Comparative Analysis of Hemodynamic Responses and Oropharyngeal Complications in Tracheal Intubation: Evaluating Conventional, Video, and Rigid Video Laryngoscopes Under General Anesthesia.

BACKGROUND This study aimed to compare the hemodynamic changes and the occurrence of oropharyngeal complications among patients undergoing tracheal intubation with an ordinary laryngoscope, video laryngoscope, and rigid video laryngoscope under general anesthesia. MATERIAL AND METHODS Patients undergoing elective tracheal intubation under general anesthesia were prospectively enrolled as study subjects. Hemodynamic indicators such as diastolic blood pressure (DBP), systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate (HR), as well as the incidences of oropharyngeal complications, including dental injury, oral mucosal injury, hoarseness, sore throat, and dysphagia, were observed in the patients of 3 groups (group A: ordinary laryngoscope, group B: video laryngoscope, group C: rigid video laryngoscope). Observations were made after anesthesia induction (T0), immediately after tracheal intubation (T1), and at 5 min after intubation (T2). RESULTS The HR at T1 in group A was significantly higher than in groups B and C (P<0.05). However, the difference in the number of tracheal intubations was statistically significant among the 3 groups (P<0.05); group C exhibited the highest first-time success rate of tracheal intubation (95%), whereas group A had the highest failure rate (5%). Significant differences were also noted in the incidences of oral mucosal injury and sore throat among the groups (P<0.05), with the highest incidence in group A and the lowest in group C. CONCLUSIONS Compared with the ordinary laryngoscope, tracheal intubation using a video or rigid video laryngoscope results in milder hemodynamic impacts and fewer intubation-related complications. The rigid video laryngoscope may be safer and more effective.

Effectiveness of intracuff alkalinized lidocaine associated with intravenous dexamethasone in reducing laryngotracheal morbidity in children undergoing general anesthesia for tonsillectomy: a randomized controlled trial.

BACKGROUND: Postoperative sore throat is one of the main postoperative complaints in patients undergoing tonsillectomy. As the primary outcome, we aimed to determine whether endotracheal tube cuffs filled with alkalinized lidocaine are associated with a lower incidence of postoperative sore throat and anesthesia emergence phenomena in children undergoing tonsillectomy or adenotonsillectomy. We also assessed the potential additional benefits of IV dexamethasone in reducing postoperative laryngotracheal morbidity. METHODS: This is a clinical prospective, randomized, controlled trial. Patients were randomly allocated to one of four groups, as follows: air - endotracheal tube cuff filled with air; air/dex - endotracheal tube cuff filled with air and intravenous dexamethasone; lido - endotracheal tube cuff filled with alkalinized lidocaine; and lido/dex - endotracheal tube cuff filled with alkalinized lidocaine and intravenous dexamethasone. Perioperative hemodynamic parameters and the incidence of postoperative nausea and vomiting, coughing and hoarseness were recorded. Postoperative sore throat was assessed in the postanesthetic care unit and 24 hours post tracheal extubation. RESULTS: In total, 154 children aged 4-12 years, ASA physical status I or II, undergoing general anesthesia for elective tonsillectomy and adenotonsillectomy, were assessed for postoperative sore throat in this study. The incidence of postoperative sore throat 24 hours after tracheal extubation was significantly lower in the lido/dex group compared to groups air and air/dex (p = 0.01). However, no additional reduction in these symptoms was observed from the intravenous administration of dexamethasone when comparing the lido and lido/dex groups. Similarly, there were no differences among groups regarding perioperative hemodynamic variables or postoperative nausea and vomiting, coughing, and hoarseness during the study period. CONCLUSION: Intracuff alkalinized lidocaine, associated with intravenous dexamethasone, might be effective in reducing sore throat 24 hours post-tonsillectomy or adenotonsillectomy in children when compared to the use of air as the cuff insufflation media.

[Prospects for the use of ozone therapy and low-intensity laser therapy in the treatment of atrophic pharyngitis]. / Perspektivy primeneniya ozonoterapii i nizkointensivnoi lazeroterapii pri lechenii atroficheskogo faringita.

