Efficacy of topical agents for prevention of postoperative sore throat after single lumen tracheal intubation: a Bayesian network meta-analysis

• Published in: Canadian journal of anesthesia 2020-11, Vol.67 (11), p.1624-1642
• Main Authors: Singh, Narinder P., Makkar, Jeetinder K., Cappellani, Ron B., Sinha, Ashish, Lakshminarasimhachar, Anand, Singh, Preet Mohinder
• Format: Article
• Language: English
• Subjects: Anesthesiology; Benzydamine; Cardiology; Critical Care Medicine; Disease prevention; General anesthesia; Humans; Intensive; Intervention; Intubation; Intubation, Intratracheal - adverse effects; Ketamine; Medical personnel; Medicine; Medicine & Public Health; Meta-analysis; Network Meta-Analysis; Pain; Pain Medicine; Patient satisfaction; Pediatrics; Pharyngitis - etiology; Pharyngitis - prevention & control; Pneumology/Respiratory System; Postoperative Complications - prevention & control; Postoperative period; Review Article/Brief Review; Steroids
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-020-01792-4

Background The optimal choice of prophylactic drugs to decrease postoperative sore throat is unclear. The objective of this network meta-analysis (NMA) was to compare and rank 11 topical agents used to prevent postoperative sore throat. Methods Various databases were searched independently for randomized-controlled trials (RCTs) comparing topical agents used for the prevention of postoperative sore throat. Inclusion criteria were parallel group studies comparing intervention with active or inactive control and reporting postoperative sore throat. The primary outcome was postoperative sore throat at 24 hr. Secondary outcomes were early sore throat at 4–6 hr, cough, and hoarseness at 24 hr. Results Evidence was synthesized from 70 RCTs reporting 7,141 patients. Topical application of lidocaine, corticosteroids, ketamine, magnesium, benzydamine, water-based lubricant, and liquorice applied along the tracheal tube, to the tracheal tube cuff, gargled or sprayed were compared with intracuff air and each other. Bayesian NMA showed that magnesium (odds ratio [OR], 0.10; 95% credible interval [CrI], 0.03 to 0.26), liquorice (OR, 0.14; 95% CrI, 0.03 to 0.55), and steroid application (OR, 0.11; 95% CrI, 0.06 to 0.22) most effectively prevented postoperative sore throat at 24 hr. Topical lidocaine was the least effective intervention. Conclusion Topical application of magnesium followed by liquorice and corticosteroids most effectively prevented postoperative sore throat 24 hr after endotracheal intubation.