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.

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.

Ease of endotracheal intubation with the conventional polyvinyl chloride endotracheal tube versus wire-reinforced flexometallic tube through the intubating laryngeal mask airway: A comparative study.

Background The I-LMA ventilates while providing a port for blind insertion of an endotracheal tube. The ILMA Fastrach is used especially for intubating in a difficult airway scenario. Its accompanying endotracheal tube is not economical nor readily available. In comparison, two alternative endotracheal tubes - polyvinyl chloride and wire-reinforced tubes were used for tracheal intubation through the ILMA. AIMS AND OBJECTIVES: The aim of our study was to compare the ease of intubation when using conventional PVC tubes versus the wire-reinforced flexometallic tubes with the ILMA-FastrachTM. The number of attempts, time taken and additional maneuvers were noted. Intra-operative hemodynamic changes, post-operative sore throat, bleeding and hoarseness of voice was recorded over a period of 24 hours. METHODOLOGY: After informed consent, 60 ASA I-II patients undergoing elective surgeries under general anesthesia were allocated to undergo blind intubation with the PVC tube or the wire-reinforced flexometallic tube. RESULTS: More attempts were required for successful intubation using the wire-reinforced tube than the PVC tube with 76.7% passing in the first attempt in the PVC, and 53.3% passing in the first attempt in the flexometallic group. (P = 0.4). Average time for intubation in the PVC group: 28.24 ± 7.22 seconds. Average time for intubation in the flexometallic tube: 45.8 ± 15.78 sec. Occurrence of post-operative sore throat was 13.3% in the PVC group and 26.6% in the flexometallic group, with minimal hoarseness of voice 3.3% in the PVC group and 10% in the flexometallic group. There was also a slightly higher hemodynamic response in those who were intubated with the flexometallic tube than a PVC tube. CONCLUSION: Intubating via the ILMA-Fastrach with the PVC tube offered better intubating conditions with regards to lesser time taken, lesser attempts, less manipulation, and less hemodynamic variations as compared to the patients who were intubated using the wire-reinforced tube.

Résumé Arrière-plan: L'I-LMA ventile tout en fournissant un port pour l'insertion aveugle d'une sonde endotrachéale. L'ILMA Fastrach est utilisé notamment pour l'intubation dans un scénario de voies respiratoires difficiles. La sonde endotrachéale qui l'accompagne n'est ni économique ni facilement disponible. En comparaison, deux tubes endotrachéaux alternatifs ­ du chlorure de polyvinyle et des tubes renforcés de fil ­ ont été utilisés pour l'intubation trachéale via l'ILMA. Buts et objectifs: Le but de notre étude était de comparer la facilité d'intubation lors de l'utilisation de tubes en PVC conventionnels par rapport aux tubes flexométalliques renforcés de fil avec l'ILMA-FastrachTM. Le nombre de tentatives, le temps nécessaire et les manÓuvres supplémentaires ont été notés. Les changements hémodynamiques peropératoires, les maux de gorge postopératoires, les saignements et l'enrouement de la voix ont été enregistrés sur une période de 24 heures. Méthodologie: Après consentement éclairé, 60 patients ASA I-II subissant des interventions chirurgicales électives sous anesthésie générale ont été affectés à une intubation aveugle avec le tube en PVC ou le tube flexométallique renforcé de fil. Résultats: Plus de tentatives ont été nécessaires pour réussir l'intubation à l'aide du tube renforcé par fil métallique qu'avec le tube PVC, avec 76,7 % de réussite lors de la première tentative dans le groupe PVC et 53,3 % de réussite lors de la première tentative dans le groupe flexométallique. (P = 0,4). Temps moyen d'intubation dans le groupe PVC : 28,24 ± 7,22 secondes. Temps moyen d'intubation dans le tube flexométallique : 45,8 ± 15,78 sec. La survenue de maux de gorge postopératoires était de 13,3 % dans le groupe PVC et de 26,6 % dans le groupe flexométallique, avec un enrouement minime de la voix de 3,3 % dans le groupe PVC et de 10 % dans le groupe flexométallique. Il y avait également une réponse hémodynamique légèrement plus élevée chez ceux qui étaient intubés avec le tube flexométallique qu'avec un tube en PVC. Conclusion: L'intubation via l'ILMA-Fastrach avec le tube en PVC offrait de meilleures conditions d'intubation en ce qui concerne moins de temps, moins de tentatives, moins de manipulations et moins de variations hémodynamiques par rapport aux patients intubés à l'aide du tube renforcé de fil Mots-clés: Facilité d'intubation, sonde endotrachéale flexométallique, masque laryngé d'intubation des voies respiratoires, sonde endotrachéale en polychlorure de vinyle.

