The impact of tracheal-tube introducer guided intubation in anticipated non-difficult airway on postoperative sore throat: a randomized controlled trial.

BACKGROUND

The passage of tube across the glottis-inlet being the significant "active" component of intubation, associating postoperative sore throat (POST) with "passive" presence of high-volume low-pressure tracheal-tube cuff is unjustified. Tracheal-tube introducers (TTI), commonly employed to facilitate tracheal intubation during difficult airway management, can influence intubation quality and decrease incidence of POST.

METHODS

Four hundred and fifty patients undergoing laparoscopic/open surgery were randomly allocated to receive conventional intubation (non-TTI group, N.=150) or intubation facilitated with rigid-TTI (rigid-TTI group, N.=150) or non-rigid TTI (non-rigid TTI group, N.=150). This study analyzed effects of conventional versus TTI-guided intubation on reducing the incidence of POST (primary objective); intubation profile (time, attempts, response), and complications (trauma, inspiratory stridor) (secondary objectives).

RESULTS

Four hundred and twenty patients completed the study. The incidence of POST was lowest in patients of rigid-TTI group (N.=40, 29.0%); which was significantly lower than the non-TTI group (N.=64, 45.1%) (P=0.005) but comparable to the non-Rigid-TTI group (N.=53, 37.9%, P=0.117). In addition, the incidence of POST in rigid-TTI group was significantly lower than those in the non-TTI group at 2-hour (rigid-TTI group: N.=19, 13.8%; non-TTI group: N.=41, 28.9%, P=0.002) and 4-hour (rigid-TTI group: N.=23, 16.7%; non-TTI group: N.=43, 30.3%, P=0.007) time points. No difference was found in the incidence of airway management related morbidity, including, laryngospasm and inspiratory stridor in the three groups.

CONCLUSIONS

Rigid-TTI by its ability to positively modify friction dynamics between glottis-inlet and the passing tracheal-tube; has the potential to improve quality of intubation and decrease the incidence of POST.