Topical application of magnesium to prevent intubation-related sore throat in adult surgical patients: a systematic review and meta-analysis

  • Akira KuriyamaEmail author
  • Hirokazu Maeda
  • Rao Sun
Review Article/Brief Review



Postoperative sore throat negatively affects patient satisfaction and recovery. We conducted a systematic review and meta-analysis to examine the efficacy of preoperative topical administration of magnesium sulfate in preventing postoperative sore throat in adult patients.


We searched Medline, EMBASE, China National Knowledge Infrastructure, and the Cochrane Central Register of Controlled Trials from inception to 6 October, 2018. We included randomized-controlled trials that assessed the efficacy and safety of topical application of magnesium preoperatively in adult patients who underwent endotracheal intubation for general anesthesia. We then pooled the data using a random-effects model and conducted a trial sequential analysis on the incidence of sore throat. Our primary outcome was the incidence of sore throat at 24 hr after surgery/extubation. Our secondary outcomes included the severity of sore throat at 24 hr after surgery/extubation and adverse events.


Eleven randomized-controlled trials involving 1,096 patients were included in this study. Topical application of magnesium was associated with reduced incidence of postoperative sore throat (risk ratio, 0.31; 95% confidence interval [CI], 0.21 to 0.45) as well as reduced severity of postoperative sore throat (standardized mean difference, − 2.66; 95% CI, − 3.89 to − 1.43). Three studies reported that significant adverse events were not associated with topical magnesium. The trial sequential analysis suggested that there is adequate evidence supporting the efficacy of topical magnesium in preventing postoperative sore throat.


Our study suggests that preoperative topical magnesium can effectively prevent postoperative sore throat.

Trial registration

PROSPERO (CRD42018110019); registered 26 September, 2018.

Application topique de magnésium pour prévenir les maux de gorge liés à l’intubation chez les patients chirurgicaux adultes: revue systématique et méta-analyse



Les maux de gorge postopératoires ont un impact négatif sur la satisfaction et la récupération des patients. Nous avons réalisé une revue systématique et une méta-analyse afin d’examiner l’efficacité d’une administration topique préopératoire de sulfate de magnésium pour prévenir les maux de gorge postopératoires chez les patients adultes.


Nous avons effectué une recherche dans les bases de données Medline, EMBASE, China National Knowledge Infrastructure et Cochrane Central Register of Controlled Trials de leur création au 6 octobre 2018. Nous avons inclus les études randomisées contrôlées ayant évalué l’efficacité et l’innocuité de l’application topique préopératoire de magnésium chez des patients adultes subissant une intubation endotrachéale pour l’anesthésie générale. Nous avons ensuite mis les données en commun à l’aide d’un modèle à effets aléatoires et réalisé une analyse séquentielle d’essai sur l’incidence des maux de gorge. Notre critère d’évaluation principal était l’incidence de maux de gorge à 24 h après la chirurgie / l’extubation. Nos critères d’évaluation secondaires comprenaient la sévérité des maux de gorge à 24 h après la chirurgie / l’extubation et les événements indésirables.


Onze études randomisées contrôlées portant sur 1096 patients ont été incluses dans cette étude. L’application topique de magnésium a été associée à une incidence réduite de maux de gorge postopératoires (risque relatif, 0,31; intervalle de confiance [IC] 95 %, 0,21 à 0,45) ainsi qu’à une réduction de la sévérité des maux de gorge postopératoires (différence moyenne normalisée, − 2,66; IC 95 %, − 3,89 à − 1,43). Trois études ont rapporté que les événements indésirables importants observés n’étaient pas associés au magnésium en application topique. Selon l’analyse séquentielle de l’essai, les données probantes soutenant l’efficacité du magnésium en application topique pour prévenir les maux de gorge postopératoires sont adéquates.


Selon les résultats de notre étude, l’application préopératoire topique de magnésium est efficace pour prévenir les maux de gorge postopératoires.

Enregistrement de l’étude

PROSPERO (CRD42018110019); enregistrée le 26 septembre 2018.


Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Associate Editor, Canadian Journal of Anesthesia.

Author contributions

Akira Kuriyama contributed to all aspects of this study, including study conception and design; acquisition, analysis, and interpretation of data; and drafting the article. Hirokazu Maeda and Rao Sun contributed to the acquisition and analysis of data and revision of the article.

