Research Advance in Influence Factors of Sore Throat after
General Anaesthesia Tracheal Intubation
 
Yixing Chinese Medicine Hospital, Jiangsu Province (214200)   
Chen Wang   Review
Xuzhou Medical College Affiliated Hospital (221003)  
Dele Geng    Revise
 
Key words: general anaesthesia; tracheal intubation; postoperative sore throat
 
       Postoperative sore throat, POST is the most common respiratory complication after general anaesthesia tracheal intubation. Compare with other airway management ways like laryngeal mask airway or cuffed oropharynx airway, it has the highest incidence rate in tracheal intubation. It is reported that the incidence rate of POST after tracheal intubation as high as 30-70%. Sore throat adds uncomfortable feeling to patients, and the incidence rate of postoperative complication as well, even causes disease of other systems, makes hospital stays longer and longer. This paper overviews the influence factors of general anaesthesia POST and aims to put forward more helpful advice, raise satisfaction degree of patients.

1. Definition of POST

Nowadays, there is no unified definition of POST at home or abroad. Most scholars consider that POST was caused by mucosal injury of laryngopharyngeal and weasand during general anaesthesia tracheal intubation operation. The clinical manifestations include varying degrees pain of laryngopharyngeal, along with hoarseness, low and deep voice, coughing, patients with severe cases may affect eating even cause fatal damage.

2. Related factors of postoperative sore throat and prevention
   2. operation of tracheal intubation

Both unskilled tracheal intubation and repeated intubation on difficult airway may cause exacerbation of laryngopharyngeal damage.
Knolih’s studies show that new staff who works less than 3 months are high-risk factor in sore throat occurrence. It should take consideration of specific circumstance during tracheal intubation, otherwise it will cause tissue damage, and these damages may become the parts for bacteria invasion, then cause infection. Therefore, skillfully master intubation techniques, operate slightly, steadily and accurately, intubate according to the operating rules strictly when the glottis exposure to fully and muscle well relaxed may effectively prevent sore throat.

2. Choice of the endotracheal tube

Thick pipe diameter will cause not only intense stimulation but also tissue damage. Compare with 7mm pipe, 6mm pipe can effectively reduce the incidence of postoperative sore throat. The incidence rate of sore throat by using double-lumen tube is much higher than using single-lumen tube. The quality of tracheal tube is another factor of laryngopharyngeal damage. So, before intubating airway should be fully assessed, then choose suitable tracheal tube according to operation demand and individual circumstance.

2. Endotracheal catheter cuff pressure

In recent years, cuff pressure draws much attention of domestic and international scholars. Most scholars agree that cuff pressure is an important factor to decide whether the airway mucosa injury or not. It has been proved that overgassing ETTC will cause oppression on tracheal. Thus, have effect on hemoperfusion of trachea mucosa, lead to tracheal mucosa ischemia necrosis. When ETTC internal pressure become over 22mmHg, trachea mucosa blood fluid decreased, when pressure reach 30mmHg, blood fluid decreased obviously. When pressure reach 50mmHg for 15mins, trachea mucosa will be ischemic injured. At present, most anesthetist in China assess cuff pressure by using touch the instruction balloon method and personal experiences. Sole and other scholars’ report consider that it can only ensure 54%patients’ ETTC pressure between15-25 mmHg by personal experience. Liu jianhui’s studies show that it can assess average ETTC pressure is 43±33.3mmHg (with the highest 210 mmHg) through touch the instruction balloon method, this proves that it obviously become higher than normal upper limit by using personal experience. Thus even in brief surgery, routine monitoring of ETTC pressure will do good for decreasing incidence rate of POST. In laparoscopic surgery, pneumoperitoneum may cause higher airway pressure after establishing pneumoperitoneum. Along with high airway pressure, trachea cuff pressure will be higher obviously. Incidence rate of POST will raise, and it proves in another way that airway cuff pressure is the main factor of POST.

2. Operation related factors

The incidence rate will be higher in head and neck surgery than in other parts. Time of operation is proportional to the occurrence of sore throat. Studies show that when tracheal intubation time last over 180mins, incidence rate of POST will increase markedly. This may because long time press to trachea and deterioration of ischemia. In addition, surgery decubitus is also a reason for POST. Zhangrui’s analysis of 201 tracheal intubation cases shows that decubitus is a reason for adding incidence rate of sore throat.

