From the Department of Anaesthesia, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China.
Anesth Analg. 2020 Dec;131(6):1864-1871. doi: 10.1213/ANE.0000000000004664.
Postoperative sore throat (POST) is not uncommon after general anesthesia with a supraglottic airway (SGA) device. Although it was reported that some pharmacological and nonpharmacological measures can reduce POST, because of limitations and variable success rates, we need to find a simpler and more effective way to alleviate POST.
This prospective, observer-blinded, randomized controlled study enrolled 140 patients who required general anesthesia administered via a streamlined liner of the pharyngeal airway (SLIPA) for <60 minutes. They were randomly divided into the gum (group G, n = 70) and control (group C, n = 70) groups. Before the induction of general anesthesia for 5-10 minutes, the patients in group G chewed gum for 2 minutes. Group C was asked to swallow twice without any additional treatment. A standard anesthesia protocol was followed. The incidence and severity of sore throat were assessed up to 24 hours postoperatively. The primary outcome was the incidence of POST numerical rating scale (NRS) scores >3 within 24 hours after surgery, and the secondary outcomes included the POST (NRS) scores 2, 6, and 24 hours after the surgery.
The incidence of moderate/severe POST (NRS >3) within 24 hours after surgery was significantly lower in group G (10.1%, 7/69) than in group C (40.6%, 28/69) (odds ratio 0.386, 95% confidence interval [CI], 0.153-0.976; P = .044). The median (interquartile range [range]) scores at 2, 6, and 24 hours after anesthesia in group G were lower than those in the control group at the same times (2 hours: 0 [0-3 {0-4}] vs 3 [0-3 {0-6}], P = .048; 6 hours: 0 [0-3 {0-6}] vs 2 [0-4 {0-6}], P = .048; 24 hours: 0 [0-1 {0-7}] vs 0 [0-2 {0-6}]; P = .011). There were 14 patients (20.3%, 14/69) in group G who had blood stains on the SGA device, which was significantly lower than the number in group C (37.7%, 26/69) (P = .024). In patients with bloody SGA devices, the incidence of POST scores >3 was significantly lower in group G (14.3%, 2/14) than in group C (73.1%, 19/26) (P < .001), while there was no significant difference between the 2 groups in the incidence of POST score >3 in patients without bloody SGA devices (group G: 9.1%, 5/55; group C: 20.9%, 9/43; P = .145).
Chewing gum before surgery can effectively reduce POST with a SGA device for hysteroscopic surgery, especially in patients with pharyngeal mucosal injury.
在使用声门上气道装置（SGA）进行全身麻醉后，术后咽喉痛（POST）并不少见。虽然有报道称，一些药理学和非药理学措施可以减轻 POST，但由于存在局限性和成功率不同，我们需要寻找一种更简单、更有效的方法来缓解 POST。
这是一项前瞻性、观察者盲法、随机对照研究，纳入了 140 名需要通过 SGA 进行 <60 分钟全身麻醉的患者。他们被随机分为口香糖组（G 组，n = 70）和对照组（C 组，n = 70）。在全身麻醉诱导前 5-10 分钟，G 组患者咀嚼口香糖 2 分钟。C 组被要求不做任何额外处理吞咽两次。遵循标准的麻醉方案。术后 24 小时内评估咽喉痛的发生率和严重程度。主要结局是术后 24 小时内 POST 数字评分量表（NRS）评分 >3 的发生率，次要结局包括术后 2、6 和 24 小时的 POST（NRS）评分。
G 组（10.1%，7/69）术后 24 小时内中度/重度 POST（NRS >3）的发生率明显低于 C 组（40.6%，28/69）（比值比 0.386，95%置信区间 [CI]，0.153-0.976；P =.044）。G 组在麻醉后 2、6 和 24 小时的中位数（四分位距 [范围]）评分均低于对照组同一时间的评分（2 小时：0 [0-3 {0-4}] vs 3 [0-3 {0-6}]，P =.048；6 小时：0 [0-3 {0-6}] vs 2 [0-4 {0-6}]，P =.048；24 小时：0 [0-1 {0-7}] vs 0 [0-2 {0-6}]；P =.011）。G 组有 14 名患者（20.3%，14/69）的 SGA 装置上有血迹，明显低于 C 组（37.7%，26/69）（P =.024）。在 SGA 装置上有血迹的患者中，G 组 POST 评分 >3 的发生率（14.3%，2/14）明显低于 C 组（73.1%，19/26）（P <.001），而在 SGA 装置上无血迹的患者中，两组 POST 评分 >3 的发生率无明显差异（G 组：9.1%，5/55；C 组：20.9%，9/43；P =.145）。
手术前咀嚼口香糖可以有效减轻使用 SGA 装置行宫腔镜手术患者的 POST，尤其是在有咽黏膜损伤的患者中。
