A common problem following general anesthesia is postoperative sore throat (POST) and postoperative hoarseness (PH). Symptoms directly correlated with less satisfaction according to the patients. The overall aim of this thesis was to describe patients' postoperative sore throat and hoarseness after general anesthesia with endotracheal intubation or laryngeal mask airway. As well as to investigate the risk factors that are associated with the symptoms, and to test methods that may prevent sore throat and hoarseness after a general anaesthetics. A total of 889 patients are included in the four studies. Incidence of POST varied from 21% up to 52 % depending on endotracheal tube (ETT) size in women (I-IV) and in men was the incidence 32-38% (III-IV). There were no gender difference in POST in study III and IV. The overall incidence of PH varied from 42- 59% (I-IV) in all patients, with no gender differences (III-IV). Following a laryngeal mask airway (LMA) 19% of the patients had POST and 33% of the patients reported PH. Patients with POST do seem to be able to localize their pain in the throat (IV). Different risk factors are shown to contribute to both POST and PH in men and women (II-III). To intubate with a smaller ETT size, 6.0 vs. 7.0 decreased POST in women in the early postoperative period as well as their discomfort from their POST (I). Only 6% of men who needed a laryngeal mask airway had POST compared to 26% of women. The symptoms are more discomforting after an ETT vs. an LMA up to 24 hours (IV). More patients have sore throat and hoarseness in the early postoperative period, but the symptoms can remain up to almost 5 days postoperatively (I, IV). In summary, sore throat and hoarseness following general anesthesia, affects many patients postoperatively. To intubate women with endotracheal size 6.0 decreases both sore throat and hoarseness postoperatively. Women are more likely than men to have a sore throat when a laryngeal mask airway is used.

Orientador: Norma Sueli Pinheiro Módolo / Resumo: Justificativa e Objetivos: a diferença na incidência de eventos adversos perioperatórios (EAPs) entre tubo traqueal (TT), máscara laríngea (ML) e máscara facial (MF) ainda é questão controversa no tocante à anestesia em crianças com infecção de vias aéreas superiores (IVAS). O objetivo desta revisão sistemática foi comparar o risco de EAPs entre os dispositivos de via aérea após anestesia em pacientes pediátricos com IVAS. Métodos: foi conduzida revisão sistemática de acordo com as recomendações da Colaboração Cochrane e declaração PRISMA. A estratégia de busca foi realizada nas principais bases de dados eletrônicas (PubMed, EMBASE, Cochrane CENTRAL, Lilacs, Scielo, Scopus e Web of Science) e a última pesquisa foi realizada em 30 de junho de 2015. Não houve restrições quanto a idioma, data, revista ou publicação. Foram incluídos somente estudos avaliando EAPs em pacientes com IVAS submetidos à anestesia e cujas vias aéreas tenham sido manejadas com MF, ML ou TT. Dados de cada ensaio clínico randomizado (ECR) foram combinados utilizando o modelo de efeito randômico para cálculo do risco relativo (RR). Resultados: dos 680 estudos identificados, 5 eram ECRs e foram incluídos na análise final. Não houve diferença estatisticamente significante entre os diferentes dispositivos estudados com relação a broncoespasmo (RR 0,47, IC 95% 0,04-6,25, p=0,57), laringoespasmo (RR 0,84, IC 95% 0,56-1,27, p=0,41), dessaturação arterial de oxigênio (RR 0,66, IC 95% 0,38-1,16, p=0,15), apneia (RR... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: rate of perioperative adverse events (PAEs) among tracheal tube (TT), laryngeal mask airway (LMA), and facemask (FM) remains a controversial issue during anesthesia in children with an upper respiratory tract infection (URTI). The aim of the present study was to compare the risk of PAEs among the different airway devices after anesthesia in pediatric patients with an URTI. Methods: a systematic review according to the Cochrane Handbook and PRISMA guidelines was conducted. The search was performed in the main electronic databases (PubMed, EMBASE, Cochrane CENTRAL, Lilacs, Scielo, Scopus and Web of Science) and the last one was carried out in June 30, 2015. There were no language, year of publication, or publication status restriction. Only randomized clinical trial evaluating anesthesia in children with URTI and who were submitted to either of the airway devices were included. Data from each trial was combined using the random effects models to calculate the pooled relative risk (RR) and 95% confidence intervals. Results: from 680 studies identified, 5 randomized clinical trials were included in the final analysis. There were no statistical difference with regard to bronchospasm (RR 0.47, CI 95% 0.04-6.25, p=0.57), laryngospasm (RR 0.84, CI 95% 0.56-1.27, p=0.41), arterial oxygen desaturation (RR 0.66, CI 95% 0.38-1.16, p=0.15), apnea or breath holding (RR 0.91, CI 95% 0.49-1.67, p=0.75), sore throat (RR 0.87, CI 95% 0.39-1.96, p=0.74), and hospital readmission (RR... (Complete abstract click electronic access below) / Doutor

