Sore Throat Post Op

[Lefty]

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Any ideas how to treat and/or prevent post op throats? I have seen a lot of sore throats post op while on my neuro rotation this month. Other than chloriseptic spray or lozenges + ice chips any other ideas out there to make pt's recovery more comfortable?

Thanks,
Lefty

 

[The_Sensei]

Don't give 'em a sore throat in the first place......

 

[Lefty]

So ideally I don't try to give pt's a sore throat in the first place, but it still happens. Any other responses?

 

[swpm]

So ideally I don't try to give pt's a sore throat in the first place, but it still happens. Any other responses?

NSAIDs if they're not contraindicated. I think a little Toradol towards the end of a case goes a long way toward reducing the impact of multiple DLs, at least, I've convinced myself it does.

 

[militarymd]

small ETT tubes

 

[VolatileAgent]

Lta

 

[militarymd]

Lta

That doesn't prevent the injury. Local anesthetic ointment used in the airway has actually been demonstrated to CAUSE severe post-op pain.

If you do post op checks on your patients (as required by CMS) as my practice does, you will find that the use of topical local anesthetic does not alter the number of complaints on POD #1.

 

[Noyac]

That doesn't prevent the injury. Local anesthetic ointment used in the airway has actually been demonstrated to CAUSE severe post-op pain.

If you do post op checks on your patients (as required by CMS) as my practice does, you will find that the use of topical local anesthetic does not alter the number of complaints on POD #1.

But if you lube the tube it may be beneficial. I don't have any hard evidence one way or the other here. I will use the lidocaine jelly on the cuff from time to time. I very rarely have pts complain of sore throats and i don't necessarily lube it every time. I use lube on tubes that will be in for a long time to theoretically help prevent aspiration around the cuff.

 

[fval28]

That doesn't prevent the injury. Local anesthetic ointment used in the airway has actually been demonstrated to CAUSE severe post-op pain.

If you do post op checks on your patients (as required by CMS) as my practice does, you will find that the use of topical local anesthetic does not alter the number of complaints on POD #1.

mil,
i also read that lido was linked to sore throats postop. heard at a meeting that it could be r/t the preservative in lido jelly- i started using the lido urojets and (so far) no more sore throats. btw i also use small ett's- 7 for men, 6.5 for women.

 

[VentdependenT]

We use Smaller ett's at the private hospital for the smaller surgeries. If we use a small tube at the big house the attendings give us a funny look. Plus it feels awesome to slug in that 9.0 for a simple lap chole.

Do you find that LMA's produce less post op soreness (pharyngeal) than an ETT (laryngeal)? I never remember to ask about that unless the patient brings it up.

LTA's are worthless from what I've seen. So are LITA-tubes. SOme folks are gonna cough no matter what.

 

[Mapleson D]

Anybody ever use lidocaine *in* the cuff instead of air? Saw one attending who used that technique (don't recall the concentration of lido, tho) on anterior c-spine cases to reduce post-op sore throat.

 

[militarymd]

Anybody ever use lidocaine *in* the cuff instead of air? Saw one attending who used that technique (don't recall the concentration of lido, tho) on anterior c-spine cases to reduce post-op sore throat.

as noted already...it doesn't work.

 

[VolatileAgent]

That doesn't prevent the injury. Local anesthetic ointment used in the airway has actually been demonstrated to CAUSE severe post-op pain.

If you do post op checks on your patients (as required by CMS) as my practice does, you will find that the use of topical local anesthetic does not alter the number of complaints on POD #1.

man, you really like to split hairs.

so, since we're splitting hairs, what are we talking about here? the person who c/o sore throat immediately post-op? or, the one who complains a day or two later? is the anesthetic procedure always to blame for a post-op sore throat?

iow, do you request that your outpatient anesthetics come back for a post-op check? you're not suggesting that, are you? or, i guess you do 100% follow-ups 100% of the time. (in which case i'd call you a liar.)

and, smaller tubes? pray, do tell what you mean by that. is your intubation technique so bad that you always have to use a 5.5 or 6.0 to prevent a "sore throat"? maybe i'm just a better anesthesiologist, but i rarely get this complaint. maybe my "injury" rate is lower because i'm more gentle. and, fwiw, i rarely use LTA.

