18 Throat packs in paediatric maxillo-facial surgery: a prospective pilot study

Introduction Throat packs are used to prevent post-operative nausea and vomiting (PONV) and respiratory complications from the ingestion/aspiration of blood during airway surgery. A systematic review found no evidence of benefits from the use of throat packs in adults, but many reports of complications. Routine insertion of throat packs by anaesthetists is not recommended.1 Unrecognised throat pack retention can cause airway obstruction resulting in serious harm and death. This constitutes a ‘Never Event’ as defined by NHS England. Twenty six throat pack retention never events have been reported since 2015.2 A retrospective study comparing children having cleft palate surgery with and without a throat pack found no difference in early post-operative complications.3 Method A prospective study comparing the incidence of PONV and respiratory complications in children undergoing maxillo-facial surgery with and without a throat pack. Data was collected prospectively from May 2019 using the electronic patient record system (EPIC). Results Total of 50 cases. Median age was 10 years and 33 (66%) were male. Throat packs were used in 29 (58%) cases. No patient had a history of PONV and all received dual anti-emetic prophylaxis. No respiratory complications occurred in any patient. There was no difference in the occurrence of PONV between the two groups; 7 (24%) children in the throat pack group versus 6 (28%) children without a throat pack, p=0.75. Discussion This study showed no increase in the incidence of PONV or respiratory complications in children having maxillo-facial surgery without a throat pack. This could be due to the low incidence of the outcomes measured. However we advocate that due to the lack of evidence for benefit and the risk of serious harm from accidental retention, routine insertion of throat packs should be questioned and the risk/benefit ratio discussed for each individual patient at the theatre team brief.