2. The patients’ own factors

Biro and other scholars’ studies indicate that incidence rate of female POST is higher than male patients. And the rate of people over 60 years is higher. Research of Dai Xuedi etc. shows that in anesthesia recovery room sore throat pain is higher than in ward, so prompt environment psychology has some influence on the occurrence of sore throat.

2. Tracheal extubation factors

Extubation is the inverse process of tube intubation. Foreign scholars think that when remove the endotracheal tube, sputum suction tube, the endotracheal tube to swallow the upper, the stimulation of the throat and the trachea, it may cause laryngeal and tracheal and bronchial spasms, damage, or even vomiting aspiration.Domestic ai-jun yao, etc. have a try on early extubation under anesthesia to effectively avoid patients choking cough, breathless when catheter friction, extrusion and other mechanical damage of the respiratory tract, the results show that the early extubation can obviously decrease the occurrence of postoperative sore throat. At present, most clinical extubation standard follow request of patients with fully conscious and normal muscle tension, can look up 5 seconds, therefore, the agreement of tracheal extubation time has not yet reached, and it is worth for further research.

2. Relationship of atomization inhalation and POST

Atomization inhalation is the most common clinical nursing intervention measures of ease a sore throat. In recent years, liquid atomizing inhalation and spary time is studied by many scholars.Research shows that sports peppermint water, budesonide suspension, lidocaine, atomized liquid mixed by 10ml normal saline, 80 thousand gentamycin and 10mg dexamethasone etc. all have good curative effect. Wu haixia and others choose intravenous dexamethasone injection plus budesonide atomizing inhalation, and finally proved thatthe combination of these two methods is better than single intravenous injection of dexamethasone. Zhang yun found that if atomizing inhalation is given as soon as patients awake, 6-8 hours, 10-12hours after operation, or 24hours after general anaesthesia operation, that’s the best time for starting early atomizing inhalation.

2. Postoperative analgesia and the use of drugs

Along with the development of evidence-based medicine, most POST studies tend to compare new method (epidural analgesia, PCA and auxiliary non- steroidal drugs) with traditional analgesic methods (usually refers to intravenous use of opioid drugs). Because drug analgesia inevitably exist various kinds of drug side effects, therefore, the analgesic drugs to be chosen is up to the key problem of best analgesic effect and minimum drug side effects. But since lack of large sample research and comparative study between the above drugs, it still needs further research to explore more scientific medicine analgesia method.

2. The application of traditional Chinese medicine acupuncture

More and more clinical evidence proves that acupuncture analgesia on premise of maximum analgesia effect, reduce the requirement of opioids, thereby reducing the side effects of drugs, and promote patients recover. At present, the research about mechanism of acupuncture analgesia has developed from cellular level to the molecular level, such as m R N A probe, genetic intervention technology such as gene knockout, acupuncture as well as regulation of the expression of proto-oncogenes, etc. acupuncture analgesia has some advantages like quick onset, long lasting time, no side effects etc. Shihong Yang etc. study 74 cases sore throat patients who were given acupuncture treatment on “sore throat cavity”, take bilateral “choke points” (located in the hand back, between the third and fourth joint, near the third joint), after disinfection needlepoint oblique volar pierce 0.3-0.5 inches, to mention reducing method, retaining needle for 30 minutes after acid bilges feeling coming.

3. Outlook

In conclusion, it has close relationship between the occurrence of postoperative sore throat and the trachea set of capsule; and has relationship with endotracheal intubation and extubation operation, the choice of the endotracheal tube, personal factors, and operational factors and so on. Analgesic drugs, aerosol inhalation and acupuncture are effective ways to ease a sore throat, and it played an important role on the improvement of the perioperative clinical outcome in patients with general anesthesia. In consideration of the existence of drug side effects, increasing clinical nursing workload of atomization inhalation, the psychological fear of acupuncture, what measures to take to get the most satisfactory analgesia effect and promote the functional recovery need to solve in the future research.
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