 

[militarymd]

man, you really like to split hairs.

so, since we're splitting hairs, what are we talking about here? the person who c/o sore throat immediately post-op? or, the one who complains a day or two later? is the anesthetic procedure always to blame for a post-op sore throat?

iow, do you request that your outpatient anesthetics come back for a post-op check? you're not suggesting that, are you? or, i guess you do 100% follow-ups 100% of the time. (in which case i'd call you a liar.)

and, smaller tubes? pray, do tell what you mean by that. is your intubation technique so bad that you always have to use a 5.5 or 6.0 to prevent a "sore throat"? maybe i'm just a better anesthesiologist, but i rarely get this complaint. maybe my "injury" rate is lower because i'm more gentle. and, fwiw, i rarely use LTA.

Junior,

I'm very sorry that you don't like it when you don't know it all.

 

[TIVA]

Cepacol throat lozenge x one/prn for post-op sore throat, repeat times one if necessary. Has never failed me yet and the PACU nurses especially seem to appreciate it when it's already written in the post-anesthesia orders.

 

[Frank Rizzo]

Do you place a OG and/or esoph temp probe? A LITTLE BIT of lubricating jelly on those goes a long way. I never really have patients complain about sore throats when I post-op them.

 

[VolatileAgent]

Junior,

I'm very sorry that you don't like it when you don't know it all.

just remember, i'll always be your senior. (and your evasion, once again, is duly noted.)

 

[militarymd]

Lta

That doesn't prevent the injury. Local anesthetic ointment used in the airway has actually been demonstrated to CAUSE severe post-op pain.

If you do post op checks on your patients (as required by CMS) as my practice does, you will find that the use of topical local anesthetic does not alter the number of complaints on POD #1.

man, you really like to split hairs.

so, since we're splitting hairs, what are we talking about here? the person who c/o sore throat immediately post-op? or, the one who complains a day or two later? is the anesthetic procedure always to blame for a post-op sore throat?

iow, do you request that your outpatient anesthetics come back for a post-op check? you're not suggesting that, are you? or, i guess you do 100% follow-ups 100% of the time. (in which case i'd call you a liar.)

and, smaller tubes? pray, do tell what you mean by that. is your intubation technique so bad that you always have to use a 5.5 or 6.0 to prevent a "sore throat"? maybe i'm just a better anesthesiologist, but i rarely get this complaint. maybe my "injury" rate is lower because i'm more gentle. and, fwiw, i rarely use LTA.

just remember, i'll always be your senior. (and your evasion, once again, is duly noted.)

damn ...you are dense....

How is a stinking resident ever senior to a doubled boarded guy in practice for 10 years?

Just because you sold insurance for a living before you finally got into medical school through the "back door" doesn't make you a "senior" to anyone.

Read the posts...the answers are there....

 

[swpm]

and, smaller tubes? pray, do tell what you mean by that. is your intubation technique so bad that you always have to use a 5.5 or 6.0 to prevent a "sore throat"? maybe i'm just a better anesthesiologist, but i rarely get this complaint. maybe my "injury" rate is lower because i'm more gentle. and, fwiw, i rarely use LTA.

So, you'll shove an 8.0 tube into everyone, even though a smaller foreign body sitting in their airway for a couple hours probably reduces postop discomfort? Nice.

And you're a resident, not an anesthesiologist. Let's not claim the honorific until we've earned it, OK? It's dishonest ... like the MS4 introducing himself as doctor.

 

[VolatileAgent]

So, you'll shove an 8.0 tube into everyone, even though a smaller foreign body sitting in their airway for a couple hours probably reduces postop discomfort? Nice.

huh? where did i ever say that? if you infer things about your patients in such a manner, you must be a terrific clinician. for the record, i use what techniqe suits the patient, and will default to lma unless a tube is necessary for short cases. so, why don't you stop trying to put words in my mouth just to appear tough on an internet forum.

we're talking about the etiology and prevention of sore throats. lta will ameliorate that in the post-op period, especially in short cases with somewhat difficult airways that require a tube and especially if the patient has asthma and/or prior events of peri-extubation coughing/bucking - which can lead to patient perception of post-operative "sore throat" even without trauma during intubation. if you don't know or understand that, then i suggest you do some further reading.

And you're a resident, not an anesthesiologist. Let's not claim the honorific until we've earned it, OK? It's dishonest ... like the MS4 introducing himself as doctor.

😴

 

[swpm]

just to appear tough on an internet forum.

You're a funny guy.

 

[toofache32]

Just bag them the whole case. Like back in the day....