Effect of peri-intubation non-pharmacological interventions on postoperative laryngeal symptoms: A systematic review with meta-analysis and meta-regression.

Objectives: To evaluate the effectiveness of peri-intubation non-pharmacological interventions in reducing postoperative sore throat (POST), cough (PEC), and hoarseness in surgical patients.

Design: A systematic review with meta-analysis and meta-regression.

Setting: Elective surgery under general anesthesia in operating rooms.

Main Outcome Measures: Evaluate the impact of non-pharmacological interventions, including pre-intubation (gargling with Sodium Azulene Sulfonate, licorice, or using Strepsils tablets of honey and lemon lozenge), during-intubation (inflating the TT cuff with normal saline and softening the ETT cuff with warm normal saline), and post-intubation (cold vapor therapy, gargling with honey lemon water, and using green tea gargle), on the occurrence of POST, PEC, and hoarseness.

Results: Nineteen trials with 2,136 participants were included. Pre-intubation intervention significantly reduced POST immediately after extubation (n = 861; OR: 0.28, 95 % CI: 0.20-0.38, P < 0.001), and 24 h post-extubation (n = 1006; OR: 0.21, 95 % CI: 0.16-0.28, P < 0.001). During-intubation intervention did not show significant effects on POST. Pre-intubation intervention also reduced POST-associated pain score at 24 h post-extubation (n = 440; MD: -0.50, 95 % CI: -0.81 to -0.18, P < 0.001). Post-intubation interventions were effective in reducing POST-associated pain scores at different time points post-extubation (P < 0.05). Pre-intubation intervention significantly reduced PEC (OR: 0.13, 95 % CI: 0.02-0.70, P = 0.02) and hoarseness (OR: 0.36, 95 %CI: 0.15-0.86, P = 0.02) at 24 h post-extubation. However, during-intubation interventions did not reduce hoarseness at 24 h post-extubation.

Conclusion: Pre-intubation non-pharmacological interventions were found to be the most effective in reducing the incidence and severity of POST, PEC, and hoarseness.

Implications For Clinical Practice: Implementing pre-intubation non-pharmacological interventions can be beneficial for bedside nurses and healthcare professionals in reducing postoperative complications and nurses can contribute to improving patient comfort and recovery outcomes following surgery.

Systematic Review Protocol: The protocol was registered in the PROSPERO international prospective register of systematic reviews on 2 January 2024 (CRD42023492813).