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Postoperative sore throat and hoarseness: clinical studies in patients undergoing general anasthesia
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0001-7574-6745
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A common problem following general anesthesia is postoperative sore throat (POST) and postoperative hoarseness (PH). Symptoms directly correlated with less satisfaction according to the patients. The overall aim of this thesis was to describe patients' postoperative sore throat and hoarseness after general anesthesia with endotracheal intubation or laryngeal mask airway. As well as to investigate the risk factors that are associated with the symptoms, and to test methods that may prevent sore throat and hoarseness after a general anaesthetics. A total of 889 patients are included in the four studies. Incidence of POST varied from 21% up to 52 % depending on endotracheal tube (ETT) size in women (I-IV) and in men was the incidence 32-38% (III-IV). There were no gender difference in POST in study III and IV. The overall incidence of PH varied from 42- 59% (I-IV) in all patients, with no gender differences (III-IV). Following a laryngeal mask airway (LMA) 19% of the patients had POST and 33% of the patients reported PH. Patients with POST do seem to be able to localize their pain in the throat (IV). Different risk factors are shown to contribute to both POST and PH in men and women (II-III). To intubate with a smaller ETT size, 6.0 vs. 7.0 decreased POST in women in the early postoperative period as well as their discomfort from their POST (I). Only 6% of men who needed a laryngeal mask airway had POST compared to 26% of women. The symptoms are more discomforting after an ETT vs. an LMA up to 24 hours (IV). More patients have sore throat and hoarseness in the early postoperative period, but the symptoms can remain up to almost 5 days postoperatively (I, IV). In summary, sore throat and hoarseness following general anesthesia, affects many patients postoperatively. To intubate women with endotracheal size 6.0 decreases both sore throat and hoarseness postoperatively. Women are more likely than men to have a sore throat when a laryngeal mask airway is used.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2013. , 86 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 51
Keyword [en]
hoarseness, postoperative, complication, endotracheal, tube, laryngeal mask airway, gender, risk factor.
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-31040Libris ID: 14717764ISBN: 978-91-7668-975-2 (print)OAI: oai:DiVA.org:oru-31040DiVA: diva2:652361
Public defence
2013-12-20, Wilandersalen, Örebro universitetssjukhus, S. Grev Rosengatan 18, 703 62 örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-09-30 Created: 2013-09-30 Last updated: 2017-10-17Bibliographically approved
List of papers
1. Endotracheal tube size and sore throat following surgery: a randomized-controlled study
Open this publication in new window or tab >>Endotracheal tube size and sore throat following surgery: a randomized-controlled study
2010 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 2, 147-153 p.Article in journal (Refereed) Published
Abstract [en]

Background: Sore throat following endotracheal intubation is a common problem following surgery and one of the factors that affects the quality of recovery. This study was carried out with the primary aim of assessing whether the size of the endotracheal tube (ETT) affects the risk of sore throat in women following anaesthesia.

Methods: One hundred healthy adult women undergoing elective surgery were randomly allocated to oral intubation with either ETT size 6.0 or 7.0. Anaesthesia was based on either inhalation or total intravenous anaesthesia according to standardized routines. Pre- and post-operatively, sore throat and discomfort were assessed on a four-graded scale and for hoarseness on a binary scale (yes or no). Post-operatively, the assessments were performed after 1–2 and 24 h, and if there was discomfort at 24 h, a follow-up call was made at 72 and 96 h.

Results: After 1–2 h post-operatively, there were a higher proportion of patients with sore throat in ETT 7.0 vs. ETT 6.0 (51.1% vs. 27.1%), P50.006. This difference between the groups was also evident, P50.002, when comparing changes between the pre- and the post-operative values. The severity of discomfort from sore throat was also higher in ETT 7.0 (38.8%) compared with ETT 6.0 (18.8%), P 50.02. No differences were found in the incidence of hoarseness between the groups. The remaining symptoms lasted up to 96 h post-operatively in 11%, irrespective of the tube size.

Conclusion:Use of a smaller-sized ETT can alleviate sore throat and discomfort in women at the post-anaesthesia care unit.

