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Predictors of postoperative sore throat in intubated children
Alyson Calder1, Mary Hegarty, Thomas O Erb
1Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Australia.
Insights
Postoperative sore throat (POST) is common in children after intubation. Using uncuffed endotracheal tubes (ETTs) and high cuff pressures increase POST risk, necessitating careful ETT management.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Postoperative sore throat (POST) incidence and risk factors in pediatric patients undergoing intubation are not well-defined.
- Etiology is multifactorial, involving subglottic mucosal perfusion impairment and edema from endotracheal tube (ETT) pressures.
- Understanding these factors is crucial for improving pediatric patient outcomes.
Purpose of the Study:
- To determine the incidence of POST in intubated children.
- To identify risk factors associated with POST in this population.
- To inform clinical practice for reducing POST in pediatric patients.
Main Methods:
- Prospective study of 500 pediatric patients (3-16 years) undergoing elective day-case surgery.
- ETT type (cuffed/uncuffed) and cuff pressure (CP) were recorded.
- POST incidence and intensity assessed via patient interviews; statistical analysis used Chi-square and logistic regression.
Main Results:
- 22% of children experienced POST; 3.8% had sore neck, 1% sore jaw.
- Incidence was higher with uncuffed ETTs (37%) compared to cuffed ETTs (19%).
- POST incidence significantly increased with higher cuff pressures, from 0% at 0 cmH2O to 96% at >40 cmH2O.
Conclusions:
- Uncuffed ETTs are associated with a higher likelihood of POST in children.
- Endotracheal tube cuff pressure is a significant positive predictor of POST incidence.
- Routine intraoperative measurement of cuff pressure is recommended when using cuffed ETTs.
Background:
The incidence of postoperative sore throat (POST) following intubation is not well defined in the pediatric population. The etiology is multifactorial and includes impairment of subglottic mucosal perfusion and edema as a result of the pressures exerted by cuffed or uncuffed tubes.
Aim:
To determine the incidence of, and risk factors for, POST in intubated children undergoing elective day-case surgery.
Methods:
Five hundred patients aged 3-16 years were studied prospectively. Endotracheal tube (ETT) choice (cuffed or uncuffed) was left to the anesthetist. The cuff was inflated either until loss of audible leak or to a determined pressure using a cuff manometer. The research team then measured the cuff pressure (CP). POST incidence and intensity was determined by interviewing patients prior to discharge from the same day procedure unit. Chi-square testing and stepwise logistic regression were used to determine the predictors of POST.
Results:
Of the 111 (22%) children developed a sore throat, 19 (3.8%) a sore neck, and 5 (1%) a sore jaw. 19% of patients with cuffed ETTs complained of sore throat compared with 37% of those intubated with an uncuffed ETT. The incidence of POST increased with CP; 0-10% at 0 cmH(2)O, 4% at 11-20 cmH(2)O, 20% at 21-30 cmH(2)O, 68% at CP 31-40 cmH(2)O, and 96% at CP >40 cmH(2)O. The ETT CP and use of uncuffed ETTs were univariate predictors of POST.
Conclusions:
Children intubated with uncuffed ETTs are more likely to have POST. ETT CP is positively correlated with the incidence of POST. When using cuffed ETTs, CP should be routinely measured intraoperatively.
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