Intraoperative Throat Pack Usage at the Kenyatta National Hospital

Abstract

Background: A throat pack is inserted to absorb fluid and prevent surgical debris from passing into the patient’s airway or digestive tract. Its use during surgery varies and poses a significant risk to the patient if forgotten. The objective of the study was to establish the current practices of throat pack usage at the Kenyatta National Hospital theatres. Methodology: This was a cross-sectional observational study. The population of interest was anesthesia providers and surgeons working in pre-selected theatres in KNH. Proportionate stratified sampling of staff category was used, followed by consecutive sampling until the target sample size was achieved. Data analysis: The data was cleaned to check for missing values, duplicates, and outliers. Excel and STATA software was used for statistical analysis. Descriptive statistics and bivariate tests using chi-square tests of association were applied. The significance level was set at p<0.05. Data was presented in the form of figures, tables, and percentages. Results: The total number of observations made was 139. Surgical indications comprised 60% of all observations made. Anaesthesia handled most of the insertions (54.7%) as compared to the surgeons (45.3%). 74% verbally announced the presence of a throat pack whereas 26% did not. 63% of those verbally announced and 25% of those not verbally announced had visual and documentary procedures added as precautions. Single successful attempts at insertion occurred 96% of the time. After the commencement of surgery, additional throat packs were used in 36% of the observations, but of these, only 10% had precautionary measures taken to signify their presence.56% of insertions were done under direct laryngoscopy with a Magill forceps, and 50% of the raytec gauze used was soaked in sterile saline. 3 cases of adverse events occurred during insertion. Additionally, two cases of accidental retention occurred representing 1.4% of all throat pack insertions. Conclusion: The indications for throat pack use were valid and matched what was found in the clinical guidelines published in literature. The anesthesia team cumulatively handled throat pack insertions. There was an overreliance on subjective precautions during the insertion and removal of throat packs. The insertion of throat packs was well handled by the participants. About half of the observations used gauze soaked in sterile saline and the appropriate tools for insertion. The three adverse events during insertion were attributed to the use of inappropriate tools and technical skills. The two accidental retentions causing airway obstruction and desaturation were ascribed to poor communication and lack of reminders of the presence of throat packs