Financial disclosures


Supplementary material

12630_2019_1396_MOESM1_ESM.pdf (259 kb)
Supplementary material 1 (PDF 259 kb)
12630_2019_1396_MOESM2_ESM.pdf (154 kb)
Supplementary material 2 (PDF 154 kb)


  1. 1.
    Ahmed A, Abbasi S, Ghafoor HB, Ishaq M. Postoperative sore throat after elective surgical procedures. J Ayub Med Coll Abbottabad 2007; 19: 12-4.Google Scholar
  2. 2.
    Biro P, Seifert B, Pasch T. Complaints of sore throat after tracheal intubation: a prospective evaluation. Eur J Anaesthesiol 2005; 22: 307-11.CrossRefGoogle Scholar
  3. 3.
    Christensen AM, Willemoes-Larsen H, Lundby L, Jakobsen KB. Postoperative throat complaints after tracheal intubation. Br J Anaesth 1994; 73: 786-7.CrossRefGoogle Scholar
  4. 4.
    Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory surgery. Br J Anaesth 2002; 88: 582-4.CrossRefGoogle Scholar
  5. 5.
    Lehmann M, Monte K, Barach P, Kindler CH. Postoperative patient complaints: a prospective interview study of 12,276 patients. J Clin Anesth 2010; 22: 13-21.CrossRefGoogle Scholar
  6. 6.
    Maruyama K, Sakai H, Miyazawa H, et al. Sore throat and hoarseness after total intravenous anaesthesia. Br J Anaesth 2004; 92: 541-3.CrossRefGoogle Scholar
  7. 7.
    Inoue S, Abe R, Tanaka Y, Kawaguchi M. Tracheal intubation by trainees does not alter the incidence or duration of postoperative sore throat and hoarseness: a teaching hospital-based propensity score analysis. Br J Anaesth 2015; 115: 463-9.CrossRefGoogle Scholar
  8. 8.
    Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89: 652-8.Google Scholar
  9. 9.
    Chandler M. Tracheal intubation and sore throat: a mechanical explanation. Anaesthesia 2002; 57: 155-61.CrossRefGoogle Scholar
  10. 10.
    Combes X, Schauvliege F, Peyrouset O, et al. Intracuff pressure and tracheal morbidity: influence of filling with saline during nitrous oxide anesthesia. Anesthesiology 2001; 95: 1120-4.CrossRefGoogle Scholar
  11. 11.
    Donnelly WH. Histopathology of endotracheal intubation. An autopsy study of 99 cases. Arch Pathol 1969; 88: 511-20.Google Scholar
  12. 12.
    Loeser EA, Hodges M, Gliedman J, Stanley TH, Johansen RK, Yonetani D. Tracheal pathology following short-term intubation with low- and high-pressure endotracheal tube cuffs. Anesth Analg 1978; 57: 577-9.CrossRefGoogle Scholar
  13. 13.
    Way WL, Sooy FA. Histologic changes produced by endotracheal intubation. Ann Otol Rhinol Laryngol 1965; 74: 799-812.CrossRefGoogle Scholar
  14. 14.
    Kuriyama A, Maeda H. Topical application of licorice for prevention of postoperative sore throat in adults: a systematic review and meta-analysis. J Clin Anesth 2018; 54: 25-32.CrossRefGoogle Scholar
  15. 15.
    Kuriyama A, Maeda H, Sun R, Aga M. Topical application of corticosteroids to tracheal tubes to prevent postoperative sore throat in adults undergoing tracheal intubation: a systematic review and meta-analysis. Anaesthesia 2018; 73: 1546-56.CrossRefGoogle Scholar
  16. 16.
    Kuriyama A, Maeda H. Preoperative intravenous dexamethasone prevents tracheal intubation-related sore throat in adult surgical patients: a systematic review and meta-analysis. Can J Anesth 2019; DOI: 10.1007/s12630-018-01288-2.Google Scholar
  17. 17.
    Kuriyama A, Aga M, Maeda H. Topical benzydamine hydrochloride for prevention of postoperative sore throat in adults undergoing tracheal intubation for elective surgery: a systematic review and meta-analysis. Anaesthesia 2018; 73: 889-900.CrossRefGoogle Scholar
  18. 18.
    Kuriyama A, Maeda H, Sun R. Aerosolized corticosteroids to prevent postoperative sore throat in adults: a systematic review and meta-analysis. Acta Anaesthesiol Scand 2019; 63: 282-91.CrossRefGoogle Scholar
  19. 19.
    Rodriguez-Rubio L, Nava E, Del Pozo JS, Jordan J. Influence of the perioperative administration of magnesium sulfate on the total dose of anesthetics during general anesthesia. A systematic review and meta-analysis. J Clin Anesth 2017; 39: 129-38.Google Scholar
  20. 20.