Chronic pharyngitis (CP) is one of the most common diseases of the oropharynx. The number of referrals from patients with CP reaches 70% of the total number of referrals to an otorhinolaryngologist. The development of this disease is facilitated by the neuro-reflex factor and a violation of trophic and metabolic processes. It should be noted that of all forms of CP, the greatest impact on the quality of life is noted precisely in atrophic pharyngitis (AP), due to the presence of pronounced subjective sensations from the oropharynx. Many of the modern methods of treatment do not provide a lasting effect due only to the application, superficial local effect on the altered mucous membrane of the posterior pharyngeal wall, without taking into account the changes caused by a violation of trophic processes in the tissue. A promising direction in the treatment of atrophic pharyngitis is the use of a combined technique - ozone therapy and low-intensity laser therapy. The article presents the results of the application of fine-drip irrigation of the mucous membrane of the posterior pharyngeal wall with Ozonide oil in combination with low-intensity laser radiation on the projection of vessels supplying blood to the middle parts of the oropharynx. OBJECTIVE: Improving the effectiveness of treatment of patients with atrophic pharyngitis through the use of ozone therapy and low-intensity laser therapy. MATERIAL AND METHODS: A single-center experimental controlled randomized open-label study of 90 patients with AP aged 18 and over was conducted. All patients were randomly divided into three groups depending on the treatment performed: group I - traditional treatment method (rinsing the oropharynx with antiseptic solutions, the use of tablets for resorption), group II - treatment with ozone therapy (fine drip irrigation of the mucous membrane of the posterior pharyngeal wall with Ozonide oil), group III - treatment with ozone therapy and laser therapy. During the examination of patients, anamnesis collection, examination of ENT organs, cytological and microbiological examination of the mucous membrane of the posterior pharyngeal wall, contact endoscopy of the mucous membrane of the posterior pharyngeal wall were performed. 5-point visual analogue scales (VAS) were used to assess complaints and pharyngoscopic signs. RESULTS: Our results showed a statistically significant improvement in the quality of life of patients with AP (p=0.012), an improvement in the pharyngoscopic picture (p=0.003). The results obtained by us indicate an improvement in microcirculation under the influence of ozone therapy and low-intensity laser radiation. The technique using ozone therapy and low-intensity laser therapy is characterized by a bactericidal and fungicidal effect. There is a decrease in the total contamination of the posterior wall of the oropharynx with pathogenic and saprophytic microflora (there is a decrease in the contamination of the posterior wall of the pharynx with saprophytic and pathogenic microflora (p≤0.05), the differences are statistically significant). The technique using ozone therapy and low-intensity laser therapy has a pronounced anti-inflammatory effect, which was expressed in a decrease in the severity of dyskeratosis and hyperkeratosis. Thus, the use of ozone therapy in combination with laser therapy opens up new prospects for pathogenetically sound and effective treatment of AP.

Intravenous versus intracuff alkalinized lidocaine to prevent postoperative sore throat: a prospective randomized controlled trial.

Introduction: postoperative sore throat (POST) is a common complication after general anesthesia with endotracheal intubation caused by tracheal mucosal injury. Multiple techniques prevent postoperative sore throat (POST). Our study aimed to compare two techniques: intravenous and intracuff lidocaine versus placebo to prevent postoperative sore throat after general anesthesia with orotracheal intubation. Methods: we conducted a prospective double-blind, randomized controlled clinical trial involving patients, proposed for a scheduled surgery less than 240 minutes under general anesthesia with orotracheal intubation. Patients were divided into three groups: L group: infused with saline, cuff filled with alkalinized lidocaine. S group: Infused with 1.5 mg/kg of lidocaine, cuff filled with saline. T group: placebo: infused with saline, cuff filled with saline. Our primary outcome was the incidence of sore throat and their (visual analog scale) VAS score in the first 24 postoperative hours. Our secondary outcomes were the incidence of cough, dysphonia, dysphagia, and postoperative nausea and vomiting. Results: ninety patients were analyzed and divided into 3 groups of 30. The incidence of POST at the sixth postoperative hour, for placebo, the "L" group, and the "S" group, respectively, was 67%, 30%, and 47%. And at the 24th postoperative hours 67%, 13%, and 37%. Intravenous lidocaine reduced significantly the VAS of POST at the 24th hour (S: 6.80 ± 20.70; T: 20.67 ± 18.182; p= 0.02). Alkalinized lidocaine decreased significantly the VAS of POST in the sixth (L: 8.17 ± 22.761; T: 23 ± 21.838; p = 0.048) and the 24th postoperative hour (L: 6.33 ± 20.592; T: 20.67 ± 18.182; p= 0.019) with the lowest pain score. There was no statistically significant difference between the L and S groups at the 6 and 24 postoperative hours. Both lidocaine techniques reduced cough at emergence, with the superiority of alkalinized lidocaine (p=0.02). They decreased the incidence of cough, dysphonia, dysphagia, nausea, and vomiting compared to a placebo. Conclusion: intravenous and intracuff lidocaine allowed better control of postoperative sore throat.

