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Effects of throat packs in upper airway surgery under intubation anesthesia: a randomized controlled trial

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Abstract

Introduction

Throat packs (TP) are used in upper airway surgery to avoid accumulation and aspiration of blood, foreign bodies, and fluids. But side effects such as sore throat and TP retention have been reported and challenge the standardized use of TP. The aim of this study is to compare benefits and side effects of TP versus no TP for upper airway procedures in intubation anesthesia.

Material and methods

One hundred forty-eight patients with surgical interventions at the upper airway under intubation anesthesia were included. Of those, n = 74 each were treated without (A, control) and with (B) TP. Study group B was subdivided whether TP was placed by the surgeon (B1; n = 37) or by the anesthesiologist (B2; n = 37). TP-related side effects such as sore throat, foreign body sensation, hoarseness, dyspnea, difficulty of swallowing, nausea, retching, nausea, aspiration, and pneumonia as well as the influence of TP design and the applicant (surgeon or anesthetist) were analyzed.

Results

A significantly increased rate of difficulty of swallowing (p = 0.045), intensity of sore throat (p = 0.04), and foreign body sensation (p = 0.024) was found in group B when compared to group A. There was no correlation between hoarseness, dyspnea, nausea, retching, and TP. No case of aspiration or pneumonia was seen but one TP was accidentally forgotten in the patient. B2 showed an increased frequency of difficulty swallowing, followed by A and B1. B1 led to the highest incidence of nausea followed by the A and B2.

Conclusion

The use of TP led to a high rate of side effects without showing the propagated advantages.

Clinical relevance

The use of TP must be considered critically and cannot generally be recommended without specific reasons, such as high aspiration risk.

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Acknowledgements

This study contains parts, data, and results of the dental doctoral thesis (Dr. med. dent.) of Dr. med. Daniel Müller, Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Germany.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstr. 170, 56072, Koblenz, Germany

    Andreas Pabst

  2. Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany

    Andreas Pabst, Daniel Müller, Daniel G. E. Thiem, Maximilian Krüger, Diana Heimes & Peer W. Kämmerer

  3. Department of Anaesthesiology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany

    Anton Scherhag

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  1. Andreas Pabst
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Correspondence to Andreas Pabst.

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Ethical approval

The study was conducted according to the principles of the Declaration of Helsinki. The study was approved by the local ethics committee (No. 2018–13556) of the Federal State Rhineland-Palate (Germany) and all individuals provided written informed consent for study participation.

Participation to the study was on a voluntary basis and data collection was conducted anonymously. This article does not contain any studies on animals performed by any of the authors.

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Pabst, A., Müller, D., Thiem, D.G.E. et al. Effects of throat packs in upper airway surgery under intubation anesthesia: a randomized controlled trial. Clin Oral Invest 26, 6795–6804 (2022). https://doi.org/10.1007/s00784-022-04641-4

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