were blinded to the treatment status. OUTCOME MEASURES: At 0, 3, and 24 hours after anesthesia recovery, an investigator (also blinded to the treatment status) recorded incidence and severity using the Numeric Rating Scale for sore throat and nausea. RESULTS: Incidence and severity of sore throat were significantly lower in the HST group than in the control group immediately and 3 hours after surgery (p<0.05). In contrast, incidence and severity of nausea did not differ significantly between the HST and control groups. CONCLUSIONS: HST administration before general anesthesia did not alleviate postoperative nausea, but effectively decreased the incidence and severity of postoperative sore throat in female patients undergoing laparoscopic surgery.

Will targeting oropharyngeal gonorrhoea delay the further emergence of drug-resistant Neisseria gonorrhoeae strains?

Gonorrhoea is an important sexually transmitted infection associated with serious complications and enhanced HIV transmission. Oropharyngeal infections are often asymptomatic and will only be detected by screening. Gonococcal culture has low sensitivity (<50%) for detecting oropharyngeal gonorrhoea, and, although not yet approved commercially, nucleic acid amplification tests (NAAT) are the assay of choice. Screening for oropharyngeal gonorrhoea should be performed in high-risk populations, such as men-who-have-sex-with-men(MSM). NAATs have a poor positive predictive value when used in low-prevalence populations. Gonococci have repeatedly thwarted gonorrhoea control efforts since the first antimicrobial agents were introduced. The oropharyngeal niche provides an enabling environment for horizontal transfer of genetic material from commensal Neisseria and other bacterial species to Neisseria gonorrhoeae. This has been the mechanism responsible for the generation of mosaic penA genes, which are responsible for most of the observed cases of resistance to extended-spectrum cephalosporins (ESC). As antimicrobial-resistant gonorrhoea is now an urgent public health threat, requiring improved antibiotic stewardship, laboratory-guided recycling of older antibiotics may help reduce ESC use. Future trials of antimicrobial agents for gonorrhoea should be powered to test their efficacy at the oropharynx as this is the anatomical site where treatment failure is most likely to occur. It remains to be determined whether a combination of frequent screening of high-risk individuals and/or laboratory-directed fluoroquinolone therapy of oropharyngeal gonorrhoea will delay the further emergence of drug-resistant N. gonorrhoeae strains.

A randomized, double-blind comparison of licorice versus sugar-water gargle for prevention of postoperative sore throat and postextubation coughing.

BACKGROUND: One small study suggests that gargling with licorice before induction of anesthesia reduces the risk of postoperative sore throat. Double-lumen tubes are large and thus especially likely to provoke sore throats. We therefore tested the hypothesis that preoperative gargling with licorice solution prevents postoperative sore throat and postextubation coughing in patients intubated with double-lumen tubes. METHODS: We enrolled 236 patients having elective thoracic surgery who required intubation with a double-lumen endotracheal tube. Patients were randomly assigned to gargle 5 minutes before induction of anesthesia for 1 minute with: (1) Extractum Liquiritiae Fluidum (licorice 0.5 g); or (2) Sirupus Simplex (sugar 5 g); each diluted in 30 mL water. Sore throat and postextubation coughing were evaluated 30 minutes, 90 minutes, and 4 hours after arrival in the postanesthesia care unit, and the first postoperative morning using an 11-point Likert scale by an investigator blinded to treatment. RESULTS: The incidence of postoperative sore throat was significantly reduced in patients who gargled with licorice rather than sugar-water: 19% and 36% at 30 minutes, 10% and 35% at 1.5 hours, and 21% and 45% at 4 hours, respectively. The corresponding estimated treatment effects (relative risks) were 0.54 (95% CI, 0.30-0.99, licorice versus sugar-water; P = 0.005), 0.31 (0.14-0.68) (P < 0.001), and 0.48 (0.28-0.83) (P < 0.001). CONCLUSION: Licorice gargling halved the incidence of sore throat. Preinduction gargling with licorice appears to be a simple way to prevent a common and bothersome complication.

Acupuncture in preventing postoperative anaesthesia-related sore throat: a comparison with no acupuncture.

