Nebulized magnesium sulfate reduces postoperative sore throat following general anesthesia: a systematic review, meta-analysis, and trial sequential analysis.

BACKGROUND

Post-operative sore throat (POST) frequently complicates general anesthesia involving endotracheal intubation, affecting roughly 60% of individuals and markedly hindering postoperative recovery. The current systematic review and meta-analysis assessed both the safety profile and prophylactic efficacy of preoperative magnesium sulfate administered via nebulization against POST.

METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing preoperative nebulized magnesium sulfate with placebo or normal saline for POST prevention in adults undergoing elective surgery under general anesthesia was conducted. The primary outcome was POST incidence at 24 h. Secondary outcomes included POST at 2, 4, 8, and 12 h, hoarseness, cough, and hemodynamic adverse events. PROSPERO registration: CRD420261308633.

RESULTS

Twelve RCTs comprising 1,023 patients were included. Nebulized Magnesium Sulfate significantly reduced POST at 24 h compared to control (RR = 0.25; 95% CI: 0.14-0.42; p < 0.00001; I² = 62%). Sensitivity analysis excluding an outlier reduced heterogeneity (I² = 7%) while maintaining significance. Significant reductions were also observed at 2 h (RR = 0.43; 95% CI: 0.32-0.58), 4 h (RR = 0.38; 95% CI: 0.19-0.77), and 12 h (RR = 0.34; 95% CI: 0.14-0.79). Subgroup analysis demonstrated comparable efficacy between the 225 mg dose and higher doses, with no statistically significant difference observed. No significant reduction was observed for hoarseness (RR = 0.44; 95% CI: 0.17-1.18) or cough (RR = 0.39; 95% CI: 0.15-1.04), and no increased hemodynamic risk was detected. Trial sequential analysis confirmed robust evidence for POST prevention.

CONCLUSION

The administration of preoperative nebulized magnesium sulfate serves as an effective and safe measure to decrease POST incidence among adult patients, thereby justifying its inclusion in standard perioperative management protocols.