Preoperative chlorhexidine mouthwash can reduce the risk of postoperative pulmonary complications in elderly patients undergoing general anesthesia with endotracheal intubation

Mingyu Wang¹Fuyan Ma²Peng Peng²Chuhao Gong^2*Teng Li^3*Lu Liu^4*

• ¹Department of Anesthesiology, Xuzhou Maternity and Child Health Care Hospital, Xuzhou, China, Xuzhou, China
• ²Department of Anesthesiology, Xuzhou Renci Hospital, Xuzhou, China, xuzhou, China
• ³Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China, Xuzhou, China
• ⁴Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China

Objective To investigate whether preoperative chlorhexidine gargle can reduce the risk of postoperative pulmonary complications(PPCs) in elderly patients with tracheal intubation under general anesthesia. Methods 78 elderly patients undergoing elective surgery under general anesthesia and endotracheal intubation were randomly divided into the chlorhexidine group (CH group, n = 39) and the normal saline group (NS group, n = 39). Nurses instructed patients to gargle with 15ml saline or compound chlorhexidine gargle the night before surgery, on the morning of surgery, and upon entering the operating room. The primary outcome was lung ultrasound score (LUS) on postoperative day 1 (D1). The secondary outcome was LUS on the preoperative day (D0) and postoperative day 3 (D3), bacterial colony count at the tip of the endotracheal tube, inflammatory markers (IL-1β, IL-6, TNF-α), and the incidence of postoperative fever, pneumonia, cough severity and sputum production. The general data, preoperative oral frailty score and duration of intubation were recorded. Results There were no significant differences in baseline characteristics between the two groups. The CH group had significantly lower D1LUS compared to the NS group, whereas there was no significant difference in D3LUS between the groups. Within three postoperative days, there were no significant differences between the groups in cough severity, sputum production, fever, or pneumonia incidence. Bacterial colony counts on the endotracheal tube at extubation were lower in the CH group than in the NS group. IL-1β, IL-6, and TNF-α levels showed no significant differences between the groups on D1 and D3. Subgroup analysis revealed that in patients with oral frailty, the number of colonies cultured at D1LUS, D3LUS, and the catheter tip inthe CH group was lower than that in the NS group. However, there was no significant difference between the two groups in terms of theincidence of pneumonia, fever, cough severity, and sputumproduction. Moreover, no significant difference was found betweenthe two groups in patients without oral frailty. Conclusion Preoperative chlorhexidine mouthwash improved early postoperative LUS in elderly patients by reducing oropharyngeal bacterial colonization, particularly in those with oral weakness, though clinical outcomes like pneumonia showed no significant differences.