Background and Goal of Study: Hoarseness is one of the most common postoperative symptom after
airway approach and their severity differs, depending on causative factors. The goal of this study was to
determine the incidence of hoarseness following airway approach in elderly patients and its associated
factors.
Materials and Methods: After study approval by institutional ethics committee, we conducted an
observational prospective study. Patients submitted to elective surgery admitted at the post anaesthesia
care unit (PACU), from May 2017 to July 2017, were included. Exclusion criteria: age < 60 years old,
postoperative ICU admission and inability to give informed consent. Hoarseness was evaluated using a
scale between 0 (none) and 3 (severe) classified by the patient himself before (T0) and 24 hours (T24h)
after surgery, the result was positive if hoarseness at T24 was higher than at T0. Patient´s demographics
and perioperative data were collected, including if there was airway approach, type of dispositive used and
anaesthesia duration. The Chi-square, Fischer´s exact or Mann-Whitney U tests were used for
comparisons. A multivariate logistic regression was done with calculation of an Odds Ratio (OR) and its
95% Confidence Interval.
Results and Discussion: Two hundred thirty five patients were included. From the 164 patients with
airway approach, 123 had orotraqueal intubation (OT) and 39 laryngeal mask (LM) insertion. Hoarseness
incidence was 48.8% in OT and 33.3% in LM. Hoarseness was more frequent after airway approach (44%
vs. 20%, p=0.001). Hoarseness was more frequent in patients submitted to general surgery (56% vs. 44%,
p<0.001). Patients that had taken intraoperative benzodiazepines had a lower incidence of hoarseness
(p=0.039). Patients that took hipnotics (p=0.004), muscle relaxants (p<0.001) and anti-emetic drugs
(p=0.022) had a higher incidence of hoarseness. AT PACU patients with hoarseness took more frequently
endovenous morfine (p=0.039). No differences were found when considered type of used device (OT or
LM), duration of anesthesia, age, gender, and comorbidities. In a logistic regression analyses the use of
muscle relaxants were the sole variable independently associated with postoperative hoarseness (OR 3.0,
CI95% 1,7 – 5,3, p<0.001).
Conclusion: Hoarseness seems to be frequent after anesthesia and the incidence is higher in those with a
airway approach. Muscle relaxants use was independently associated with hoarseness.

10 / Hoarseness incidence: what to expect?