The Effect of Intracuff Pressure Adjustment on Postoperative Sore Throat and Hoarseness after Nitrous Oxide and Air Anesthesia

An Na Gu; Mi Yu

doi:10.4040/jkan.2019.49.2.215

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Gu and Yu: The Effect of Intracuff Pressure Adjustment on Postoperative Sore Throat and Hoarseness after Nitrous Oxide and Air Anesthesia

Original Article

Journal of Korean Academy of Nursing 2019; 49(2): 215-224.

Published online: 30 April 2019

DOI: https://doi.org/10.4040/jkan.2019.49.2.215

The Effect of Intracuff Pressure Adjustment on Postoperative Sore Throat and Hoarseness after Nitrous Oxide and Air Anesthesia

An Na Gu¹

, Mi Yu²

¹Department of Nursing, Gyeongsang National University Hospital, Jinju, Korea.

²College of Nursing, Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.

Address reprint requests to: Yu, Mi. College of Nursing, Institute of Health Sciences, Gyeongsang National University, 816 beon-gil 15 Jinju-daero, Jinju 52727, Korea. Tel: +82-55-772-8229, Fax: +82-55-772-8222, yumi825@gnu.ac.kr

Received 18 April 2018 Revised 8 November 2018 Accepted 19 March 2019

Korean Society of Nursing Science

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

To investigate the differences in postoperative sore throat and hoarseness by adjustment of endotracheal tube cuff pressure (CP) during nitrous oxide (N₂O) and air anesthesia.

Methods

A one-equivalent control group pretest-posttest design was used. Data were collected from August 8 to October 19, 2017 and analyzed using the independent t-test and repeated measures ANOVA. Eighty-four participants were enrolled and divided into three groups: 28 in the Control Group (CP adjusted every 30 minutes using N₂O), 28 in Experimental Group 1 (CP adjusted every 10 minutes using N₂O), and 28 in Experimental Group 2 (non-adjusted CP using air), all of whom underwent urologic, gynecologic, and orthopedic surgeries at the G University hospital. Sore throat was assessed using a numeric rating scale; hoarseness was evaluate using the Stout classification at 1, 6, and 24 hours after surgery.

Results

Scores for sore throat and hoarseness were significantly different between the groups at each measurement time, and scores were consistently higher in the control group. During subsequent measurements, sore throat and hoarseness scores were significantly lower at 6 hours. Cuff pressure changed significantly using air anesthesia (χ²=10.41, p=.015) up to 2 hours after induction. Severe sore throat and hoarseness was observed for up to 6 hours after surgery.

Conclusion

Cuff pressure adjustment at short time intervals would be helpful in reducing postoperative sore throat and hoarseness. Nursing intervention focused on prevention of sore throat and hoarseness should be required up to 6 hours postoperatively in patients undergoing endotracheal intubation.

Keywords: Air, Hoarseness, Intubation, Nitric Oxide, Sore Throat

Figures and Tables

Figure 1

(A) Mean scores of sore throat by group over time. (B) Mean scores of hoarseness by group over time.

Table 1

General and Clinical Characteristics and Homogeneity Test (N=84)

ASA=American society of anesthesiologists; ASA I=A normal healthy patient; ASA II=A patient with mild systemic disease; GY=Gynecologic surgery; OS=Orthopedic surgery; URO=Urologic surgery; PCA=Patient controlled analgesia; M=Mean; SD=Standard deviation.

^†Fisher's exact test; ^††Additional analgesics include Fentanyl, Morphine, Ketocin, Denogan.

Table 2

Differences in Sore Throat by Group over Time (N=84)

M=Mean; SD=Standard deviation.

^†Friedman test; ^††Kruskal-Wallis test; ^§Control Group (cuff pressure adjusted every 30 minutes using N₂O); ^∥Experimental Group 1 (cuff pressure adjusted every 10 minutes using N₂O); ^¶Experimental Group 2 (non-adjusted cuff pressure using air).

Table 3

Differences in Hoarseness by Group over Time (N=84)

M=Mean; SD=Standard deviation.

^‡Friedman test; ^††Kruskal-Wallis test.

Table 4

Changes in Cuff Pressure over Time with Non-adjusted Cuff Pressure using Air (N=28)

M=Mean; SD=Standard deviation.

^‡Friedman test; ^††Kolmogorov-Smirnov test.

Notes

This manuscript is based on condensed form of the first author's master's thesis from Gyeongsang National University.

^{CONFLICTS OF INTEREST} The authors declared no conflict of interest.

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ORCID iDs

An Na Gu
https://orcid.org/0000-0002-9551-5394

Mi Yu
https://orcid.org/0000-0002-7947-0923

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