A Case of Ludwig's Angina Following Influenza in a 16-Year-Old Male.

This case report illuminates an instance of Ludwig's Angina in a 16-year-old male patient with concurrent Influenza A. Ludwig's Angina, a potentially fatal, rapidly spreading cellulitis, primarily affects the submandibular and sublingual spaces. This case emphasizes the importance of early detection, immediate intervention, and multidisciplinary management to prevent life-threatening complications. The patient presented with fever, sore throat, swelling under the tongue and submandibular region, and difficulty breathing following a family trip to Puerto Rico. Despite initial respiratory distress and severe soft tissue swelling, the patient responded positively to broad-spectrum antibiotics, with clinical improvement leading to discharge after five days. The report discusses the challenges in diagnosing and managing Ludwig's Angina, the potential role of the patient's environment in disease presentation, and the relevance of historical medical literature in contemporary clinical practice. This case underscores the need for vigilance in patients with influenza for potential secondary bacterial complications and the necessity of expedited airway management in patients with Ludwig's Angina.

Comparison between intravenous lidocaine and dexamethasone in reducing postoperative sore throat after endotracheal extubation at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia; a prospective cohort study.

BACKGROUND: Post-operative sore throat is the common complaint and uncomfortable side effect in patients receiving general anesthesia with endotracheal intubation. Drugs with analgesic and anti-inflammatory properties, like steroids and local anesthetics, are the best options for postoperative sore throat prophylaxis. Therefore, this study aimed to compare the effects of intravenous lidocaine and dexamethasone in reducing postoperative sore throat following endotracheal extubation at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, from January 1 to March 30, 2023 G.C. METHODS: A prospective cohort study was carried out at Tikur Anbessa Specialized Hospital. Data from 50 patients in the lidocaine (1.5 mg/kg), 50 in the dexamethasone (8 mg), and 49 in the control groups were analyzed. The data were collected using observation based on structured questionnaires. A systematic random sampling technique was applied to select respondents. The data were entered into EpiData version 4.6.0.6 and transferred to STATA version 17 statistical software for analysis. A comparison of continuous data among the groups were performed using a one-way ANOVA test for parametric data. The Kruskal-Wallis rank test was used for non-parametric data. Associations between variables were tested using chi-squared test, Fisher's exact test, and binary logistic regression. Bivariable and multivariable logistic regression was used to determine degree of association. RESULTS: The incidence of POST was 40%, 32%, and 57.1% in the lidocaine, dexamethasone, and control groups, respectively (P = .0356). Dexamethasone reduced the incidence of POST during the first 24 h (AOR: 0.374, 95% CI: 0.149-0.939). However, no difference was observed in the severity of POST at 3 h (p = 0.130), 6 h (p = 0.096), 12 h (p = 0.313), and 24 h (p = 0.525) of the post-extubation period among the three groups. IV lidocaine did not effectively reduce the incidence and severity of postoperative sore throat at different time intervals. CONCLUSION AND RECOMMENDATION: Intravenous dexamethasone is more effective than intravenous lidocaine in reducing the incidence of postoperative sore throat among the groups. Based on these findings, intravenous dexamethasone is recommended to decrease the incidence of postoperative sore throat.