BACKGROUND: Postoperative sore throat occurs frequently in surgical patients as a result of tracheal intubation. Despite advances in medical and anaesthetic care, the incidence of postoperative sore throat remains high. Our study aimed to assess the efficacy of acupuncture in the prevention of postoperative sore throat following general anaesthesia. METHODS: A non-randomised clinical study (NRS) was carried out in a tertiary care hospital in Tehran, Iran on 228 consecutive patients undergoing elective surgeries under general anaesthesia. Of these, 114 patients were assigned to the acupuncture group and treated with body acupuncture at the PC6 point, while the remaining 114 patients received no preventive care and were treated with routine medical treatment where necessary. The incidence of sore throat within the first 24 h postoperatively was then compared between the two study groups. RESULTS: Of the 114 patients in the acupuncture group, 16 patients (14%) experienced sore throat within the first 24 h postoperatively, which was significantly lower compared to the 34 patients (29.8%) with sore throat in the medical treatment group (p<0.05). However, the frequency of patients with severe sore throat requiring medical treatment did not differ significantly (12.3% vs 16.7%, p>0.05). CONCLUSIONS: Our study suggests that acupuncture could be considered as an option in prevention of postoperative anaesthesia-related sore throat.

Gargling with sodium azulene sulfonate reduces the postoperative sore throat after intubation of the trachea.

Postoperative sore throat (POST) is a complication that remains to be resolved in patients undergoing endotracheal intubation. In this study, we investigated whether preoperative gargling with sodium 1,4-dimethyl-7-isopropylazulene-3-sulfonate monohydrate (sodium azulene sulfonate, Azunol) reduces POST after endotracheal intubation. Forty patients scheduled for elective surgery under general anesthesia were randomized into Azunol and control groups. In the Azunol group, patients gargled with 4 mg Azunol diluted with 100 mL tap water (40 microg/mL). In the control group, patients gargled with 100 mL of tap water. After emergence from general anesthesia, the patients with POST were counted and POST was evaluated using a verbal analog pain scale. There were no significant differences between the two groups by age, height, body weight, gender distribution, or duration of anesthesia and surgery. In the control group, 13 patients (65%) complained of POST, which remained 24 h later in nine patients (45%). In the Azunol group, five patients (25%) also complained of POST, which completely disappeared by 24 h later. The incidence of POST and verbal analog pain scale scores in the Azunol group decreased significantly compared with the control group. We demonstrated that gargling with Azunol effectively attenuated POST with no adverse reactions.

Prevention of postoperative sore throat using capsicum plaster applied at the Korean hand acupuncture point.

In a randomised, double-blind, sham-controlled study, we compared the efficacy of capsicum plaster (PAS) applied at the Korean hand acupuncture point for the prevention of postoperative sore throat in 150 patients scheduled to undergo abdominal hysterectomy. The K group had PAS applied at the K-A20 of both hands and placebo tape at both non-acupoints. The PAS was applied prior to induction of anaesthesia and removed 8 h postoperatively. The sore throat scores of Group K were significantly lower than those of other groups at 24 h following surgery (p = 0.00027). The prevalence of moderate to severe sore throat at 24 h was lower for Group K (0%) than for sham and placebo controls (16%[p = 0.038] and 19%[p = 0.032], respectively). There were no differences in the recovery room of the sore throat scores for all groups. We found that the PAS applied at the K-A20 was an alternative method for reducing postoperative sore throat.

Effectiveness of lubrication of endotracheal tube cuff with chamomile-extract for prevention of postoperative sore throat and hoarseness.

PURPOSE OF THE STUDY: To determine the efficacy of lubrication of the endotracheal tube cuff with Chamomile extract (Kamillosan M) before intubation on postoperative sore throat and hoarseness. MATERIAL AND METHOD: The authors randomly assigned 161 patients ASA (American Society of Anesthesiologists) physical status I, II elective surgical, orthopedic, gynecological or urological into 2 groups. The study group received 10 puffs of total 370 mg of Chamomile extract (Kamillosan M spray) lubricated at cuff of endotracheal tube while the control group did not receive any lubrication before intubation. Standard general anesthesia with tracheal intubation was given in both groups. Sore throat and hoarseness were recorded in post anesthetic care unit and at 24 h after operation. RESULTS: One hundred and sixty-one ASA physical status I, II elective surgical patients were recruited. Forty one out of 81 patients (50.6%) in the Chamomile group, scored no postoperative sore throat in the post-anesthesia care unit compared with 45 out of 80 patients (56.3%) in the control group p=0.386. Postoperative sore throat and hoarseness both in the postanesthesia care unit and at 24 h postoperation were not statistically different. There was no statistically significant relationship between sore throat or hoarseness and postoperative nausea or vomiting, ASA physical status, gender, history of smoking, grade of laryngoscopic view, number of intubation attempts, condition during intubation, use of oral airway and couching during extubation. CONCLUSION: Lubrication of endotracheal tube cuff with Chamomile extract spray before intubation can not prevent post operative sore throat and hoarseness.