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No. of bitstreams: 1 carvalho_alr_dr_bot.pdf: 1510567 bytes, checksum: 016ef353508cc1d168cdef1d8cf5cea3 (MD5) Previous issue date: 2016-02-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Justificativa e Objetivos: a diferença na incidência de eventos adversos perioperatórios (EAPs) entre tubo traqueal (TT), máscara laríngea (ML) e máscara facial (MF) ainda é questão controversa no tocante à anestesia em crianças com infecção de vias aéreas superiores (IVAS). O objetivo desta revisão sistemática foi comparar o risco de EAPs entre os dispositivos de via aérea após anestesia em pacientes pediátricos com IVAS. Métodos: foi conduzida revisão sistemática de acordo com as recomendações da Colaboração Cochrane e declaração PRISMA. A estratégia de busca foi realizada nas principais bases de dados eletrônicas (PubMed, EMBASE, Cochrane CENTRAL, Lilacs, Scielo, Scopus e Web of Science) e a última pesquisa foi realizada em 30 de junho de 2015. Não houve restrições quanto a idioma, data, revista ou publicação. Foram incluídos somente estudos avaliando EAPs em pacientes com IVAS submetidos à anestesia e cujas vias aéreas tenham sido manejadas com MF, ML ou TT. Dados de cada ensaio clínico randomizado (ECR) foram combinados utilizando o modelo de efeito randômico para cálculo do risco relativo (RR). Resultados: dos 680 estudos identificados, 5 eram ECRs e foram incluídos na análise final. Não houve diferença estatisticamente significante entre os diferentes dispositivos estudados com relação a broncoespasmo (RR 0,47, IC 95% 0,04-6,25, p=0,57), laringoespasmo (RR 0,84, IC 95% 0,56-1,27, p=0,41), dessaturação arterial de oxigênio (RR 0,66, IC 95% 0,38-1,16, p=0,15), apneia (RR 0,91, IC 95% 0,49-1,67, p=0,75), dor de garganta (RR 0,87, IC 95% 0,39-1,96, p=0,74) e taxa de readmissão hospitalar (RR 0,76, IC 95% 0,17-3,33, p=0,71). O uso de ML resultou em significante redução da incidência de tosse (RR 0,63, IC 95% 0,45-0,89, p=0,009) comparado aos outros dispositivos de via aérea. Notou-se, também, tendência à redução da incidência de vômito com o uso da ML quando comparado ao TT e MF, embora sem significância estatística (RR 0,57, IC 95% 0,33-1,00, p=0,05). Conclusões: o manejo ideal das vias aéreas em crianças com IVAS permanece incerto. Esta revisão sistemática demonstra que o uso da ML durante anestesia em crianças com IVAS não resultou na diminuição dos mais temidos EAPs. Entretanto, o uso da ML foi mais eficaz em reduzir a incidência de tosse comparado aos outros dispositivos de via aérea. Além disso, houve tendência da ML em reduzir a incidência de vômito. / Background: rate of perioperative adverse events (PAEs) among tracheal tube (TT), laryngeal mask airway (LMA), and facemask (FM) remains a controversial issue during anesthesia in children with an upper respiratory tract infection (URTI). The aim of the present study was to compare the risk of PAEs among the different airway devices after anesthesia in pediatric patients with an URTI. Methods: a systematic review according to the Cochrane Handbook and PRISMA guidelines was conducted. The search was performed in the main electronic databases (PubMed, EMBASE, Cochrane CENTRAL, Lilacs, Scielo, Scopus and Web of Science) and the last one was carried out in June 30, 2015. There were no language, year of publication, or publication status restriction. Only randomized clinical trial evaluating anesthesia in children with URTI and who were submitted to either of the airway devices were included. Data from each trial was combined using the random effects models to calculate the pooled relative risk (RR) and 95% confidence intervals. Results: from 680 studies identified, 5 randomized clinical trials were included in the final analysis. There were no statistical difference with regard to bronchospasm (RR 0.47, CI 95% 0.04-6.25, p=0.57), laryngospasm (RR 0.84, CI 95% 0.56-1.27, p=0.41), arterial oxygen desaturation (RR 0.66, CI 95% 0.38-1.16, p=0.15), apnea or breath holding (RR 0.91, CI 95% 0.49-1.67, p=0.75), sore throat (RR 0.87, CI 95% 0.39-1.96, p=0.74), and hospital readmission (RR 0.76, CI 95% 0.17-3.33, p=0.71). The use of LMA produced a significant reduction of cough (RR 0.63, CI 95% 0.45- 0.89, p=0.009) compared with other airway devices. Also, LMA tended toward a reduction of vomiting compared with other forms of airway management but did not reach statistical significance (RR 0.57, CI 95% 0.33-1.00, p=0.05). Conclusions: the ideal airway management in children with URTI remains obscure. This systematic review demonstrates that the use of LMA during anesthesia for surgery in children with URTI did not result in decrease of the most feared PAEs. However, the use of LMA was better than other airway devices in reducing cough and tended toward a protective effect against vomiting.

