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Prophylactic Administration of Corticosteroids for Preventing Postoperative Complications Related to Tracheal Intubation: A Systematic Review and Meta-Analysis of 18 Randomized Controlled Trials

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Abstract

Background and Objectives

Sore throat, cough, and hoarseness are the common and severe complications after general anesthesia with tracheal intubation. The efficacy of prophylactic administration of corticosteroids in reducing the incidence of postoperative complications is controversial. Thus, we conducted a meta-analysis to assess the effects of corticosteroids in the prevention of postoperative complications.

Methods

A comprehensive literature search of Pubmed, Embase, and Web of Science was conducted to identify relative trials. Eligible studies were randomized controlled trials (RCTs) that assessed the effect of corticosteroids for preventing postoperative complications. The outcomes included the prevalence of postoperative sore throat, cough, hoarseness, laryngeal edema, and reintubation. A random-effects or fixed-effects model was used to pool the estimates, according to the heterogeneity among the included studies.

Results

Eighteen RCTs with a total of 2685 patients were included in this meta-analysis. Pooled estimates showed that corticosteroids significantly reduced the incidence of postoperative sore throat, hoarseness, and cough. Moreover, corticosteroids had a positive effect on the incidence of laryngeal edema and reintubation. Subgroup analysis showed that corticosteroids significantly decreased the incidence of severe sore throat and hoarseness, but not cough.

Conclusion

Evidence from this meta-analysis of 18 RCTs indicated that prophylactic administration of corticosteroids is not only effective in reducing the incidence and severity of postoperative sore throat and hoarseness, but also the incidence of laryngeal edema and reintubation.

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References

  1. Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med. 1981;70(1):65–76.

    Article  CAS  PubMed  Google Scholar 

  2. Kastanos N, Estopa Miro R, Marin Perez A, Xaubet Mir A, Agusti Vidal A. Laryngotracheal injury due to endotracheal intubation: incidence, evolution, and predisposing factors. A prospective long-term study. Crit Care Med. 1983;11(5):362–7.

    Article  CAS  PubMed  Google Scholar 

  3. McHardy FE, Chung F. Postoperative sore throat: cause, prevention and treatment. Anaesthesia. 1999;54(5):444–53.

    Article  CAS  PubMed  Google Scholar 

  4. Jones MW, Catling S, Evans E, Green DH, Green JR. Hoarseness after tracheal intubation. Anaesthesia. 1992;47(3):213–6.

    Article  CAS  PubMed  Google Scholar 

  5. Oczenski W, Krenn H, Dahaba AA, Binder M, El-Schahawi-Kienzl I, Kohout S, et al. Complications following the use of the Combitube, tracheal tube and laryngeal mask airway. Anaesthesia. 1999;54(12):1161–5.

    Article  CAS  PubMed  Google Scholar 

  6. Christensen AM, Willemoes-Larsen H, Lundby L, Jakobsen KB. Postoperative throat complaints after tracheal intubation. Br J Anaesthesia. 1994;73(6):786–7.

    Article  CAS  Google Scholar 

  7. Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory surgery. Br J Anaesthesia. 2002;88(4):582–4.

    Article  CAS  Google Scholar 

  8. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesthesia Analgesia. 1999;89(3):652–8.

    CAS  PubMed  Google Scholar 

  9. Biro P, Seifert B, Pasch T. Complaints of sore throat after tracheal intubation: a prospective evaluation. Eur J Anaesthesiol. 2005;22(4):307–11.

    Article  CAS  PubMed  Google Scholar 

  10. Porter NE, Sidou V, Husson J. Postoperative sore throat: incidence and severity after the use of lidocaine, saline, or air to inflate the endotracheal tube cuff. AANA J. 1999;67(1):49–52.

    CAS  PubMed  Google Scholar 

  11. Stout DM, Bishop MJ, Dwersteg JF, Cullen BF. Correlation of endotracheal tube size with sore throat and hoarseness following general anesthesia. Anesthesiology. 1987;67(3):419–21.

    Article  CAS  PubMed  Google Scholar 

  12. Stenqvist O, Nilsson K. Postoperative sore throat related to tracheal tube cuff design. Can Anaesthetists Soc J. 1982;29(4):384–6.

    Article  CAS  Google Scholar 

  13. Estebe JP, Delahaye S, Le Corre P, Dollo G, Le Naoures A, Chevanne F, et al. Alkalinization of intra-cuff lidocaine and use of gel lubrication protect against tracheal tube-induced emergence phenomena. Br J Anaesthesia. 2004;92(3):361–6. doi:10.1093/bja/aeh078.

