The Effect of Controlled Hypotensive Anesthesia on Postoperative Sore Throat

Year 2024, Volume: 6 Issue: 3, 537 - 541, 24.09.2024

Uğur Avcı , Tuğba Karaman , Mehtap Gürler Balta , Hakan Tapar , Serkan Karaman

https://doi.org/10.37990/medr.1529150

Abstract

Aim: Postoperative sore throat (POST) is a commonly encountered and significant complication following anesthesia, which can adversely affect the quality of a patient's recovery. Many factors contribute to the development of POST. Controlled hypotension (CH) is a surgical technique used to reduce blood flow, improve visibility, and shorten procedure time by safely lowering blood pressure. In this study, we aimed to investigate the effects of CH on POST, coughing, hoarseness, and vomiting in patients undergoing surgery in a supine position with a fixed endotracheal cuff pressure.
Material and Method: A total of 124 patients, aged between 18 and 65 years, classified as American Society of Anesthesiologists (ASA) class I-II and scheduled for elective surgical procedures, were included in the study. The patients were divided into two groups: Group N (n=65), consisting of normotensive individuals, and Group H (n=59), which included patients subjected to CH. In both groups, the endotracheal cuff pressure was manually set to 25 cmH2O using a cuff pressure manometer. CH was achieved in Group H by administering glyceryl trinitrate (nitroglycerin) infusion, maintaining the mean arterial pressure (MAP) within the range of 55-65 mmHg. Patients were assessed for POST, coughing, hoarseness, and vomiting at postoperative 15 minutes, 2, 6, 12, and 24 hours.
Results: Demographic data, smoking status, ASA scores, surgical and anesthesia durations were similar between the groups. Statistically significant differences were observed between the groups in the numeric rate scores (NRS) for throat pain at 15 minutes and 2 hours, as well as hoarseness scores at 2 and 6 hours. The groups were similar regarding vomiting rates and cough scores.
Conclusion: In this study investigating the impact of CH on sore throat, we observed an increased incidence of POST and hoarseness in patients subjected to CH.

Keywords

Sore throat, intubation, hoarseness, controlled hypotension

References

• Choi E, Park Y, Jeon Y. Comparison of the cuff pressure of a TaperGuard endotracheal tube and a cylindrical endotracheal tube after lateral rotation of head during middle ear surgery: a single-blind, randomized clinical consort study. Medicine (Baltimore). 2017;96:e6257.
• Van Esch BF, Stegeman I, Smit AL. Comparison of laryngeal mask airway vs tracheal intubation: a systematic review on airway complications. J Clin Anesth. 2017;36:142-50.
• McHardy FE, Chung F. Postoperative sore throat: cause, prevention and treatment. Anaesthesia. 1999;54:444-53.
• Peppard SB, Dickens JH. Laryngeal injury following short-term intubation. Ann Otol Rhinol Laryngol. 1983;92:327-30.
• Degoute CS. Controlled hypotension: a guide to drug choice. Drugs. 2007;67:1053-76.
• Çimen NK, Kösem B, Çimen T, et al. Effects of remifentanil, nitroglycerin, and sevoflurane on the corrected QT and Tp-e intervals during controlled hypotensive anesthesia. J Clin Anesth. 2016;33:365-72.
• Scuderi PE. Postoperative sore throat: more answers than questions. Anesth Analg. 2010;111:831-2.
• Ryu JH, Han SS, Do SH, et al. Effect of adjusted cuff pressure of endotracheal tube during thyroidectomy on postoperative airway complications: prospective, randomized, and controlled trial. World J Surg. 2013;37:786-91.
• Canbay Ö, Celebi N, Uzun Ş, et al. Topical ketamine and morphine for posttonsillectomy pain. Eur J Anaesthesiol. 2008;25:287-92.
• Hung N-K, Wu C-T, Chan S-M, et al. Effect on postoperative sore throat of spraying the endotracheal tube cuff with benzydamine hydrochloride, 10% lidocaine, and 2% lidocaine. Anesth Analg. 2010;111:882-6.
• Agarwal A, Nath SS, Goswami D, et al. An evaluation of the efficacy of aspirin and benzydamine hydrochloride gargle for attenuating postoperative sore throat: a prospective, randomized, single-blind study. Anesth Analg. 2006;103:1001-3.
• Seegobin RD, van Hasselt GL. Endotracheal cuff pressure and tracheal mucosal blood flow: Endoscopic study of effects of four large volume cuffs. Br Med J (Clin Res Ed). 1984;288:965-8.
• Nseir S, Duguet A, Copin MC, et al. Continuous control of endotracheal cuff pressure and tracheal wall damage: a randomized controlled animal study. Crit Care. 2007;11:R109.
• Yildirim ZB, Uzunkoy A, Cigdem A, et al. Changes in cuff pressure of endotracheal tube during laparoscopic and open abdominal surgery. Surg Endosc. 2012;26:398-401.
• Kim D, Jeon B, Son JS, et al. The changes of endotracheal tube cuff pressure by the position changes from supine to prone and the flexion and extension of head. Korean J Anesthesiol. 2015;68:27-31.
• Olsen GH, Krishna SG, Jatana KR, et al. Changes in intracuff pressure of cuffed endotracheal tubes while positioning for adenotonsillectomy in children. Paediatr Anaesth. 2016;26:500-3.
• Jiang J, Zhou R, Li B, et al. Is deliberate hypotension a safe technique for orthopedic surgery?: a systematic review and meta-analysis of parallel randomized controlled trials. J Orthop Surg Res. 2019;14:409.
• Choi WS, Samman N. Risks and benefits of deliberate hypotension in anaesthesia: a systematic review. Int J Oral Maxillofac Surg. 2008;37:687-703.
• Riedel K, Thudium M, Boström A, et al. Controlled arterial hypotension during resection of cerebral arteriovenous malformations. BMC Neurol. 2021;21:339.
• Chia TY, Murugaiyah V, Sattar MA, et al. The restorative effect of apocynin and catalase in l-arginine induced hypotension on normotensive subjects-the role of oxidative stress. Physiol Res. 2020;69:1051-66.
• Yamamoto T, Iwamoto T, Kimura S, et al. Persistent isoflurane-induced hypotension causes hippocampal neuronal damage in a rat model of chronic cerebral hypoperfusion. J Anesth. 2018;32:182-8.
• Zhang J, Li H, Zhou G, et al. Changes of endoplasmic reticulum stress- and apoptosis-related factors in rat cerebral cortex following controlled hypotension. Nan Fang Yi Ke Da Xue Xue Bao. 2014;34:1804-8.
• Kozlov AV, Duvigneau JC, Hyatt TC, et al. Effect of estrogen on mitochondrial function and intracellular stress markers in rat liver and kidney following trauma-hemorrhagic shock and prolonged hypotension. Mol Med. 2010;16:254-61.
• O'Meara JB, Chalon J, Amirdivani M, et al. Tracheobronchial cytologic changes and abnormal serum electrophoretic pattern during induced hypotension. Anesth Analg. 1980;59:197-202.