Effect of peri-intubation non-pharmacological interventions on postoperative laryngeal symptoms: A systematic review with meta-analysis and meta-regression.

OBJECTIVES: To evaluate the effectiveness of peri-intubation non-pharmacological interventions in reducing postoperative sore throat (POST), cough (PEC), and hoarseness in surgical patients. DESIGN: A systematic review with meta-analysis and meta-regression. SETTING: Elective surgery under general anesthesia in operating rooms. MAIN OUTCOME MEASURES: Evaluate the impact of non-pharmacological interventions, including pre-intubation (gargling with Sodium Azulene Sulfonate, licorice, or using Strepsils tablets of honey and lemon lozenge), during-intubation (inflating the TT cuff with normal saline and softening the ETT cuff with warm normal saline), and post-intubation (cold vapor therapy, gargling with honey lemon water, and using green tea gargle), on the occurrence of POST, PEC, and hoarseness. RESULTS: Nineteen trials with 2,136 participants were included. Pre-intubation intervention significantly reduced POST immediately after extubation (n = 861; OR: 0.28, 95 % CI: 0.20-0.38, P < 0.001), and 24 h post-extubation (n = 1006; OR: 0.21, 95 % CI: 0.16-0.28, P < 0.001). During-intubation intervention did not show significant effects on POST. Pre-intubation intervention also reduced POST-associated pain score at 24 h post-extubation (n = 440; MD: -0.50, 95 % CI: -0.81 to -0.18, P < 0.001). Post-intubation interventions were effective in reducing POST-associated pain scores at different time points post-extubation (P < 0.05). Pre-intubation intervention significantly reduced PEC (OR: 0.13, 95 % CI: 0.02-0.70, P = 0.02) and hoarseness (OR: 0.36, 95 %CI: 0.15-0.86, P = 0.02) at 24 h post-extubation. However, during-intubation interventions did not reduce hoarseness at 24 h post-extubation. CONCLUSION: Pre-intubation non-pharmacological interventions were found to be the most effective in reducing the incidence and severity of POST, PEC, and hoarseness. IMPLICATIONS FOR CLINICAL PRACTICE: Implementing pre-intubation non-pharmacological interventions can be beneficial for bedside nurses and healthcare professionals in reducing postoperative complications and nurses can contribute to improving patient comfort and recovery outcomes following surgery. SYSTEMATIC REVIEW PROTOCOL: The protocol was registered in the PROSPERO international prospective register of systematic reviews on 2 January 2024 (CRD42023492813).

Onset time, duration of action, and intubating conditions after mivacurium in elderly and younger patients.

BACKGROUND: The neuromuscular blocking agent mivacurium can be used during anesthesia to facilitate tracheal intubation. Data on onset time, duration of action, and effect on intubating conditions in patients 80 years and older are however limited. We hypothesized that onset time and duration of action of mivacurium would be longer in elderly patients than in younger adults. METHODS: This prospective observational study included 35 elderly (≥80 years) and 35 younger (18-40 years) patients. Induction of anesthesia comprised fentanyl 1-3 µg kg-1 and propofol 1.5-2.5 mg kg-1 and propofol and remifentanil for maintenance. Acceleromyography was used for monitoring neuromuscular blockade. The primary outcome was onset time defined as time from injection of mivacurium 0.2 mg kg-1 to a train-of-four (TOF) count of zero. Other outcomes included duration of action (time to TOF ratio ≥0.9), intubating conditions using the Fuchs-Buder scale and the intubating difficulty scale (IDS), and occurrence of hoarseness and sore throat postoperatively. RESULTS: No difference was found in onset time comparing elderly with younger patients; 219 s (SD 45) versus 203 s (SD 74) (difference: 16 s (95% CI: -45 to 14), p = .30). Duration of action was significantly longer in elderly patients compared with younger patients; 52 min (SD 17) versus 30 min (SD 8) (difference: 22 min [95% CI: 15 to 28], p < .001). No difference was found in the proportion of excellent intubating conditions (Fuchs-Buder); 31/35 (89%) versus 26/35 (74%) (p = .12) or IDS score (p = .13). A larger proportion of younger patients reported sore throat 24 h postoperatively; 34% versus 0%, p = .0002. No difference was found in hoarseness. CONCLUSION: No difference in onset time of mivacurium 0.2 mg kg-1 was found comparing elderly and younger patients. However, elderly patients had significantly longer duration of action. No difference was found in intubating conditions.