Postoperative Sore Throat among Patients Following General Anesthesia with Endotracheal Intubation in a Tertiary Care Centre.

Introduction: Postoperative sore throat is the second most common minor adverse event after general anaesthesia with endotracheal intubation. It is an uncomfortable and stressful sequel of tracheal intubation. The incidence of postoperative sore throat varies across different studies and type of anesthesia technique used. The aim of the study was to find out the prevalence of postoperative sore throat following general anaesthesia with endotracheal intubation in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among the patients who underwent surgery under general anaesthesia with endotracheal intubation from 1 December 2022 to 31 October 2023 after receiving ethical approval from the Institutional Review Committee. The anaesthesia technique was standardized in all the patients. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 200 patients, postoperative sore throat was seen in 86 (43%) (36.14-49.86, 95% Confidence Interval) patients. The maximum reported time of sore throat was at a fourth postoperative hour 80 (93.02%). Conclusions: The prevalence of postoperative sore throat among patients undergoing surgery under general anaesthesia with endotracheal intubation was similar to the studies conducted in similar settings. Keywords: endotracheal intubation; general anaesthesia; prevalence.

The effects of video double-lumen tubes on intubation complications in patients undergoing thoracic surgery: A randomised controlled study.

BACKGROUND: Tracheal injuries, vocal cord injuries, sore throat and hoarseness are common complications of double-lumen tube (DLT) intubation. OBJECTIVE: This study aimed to evaluate the effects of 'video double-lumen tubes' (VDLTs) on intubation complications in patients undergoing thoracic surgery. DESIGN: A randomised controlled study. SETTINGT: Xuzhou Cancer Hospital, Xuzhou, China, from January 2023 to June 2023. PATIENTS: One hundred eighty-two patients undergoing elective thoracic surgery with one-lung ventilation were randomised into two groups: 90 in the DLT group and 92 in the VDLT group. INTERVENTION: VDLT was selected for intubation in the VDLT group, and DLT was selected for intubation in the DLT group. A fibreoptic bronchoscope (FOB) was used to record tracheal and vocal cord injuries. MAIN OUTCOME MEASURES: The primary outcomes were the incidence of moderate-to-severe tracheal injury and the incidence of vocal cord injury. The secondary outcomes included the incidence and severity of postoperative 24 and 48 h sore throat and hoarseness. RESULTS: The incidence of moderate-to-severe tracheal injury was 32/90 (35.6%) in the DLT group, and 45/92 (48.9%) in the VDLT group ( P  = 0.077; relative risk 1.38, 95% CI, 0.97 to 1.95). The incidence of vocal cord injury was 31/90 (34.4%) and 34/92 (37%) in the DLT and VDLT groups, respectively ( P  = 0.449). The incidence of postoperative 24 h sore throat and hoarseness was significantly higher in the VDLT group than in the DLT group (for sore throat: P  = 0.032, relative risk 1.63, 95% CI, 1.03 to 2.57; for hoarseness: P  = 0.018, relative risk 1.48, 95% CI, 1.06 to 2.06). CONCLUSION: There was no statistically significant difference in the incidence of moderate-to-severe tracheal injury and vocal cord injury between DLTs and VDLTs. While improving the first-attempt success rate, intubation with VDLT increased the incidence of postoperative 24 h sore throat and hoarseness. TRIAL REGISTRATION: Chinese Clinical Trial Registry identifier: ChiCTR2300067348.