    Pascual-Ramirez J, Gil-Trujillo S, Alcantarilla C. Intrathecal magnesium as analgesic adjuvant for spinal anesthesia: a meta-analysis of randomized trials. Minerva Anestesiol 2013; 79: 667-78.Google Scholar
  21. 21.
    De Oliveira GS, Jr Castro-Alves LJ, Khan JH, McCarthy RJ. Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 2013; 119: 178-90.CrossRefGoogle Scholar
  22. 22.
    Morrison AP, Hunter JM, Halpern SH, Banerjee A. Effect of intrathecal magnesium in the presence or absence of local anaesthetic with and without lipophilic opioids: a systematic review and meta-analysis. Br J Anaesth 2013; 110: 702-12.CrossRefGoogle Scholar
  23. 23.
    Shin HJ, Kim EY, Na HS, Kim TK, Kim MH, Do SH. Magnesium sulphate attenuates acute postoperative pain and increased pain intensity after surgical injury in staged bilateral total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial. Br J Anaesth 2016; 117: 497-503.CrossRefGoogle Scholar
  24. 24.
    Fawcett WJ, Haxby EJ, Male DA. Magnesium: physiology and pharmacology. Br J Anaesth 1999; 83: 302-20.CrossRefGoogle Scholar
  25. 25.
    James MF, Beer RE, Esser JD. Intravenous magnesium sulfate inhibits catecholamine release associated with tracheal intubation. Anesth Analg 1989; 68: 772-6.CrossRefGoogle Scholar
  26. 26.
    Cairns BE, Svensson P, Wang K, et al. Activation of peripheral NMDA receptors contributes to human pain and rat afferent discharges evoked by injection of glutamate into the masseter muscle. J Neurophysiol 2003; 90: 2098-105.CrossRefGoogle Scholar
  27. 27.
    McRoberts JA, Coutinho SV, Marvizon JC, et al. Role of peripheral N-methyl-D-aspartate (NMDA) receptors in visceral nociception in rats. Gastroenterology 2001; 120: 1737-48.CrossRefGoogle Scholar
  28. 28.
    Alfredson H, Lorentzon R. Chronic tendon pain: no signs of chemical inflammation but high concentrations of the neurotransmitter glutamate. Implications for treatment? Curr Drug Targets 2002; 3: 43-54.Google Scholar
  29. 29.
    Lawand NB, Willis WD, Westlund KN. Excitatory amino acid receptor involvement in peripheral nociceptive transmission in rats. Eur J Pharmacol 1997; 324: 169-77.CrossRefGoogle Scholar
  30. 30.
    Carlton SM, Zhou S, Coggeshall RE. Evidence for the interaction of glutamate and NK1 receptors in the periphery. Brain Res 1998; 790: 160-9.CrossRefGoogle Scholar
  31. 31.
    Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535.Google Scholar
  32. 32.
    Chen KT, Tzeng JI, Lu CL, et al. Risk factors associated with postoperative sore throat after tracheal intubation: an evaluation in the postanesthetic recovery room. Acta Anaesthesiol Taiwan 2004; 42: 3-8.Google Scholar
  33. 33.
    Piriyapatsom A, Dej-Arkom S, Chinachoti T, Rakkarnngan J, Srishewachart P. Postoperative sore throat: incidence, risk factors, and outcome. J Med Assoc Thai 2013; 96: 936-42.Google Scholar
  34. 34.
    Minamiguchi M, Tanaka Y, Kitagawa K, Inoue S, Kawaguchi M, Kirita T. Evaluation of factors associated with postoperative sore throat (Japanese). Masui 2014; 63: 401-5.Google Scholar
  35. 35.
    Kim E, Yang SM, Kwak SG, Park S, Bahk JH, Seo JH. Tracheal tubes lubricated with water to reduce sore throat after intubation: a randomized non-inferiority trial. PLoS One 2018; 13: e0204846.CrossRefGoogle Scholar
  36. 36.
    Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. 1st ed. Chichester, England: John Wiley & Sons, Ltd; 2008 .CrossRefGoogle Scholar
  37. 37.
    Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928.CrossRefGoogle Scholar
  38. 38.
    Sweeting MJ, Sutton AJ, Lambert PC. What to add to nothing? Use and avoidance of continuity corrections in meta-analysis of sparse data. Stat Med 2004; 23: 1351-75.CrossRefGoogle Scholar
  39. 39.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-88.CrossRefGoogle Scholar
  40. 40.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-60.CrossRefGoogle Scholar
  41. 41.
    Wetterslev J, Jakobsen JC, Gluud C. Trial Sequential Analysis in systematic reviews with meta-analysis. BMC Med Res Methodol 2017; 17: 39.CrossRefGoogle Scholar
  42. 42.
    Jackson JL, Kuriyama A. From the editors’ desk: bias in systematic reviews-let the reader beware. J Gen Intern Med 2018; 33: 133-5.CrossRefGoogle Scholar