Effects of preoperative inhaled budesonide combined with intravenous dexamethasone on postoperative sore throat in patients who underwent thyroidectomy: A randomized controlled trial.

BACKGROUND: This randomized controlled trial aimed to evaluate the efficacy of preoperative inhaled budesonide combined with intravenous dexamethasone on postoperative sore throat (POST) after general anesthesia in patients who underwent thyroidectomy. METHODS: Patients who underwent elective thyroidectomy were randomly divided into the intravenous dexamethasone group (group A) and budesonide inhalation combined with intravenous dexamethasone group (group B). All patients underwent general anesthesia. The incidence and severity of POST, hoarseness, and cough at 1, 6, 12, and 24 hours after surgery were evaluated and compared between the 2 groups. RESULTS: There were 48 and 49 patients in groups A and B, respectively. The incidence of POST was significantly lower at 6, 12, and 24 hours in group B than that in group A (P < .05). In addition, group B had a significantly lower incidence of coughing at 24 hours (P = .047). Compared with group A, the severity of POST was significantly lower at 6 (P = .027), 12 (P = .004), and 24 (P = .005) hours at rest, and at 6 (P = .002), 12 (P = .038), and 24 (P = .015) hours during swallowing in group B. The incidence and severity of hoarseness were comparable at each time-point between the 2 groups (P > .05). CONCLUSION: Preoperative inhaled budesonide combined with intravenous dexamethasone reduced the incidence and severity of POST at 6, 12, and 24 hours after extubation compared with intravenous dexamethasone alone in patients who underwent thyroidectomy. Additionally, this combination decreased the incidence of postoperative coughing at 24 hours.

Perioperative care of the patient with a periodic fever syndrome.

Periodic fever syndromes are autoinflammatory disorders associated with recurrent fevers unrelated to infection. Little is known about the perioperative management of patients with these syndromes, and existing literature consists primarily of case reports and occasional case series. This narrative review discusses background information and diagnostic criteria for the three most common periodic fever syndromes: periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA), familial Mediterranean fever (FMF), and TNF receptor-associated periodic syndrome (TRAPS), and describes perioperative considerations for anesthesia providers when caring for the patient with a periodic fever syndrome. We include a systems-based framework in which to organize these considerations.

What Is Strep Throat?

This JAMA Patient Page describes strep throat, its signs and symptoms, diagnosis, treatment, and potential complications.

Role of preoperative zinc, magnesium and budesonide gargles in Postoperative Sore Throat (POST) - a randomised control trial.

BACKGROUND: Post-operative sore throat (POST) has an incidence ranging from 21 to 80%. To prevent the development of POST, several pharmacological measures have been tried. Aim of this study was to compare the efficacy of preoperative zinc, magnesium and budesonide gargles in reducing the incidence and severity of POST in patients who underwent endotracheal intubation for elective surgeries. METHODS: We conducted a prospective, randomized, double-blind, controlled equivalence trial in 180 patients admitted for elective surgical procedures under general anaesthesia. Patients were randomised into three groups; group Z received 40 mg Zinc, group M received 250 mg Magnesium Sulphate and group B received 200 µg Budesonide in the form of 30 ml tasteless and colourless gargle solutions. Sore throat assessment and haemodynamic recording was done postoperatively at immediate recovery (0 h) and 2, 4, 6, 8, 12 and 24 h post-operatively. POST was graded on a four-point scale (0-3). RESULTS: POST score was comparable at all recorded time points i.e. 0,2,4,6,8,12 and 24 h. Maximum incidence was seen at 8 h in group B (33.3%) and the minimum incidence was at 24 h in group Z (10%) (p > 0.05). It was found that the incidence of POST was more in the surgeries lasting longer than 2 h in all groups. This difference was found to be statistically significant in Groups M and B. The incidence of POST was found to be comparable between laparoscopic and open procedures. CONCLUSION: Magnesium, zinc and budesonide have an equivocal effect in the prevention of POST at different time points. The incidence of sore throat increases significantly in surgeries lasting more than two hours if magnesium or budesonide have been used as premedicant. Duration of surgery is an independent predictor for POST. TRIAL REGISTRATION: CTRI/2021/05/033741 Date-24/05/2021(Clinical Trial Registry of India).

