Effect of budesonide aerosol inhalation on postoperative complications and foreign body sensation in the throat of goiter resection patients

Purpose: To study the effect of budesonide aerosol inhalation on postoperative complications and foreign-body sensation in the throat of patients who underwent goiter resection. Methods: One hundred and twenty patients who underwent goiter resection at The Affiliated Hospital of Putian University (Fujian, China) from January 2019 to January 2020 were included in the study, and then equally and randomly assigned to groups A and B. During the perioperative period, group A patients were given budesonide aerosol inhalation, while group B patients received aerosol inhalation of equivalent volume of normal salineectively. Postoperative complication rate (CR), complication pain scores, scores on mucosal response in the throat, and scores on foreign body sensation in the throat were determined for both groups. Results: Postoperative complications in patients were hoarseness, sore throat and cough. Group A had significantly lower postoperative CR, lower complication pain scores, lower scores on mucosal response in the throat, and lower scores on foreign body sensation in the throat, when compared to group B (p < 0.001). Conclusion: Budesonide aerosol inhalation in patients who underwent goiter resection is effective in relieving throat injury from general anesthesia, minimizing likelihood of postoperative complications, and easing foreign-body sensation in the throat. Thus, this strategy may be suitable for the management of postoperative complications.


INTRODUCTION
Goiter is found mostly among female patients, and it is generally treated with surgical resection in the clinic. However, patients experience throat discomfort and foreign body sensation caused by the intraoperative intubation of general anesthesia, and even suffer from more serious postoperative complications, leading to a greatly reduced operative effect [1][2][3]. Aerosol inhalation of glucocorticoids is an important means of relieving throat inflammation. Glucocorticoids are preliminarily applied in the postoperative treatment of patients with throat diseases [4][5][6]. However, few theoretical studies linking glucocorticoids with postoperative complications in patients who underwent goiter resection have been published. In addition, not much is known about the potential of a glucocorticoid such as budesonide to reduce the incidence of postoperative complications in patients.
The present study was carried out to investigate the effect of budesonide aerosol inhalation on postoperative complications and foreign-body sensation in the throat of patients who underwent goiter resection.

General information on patients
A total of 120 patients who underwent goiter resection at The Affiliated Hospital of Putian University (Fujian, China) from January 2019 to January 2020 were chosen for the study. They were equally and randomly divided into two groups: groups A and B. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013) [7]. The study received the approval of the Ethics Committee of The Affiliated Hospital of Putian University (approval no. = 20181146). Patients and/or their family members were fully briefed on the study process and signed the informed consent forms.

Inclusion criteria
Patients who met the following criteria were included: those who were diagnosed with goiter through medical examination, and were treated surgically; those with normal articulation and no other throat diseases, and those who underwent orotracheal intubation under general anesthesia.

Exclusion criteria
Patients who met the following criteria were excluded: those with mental problems or communication disorders; patients with other organic diseases, those with abnormal levels of plasma calcium, and those for whom the duration of intubation for general anesthesia was under 1 h.

Treatments
During the perioperative period, group A was given budesonide aerosol inhalation, while group B was given aerosol inhalation of equivalent volume of normal saline, with the following specific steps: At 1 h before operation, 7 h after operation, and 24 h after operation, group A received 2 mg of budesonide suspension (CHIA TAI TIANQING Pharmaceutical Group Co. Ltd; NMPA approval no. H20203063) via aerosol inhalation driven by oxygen, at an oxygen flow rate of 6 L/min. At the same time points, group B received equivalent amount of normal saline via aerosol inhalation. Comprehensive nursing and preventive measures were given to patients in both groups to avoid the factors that could affect the study results.

Postoperative complication rate (CR)
The complications included dyspnea, hoarseness, incision site infection, numbness of hands and feet, subcutaneous emphysema, sore throat and cough. The number of patients with complications was recorded.

Score on mucosal reaction in the throat
This was calculated based on the WHO grading of mucosal reaction at 1, 7 and 24 h after operation [12,13].

Score of foreign body sensation in the throat
This was rated on a scale of 0-10 at 1, 7 and 24 h after operation, with the self-prepared scale of The Affiliated Hospital of Putian University.

Statistical analysis
The data were processed using SPSS20.0 software. GraphPad Prism 7 (GraphPad Software, San Diego, USA) was used for graphics. Enumeration data and measurement data were included. Statistical analysis was done using ꭓ 2 test and t-test. Differences were considered statistically significant at p < 0.05.

Patients' general profile
No marked differences in the general information were observed between the two groups (p > 0.05). These results are shown in Table 1.

Patients' postoperative CR
As shown in Table 2, there were no cases of dyspnea, incision site infection, numbness of hands and feet or subcutaneous emphysema in patients in both groups. Compared with group B, fewer patients in group A suffered from hoarseness, sore throat and cough, which were the main symptoms (p < 0.001).

Comparison of patients' scores on mucosal response in the throat
The scores on mucosal response in the throat were markedly lower in group A than in group B (p < 0.001), as presented in Table 3. Table 4, scores on foreign body sensation in the throat were lower in group A than in group B (p < 0.001).

DISCUSSION
Discomfort and foreign body sensation in the throat are typical complaints of patients after general anesthesia through oral intubation. Compared with other patients, those who underwent goiter resection often show more serious symptoms in the throat [14][15]. In this study, the postoperative complications included hoarseness, sore throat and cough, with more number of patients having sore throat than the number of patients with the other two complications. This may be due to the fact that foreign body sensation in the throat increases the frequency of swallowing. Therefore, the patients in group B swallowed more often and had higher throat pain scores.
Since sore throat is the most common postoperative reaction in goiter resection, many scholars in academia have carried out studies to investigate the influence of different drugs on the symptom. Some research results showed that preoperative administration of drugs worked well in prevention, and reduced the possibility of postoperative sore throat [16,17]. Therefore, preoperative administration was selected in this study, and the results showed that the probability of sore throat was lower than that obtained in general research.
Different drugs have different effects on patients' postoperative symptoms. Budesonide relieves the irritation to the throat during intubation under general anesthesia, lowers the release frequency of inflammatory mediators, and reduces vascular permeability, thereby lowering the degree of mucosal exudation in the throat and reducing the possibility of sore throat. Therefore, group A achieved markedly lower scores of mucosal response and foreign body sensation in the throat, relative to group B. In a study by Seitz, budesonide aerosol inhalation was given to patients who underwent goiter resection in the experimental group, while aerosol inhalation of normal saline was given to those in the control group. The results showed that the scores of mucosal response in the throat of the experimental group at 1, 7 and 24 h after operation were 2.51 ± 1.15, 2.45 ± 1.56 and 0.72 ± 0.05, which were markedly lower than the corresponding scores in the control group [18]. This is in line with present study. Thus, budesonide played an active role in relieving patients' throat discomfort and foreign body sensation.

Limitations of the study
It should be noted that the hoarseness of patients in group A was milder. However, this study did not deeply investigate the relationship between budesonide and hoarseness. This needs to be further confirmed in subsequent studies.

CONCLUSION
Budesonide aerosol inhalation reduces the possibility of postoperative complications and eases throat discomfort and foreign body sensation in patients who underwent goiter resection. Thus, this treatment strategy may be suitable for the management of postoperative complications.