1Department of Anesthesia, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8*Corresponding author
LMA® is the property of Intavent Limited.
Accepted for publication: December 4, 2001
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Abstract |
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Methods. We studied 5264 ambulatory surgical patients prospectively to determine the patient, anaesthetic, and surgical factors associated with sore throat.
Results. In 5264 patients, 12.1% reported a sore throat. Patients with tracheal tube had the greatest incidence, 45.4%, followed by patients with laryngeal mask airway, 17.5%, while patients with a facemask had a lower incidence of sore throat, 3.3%. Female patients had more sore throats than male patients (13.4 vs 9.1%). Airway management had the strongest influence on the incidence of sore throat. Sore throat in ambulatory surgical patients was associated with female sex, younger patients, use of succinylcholine, and gynaecological surgery.
Conclusion. Airway management, female sex, younger patients, surgery for gynaecological procedure, and succinylcholine predicts postoperative sore throat. Increased awareness of the predictive factors can help to avoid this combination and improve patient satisfaction.
Br J Anaesth 2002; 88: 5824
Keywords: complications, sore throat; surgery, ambulatory
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Introduction |
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Several factors contribute to postoperative sore throat. Reporting of a sore throat can be affected by whether this symptom is asked about directly or indirectly.4 The incidence varies with the method of airway management. Tracheal intubation (ETT) is associated with a greater incidence of sore throat than laryngeal mask airway (LMA) or facemask (FM).2 Studies of postoperative sore throat have not distinguished ambulatory surgical patients from inpatients. We set out to determine which patient characteristics and operative factors predict sore throat in ambulatory surgical patients.
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Methods and results |
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We recorded the patients age, sex, weight, height, and ASA physical status on a standardized information sheet. The type and duration of surgery, operative airway management (ETT, LMA, or FM) tracheal tube size, patient position during surgery, drugs given, and duration of stay in the postanaesthetic care unit and ambulatory surgical unit (ASU) were also recorded.
An aqueous lubricant was applied to the tracheal tube and LMA airway cuffs. A standard method was used for placement of tracheal tubes and LMA. After ETT, patients lungs were mechanically ventilated, and patients with LMA breathed spontaneously. After intubation or placement of an LMA, anaesthesia was maintained with an inhalation agent in a mixture of oxygen and nitrous oxide. Patients with an FM received oxygen only. Airway devices were removed when patients were able to open their eyes to command.
The clinical management of the patients was left to the discretion of the anaesthetist. Postanesthesia Discharge Score (PADS) was used to decide when to discharge the patient.5 All patients were discharged on the same day as the surgery. An ASU nurse interviewed the patient by telephone after 24 h and the incidence of sore throat was noted by using standardized direct questions. Patients were asked directly whether they had a sore throat, and whether they had any hoarseness of voice.
Statistical analysis
The incidence of sore throat was compared between different patient groups using chi-squared statistics. Continuous variables were compared between patients with and without sore throat using Students t-test. We used multiple logistic regression modelling with backward stepwise variable selection to identify factors associated with sore throat. Variables with P>0.1 were eliminated from the model. Statistical analysis was with SAS statistical software, version 6.12 (SAS Institute Inc., Cary, NC, USA).
During the study period, 17 877 patients were to undergo ambulatory surgery. A total of 239 patients were excluded as a result of cancellation or incomplete data. Of the remaining 17 638 patients, a successful telephone interview was conducted with 5264 patients (29.84%). Of the non-respondents, 5878 (33.3%) refused to give an interview, 2169 (12.3%) did not speak English, and 4327 (23.6%) could not be contacted. There was no significant difference between respondent and non-respondent in mean age or duration of anaesthesia. The response rate was greater for patients after procedures for urology (38%), general surgery (37%), ENT or dental surgery (33%), orthopaedic surgery (32%), or ophthalmology (31%): patients after gynaecological procedures were less likely to give an interview (27%).
The mean age was 47 yr (range 1685). Two-thirds of the patients were female, one-third of the patients were male. Most of the patients had procedures for ophthalmological, gynaecological, or orthopaedic conditions (38, 31, and 19%, respectively). A tracheal tube was used in 14.3% of patients, an LMA in 19.4% of patients, an FM in 62.8%, and no airway management was used in 3.5% of the patients.
Of the 5264 patients, 12.1% (635) reported a sore throat. Patients with ETT had the greatest incidence (45.5%, 345 of 755), followed by patients with LMA (17.5%, 178 of 1020), whereas patients with FM had a lower incidence of sore throat (3.3%, 108 of 3303). In the patients with sore throat, the duration of stay in PACU was 14 min longer (P<0.05), the duration of ASU stay 25 min longer (P<0.05), and discharge time 51 min longer (P<0.05).
Univariate analysis showed that female patients had more sore throats than males (overall 13.4 vs 9.1%, ETT 50.1 vs 32.5%, LMA 21.6 vs 13.6%, and FM 3.9 vs 1.7%; P<0.05 for all comparisons).
After surgery in the lithotomy position, patients had more sore throat compared with patients after surgery in the supine position (ETT 56.0 vs 35.7%, LMA 25.0 vs 16.1%, and FM 5.9 vs 1.9%; P<0.05 for all comparisons). Patients given succinylcholine also had more sore throat than patients not given this agent (51.3 vs 35.8%; P<0.05). Ease of intubation was not associated with the development of postoperative sore throat (46.4%) compared with 47.8% in patients with difficult intubation.
After gynaecological surgery, patients had a greater risk of sore throat compared with other patients (ETT 57.4 vs 31.6%, LMA 25.3 vs 16.5%, FM 5.9 vs 2.0%; P<0.05 for all comparisons). In patients managed with an LMA, orthopaedic patients had less sore throat than other patients (15.1 vs 23.2%, P<0.05), and in patients managed with an FM, patients after ophthalmic procedures had less than other patients (1.7 vs 5.3%, P<0.05). Univariate analyses showed no other statistically significant associations.
Multiple logistic regression
A multiple logistic regression model with stepwise variable selection was set up including all subjects. Variables included in the model at the first step of variable selection were: age, sex, ASA status, BMI, duration of surgery, duration of postoperative stay, position of patient, succinylcholine use, type of airway management, and type of surgery. Table 1 shows the variables that remained in the final model.
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Comment |
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References |
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