LAUSR

Throat packs have traditionally been placed in order to collect shed blood, bodily or external fluids and other material that may collect in the oropharynx during nose, throat, oral and maxillofacial surgery. They are also inserted, although less commonly, to stabilise an artificial airway, particularly in neuro-anaesthesia and, in children, to reduce a leak around an uncuffed tracheal tube. If a throat pack has been inserted but not removed at the end of a procedure, then the obvious danger is that the retained pack may cause airway obstruction. The U.K. National Patient Safety Agency (NPSA) issued a report in 2009 on ‘Reducing the risk of retained throat packs after surgery’ [1]. It produced an algorithm which, if followed, should reduce the likelihood of unintentional throat pack retention. The report recommended at least one visual aid (such as labelling the patient or their airway, attaching the pack to the airway, or having a portion protruding from the mouth) and at least one documented piece of evidence (such as writing on the operating theatre white board or recording the information as part of the swab count). Unintentionally retained throat packs are a ‘Never Event’ as defined by NHS England, i.e. they are medical errors believed to be preventable with appropriate measures [2]. Moppett and Moppett [3] surveyed all English acute NHS Trusts to determine the number of Never Events relative to surgical caseload for the years 2011–2014. They calculated that the risk of a Never Event was approximately 1:17,000 operations and noted that there were six retained throat packs over the threeyear period. In the 12 months from April 2016 until the end of March 2017, there were three reports of retained throat packs and in the last four months alone there have been a further three cases of retained throat packs [2]. It is possible that the unintentional retention of a throat pack is a random event that has happened by chance and ‘does not reflect fundamentally poor care in an organisation’ [4]. It is also possible that raised awareness of the danger following publication of the NPSA report has resulted in more open and accurate reporting. Nevertheless, any measures that can be undertaken to reduce the likelihood of a retained throat pack are to be welcomed. Incidence Despite the potential danger of airway obstruction due to retained throat packs, there is no doubt that throat pack insertion is common. A survey of neuro-anaesthetists [5] found that the majority used throat packs when the patient was placed prone (in order to stabilise the tracheal tube) or during trans-sphenoidal surgery. According to the survey, throat packs were invariably inserted by the anaesthetist. Another survey of both surgeons and anaesthetists [6], found that although the use of throat packs is not routine, it is common practice. The authors pointed out that policies for insertion and removal are not, but should be, universal. In this issue of Anaesthesia, Athanassoglou et al. [7] report the results of a systematic review of the benefits or harms of throat pack usage. The primary purpose of their research was to question the evidence base for the insertion of throat packs by anaesthetists. Their conclusion was that they no longer recommend the routine insertion of throat packs by anaesthetists. They recommend that throat packs should only be inserted in carefully selected cases, and in these situations it should usually be performed by the surgeon. This editorial accompanies an article by Athanassoglou et al., Anaesthesia 2018; 73; 612–8.