Postoperative Sore Throat in the Pediatric Population.
Condition: Anesthesia Morbidity; Sore Throat
MeSH terms: Pharyngitis
Study type: Observational

Summary: 
      Endotracheal tubes (ETT) and laryngeal mask airways (LMA) are devices used to help breathing
      whilst patients are asleep for surgery. Children may have a more satisfying experience if the
      rate of of post operative sore throat (POST) and hoarseness (PH) could be reduced. The
      incidence of POST and PH may be as high as 42% in children undergoing anesthesia. ETTs and
      LMAs require inflation of a cuff after insertion to obtain a seal to a patient's airway for
      them to be effective. It is recommended that cuff pressures are checked after insertion and
      inflation with a pressure checking device but this does not occur in all routine anesthetic
      practice. Overinflation of these cuffs may cause damage to the airway by exerting pressure on
      surrounding structures. Studies have shown both children and adults to have increased risk of
      POST with higher LMA pressure. The number of times it takes to successfully insert a LMA has
      also been associated with POST as has female gender and older age.

      Similarly to LMAs, multiple insertion attempts of ETT insertion, female gender and a larger
      size are more likely to cause POST and PH.

      Although patients with uncuffed have a higher incidence of POST than those with a cuffed ETT,
      when using cuffed tubes ETT, POST occurs more often as cuff pressure increases and should
      therefore be routinely measured.

      The location of a patient's sore throat may vary. It may be intermittent or constant, or
      described as difficulty in swallowing, painful swallowing or hoarse voice and may there may
      be difference locations within the throat. In the current literature there is no one
      definition of what constitutes a sore throat or how or when it should be measured.

      The hypothesis is that occurrence and severity of POST could be determined by various factors
      other than the pressure of the cuff alone. In particular, the pressure of cuff, the duration
      of anesthesia, the airway manipulations, could all be factors determining the occurrence of
      postoperative sore throat.

      Based on the above hypothesis, Investigators planed to perform a prospective cohort study.

      Aims: to determine the occurrence and severity of post-anaesthesia sore throat in children
      undergoing surgical procedures with LMA or ETT placement.

      If clear factors are demonstrated for POST and PH in pediatric population then measures can
      be taken to reduce them and thereby improve outcome and patient satisfaction.
    

Detailed description: 
      The study is a prospective, descriptive study, involving patient interview and objective data
      collected as part of routine anesthetic care. No intervention will take place. Once
      identified from a theatre list, patients/parents will be approached preoperatively and
      consent taken to participate. If inclusion criteria are met and consent gained the
      preoperative questionnaire will be completed to obtain information regarding pain, nausea,
      sore throat, itching, thirst and hunger. Each symptom will be graded none, mild, moderate,
      severe. Intraoperative data will be collected after surgery whilst the child is in the
      recovery room. This is objective data obtained from the anesthetic chart. Prior to discharge
      to the ward the child will undergo a second interview answering the same questions as he/she
      did preoperatively (a further 1-2 minutes). Any child who has a sore throat in the recovery
      room will then be followed up 2 hours later on the ward with a further questionnaire. This
      will include questions about the location of the sore throat, severity and voice changes
      (5-10 mins). This will be the end of the participants input.
    

Intervention name(s): Anesthesia
Intervention type(s): Procedure
Intervention description(s): Occurrence and severity of postoperative sore throat could be determined by various factors other than the pressure of the cuff alone. In particular, cuff pressure measurement, duration of anaesthesia, airway manipulations e.g. multiple insertion attempts, could all be factors determining the occurrence of postoperative sore throat.
Intervention MeSH terms: Anesthetics
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        A cohort of minimum 255 children will be prospectively collected from the elective surgical
        lists of Great Ormond Street Hospital, London, UK. Children 5 years of age or greater,
        scheduled for surgical procedures will be included.