No description available.

A research report submitted in partial fulfilment of the requirements for the degree Master of Science in Medicine in the Field of Emergency Medicine in the Division of Emergency Medicine, University of the Witwatersrand / Introduction: Control over the patient bears time-critical importance in emergency medicine. In the entrapment situation after a Motor Vehicle Collision (MVC), emergency care including airway management may need to be initiated before extrication and thus with restricted access. Objective: This manikin study aimed at answering the question of which advanced airway device can be inserted the fastest and most reliably by paramedics in the simulated entrapped patient. Methods: Paramedics were asked to insert four airway devices (endotracheal tube with the Macintosh laryngoscope, endotracheal tube with the Airtraq® optical laryngoscope, Laryngeal Mask Airway - SupremeTM, and Laryngeal Tube Suction - DisposableTM) in randomised order into a manikin seated in the driver seat of a light motor vehicle. Time to first successful ventilation and number of attempts required for successful insertion were measured. Following each insertion, participants were asked by means of a questionnaire to rate the degree of insertion difficulty (scale 1 – 10) and provide reasons for this rating. Finally, participants were asked which device they preferred and why. Results: Prospectively collected data from 26 paramedics were analysed. The LMA-SupremeTM had the shortest mean time to first successful ventilation (16.7 seconds (CI [0.95]; 14.9 - 18.6)), followed by the LTS-DTM (19.4 seconds (CI [0.95]; 18.0 - 20.8)), ETI using the Macintosh laryngoscope (37.7 seconds (CI [0.95]; 31.8 - 43.5)) and ETI using the Airtraq® (41.2 seconds (CI [0.95]; 36.7 - 45.6)). Both face-to-face ETI with the Macintosh laryngoscope and the insertion of the LMA-SupremeTM had 100% first-attempt success. Five participants required a second attempt to successfully intubate the manikin using the Airtraq® and one participant had to re-insert the LTS-DTM for correct placement. In terms of insertion difficulty, the LMA-SupremeTM received the lowest mean score (1.7/10 (CI [0.95]; 1.2 - 2.1)) followed by the LTS-DTM (2.5/10 (CI [0.95]; 1.8 – 3.2)), face-to-face ETI using the Macintosh laryngoscope (3.7/10 (CI [0.95]; 2.9 - 4.5)), and ETI with the Airtraq® (4.5/10 (CI [0.95]; 3.7 - 5.3)). Most participants chose the Macintosh laryngoscope for ETI as their preferred device (10/26; 38%) followed closely by the LMA-SupremeTM (9/26; 35%). These participants stated clinical experience and ease of insertion respectively as the primary reasons for their preference. Conclusion: Besides ETI, Supraglottic Airway Devices are beneficial alternative airway devices to be considered by paramedics in the entrapped patient after a MVC. The LMA-SupremeTM was the fastest and least difficult airway device to insert. Face-to-face endotracheal intubation with the Macintosh laryngoscope remains an important definitive airway that was shown to be performed competently by participating paramedics. The Airtraq® can be used for face-to-face ETI and enables improved laryngoscopy.