  43. 43.
    Borazan H, Kececioglu A, Okesli S, Otelcioglu S. Oral magnesium lozenge reduces postoperative sore throat: a randomized, prospective, placebo-controlled study. Anesthesiology 2012; 117: 512-8.CrossRefGoogle Scholar
  44. 44.
    Ashwini H, Seema Kumari K, Lavanya R. Comparative study of dexamethasone nebulisation with magnesium sulphate nebulisation in preventing post operative sore throat following endotracheal intubation. Indian J Clin Anaesth 2018; 5: 341-7.CrossRefGoogle Scholar
  45. 45.
    Gupta SK, Tharwani S, Singh DK, Yadav G. Nebulized magnesium for prevention of postoperative sore throat. Br J Anaesth 2012; 108: 168-9.CrossRefGoogle Scholar
  46. 46.
    Jain S, Kumar S. A comparative study of preoperative ketamine and MgSO4 nebulisation for incidence of post operative sore throat after endotracheal intubation. IJCMR 2017; 4: 1356-9.Google Scholar
  47. 47.
    Rajan S, Malayil GJ, Varghese R, Kumar L. Comparison of usefulness of ketamine and magnesium sulfate nebulizations for attenuating postoperative sore throat, hoarseness of voice, and cough. Anesth Essays Res 2017; 11: 287-93.CrossRefGoogle Scholar
  48. 48.
    Teymourian H, Mohajerani SA, Farahbod A. Magnesium and ketamine gargle and postoperative sore throat. Anesth Pain Med 2015; 5: e22367.CrossRefGoogle Scholar
  49. 49.
    Yadav M, Chalumuru N, Gopinath R. Effect of magnesium sulfate nebulization on the incidence of postoperative sore throat. J Anaesthesiol Clin Pharmacol 2016; 32: 168-71.CrossRefGoogle Scholar
  50. 50.
    Wu X, Ji L, Wang S, Shen R, Guo X, Gao Q. Effects of prophylactic magnesium sulphate on the sore throat after tracheal extubation with a double-lumen endobronchial tube (Chinese). Modern Medical Journal 2013; 41: 474-7.Google Scholar
  51. 51.
    Shen S, Xie Y, Chen Y. Comparison of the effect of ketamine and magnesium sulfate gargle in preventing sore throat after removal of a double-lumen endobronchial tube (Chinese). Chinese Journal of General Practice 2018; 16: 188-91.Google Scholar
  52. 52.
    Lin S, Jin X, Shen S. Comparison of the effect of magnesium sulfate gargle and compound lidocaine cream smeared in preventing postoperative sore throat. Chin J Mod Appl Pharm 2016; 33: 1587-91.Google Scholar
  53. 53.
    Sharma M, Loyal MK, Purohit S, Maniyar F, Gupta D. Comparison of magnesium sulfate and normal saline (placebo) nebulization for prevention of postoperative sore throat in patients undergoing lumbar spine surgeries under general anaesthesia with endotracheal intubation in prone position. Int J Sci Res 2017; 6: 656-8.Google Scholar
  54. 54.
    Kuriyama A, Umakoshi N, Sun R. Prophylactic corticosteroids for prevention of postextubation stridor and reintubation in adults: a systematic review and meta-analysis. Chest 2017; 151: 1002-10.CrossRefGoogle Scholar
  55. 55.
    Hu B, Bao R, Wang X, et al. The size of endotracheal tube and sore throat after surgery: a systematic review and meta-analysis. PLoS One 2013; 8: e74467.CrossRefGoogle Scholar
  56. 56.
    Mayhood J, Cress K. Effectiveness of ketamine gargle in reducing postoperative sore throat in patients undergoing airway instrumentation: a systematic review. JBI Database System Rev Implement Rep 2015; 13: 244-78.Google Scholar
  57. 57.
    Tanaka Y, Nakayama T, Nishimori M, Tsujimura Y, Kawaguchi M, Sato Y. Lidocaine for preventing postoperative sore throat. Cochrane Database Syst Rev 2015; 7: CD004081.Google Scholar
  58. 58.
    Begg C, Cho M, Eastwood S, et al. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA 1996; 276: 637-9.CrossRefGoogle Scholar
  59. 59.
    El-Boghdadly K, Bailey CR, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia 2016; 71: 706-17.CrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  1. 1.Emergency and Critical Care Center, Kurashiki Central HospitalOkayamaJapan
  2. 2.Department of Emergency MedicineSugita Genpaku Memorial Obama Municipal HospitalFukuiJapan
  3. 3.Department of Anesthesiology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyHubeiChina

Personalised recommendations