Postoperative Sore Throat

Postoperative sore throat (POST) is one of the most common complications following general anesthesia with endotracheal intubation, affecting patient comfort, delaying recovery, and reducing overall satisfaction with perioperative care. Although POST is usually self-limiting, its high incidence makes it an important target for preventive interventions. Nebulized ketamine has emerged as a promising non-invasive strategy for reducing POST because of its local analgesic and anti-inflammatory effects mediated through N-methyl-D-aspartate (NMDA) receptor antagonism. Previous randomized trials and systematic reviews have demonstrated that nebulized ketamine can reduce both the incidence and severity of POST compared with placebo. However, most published studies have evaluated a single 50-mg dose, and the minimum effective dose remains uncertain. This prospective, randomized, placebo-controlled, double-blind clinical trial aims to compare the efficacy and safety of two preoperative doses of nebulized ketamine (25 mg and 50 mg) with placebo in adult patients undergoing elective surgery under general anesthesia with endotracheal intubation. Participants aged 18-65 years with American Society of Anesthesiologists (ASA) physical status I or II will be randomly assigned in a 1:1:1 ratio to receive nebulized ketamine 25 mg, nebulized ketamine 50 mg, or nebulized normal saline 15 minutes before induction of anesthesia. The primary outcome is the incidence of postoperative sore throat assessed at 2, 4, 6, 12, and 24 hours after surgery using a standardized four-point grading scale. Secondary outcomes include the severity of POST, postoperative pain intensity measured using the Visual Analog Scale (VAS), patient satisfaction, need for rescue analgesia, sedation assessed using the Ramsay Sedation Scale, and the incidence of adverse effects, including nausea, dizziness, and hallucinations. The study hypothesizes that a lower dose of nebulized ketamine (25 mg) will provide comparable protection against postoperative sore throat to the conventional 50-mg dose while minimizing dose-related adverse effects. Identifying the minimum effective dose may improve the safety profile, optimize perioperative patient comfort, and support evidence-based recommendations for preventing postoperative sore throat after endotracheal intubation.

Several studies have demonstrated that inhalational anesthetic agents such as desflurane and sevoflurane may cause varying degrees of postoperative sore throat, hoarseness, and cough in orotracheally intubated patients. However, data evaluating these outcomes under low-flow anesthesia conditions remain limited and insufficient. This single-center, prospective, randomized controlled study will be conducted in patients aged 18-65 years, classified as American Society of Anesthesiologists (ASA) physical status I-II, who are scheduled to undergo elective laparoscopic cholecystectomy under general anesthesia and who provide written informed consent to participate in the study. The primary objective of the study is to compare the effects of low-flow desflurane and low-flow sevoflurane anesthesia on the incidence and severity of postoperative sore throat. The secondary outcomes include the evaluation of postoperative hoarseness and cough, the incidence of postoperative nausea and vomiting (PONV), and the total consumption of inhalational anesthetic agents.

The aim of this study is to compare the efficacy of nebulized ketamine versus nebulized magnesium sulfate in reducing the incidence and severity of POST. * Primary outcome • To compare the incidence of POST method. * Secondary outcomes * Onset, Severity, and duration of POST at 0, 2, 4, 6, 12, 24 hours postoperative. * The hemodynamics recording (HR, BP, MBP, pre and post nebulization) * Adverse Effects (e.g., sedation, cough, nausea, vomiting, ….)

Endotracheal intubation is a standard procedure used to secure the airway during general anesthesia. A key component of the breathing tube is the "cuff," a balloon-like device that is inflated to seal the airway and prevent aspiration. However, if the pressure within this cuff is too high, it can restrict blood flow to the tracheal lining, leading to complications such as postoperative sore throat, hoarseness, and difficulty swallowing (dysphagia). Currently, there are various methods to monitor and adjust this pressure. In many clinical practices, the pressure is adjusted subjectively or checked only once at the beginning of the surgery. These methods may allow pressure to exceed safe limits (typically 20-30 cmH₂O) or fluctuate during the procedure, potentially causing tissue irritation. This randomized controlled trial aims to compare three different methods of assessing and maintaining endotracheal tube cuff pressure to determine which is most effective at reducing postoperative complications. The study focuses on women undergoing elective breast surgery, a group chosen because the surgery typically lasts 1-3 hours and does not involve major changes in head and neck position, allowing for a clear assessment of the cuff pressure methods. Participants will be randomly assigned to one of three groups: * Continuous Monitoring Group: Cuff pressure is monitored continuously using a pressure indicator and maintained within the 20-30 cmH₂O range throughout the surgery. * Manometer Group: Cuff pressure is measured and set to 20-30 cmH₂O using a manual manometer once, immediately after intubation. * Control Group (Minimal Occlusive Volume): The cuff is inflated with the minimum amount of air required to prevent an air leak, without using a pressure gauge. Researchers will assess patients for sore throat, cough, hoarseness, and swallowing difficulties at 0, 1, 12, and 24 hours after surgery to identify the safest and most comfortable method for airway management.

This observational study aims to identify the risk factors associated with postoperative sore throat (POST) and to develop a clinical prediction model for patients undergoing thyroid surgery under general anesthesia. Despite improvements in surgical and anesthetic techniques, POST remains one of the most common complications following thyroidectomy, with an incidence of up to 80%. POST can significantly impact patient comfort, swallowing function, nutritional intake, and recovery quality, leading to prolonged hospitalization and increased healthcare costs. The etiology of POST is multifactorial, involving intubation-related factors (e.g., endotracheal tube size, cuff pressure), surgery-related factors (e.g., duration of surgery, neck hyperextension), and patient-related factors (e.g., age, sex, smoking history, pre-existing throat symptoms). However, large-scale, systematic studies in the Chinese population remain limited. With the increasing adoption of Enhanced Recovery After Surgery (ERAS) principles, the accurate identification of modifiable risk factors and early prediction of POST risk are essential for targeted preventive strategies and improved perioperative management. Recent advancements in machine learning and statistical modeling allow for the development of personalized, multifactorial risk assessment tools. In this study, clinical data from patients undergoing thyroid surgery at Nanjing First Hospital will be collected and analyzed. The primary goal is to identify key preoperative and intraoperative predictors of POST and to establish a multivariable nomogram-based prediction model. Internal validation using bootstrap methods will be performed to evaluate the model's discrimination, calibration, and clinical utility, ultimately supporting evidence-based interventions to improve postoperative outcomes and patient satisfaction.