Effect of chewing gum of different weights before surgery on sore throat after total thyroidectomy: A randomized controlled trial.

BACKGROUND: Postoperative sore throat (POST) is a common postoperative complication. COMPLICATION: Chewing gum can inhibit the growth of oral bacteria, cleanse, and lubricate the oral cavity, which can help reduce postoperative sore throat. We hypothesize that chewing gum before surgery could relieve POST. METHODS: Patients planned to undergo total thyroidectomy under general anesthesia with tracheal intubation were randomized to swallow saliva twice or chew 1.4 g/2.8 g of gum for 2 minutes before surgery. A standard anesthesia protocol was performed. The numerical rating scale scores of POST at 1, 24, and 48 h after surgery were collected. The primary outcome was the incidence of moderate/severe POST (numerical rating scale score >3) within 48 h. RESULTS: Data from 148 patients (control group, n = 50; 1.4 g group, n = 48; and 2.8 g group, n = 50) were included in the analysis. Within 48 h, there was a significant difference among the three groups in the incidence of moderate/severe POST (control group: 74% vs. 1.4 g group: 65% vs. 2.8 g group: 50%. P = 0.04). The 2.8 g group had less incidence of moderate/severe POST than the control group (Odds Ratio = 0.351 95% Confidence Interval: (0.152 and 0.814) P = 0.02). CONCLUSION: Chewing 2.8 g gum before total thyroidectomy can reduce the incidence of moderate/severe POST within 48 h after surgery.

Comparison of lidocaine viscous gargle and topical application on laryngeal mask airway in general anesthesia: A randomized clinical trial.

OBJECTIVES: To investigate the effects and safety of lidocaine viscous gargle on postoperative sore throat (POST) in patients receiving a laryngeal mask airway (LMA) in general anesthesia. METHODS: In this randomized controlled trial, 90 patients undergoing urological surgery were allocated into 2 treatment arms (n=45): lidocaine viscous gargle before LMA insertion (Group G) and topical application of lidocaine viscous on the LMA (Group T). Outcome data were collected before placement of LMA (T0), after insertion of LMA (T1), immediately (T2), one hour (T3), and 24 hours after removal of LMA (T4). We analyzed the incidence of POST, pharynx dryness, and adverse events. RESULTS: The incidence of POST was lower in Group G than Group T at T2 (11.1% vs. 28.9%; p=0.063), T3 (11.1% vs. 24.4%; p=0.167), and T4 (2.2% vs. 4.4%; p=0.566), but there was no significant difference between groups. No patient in either group experienced severe pain or treatment-related adverse events. There was a significantly lower incidence of pharynx dryness in Group G than Group T (p<0.05) at T2, T3, and T4. CONCLUSION: Lidocaine viscous gargle showed no statistically significant difference in incidence of POST and incidence of pharynx dryness compared with topical application of lidocaine on the LMA. Both approaches were safe for patients receiving LMA.Chinese Clinical Trial Register No.: ChiCTR2200059720.

Not Your Typical Sore Throat-A Case Report on Delayed Complications From Cervical Spinal Surgery.

Esophageal perforation is an uncommon illness with a mortality rate as high as 50%. It is most frequently caused by iatrogenic instrumentation for both diagnostic and therapeutic purposes. Noniatrogenic spontaneous ruptures account for 15% of cases, followed by traumatic injury and rupture secondary to a foreign body.1 Sore throat is a common emergency medicine complaint with an array of causes and severity of pathology. We report a case of a sore throat resulting from esophageal perforation and prevertebral abscess as delayed complications from an anterior cervical surgery.

Is there an optimal place for holding the tracheal tube during intubation? A proof-of-concept randomised clinical trial.