Efficacy of chamomile-extract spray for prevention of post-operative sore throat.

A randomized, double-blind study was carried out to assess the effect of 111 mg of Chamomile extract spray compared with normal saline spray (placebo) administered before intubation on post-operative sore throat and hoarseness. One hundred and sixty-one ASA (American Society of Anesthesiologists) physical status I, II elective surgical patients were recruited. Forty-two out of 80 patients (52.5%) in the Chamomile group scored no post-operative sore throat in the post-anesthesia care unit compared with 41 out of 81 patients (50.6%) in the placebo group, p=0.159. Post-operative sore throat and hoarseness both in the post-anesthesia care unit and 24 hour after operation were not statistically different. There was no statistically significant relationship between sore throat or hoarseness and ASA physical status, sex, history of smoking, grade of laryngoscopic view, number of intubation attempts, condition during intubation and condition of extubation. However, there was significant correlation between use of oral airway and sore throat in the post-anesthesia care unit and 24 hours after operation (p=0.031 and 0.002 respectively). Chamomile extract spray administered before intubation, therefore, can not prevent post-operative sore throat and hoarseness.

Can prophylactic application of immunoglobulin decrease radiotherapy-induced oral mucositis?

Therapeutic application of immunoglobulin is reported to be successful in radiation-induced oral and oropharyngeal mucositis. In this study the efficacy of prophylactic application of immunoglobulin was investigated. In 42 patients with head and neck cancer, postoperative radiation treatment or radiation combined with chemotherapy was performed. In 20 consecutive patients, prophylactic mucositis treatment consisted of panthenol (4 x 10 ml/day) and nystatin (4 x 1 ml/day). The 22 following patients received, supplementary to panthenol and nystatin, 800 mg (5 ml) human immunoglobulin intramuscularly once weekly. During the treatment time, the degree of mucositis was examined 3 times a week. The distribution of maximal mucositis degree revealed slightly more severe mucous membrane reaction in the control group compared with the immunoglobulin group (n.s.). The analysis of mean mucositis degrees in both groups demonstrated statistically significant differences (t test, p = 0.031) related to the entire group (n = 42) and to those 16 patients receiving radiation combined with chemotherapy. There was no significant immunoglobulin-induced effect on mucositis in patients treated by radiation alone. The time from the beginning of therapy to the first interruption could be prolonged 5 days in the immunoglobulin group (n.s.). In conclusion, it is demonstrated that the prophylactic application of immunoglobulin seems to lower the degree of radiation-induced mucositis. In comparison to the published data about therapeutically given immunoglobulin, the clinical efficacy of the prophylactic application of immunoglobulin as it is performed in this study is less evident.

Premedication with meperidine and diazepam for upper gastrointestinal endoscopy precludes the need for topical anesthesia.

The authors conducted a prospective study in 90 patients undergoing upper endoscopic examination under sedation to determine whether there was any beneficial effect in anesthetizing the pharynx with topical anesthesia. These patients were divided into three groups of 30 patients. Group A received 39 ml of viscous lidocaine gargle (2%) diluted with 15 ml of tap water. Group B received the placebo. Group C received neither viscous lidocaine nor placebo. All patients received intravenous meperidine and diazepam titrated to produce adequate sedation for upper endoscopy. It was demonstrated that the undesirable effects of upper endoscopy, that is, gagging, sore throat, and dysphagia, did not differ significantly in any of the three study groups as evaluated by either the patients or the endoscopist. Only two patients complained that the procedure was mildly unpleasant. The authors conclude that the practice of anesthetizing the pharynx in patients receiving sedation for upper endoscopy should be abandoned since anesthesia of the pharynx is not exempt from morbidity and mortality as well as being time-consuming and expensive.