Sore throat and pharyngeal trauma after extratracheal airway placement: does the literature help practitioners?

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To the Editor: Brimacombe et al. [1] recently demonstrated that the laryngeal mask (LMA) has a higher success rate and airway stability, and is associated with less pharyngeal trauma and postoperative sore throat, than the cuffed oropharyngeal airway (COPA) (Study 1) whereas results of a previous study [2] reported more frequent blood and postoperative sore throats after LMA than COPA (Study 2). Information from the literature should be always balanced against daily practice, but the practitioner may be perplexed after reading opposite results published at nearly the same time by the same research group. It seems that the COPA would be more difficult to place and require more airway manipulation than LMA, but are these disadvantages balanced by less pharyngeal trauma, or are they further enhanced by the risk of higher postoperative sore throat? In Study 2, they evaluated a large number of COPA placements in different institutions and the severity of sore throat was not assessed, whereas in Study 1, a small number of COPA placements were evaluated in one institution only, and the overwhelming number of sore throats were of mild severity. Moreover, if data from the two studies are pooled together and the incidence of sore throat compared using the chi squared test, immediate postoperative sore throat is more frequent after LMA than COPA (Table 1). Further, Nakata et al. [3] recently demonstrated that the anesthetic exposure associated with acceptable conditions for COPA placement was shorter than that for LMA, which suggests that COPA insertion could be less stimulating than LMA insertion. However, no one could answer this simple and humble question better than the authors themselves.Table 1: Incidence of Pharyngeal Trauma and Postoperative Sore Throat After Results of Studies 1 and 2 Have Been PooledAndrea Casati, MD Elisabetta Casaletti, MD Department of Anesthesiology; University of Milan; IRCCS H. San Raffaele; 20132 Milan, Italy