Keyword
Adult, Anesthesia Recovery Period, Anesthesia Intravenous, Anesthetics Intravenous, Anti-Inflammatory Agents Non-Steroidal, Antiemetics, Atracurium, Double-Blind Method, Equipment Design, Female, Fentanyl, Follow-Up Studies, Hoarseness, Humans, Intubation Intratracheal, Middle Aged, Narcotics, Neuromuscular Nondepolarizing Agents, Pain Measurement, Pharyngitis, Preanesthetic Medication, Propofol, Surface Properties, Surgical Procedures Elective, Time Factors
National Category
Anesthesiology and Intensive Care Nursing
Research subject
Nursing Science; Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-24529 (URN)10.1111/j.1399-6576.2009.02166.x (DOI)000273448700005 ()19930246 (PubMedID)2-s2.0-74549185000 (Scopus ID)
Available from: 2012-08-17 Created: 2012-08-17 Last updated: 2017-12-07Bibliographically approved
2. Risk factors for development of postoperative sore throat and hoarseness after endotracheal intubation in women: a secondary analysis
Open this publication in new window or tab >>Risk factors for development of postoperative sore throat and hoarseness after endotracheal intubation in women: a secondary analysis
2012 (English)In: AANA Journal, ISSN 2162-5239, Vol. 80, no 4 (Suppl), 67-73 p.Article in journal (Refereed) Published
Abstract [en]

Postoperative sore throat and hoarseness are common and disturbing complications following endotracheal intubation, and women are more frequently affected by these symptoms. This study explores risk factors associated with postoperative sore throat and hoarseness in women following intubation. In this prospective cross-sectional study, 97 patients undergoing elective ear, nose, and throat surgery or plastic surgery were included. Eight different variables were analyzed to detect possible associations for the development of postoperative sore throat or hoarseness. For data analysis, the χ2 test and the odds ratio were used. Three variables were found to be significant risk factors for postoperative sore throat: age greater than 60 years (P = .01), the use of a throat pack (P = .04),and endotracheal tube No. 7.0 (size 7 mm; P = .02).The only risk factor found to be significantly associated with developing hoarseness was an endotracheal cuff pressure below 20 centimeters of water (P = .04). Larger studies are needed to confirm these risk factors.

Place, publisher, year, edition, pages
West Sussex, United Kingdom: AANA Publishing, Inc, 2012
Keyword
Endotracheal intubation, hoarseness, postoperative complications, risk factors, sore throat
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-24526 (URN)23248834 (PubMedID)2-s2.0-84867579727 (Scopus ID)
Available from: 2012-08-17 Created: 2012-08-17 Last updated: 2017-10-18Bibliographically approved
3. Gender differences in risk factors for airway symptoms following tracheal intubation
Open this publication in new window or tab >>Gender differences in risk factors for airway symptoms following tracheal intubation
2012 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 56, no 10, 1306-1313 p.Article in journal (Refereed) Published
Abstract [en]

Background: A common complaint after endotracheal intubation is sore throat and hoarseness. The aim of this study was to describe gender differences and independent risk factors in the development of post-operative sore throat and hoarseness after endotracheal intubation in adults.

Methods: This prospective cross-sectional observational study was conducted at a university hospital in Sweden. A total of 495 patients were included (203 men and 292 women) and enrolled from a total of eight different surgical departments. Outcome variables were post-operative sore throat and hoarseness evaluated post-operatively in the post-anaesthesia care unit. A total of 31 variables were recorded which described the intubation process, intraoperative factors as well as the extubation process. Bivariate and multivariate analyses were performed.

Results: The overall incidence of post-operative sore throat was 35% and hoarseness 59%. The results show different predictors for men and women in the development of airway symptoms. The main risk factor for developing sore throat in men was intubation by personnel with <?3 months' work experience. In women, it was endotracheal tube size 7.0 and multiple laryngoscopies during intubation. The main risk factors for hoarseness were cuff pressure for both men and women, and oesophageal temperature probe in women.

Conclusion: Post-operative sore throat and hoarseness result from several factors, and the cause of these symptoms are multifactorial and differs by gender. Identification of these factors pre-operatively may increase awareness among anaesthesia personnel and possibly reduce the incidence of these minor but distressing symptoms.

Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell, 2012
Keyword
Adult, Age Factors, Aged, Anesthesia Inhalation, Cross-Sectional Studies, Female, Hoarseness, Humans, Intubation Intratracheal, Laryngoscopy, Logistic Models, Male, Middle Aged, Multivariate Analysis, Pharyngitis, Postoperative Complications, Prospective Studies, Risk Factors, Sex Factors
National Category
Medical and Health Sciences Nursing Anesthesiology and Intensive Care
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-26523 (URN)10.1111/j.1399-6576.2012.02771.x (DOI)000309714000013 ()22998099 (PubMedID)2-s2.0-84867582026 (Scopus ID)
Available from: 2012-11-27 Created: 2012-11-27 Last updated: 2017-12-07Bibliographically approved
4. Sore throat and hoarseness following endotracheal tube or laryngeal mask airway: a prospective study
Open this publication in new window or tab >>Sore throat and hoarseness following endotracheal tube or laryngeal mask airway: a prospective study
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-32041 (URN)
Available from: 2013-10-17 Created: 2013-10-17 Last updated: 2017-10-17Bibliographically approved

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