Effect of intravenous and topical laryngeal lidocaine on sore throat after extubation: a prospective randomized controlled study.

OBJECTIVE: The present study aimed to compare the effect of topical laryngeal lidocaine with intravenous lidocaine before endotracheal intubation on the incidence and severity of postoperative sore throat, hoarseness, and cough. PATIENTS AND METHODS: This prospective randomized controlled study enrolled 144 patients undergoing laparoscopic cholecystectomy with endotracheal intubation. The patients were randomized to three groups and received 2% lidocaine by topical laryngeal spray (group T), intravenous 2% lidocaine (group I), and the equivalent volume of intravenous saline (group C) before intubation. The incidence and severity of sore throat, hoarseness, and cough reaction at 0.5, 1, 6, and 24 h after extubation were collected. RESULTS: The incidence of sore throat was significantly lower in group T than in groups I and C (6.4% vs. 37.2% and 86.7%, p < 0.001), respectively at 0.5 h after extubation, and it was significantly lower in group I than that in group C (37.2% vs. 86.7%, p < 0.001). Both the incidence of hoarseness and cough were significantly lower in group T than in group I and in group C (14.9% vs. 97.7% and 97.8%, p < 0.001, and 19.1% vs. 72.0% and 93.3%, p < 0.001), respectively. The severity of sore throat, hoarseness and cough in group T was significantly lower than that in group I and that in group C (p < 0.05), and it was significantly lower in group I than in group C (p < 0.05). CONCLUSIONS: Both topical laryngeal lidocaine and intravenous lidocaine before intubation have positive effects on preventing sore throat. Topical laryngeal route was superior to intravenous route. Chictr.org.cn ID: ChiCTR2100042442.

Does salivary pH affect postoperative sore throat in the head-down position of general anesthesia?

BACKGROUND: Tracheal intubation sometimes causes postoperative sore throat (POST) due to laryngeal damage. However, clinical observations suggest that the environment of the oral cavity may also affect POST. OBJECTIVE: The purpose of this study was to investigate whether salivary pH in the oral cavity affects POST. METHODS: After obtaining ethical approval, informed consent was obtained from all patients. Patients who underwent surgery in the supine position were enrolled as the control group. Patients who underwent laparoscopic surgery in the head-down position were enrolled as the intervention group. Immediately before both groups of patients were anaesthetised, expelled saliva was collected, and salivary pH was measured. Immediately postoperatively, the same measurement was carried out before the patient regained consciousness. The primary outcome was the change in salivary pH. The secondary outcome was POST. In our study, POST was defined as pharyngeal and swallowing pain in the glossopharyngeal and superior laryngeal nerves. The normal distribution of pH was tested using the Shapiro-Wilk test followed by analysis using repeated-measurements and one-way analysis of variance. Statistical significance was set at p < .05. RESULTS: A total of 62 patients were enrolled, of whom two were excluded based on the exclusion criteria. Salivary pH in the intervention group was significantly lower than that in the control group. Five patients had POST in the intervention group, whereas none had POST in the control group had POST. CONCLUSION: Acidotic-shifted saliva is considered one of the causes of POST.

The effect of different endotracheal tube cuff pressure monitoring systems on postoperative sore throat in patients undergoing tracheal intubation: a randomized clinical trial.