BACKGROUND: The optimal way to hold an endotracheal tube (ETT) during intubation has not been studied. In this randomised clinical trial, we examined the effect of site-holding the ETT in two different positions on time and ease of intubation by anaesthesia trainees. METHODS: A single-centre, randomised trial of intubations of stable patients with uncomplicated airways was conducted from 15 September 2019 to 31 May 2021 in the All India Institute of Medical Sciences, Bhubaneswar, India. A previous pilot study performed in the unit determined the comparator positions for the ETT and the sample size for a 20% difference for the primary outcome of mean time to intubation (TTI). Patients were randomised at the time of the intubation; anaesthesia trainees held the ETT at 19 or 24 cm according to the patient's assignment. Video recordings of intubations were independently reviewed by two assessors blinded to the assignment. Secondary outcomes were intubation success, ease of intubation and complications. Intention-to-treat and per-protocol analyses were performed. RESULTS: 360 adults were randomised (180/arm) and intubated by 19 trainees. In intention-to-treat analysis, there was no significant difference in TTI. Sixteen times, trainees assigned to hold the ETT at 24 cm moved their grip distally (closer to the cuff) during the procedure. In a per-protocol analysis, TTI for those whose grip remained at 24 cm was shorter than those holding at 19 cm: 6.6 (SD 3.0) vs 7.6 (SD 4.2) s (95% CI for the difference 0.2 to 1.7 s), p=0.01. In both intention-to-treat and per-protocol analyses, there was no difference in first-pass success or ease of intubation between techniques. Eight patients assigned to 19 cm group and four assigned to 24 cm developed sore throats. CONCLUSION: In stable patients with uncomplicated airways, there was no significant difference in TTI based on the site at which trainees were assigned to hold the ETT. However, the shorter TTI at 24 cm in per-protocol analysis and fewer sore throat observed suggest this practice change warrants further investigation. TRIAL REGISTRATION NUMBER: CTRI/ 2019/09/021201.

Feasibility study of intubation in lateral position using Viva-sight double-lumen tube combined with video laryngoscope in patients undergoing pulmonary lobectomy.

BACKGROUND: Double-lumen tube (DLT) intubation in lateral decubitus position is rarely reported. We designed this study to evaluate the feasibility of VivaSight double-lumen tube (VDLT) intubation assisted by video laryngoscope in lateral decubitus patients. METHODS: Patients undergoing elective video-assisted thoracoscopic surgery (VATS) for lung lobectomy were assessed for eligibility between January 2022 and December, 2022. Eligible patients were randomly allocated into supine intubation group (group S) and lateral intubation group (group L) by a computer-generated table of random numbers. The prime objective was to observe whether the success rate of VDLT intubation in lateral position with the aid of video laryngoscope was not inferior to that in supine position. RESULTS: A total of 116 patients were assessed, and 88 eligible patients were randomly divided into group L (n = 44) and group S (n = 44). The success rate of the first attempt intubation in the L group was 90.5%, lower than that of S group (97.7%), but there was no statistical difference (p > 0.05). Patients in both groups were intubated with VDLT for no more than 2 attempts. The mean intubation time was 91.98 ± 26.70 s in L group, and 81.39 ± 34.35 s in S group (p > 0.05). The incidence of the capsular malposition in the group L was 4.8%, less than 36.4% of group S (p < 0.001). After 24 h of follow-up, it showed a higher incidence of sore throat in group S, compared to that in group L (p = 0.009). CONCLUSION: Our study shows the comprehensive success rate of intubation in lateral decubitus position with VDLT assisted by video laryngoscope is not inferior to that in supine position, with less risk of intraoperative tube malposition and postoperative sore throat. TRIAL REGISTRATION: Chinese Clinical Trail Register (ChiCTR2200062989).

The effect of pharyngeal packing on gastric volume in patients undergoing nasal surgery: a randomised, controlled trial.

