Sore throat following routine tracheal intubation with a single-use plastic laryngoscope blade versus a reusable metal laryngoscope blade: A multicenter, prospective, randomized, single-blind controlled study

Abstract

Abstract Background Reusable metal blade induces throat pain after tracheal intubation in 30% of patients. After the implementation of the Heineâ single-use plastic blade in our theater, throat pain increased in a magnitude of 10%. However, throat pain induced by plastic blades has not been investigated. We aimed to evaluate the frequency of throat pain induced by this plastic blade in comparison to the Heineâ reusable metal blade after tracheal intubation. Methods This trial was multicenter, prospective, randomized, and single-blind controlled. We included 693 adult patients scheduled for surgery with tracheal intubation. They did not have any predictive criteria for difficult tracheal intubation. A 60-second step-limit tracheal intubation algorithm was used when performing tracheal intubation using a plastic or reusable blade. The primary endpoint was the frequency of throat pain, without swallowing, 24 hours after tracheal intubation. The first secondary endpoint was the incidence of unexpectedly difficult tracheal intubation (Intubation Difficulty Score ³ 1). Results At 24 hours, the throat pain incidence was not significantly higher in the plastic group: 81 (23.1%) vs. 61 (17.8%); difference, 5.3%; 95% Confidence Interval, [– 0.8 - 11.2]; P = 0.087; The unexpectedly difficult tracheal intubation incidence was significantly higher in the plastic group: 194 (55.3%) vs. 146 (42.7%); difference, 12.6%; 95% Confidence Interval, [12.3 - 12.8]; P = 0.0009. Conclusions The plastic blade used in this study exhibited subpar performance in tracheal intubation compared to the reusable metal blade. The protective tracheal intubation algorithm used may explain the low incidence of throat pain in the two groups and the absence of a significant difference. Further studies with other plastic blades are necessary to confirm that their implementation in the operating rooms, especially in the context of video-assisted laryngoscopes and ecological plastic recycling, is not solely dependent on their performance.