Nebulized pharmacological agents for preventing postoperative sore throat: A systematic review and network meta-analysis

Jian Yu, Li Ren, Su Min, You Yang, Feng Lv, Jian Yu, Li Ren, Su Min, You Yang, Feng Lv

Abstract

Postoperative sore throat is one of the most common complications following endotracheal intubation. Nebulization therapy, a preferable and safety method of drug delivery, has been shown to be effective in postoperative sore throat prevention in many studies. However, the relative efficacy of various nebulized agents remains unknown. In this review, we aimed to quantify and rank order the efficacy of available nebulized agents for various postoperative sore throat-related outcomes. A comprehensive literature search of PubMed, EMBASE, CENTRAL and Google Scholar was conducted to identify eligible studies from inception to 25 May 2020. Incidence of postoperative sore throat 1hour and 24hours postoperatively and severity of postoperative sore throat 24 hours postoperatively were the primary outcomes. We conducted a Bayesian network meta-analysis to combine direct and indirect evidence to estimate the relative effects between treatments as well as the probabilities of ranking for treatments based on their protective effects. We identified 32 trials assessing 6 interventions. Overall inconsistency and heterogeneity were acceptable. Nebulized corticosteroids, magnesium, and ketamine differed from non-analgesic methods on the three primary outcomes. Based on the surface under the cumulative ranking curve, nebulized corticosteroids ranked first in almost all outcomes among the nebulized drugs. Considering only high-quality and 2-arm design studies, nebulized corticosteroids still seemed best. In conclusion, prophylactic use of nebulized corticosteroids, magnesium, and ketamine can effectively prevent postoperative sore throat, and nebulized corticosteroids appears to be the overall best approach.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram of the literature…
Fig 1. Flow diagram of the literature review.
Fig 2
Fig 2
Network plot of eligible comparisons for (A) incidence of POST 24h after surgery, (B) incidence of POST 1h after surgery and (C) incidence of moderate to severe POST 24h after surgery. The size circle reflects the number of participants (sample size), and the width of the lines reflects the number of direct comparisons. n = number of trials for the direct comparisons. COR = corticosteroids; KET: ketamine; MAG: magnesium; LID: lidocaine; BH: benzydamine hydrochloride; PLA: placebo.
Fig 3
Fig 3
Results of the network meta-analysis for nebulized agents in terms of (A)incidence of POST 24h after surgery, (B)incidence of POST 1h after surgery and (C)incidence of moderate to severe POST 24h after surgery. Results were presented as OR with 95% CI, the estimations should read as column-defining treatment compared with the row-defining treatment. The OR below 1 was identified that the column-defining treatment had better effect on preventing POST. OR = odds ratios. CI = credible interval. * = 95% CI did not include 1. COR = corticosteroids; KET: ketamine; MAG: magnesium; LID: lidocaine; BH: benzydamine hydrochloride; PLA: placebo.
Fig 4
Fig 4
Plots of the SUCRA probabilities for nebulized agents in terms of (A)incidence of POST 24h after surgery, (B)incidence of POST 1h after surgery and (C)incidence of moderate to severe POST 24h after surgery. The area under the curve is equivalent to the value of SUCRA, and thus a bigger area corresponds to a better outcome. COR = corticosteroids; KET: ketamine; MAG: magnesium; LID: lidocaine; BH: benzydamine hydrochloride; PLA: placebo.

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