BACKGROUND: Postoperative sore throat (POST) is an unpleasant outcome that can occur as a result of tracheal intubation in adults. Increased pressure from the endotracheal tube (ETT) cuff often leads to local mucosal injury, resulting in sore throat. The purpose of this study was to compare the effect of two different ETT cuff pressure monitoring systems vs. no cuff pressure monitoring on the incidence and severity of POST in adults. METHODS: One hundred and fourteen ASA I-III patients of either gender, aged 18-65 years, and undergoing surgery requiring endotracheal intubation were included in this study. Patients were randomized into three groups: control (C), cuff pressure gauge (G), and automated cuff controller (A). The ETT cuff pressure was not monitored intraoperatively in group C but was monitored using a cuff pressure gauge and an automated cuff controller in groups G and A, respectively. Postoperatively, patients were assessed at 2, 24, and 48 h for the presence and severity of POST, hoarseness and cough. RESULTS: One hundred and eleven patients completed the study. POST occurred in 40.5% of the patients in group G (n = 37) (p = 0.013) and 23.7% of the patients in group A (n = 38) (p < 0.001) within 48 h after surgery, compared to 69.4% in group C (n = 36). There were no significant differences in hoarseness, coughing, and dysphagia across the groups at any time. When comparing groups A and C, individuals in group A exhibited a lower occurrence of significant (grade ≥ 2) POST and hoarseness (10.5% vs. 41.7%, p = 0.002; 26.3% vs. 58.3%, p = 0.005). The incidence of significant cough and dysphagia did not differ substantially across the patient groups within 48 h after surgery. POST scores in group A at 2, 24 h postoperatively were both 0 (0-0), which was significantly lower than those in group C (1 (0-2) at 2 h, p < 0.001 ; 1 (0-1) at 24 h, p = 0.001). POST in group G at 2 h postoperatively was graded as 0 (0-1.5) which was milder than group C (P = 0.024). The severity of hoarseness in group A with scores of 0 (0-2) was superior to that in group C (2 (0-2), p = 0.006) at 2 h postoperatively. CONCLUSIONS: In conclusion, the findings of this study indicated that the occurrence of POST can be reduced by using either the cuff pressure gauge approach or the automated cuff controller method. The automated cuff controller monitoring can potentially decrease the severity of POST and hoarseness. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

Group A Streptococcus Infections.

Group A Streptococcus causes a variety of clinical manifestations, including pharyngitis and skin and soft tissue infections as well as more invasive disease. There are also multiple nonsuppurative complications of group A Streptococcus infection, including acute rheumatic fever and poststreptococcal glomerulonephritis. Pediatricians should be able to diagnose and treat the various presentations of the infection.

Flurbiprofen in the subglottic space to prevent postoperative sore throat after cardiac surgery: A randomized double-blind study.

STUDY OBJECTIVE: Postoperative sore throat (POST) and hoarseness are common complications of tracheal intubation. This study aims to evaluate the efficacy of flurbiprofen administered through the subglottic port of tracheal tubes to prevent POST after cardiac surgery. DESIGN: Single-center, prospective, randomized, double-blind, placebo-controlled trial. SETTING: Tertiary Care Referral University Hospital (Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome). PATIENTS: Included 71 patients undergoing for elective cardiac surgery. Inclusion criteria were (a) age between 50 and 75 years, (b) NYHA class I or II, (c) surgery for myocardial revascularization or valve repair or replacement under cardiopulmonary bypass. INTERVENTION: Patients were double blind randomized to receive flurbiprofen or saline in the subglottic port of the endotracheal tube (groups F and P). The solution was injected ten minutes after tracheal tube placement, ten minutes after ICU admission and ten minutes before tracheal tube removal. MEASUREMENTS: The primary outcome was to assess the effect of topical flurbiprofen administered through the subglottic port of the tracheal tube to prevent post-operative sore throat (POST). The secondary outcomes were the presence of hoarseness safety and patient's subjective satisfaction with their recovery. We did not report any exploratory outcomes. MAIN RESULTS: We analyzed 68 patients, 34 patients in each group. In group F, two patients complained of POST and hoarseness (5.9%), while all controls did. The two groups significantly differed in the severity scores (VAS and TPS for sore throat and HOAR for hoarseness) at all time points. In group P, patients reported mild to moderate symptoms that significantly improved or disappeared 36 h after tracheal tube removal. According to the multivariable model, hoarseness affected women less than men, in the control group (p = 0.002). None of the patients in either group reported any adverse effects. CONCLUSIONS: Repeated administration of flurbiprofen through the subglottic port of tracheal tubes reduced the incidence of sore throat and hoarseness after cardiac surgery without evidence of complications.