OBJECTIVE: To explore the effects of pharyngeal packing on antral cross-sectional area, gastric volume and post-operative complications. METHODS: In this prospective, randomised, controlled study, 180 patients were randomly assigned to a control group or a pharyngeal packing group. Gastric antral dimensions were measured with pre- and post-operative ultrasound scanning. Presence and severity of post-operative nausea and vomiting and sore throat were recorded. RESULTS: Post-operative antral cross-sectional area and gastric volume were significantly larger in the pharyngeal packing group compared to the control group. The incidence and severity of post-operative nausea and vomiting were significantly less in the pharyngeal packing group. More frequent and severe sore throat was observed in the control group within the ward. An increased Apfel simplified risk score and post-operative antral cross-sectional area were associated with post-operative nausea and vomiting during the first 2 hours, whereas septorhinoplasty and functional endoscopic sinus surgery, absent pharyngeal packing, and lower American Society of Anesthesiologists' physical status were associated with post-operative nausea and vomiting within the ward. CONCLUSION: Regardless of operation type, pharyngeal packing use resulted in smaller gastric volume, which was associated with reduced post-operative nausea and vomiting frequency and severity, and lower sore throat incidence.

Comparison of the Laryngeal Mask Airway ProSeal and the Streamlined Liner of the Pharynx Airway During General Anesthesia: A Systematic Review and Meta-analysis.

PURPOSE: The purpose of this article is to compare the safety of the laryngeal mask airway ProSeal (PLMA) and the streamlined liner of the pharynx airway (SLIPA) during general anesthesia. DESIGN: This study is a systematic review and meta-analysis. METHODS: Two authors performed searches of Embase, Web of Science, and PubMed to identify clinical trials that compared PLMA and SLIPA in patients receiving general anesthesia. Relative risk (RR) with corresponding 95% confidence intervals (CI) were used to pool the dichotomous data. The mean difference (MD) and the associated 95% CI were applied to pool continuous data. RevMan 5.0 software was used for data analysis. FINDINGS: A total of 15 studies with 1263 patients were included. There was no significant difference between PLMA and SLIPA in the rate of insertion success on the first attempt (RR = 1.02, 95% CI [0.95, 1.09], P = .59), airway sealing pressure (MD = 0.75, 95% CI [-0.09, 1.58], P = .08) and the incidence of a sore throat (RR = 0.85, 95% CI [0.7, 1.04], P = .12). The insertion time of PLMA was shorter than SLIPA (MD = 5.24, 95% CI [0.51, 9.98], P = .03), and the incidence of bloodstaining on the device was lower (RR = 0.72, 95% CI [0.55, 0.94], P = .02). CONCLUSIONS: Both devices have a high rate of insertion success on the first attempt and airway sealing pressure. But PLMA has a shorter insertion time and less incidence of blood staining, which is more advantageous than SLIPA.

Comparison of adding magnesium sulfate, dexmedetomidine and ondansetron to lidocaine for gargling before laryngoscopy and endotracheal intubation to prevent sore throat: a randomized clinical trial.

Postoperative sore throat is one well-recognized complication, occurring most frequently following tracheal intubation. Effective prevention of postoperative sore throat has been recognized as a top priority, bringing pleasant feelings and satisfaction to patients. This study aimed to assess the efficacy of magnesium sulfate, dexmedetomidine and ondansetron gargle with lidocaine administrated prior to laryngoscopy and tracheal intubation for postoperative sore throat prevention alongside hemodynamic management. This double-blind randomized clinical trial enrolled 105 general anesthesia-administered patients who had undergone laryngoscopy and endotracheal intubation, and they were equally randomized into three groups: magnesium sulfate, dexmedetomidine, and ondansetron groups. No significant intergroup difference was seen in oxygen saturation, non-invasive blood pressure, heart rate, duration of surgery, postoperative complications, analgesic consumption, and incidence of cough and hoarseness. The results showed statistically significant intergroup differences in pain scores and average pain intensity in the dexmedetomidine group was significantly lower than the other groups. Results suggest that dexmedetomidine gargle with lidocaine before general anesthesia induction could be recommended as an option depending on the patient's general condition and the anesthesiologist's discretion.

