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

Abstract

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. 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). 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. 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.