    Article  CAS  Google Scholar 

  14. Estebe JP, Dollo G, Le Corre P, Le Naoures A, Chevanne F, Le Verge R, et al. Alkalinization of intracuff lidocaine improves endotracheal tube-induced emergence phenomena. Anesthesia Analgesia. 2002;94(1):227–30.

    CAS  PubMed  Google Scholar 

  15. Wei JL, Kasperbauer JL, Weaver AL, Boggust AJ. Efficacy of single-dose dexamethasone as adjuvant therapy for acute pharyngitis. Laryngoscope. 2002;112(1):87–93. doi:10.1097/00005537-200201000-00016.

    Article  CAS  PubMed  Google Scholar 

  16. Way WL, Sooy FA. Histologic changes produced by endotracheal intubation. Ann Otol Rhinol Laryngol. 1965;74(3):799–812.

    Article  CAS  PubMed  Google Scholar 

  17. Ruangsin S, Wanasuwannakul T, Pattaravit N, Asim W. Effectiveness of a preoperative single dose intravenous dexamethasone in reducing the prevalence of postoperative sore throat after endotracheal intubation. J Med Assoc Thailand (Chotmaihet thangphaet). 2012;95(5):657–60.

    Google Scholar 

  18. Cheng KC, Hou CC, Huang HC, Lin SC, Zhang H. Intravenous injection of methylprednisolone reduces the incidence of postextubation stridor in intensive care unit patients. Crit Care Med. 2006;34(5):1345–50. doi:10.1097/01.ccm.0000214678.92134.bd.

    Article  CAS  PubMed  Google Scholar 

  19. Ayoub CM, Ghobashy A, Koch ME, McGrimley L, Pascale V, Qadir S, et al. Widespread application of topical steroids to decrease sore throat, hoarseness, and cough after tracheal intubation. Anesthesia Analgesia. 1998;87(3):714–6.

    CAS  PubMed  Google Scholar 

  20. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ (Clin Res ed). 2009;339:b2535. doi:10.1136/bmj.b2535.

    Article  Google Scholar 

  21. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clin Trials. 1996;17(1):1–12.

    Article  CAS  PubMed  Google Scholar 

  22. Kjaergard LL, Villumsen J, Gluud C. Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med. 2001;135(11):982–9.

    Article  CAS  PubMed  Google Scholar 

  23. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. doi:10.1136/bmj.327.7414.557.

    Article  PubMed  PubMed Central  Google Scholar 

  24. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.

    Article  CAS  PubMed  Google Scholar 

  25. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Nat Cancer Inst. 1959;22(4):719–48.

    CAS  PubMed  Google Scholar 

  26. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.

    Article  CAS  PubMed  Google Scholar 

  27. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clin Res ed). 1997;315(7109):629–34.

    Article  CAS  Google Scholar 

  28. Tazeh-Kand NF, Eslami B, Mohammadian K. Inhaled fluticasone propionate reduces postoperative sore throat, cough, and hoarseness. Anesthesia Analgesia. 2010;111(4):895–8. doi:10.1213/ANE.0b013e3181c8a5a2.

    CAS  PubMed  Google Scholar 

  29. Lee CH, Peng MJ, Wu CL. Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study. Crit Care (London, England). 2007;11(4):R72. doi:10.1186/cc5957.

    Article  PubMed Central  Google Scholar 

  30. Park SH, Han SH, Do SH, Kim JW, Rhee KY, Kim JH. Prophylactic dexamethasone decreases the incidence of sore throat and hoarseness after tracheal extubation with a double-lumen endobronchial tube. Anesthesia Analgesia. 2008;107(6):1814–8. doi:10.1213/ane.0b013e318185d093.

    Article  CAS  PubMed  Google Scholar 

  31. Francois B, Bellissant E, Gissot V, Desachy A, Normand S, Boulain T, et al. 12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: a randomised double-blind trial. Lancet (London, England). 2007;369(9567):1083–9. doi:10.1016/s0140-6736(07)60526-1.

    Article  CAS  Google Scholar 

  32. Narasethakamol A, Techanivate A, Saothongthong J, Yurakate N, Cousnit P. Application of mometasone spray to reduce sore throat after tracheal intubation. J Med Assoc Thailand (Chotmaihet thangphaet). 2011;94(8):958–64.

    Google Scholar 

  33. Thomas S, Beevi S. Dexamethasone reduces the severity of postoperative sore throat. Can J Anaesthia (J Can d’Anesthesie). 2007;54(11):897–901. doi:10.1007/bf03026793.