Effect of thermal softening of double-lumen endobronchial tubes on postoperative sore throat in patients with prior SARS-CoV-2 infection: a randomized controlled trial.

BACKGROUND: The incidence of postoperative sore throat (POST) after tracheal intubation using double-lumen endobronchial tubes (DLTs) is higher in patients with prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than in the general population. This prospective trial was conducted to determine whether thermal softening of DLTs could decrease the incidence of POST or other airway injuries in patients with prior SARS-CoV-2 infection. METHODS: A total of 120 patients with prior SARS-CoV-2 infection undergoing thoracoscopic surgery were randomly assigned to two groups (n = 60 each). In the thermal softening group, the distal portion of the DLT was placed in thermostatic saline (50 °C) for 10 min before endotracheal intubation. In the control group, the distal portion of the DLT was placed in room temperature saline for 10 min before endotracheal intubation. The incidence and severity of POST and hoarseness were assessed at 1, 6 and 24 h postoperatively. The primary outcomes were the incidence and severity of POST at 6 h postoperatively. The secondary outcomes were the incidence and severity of hoarseness, vocal cord and tracheal injuries, and hemodynamic changes in patients at intubation. RESULTS: The incidence of POST at 6 h postoperatively was greater in the control group than in the thermal softening group [41 (68%) vs. 22 (37%), P = 0.001]. The overall incidence of POST at 24 h postoperatively was greater in the control group than in the thermal softening group [46 (76%) vs. 24 (40%), P < 0.001]. The overall incidence of tracheal injuries was also greater in the control group than in the thermal softening group (P = 0.016). Vocal cord injuries occurred more frequently in the control group than in the thermal softening group (P = 0.006). CONCLUSION: Thermal softening of DLTs before intubation can reduce the incidence of POST and airway injuries in patients with prior SARS-CoV-2 infection undergoing DLT insertion. TRIAL REGISTRATION: This trial has been registered at www.chictr.org.cn (registration number: ChiCTR2200066821; registration date: December 19, 2022).

Antibiotic consumption for sore throat and the potential effect of a vaccine against group A Streptococcus: a systematic review and modelling study.

BACKGROUND: Antibiotic consumption can lead to antimicrobial resistance and microbiome imbalance. We sought to estimate global antibiotic consumption for sore throat, and the potential reduction in consumption due to effective vaccination against group A Streptococcus (Strep A). METHODS: We reviewed and analysed articles published between January 2000 and February 2022, identified though Clarivate Analytics' Web of Science search platform, with reference to antibiotic prescribing or consumption, sore throat, pharyngitis, or tonsillitis. We then used those analyses, combined with assumptions for the effectiveness, duration of protection, and coverage of a vaccine, to calculate the estimated reduction in antibiotic prescribing due to the introduction of Strep A vaccines. FINDINGS: We identified 101 studies covering 38 countries. The mean prescribing rate for sore throat was approximately 5 courses per 100 population per year, accounting for approximately 5% of all antibiotic consumption. Based on 2020 population estimates for countries with empiric prescribing rates, antibiotic consumption for sore throat was estimated to exceed 37 million courses annually, of which half could be attributable to treatment for Strep A. A vaccine that reduces rates of Strep A infection by 80%, with 80% coverage and 10 year's duration of protection, could avert 2.8 million courses of antibiotics prescribed for sore throat treatment among 5-14 year-olds in countries with observed prescribing rates, increasing to an estimated 7.5 million averted if an effective vaccination program also reduced precautionary prescribing. INTERPRETATION: A vaccine that prevents Strep A throat infections in children may reduce antibiotic prescribing for sore throat by 32-87% depending on changes to prescribing and consumption behaviours. FUNDING: The Wellcome Trust, grant agreement number 215490/Z/19/Z.

