Two-handed jaw thrust decreases postoperative sore throat in patients undergoing double-lumen endobronchial intubation

Abstract

BACKGROUND Tracheal intubation using a double-lumen endobronchial tube (DLT) causes postoperative sore throat. OBJECTIVE To determine the effect of two-handed jaw thrust on postoperative sore throat in patients requiring insertion of a DLT. DESIGN A randomised study. SETTING A tertiary teaching hospital from December 2017 to May 2018. PATIENTS One-hundred and six patients undergoing one-lung anaesthesia. INTERVENTIONS Patients were allocated to one of two groups (n=53 each). In the jaw thrust group, the two-handed jaw thrust manoeuvre was applied at intubation and advancement of the DLT. In the control group, conventional intubation with a sham jaw thrust was performed. MAIN OUTCOME MEASURES Incidence of sore throat at 1, 6 and 24 h postoperatively. RESULTS The incidence of sore throat at 6 h postoperatively was higher in the control group than in the jaw thrust group [31 (59%) vs. 14 (26%), risk ratio (95% confidence interval) 0.45 (0.27 to 0.75), P < 0.01]. The overall incidence of sore throat was higher in the control group than in the jaw thrust group [35 (66%) vs. 18 (34%), risk ratio (95% confidence interval) 0.51 (0.34 to 0.78), P < 0.01]. CONCLUSION The jaw thrust manoeuvre can reduce the incidence of sore throat in patients undergoing DLT insertion for one-lung ventilation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03331809.

Influence of two-handed jaw thrust during tracheal intubation on postoperative sore throat: a prospective randomised study

“…The protective effect of jaw thrust on the severity of sore throat was observed mainly at postoperative 24 hours, which is consistent with the previous investigation regarding double-lumen endobronchial intubation. 11 This study showed no significant decrease in severity of sore throat in the early stage—postoperative 2 and 4 hours—of the postoperative period compared with the aforementioned investigation. 11 Sore throat may be influenced by either the different types of surgical procedure or postoperative pain control in the post anaesthesia care unit.…”

“…11 This study showed no significant decrease in severity of sore throat in the early stage—postoperative 2 and 4 hours—of the postoperative period compared with the aforementioned investigation. 11 Sore throat may be influenced by either the different types of surgical procedure or postoperative pain control in the post anaesthesia care unit. More severe pain and additional rescue analgesics administered at the immediate postoperative period in the PACU may have blunted the protective effect of jaw thrust.…”

“…A previous report regarding double-lumen endobronchial intubation and sore throat showed fewer laryngeal injuries and a lower sore throat incidence in intubations that were facilitated by the jaw thrust manoeuvre. 11 Although the laryngeal and pharyngeal injuries were not evaluated, increased pharyngeal cavity and laryngeal inlet size that was induced by the jaw thrust manoeuvre may have decreased the physical trauma to the airway mucosa and reduced the incidence of sore throat in our study. The jaw thrust manoeuvre decreased double-lumen endobronchial tube advancement resistance during double-lumen endobronchial intubation.…”

“…The jaw thrust manoeuvre decreased double-lumen endobronchial tube advancement resistance during double-lumen endobronchial intubation. 11 Although double-lumen endobronchial tube advancement resistance during endotracheal intubation was not assessed, the decreased resistance by the jaw thrust manoeuvre may reduce the damage to the airway, and consequently decrease airway complications. A previous report showed that the jaw thrust manoeuvre decreased airway obstruction at the soft palate and epiglottic level.…”

“…9,10 A previous investigation demonstrated that jaw thrust that is applied during double-lumen endobronchial intubation decreased the incidence of sore throat and airway injuries. 11 Whether the jaw thrust manipulation prevents postoperative sore throat in patients undergoing conventional tracheal intubation using a laryngoscope has not yet been determined.…”