Volume 23, Issue 6 (Feb - Mar 2020)                   2020, 23(6): 540-549 | Back to browse issues page

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Masoumifar M A, Ebtehaj M, Kayalha H, Shafikhani A A. Comparing the Postoperative Sore Throat Incidence and Hemodynamic Changes after Using Macintosh and GlideScope Laryngoscopes and Laryngeal Mask Airway. Journal of Inflammatory Diseases. 2020; 23 (6) :540-549
URL: http://journal.qums.ac.ir/article-1-2933-en.html
1- Department of Anesthesiology, Metabolic Disease Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
2- Department of Anesthesiology, Metabolic Disease Research Center, Qazvin University of Medical Sciences, Qazvin, Iran. , hamid.kayalha@yahoo.com
3- Department of Occupational Health Engineering, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Extended Abstract
1. Introduction

Tracheal intubation is a conventional method to maintain an open airway in patients. This procedure is used in a variety of surgeries in the operating room. Various methods have been introduced for this purpose including using macintosh laryngoscope (MCL), glidescope laryngoscope (GSL), and laryngeal mask airway (LMA). Studies have shown that Postoperative Sore Throat (POST) is the most common complication of tracheal intubation; however, its actual incidence and extent are not well documented [11, 12]. On the other hand, researchers have presented controversial results regarding the superiority of each of these methods in terms of sympathetic reflexes (hypertension and tachycardia) [13, 14]. So the best laryngoscope to achieve this goal is not clear. This study aimed to compare the POST incidence and hemodynamic changes after using MCL, GSL, and LMA.
2. Materials and Methods
This randomized double-blind clinical trial was performed on 90 patients aged 20-40 years undergoing elective surgery in Shahid Rajaee Hospital in Qazvin, Iran. Patients were randomly divided into three groups of MCL (n=30), GSL (n=30), and LMA (n=30). All interventions in the three groups were performed by an anesthesia resident with at least 30 successful intubation experiences in each of the three methods. For all patients, airway parameters (neck circumference and thyroid cartilage level) and demographic information (age, sex, height, and weight) were collected. Using a questionnaire, all patients were asked to report their sore throat 6-24 hours after surgery. Intubation problems were identified based on the Mallampati criterion. The duration of laryngoscopy and LMA placement were measured by a timer. In all patients, hemodynamic variables including heart rate and blood pressure (systolic, diastolic, overall) were recorded 1 minute before induction of anesthesia, and 3-5 minutes after intervention. To compare continuous variables, ANOVA and independent t-test, and to compare categorical variables, chi-square test were used in SPSS v. 22 software at a significance level of P<0.05.
3. Results
There was no significant difference between the three study groups in terms of gender, age and body mass index and Mallampati criteria (P<0.05). Clinical and laryngoscopic information of patients in three groups are presented in Table 1. POST incidence was significantly higher in the MCL group compared to other two groups (P<0.05). Duration of laryngoscopy in the two periods was significantly longer in the MCL group compared to the GSL group (P=0.02). Regarding hemodynamic variables, only heart rate in the LMA group 3 minutes after intervention was significantly lower compared to other two groups (P=0.02).
4. Discussion
The results of the present study showed that the incidence of POST in MCL group was higher compared to GSL and LMA groups. This is consistent with the results of other studies [15-17]. Aqil et al. [18] also showed that the incidence and severity of POST 6 hours after surgery in the MCL group was significantly higher than in the GSL group. Najafi et al. [19] also reported similar results. In this method, since direct vision is required, significant pressure is applied for inserting tube which can cause soft tissue damage and POST. 
One of the factors that is effective in the occurrence of POST after anesthesia is the duration of intubation [12]. In the present study, no significant difference was observed in the duration of intubation between the three groups. The results of previous studies in this regard are contradictory. For example, Aqil et al. [18] reported that the duration of intubation in the MCL group was longer than in the GSL group, while Healy et al. [24] showed that its duration was longer in the GSL group. This difference may be due to the lack of hand-eye coordination or better vision for facilitating and accelerating intubation, both of which are dependent on the skill of the performer. 
There was no significant difference between the groups in terms of hemodynamic variables such as heart rate, blood pressure (systolic, diastolic, overall); however, the heart rate was lower 3 minutes after anesthesia and intervention by the LMA method than by the other two methods. Woo et al. [25] also found no significant changes in systolic and diastolic blood pressure in both MCL and GSL groups; however, the heart rate of MCL used patients increased immediately after intubation. The discrepancy in results can be due to the different sample size, age of the patients and the type of used device.
Overall, it can be concluded that LMA is a preferred method in the elderly or people with cardiovascular disease. Further studies are needed to confirm these results. In future studies, it is recommended that the confirmation of POST results be performed using other methods and compared with one another to determine the effectiveness and complications of each method.
Ethical Considerations
Compliance with ethical guidelines
This is a registered clinical trial (Code: IRC T20180207038661N1) approved by the Research Ethics Committee of Qazvin University of Medical Sciences (Code: IR.QUMS.REC.1395.192). Informed consent was obtained from the all patients.
This study did not receive any specific grant from funding agencies in the public, commercial, or not for profit sectors.
Authors' contributions
Conceptualization, data collection and draft preparation: Mohammad Ali Masoumifar and Hamid Kayalha; Data analysis and interpretation: Mahdi Ebtehaj and Ali Akbar Shafikhani; Editing and review: All Authors.
Conflicts of interest
The authors declared no conflicts of interest.
Type of Study: Clinical trial | Subject: Anesthesiology

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