**4. Conclusion**

When patients present with more than one risk factor, we recommend interventions on behalf of the anesthesia providers to reduce the incidence and intensity of POST. In healthy patients, one may consider the use of a smaller ETT with the concomitant cuff pressure control with the use of a manometer. The use of benzydamine spray on the outside of the ETT or alkalinized lidocaine inside the cuff have proven to be effective and low-cost interventions which can reduce the intensity of POST. The use of multimodal analgesia has been recommended for a few years now as a staple for any anesthetic procedure and can be extremely beneficial for the prevention of POST. Intravenous lidocaine before suction and extubation can reduce the presence of coughing, and improve ETT tolerance upon emersion [20], given the patient has no contraindication for its use which is beyond the scope of this chapter.

Additionally, extubation parameters may contribute to POST, including but not limited to blood stained ETT, presence of blood during suctioning, coughing during emersion and delay to extubation once awake [21]. These factors are usually associated with those above mentioned as are difficult airway and excessive airway manipulation. These parameters can be modified or prevented in some cases with maneuvers such as use of multimodal anesthesia or lidocaine bolus to increase ETT tolerance upon emersion and suctioning.

POST is a very common complaint following anesthetic procedures and should not be overlooked.