Effect of Esketamine Gargle on Postoperative Sore Throat in Patients Undergoing Double-Lumen Endobronchial Intubation: A Randomised Controlled Trial.

Background: Postoperative sore throat is a frequent adverse event after double-lumen endobronchial tube (DLT) intubation. The aim of this study was to investigate whether esketamine gargle has a preventive effect on the incidence of postoperative sore throat in patients undergoing DLT intubation. Methods: This trial included 140 patients undergoing elective thoracic surgery at the third affiliated hospital of Sun Yat-Sen University. Patients were randomly allocated into the following two groups of 70 patients each: the control group, gargling with saline of 30 mL, and the esketamine group, gargling with an esketamine solution of 30 mL (2 mL/50 mg esketamine in 28 mL saline), 5 min prior to anaesthesia induction. The primary outcome was the incidence of sore throat 24 h after surgery. The main secondary outcomes included the incidence of sore throat and hoarseness at 1 h and 48 h after surgery, as well as the intraoperative haemodynamic responses. Results: The incidence of sore throat was significantly higher in the control group (47.1%, 33/70 patients) compared with the esketamine group (12.9%, 9/70 patients) at 24 h after surgery (RD, 0.41; 95% confidence interval, 0.26-0.57; p < 0.001). Furthermore, the incidence of sore throat at 1 h (p = 0.027), 24 h (p = 0.019), and seventh day (p = 0.031) as well as hoarseness at 1 h (p = 0.027), 24 h (p = 0.019), and 48 h (p = 0.031) after surgery were reduced in the esketamine group. Significant differences were seen in the peak levels of systolic blood pressure, mean arterial blood pressure, and heart rate between the groups during the intubation (p < 0.05). Besides, no patient developed an adverse reaction to esketamine. Conclusion: Preoperative gargling of esketamine can provide an effect against sore throat after DLT intubation without adverse side effects and effectively inhibit sharp elevations in heart rate and blood pressure during double-lumen intubation procedures.

Effect of superior laryngeal nerve block in alleviating sore throat after application of i-gel supraglottic airway: a randomized controlled trial.

BACKGROUND: Postoperative sore throat (POST) is a common complaint after supraglottic airway device (SAD) application. Internal branch of the superior laryngeal nerve (iSLN) block has the potential to alleviate POST. The aim of this trial was to explore the effect of iSLN block in alleviating sore throat, as well as to identify the potential risk factors for POST after SAD insertion. METHODS: One hundred thirty-four patients scheduled for elective gynecological surgery were randomized to either group T: tetracaine syrup (1%) for local lubrication on i-gel supraglottic device (n = 67) or group B: i-gel insertion with water based lubricant on it and followed by bilateral iSLN block (ropivacaine, 0.375%, 2 ml for each side) (n = 67). Under ultrasound guidance, iSLN was exposed below thyrohyoid membrane. The primary outcome was the intensity of sore throat at 6 h after surgery. In addition, POST score at 0.5 h and 24 h, the severity of postoperative swallowing discomfort, acoustic analysis and complications were measured. RESULTS: Compared with tetracaine syrup for local lubrication, iSLN block resulted in a reduced intensity of POST at 0.5 h (P = 0.044, OR = 1.99, 95%CI 1.02 to 3.88) and 6 h (P < 0.001, OR = 5.07, 95%CI 2.53 to 10.14) after surgery, as well as less severity of swallowing discomfort (P < 0.001, OR = 2.21, 95%CI 1.63 to 2.99) and cough (P = 0.039, OR = 1.97, 95%CI 1.04 to 3.73). The patients after iSLN block presented lower jitter and shimmer value in acoustic analysis at 6 h after surgery (P < 0.001). CONCLUSIONS: iSLN block was effective in alleviating POST, improving voice function, as well as reducing postoperative swallowing discomfort and coughing. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2000037974) on 8th Sept 2020.