    Article  Google Scholar 

  34. Park SY, Kim SH, Lee SJ, Chae WS, Jin HC, Lee JS, et al. Application of triamcinolone acetonide paste to the endotracheal tube reduces postoperative sore throat: a randomized controlled trial. Can J Anaesthia (J Can d’Anesthesie). 2011;58(5):436–42. doi:10.1007/s12630-011-9478-6.

    Article  Google Scholar 

  35. De Oliveira GS, Ahmad S, Fitzgerald PC, Marcus RJ, Altman CS, Panjwani AS, et al. Dose ranging study on the effect of preoperative dexamethasone on postoperative quality of recovery and opioid consumption after ambulatory gynaecological surgery. Br J Anaesthesia. 2011;107(3):362–71. doi:10.1093/bja/aer156.

    Article  Google Scholar 

  36. Kazemi A, Amini A. The effect of betamethasone gel in reducing sore throat, cough, and hoarseness after laryngo-tracheal intubation. Middle East J Anaesthesiol. 2007;19(1):197–204.

    PubMed  Google Scholar 

  37. Bagchi D, Mandal MC, Das S, Sahoo T, Basu SR, Sarkar S. Efficacy of intravenous dexamethasone to reduce incidence of postoperative sore throat: A prospective randomized controlled trial. J Anaesthesiol Clin Pharmacol. 2012;28(4):477–80. doi:10.4103/0970-9185.101920.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Eydi M, Kolahdouzan K, Golzari SE. Effect of intravenous hydrocortisone on preventing postoperative sore throat followed by laryngeal mask airway use in patients undergoing urogenital surgeries. J Cardiovasc Thor Res. 2013;5(1):29–33. doi:10.5681/jcvtr.2013.006.

    Google Scholar 

  39. Cheng KC, Chen CM, Tan CK, Chen HM, Lu CL, Zhang H. Methylprednisolone reduces the rates of postextubation stridor and reintubation associated with attenuated cytokine responses in critically ill patients. Minerva Anestesiologica. 2011;77(5):503–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Darmon JY, Rauss A, Dreyfuss D, Bleichner G, Elkharrat D, Schlemmer B, et al. Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by dexamethasone. A placebo-controlled, double-blind, multicenter study. Anesthesiology. 1992;77(2):245–51.

    Article  CAS  PubMed  Google Scholar 

  41. Ho LI, Harn HJ, Lien TC, Hu PY, Wang JH. Postextubation laryngeal edema in adults. Risk factor evaluation and prevention by hydrocortisone. Intens Care Med. 1996;22(9):933–6.

    Article  CAS  Google Scholar 

  42. Gaussorgues P, Boyer F, Piperno D, Gerard M, Leger P, Robert D. Do corticosteroids prevent postextubation laryngeal edema? Prospective study of 276 adults. Crit Care Med. 1988;16(6):649.

    Article  CAS  PubMed  Google Scholar 

  43. Donnelly WH. Histopathology of endotracheal intubation. An autopsy study of 99 cases. Arch Pathol. 1969;88(5):511–20.

    CAS  PubMed  Google Scholar 

  44. Colice GL, Stukel TA, Dain B. Laryngeal complications of prolonged intubation. Chest. 1989;96(4):877–84.

    Article  CAS  PubMed  Google Scholar 

  45. Ferrara TB, Georgieff MK, Ebert J, Fisher JB. Routine use of dexamethasone for the prevention of postextubation respiratory distress. J Perinatol. 1989;9(3):287–90.

    CAS  PubMed  Google Scholar 

  46. Tellez DW, Galvis AG, Storgion SA, Amer HN, Hoseyni M, Deakers TW. Dexamethasone in the prevention of postextubation stridor in children. J Pediatr. 1991;118(2):289–94.

    Article  CAS  PubMed  Google Scholar 

  47. Parfitt K, Martindale W. The complete drug reference, 32nd edn. 1999. p. 1046.

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Authors and Affiliations

  1. Department of Anesthesiology, The China–Japan Union Hospital, Jilin University, No. 126, Xiantai Street, 130033, Changchun, Jilin, China

    Wenyu Zhang, Guoqing Zhao, Longyun Li & Pengcheng Zhao

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Correspondence to Pengcheng Zhao.

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Wenyu Zhang, Guoqing Zhao, Longyun Li, and Pengcheng Zhao declare that they have no conflicts of interest.

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Zhang, W., Zhao, G., Li, L. et al. Prophylactic Administration of Corticosteroids for Preventing Postoperative Complications Related to Tracheal Intubation: A Systematic Review and Meta-Analysis of 18 Randomized Controlled Trials. Clin Drug Investig 36, 255–265 (2016). https://doi.org/10.1007/s40261-015-0369-4

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