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The Impacts of Nasotracheal Intubation on Postoperative Sore Throat

Anesthesia Progress – Stress and anxiety often accompany oral and maxillofacial surgery, but the common side effect of a postoperative sore throat from intubation increases patient complications. The intubation process can occur via direct laryngoscopy, video laryngoscopy, or nasotracheal intubation procedures. Each intubation type has risk factors, but the common occurrence of a resulting sore throat has not been widely reviewed during nasotracheal intubation.

To determine the highest risk factors for postoperative sore throat in nasotracheal intubation, researchers from the Kyushu University Hospital and Kyushu University, Fukuoka, Japan, recently published a retrospective study in the current issue of Anesthesia Progress. Lead author Masanori Tsukamoto, DDS, PhD, and colleagues hypothesized “that postoperative sore throat is influenced by the intubating conditions and utilized airway devices, especially the use of a fiberoptic scope, which would have higher incidence or more severe sore throat due to difficulty advancing the [endotracheal tube] ETT.”

A total of 167 case reports of patients aged 16 to 80 who underwent nasotracheal intubation during oral or maxillofacial surgery were analyzed. Researchers investigated the following risk factors: type of airway device (Macintosh laryngoscope, Pentax-AWS, or McGrath video laryngoscope, or fiberoptic scope), sex, age, height, weight, American Society of Anesthesiologists physical status classification, intubation attempts, duration of intubation, intubation time, tube size, and fentanyl and remifentanil dosages. Postoperative evaluation by an independent observer measured the presence, duration, and severity of throat discomfort between 2 and 24 hours.

Postoperative sore throat was reported in 126 (74.6%) cases. Of the 12 risk factors examined, researchers found the two variables most strongly related to postoperative sore throat were airway device type and intubation attempts. Results show that the fiberoptic scope (92%) more significantly impacted sore throat compared with direct laryngoscopy (82%), McGrath (65%), and Pentax-AWS (60%). The most significant differences in postoperative pain scores and recovery time were between the fiberoptic scope and the Pentax-AWS. Hoarseness also occurred in 3.6% to 13% of cases.

Results of this retrospective analysis showed that postoperative sore throat occurred in 74.6% of patients who underwent nasotracheal intubation for oral or maxillofacial surgery. Tsukamoto and colleagues believe nasal intubation is associated with a higher risk of postoperative pain because it “is typically performed blindly and may result in tissue damage. In addition, it has been reported that even when a fiberoptic scope is used, it could be difficult to advance the ETT over the scope and into the trachea.”

Study author, Takehiko Iijima, DDS, PhD, adds “acetaminophen has been recognized to become effective after a considerable interval. No one has made clear how long it takes. Thus, the optimal regimen for how to prescribe acetaminophen has not been determined. Our article has shown that more than two hours are required to achieve the peak of effect site concentration.”

Full text of the article, “Risk Factors for Postoperative Sore Throat After Nasotracheal Intubation,” Anesthesia Progress, Vol. 69, No. 3, 2022, is now available at https://doi.org/10.2344/anpr-69-01-05.

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About Anesthesia Progress

Anesthesia Progress is the official publication of the American Dental Society of Anesthesiology (ADSA). The quarterly journal is dedicated to providing a better understanding of the advances being made in the science of pain and anxiety control in dentistry. The journal invites submissions of review articles, reports on clinical techniques, case reports, and conference summaries. To learn more about the ADSA, visit:http://www.adsahome.org/.

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