POST-OPERATIVE SORE THROAT IN GA: A CONCERN

Post-operative sore throat in GA: A concern

K. Senthil Kumar*

Department Anaesthesiology, Kauvery Hospital, Cantonment, Trichy

*Correspondence: ksk@kauveryhospital.com

Background

Post-operative sore throat is a common occurrence following general anaesthesia immediately upon awakening, extending up to 24 h. It is the most common undesirable event after general anaesthesia. Hence, this clinical audit was aimed to reduce this incidence of sore throat by adopting various strategies.

Aim

To reduce the incidence of post-operative sore throat to half of its previous incidence
To minimize intubation attempts and laryngoscopy duration
To monitor cuff pressure intra-operatively at periodic intervals
To improve patient comfort at the end of surgery by providing smooth extubation.

Methods

All patients posted for surgeries under general anaesthesia planned for routine tracheal intubation with endotracheal tubes. Surgeries that lasted less than 4 h were included. Patients who underwent nasal intubation and supraglottic airway devices were not included. Various factors like the size of the endotracheal tube, attempts of intubation, and cuff pressure were considered.

Endotracheal tube size was standardized, using 8.5 (OD-11.6) mm for men and 7.5 (OD-10.3) mm for women.
After intubation, anaesthesia was maintained with oxygen, air and sevoflurane in most of the cases.
At the end of surgery patient was extubated and assessed for sore throat in the post-operative ward and further for 48 h.
Grading of post-operative sore throat.

Findings

From the data collected in the year 2021.
Incidence of sore throat: Men-24%, Women-30%.
Women were found to have more incidence of sore throat than men.
Almost one-third of the patients had complaints of sore throat in the immediate post-operative period.

Analysis of Journals

Methods Implemented

Minimisation of intubation attempts and minimising airway trauma
Application of lignocaine jelly over the cuff before intubation can be done to reduce the incidence of sore throat
In prolonged surgeries, cuff pressure monitoring can be done periodically and the use of nitrous oxide can be minimised as cuff inflation may cause airway edema and increase the incidence of sore throat.

Monitoring cuff pressure Minimising N2O

Use of lignocaine jelly

Data collected in next 3 months

Findings

The incidence of sore throat in men is 10% (previous 24%).
The incidence of sore throat in women is 14% (previous 30%).

Methods Implemented

Minimisation of intubation attempts and minimising airway trauma.
Application of lignocaine jelly over the cuff before intubation can be done to reduce the incidence of sore throat.
In prolonged surgeries, cuff pressure monitoring can be done periodically and the use of nitrous oxide can be minimised as cuff inflation may cause airway edema and increase the incidence of sore throat.

Conclusion

Thus after implementing the above-mentioned measures incidence of post-operative sore throat was minimised to almost half the incidence of the previous year.
Patient comfort improved after general anaesthesia.
Intracuff instillation of lignocaine is also another method and it’s an ongoing audit.

Dr. K. Senthil Kumar

HOD – Anesthesiology and Toxicology