Post-operative sore throat and hoarseness as a result of endotracheal tube positioning in thyroidectomy

ABSTRACT

Introduction: During a thyroidectomy, the neck is hyperextended. This position may inverse the tracheal axis to the endotracheal tube (ET), can cause damage to the vocal cords and tracheal wall. We propose a simple turn of the ET corresponding with the laryngo-tracheal axis to reduce of post-operative sore throat (PST) and hoarseness (H) in thyroidectomy patients. Methods: 122 patients undergoing general anesthesia were prospectively randomized divided into 4 groups. Gp1 (n=31): normal ET tube placement. Gp2 (n=30): normal ET tube rotated 180o following insertion. Gp3 (n=30): armoured tube. Gp4 (control, n=31): Normal ET tube in operations other than thyroidectomy, that require hyperextension. Cuff pressure (CP) and inspiratory peak pressure (IPP) were monitored during anesthesia. PST and H were evaluated by a VAS (0-10mm). Results: The 4 groups were similar in age, gender and intubation duration. IPP remained stable in all 4 groups. However, CP increased significantly in Gp1 and Gp4 after hyperextension. GP1 had the most PST and H (p<0.05). Tube rotation achieved the same results as the Armoured tube. Discussion: Rotating ET tube 180o reduced PST and H as much as intubation with a armoured tube. This rotation did not interfere with ventilation during anesthesia.