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Minerva Anestesiologica 2020 Jun 12

DOI: 10.23736/S0375-9393.20.14257-3


lingua: Inglese

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

Amitabh DUTTA, Nitin SETHI , Prabhat CHOUDHARY, Manish GUPTA, Savitar Malhotra, Bhuwan C. Panday, Jayashree SOOD, Shvet MAHAJAN

Department of Anaesthesiology, Pain, & Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India


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 analysed 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.

KEY WORDS: Airway; Intubation; Endotracheal-tube; Tracheal-tube introducer; Post-operative sore throat

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