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Effects of GlideScope, Pentax Airway Scope, and Macintosh Blade on the incidence of postoperative sore throat: a cohort study of 9,881 patients

BMC Anesthesiology volume 24, Article number: 409 (2024) Cite this article

Abstract

Background

Postoperative sore throat (POST) is a common complaint after general anesthesia. POST is defined by the presence of a self-reported foreign body sensation or a painful sensation in the throat after general anesthesia. This condition may affect recovery and patient satisfaction and is associated with many factors, including intubation tools. Previous studies have reported conflicting results on POST. This retrospective cohort study, with sample size of 9,881 patients, was conducted to confirm the hypothesis that the use of video laryngoscopy (VL) is associated with a lower incidence of POST compared with direct laryngoscopy (DL).

Methods

Data were extracted from a prospectively maintained quality improvement database. A total of 9,881 patients were included in the study. Statistical analysis was conducted for comparisons of demographic characteristics and to determine the effect of intubation tools on the incidence of POST.

Results

The patients had similar baseline demographic characteristics. Compared with DL, VL was associated with a lower incidence of POST (12.98% vs. 17.49%, P < 0.001). In addition, the use of Pentax Airway Scope (AWS) was associated with a lower incidence of POST compared with the use of GlideScope (GVL, 8.14% vs. 16.25%, P < 0.001). To better adjust for possible confounding factors, mixed-effects generalized linear model analysis revealed that older age (odds ratio [OR]: 0.995, 95% confidence interval [CI]: 0.992–0.999, P = 0.006), AWS compared to DL (OR: 0.416, 95% CI: 0.350–0.494, P < 0.001), and male sex (OR: 0.836, 95% CI: 0.747–0.935, P = 0.002) are associated with reduced incidence of POST.

Conclusion

Compared with DL, VL is associated with a lower incidence of POST. In addition, the use of AWS is associated with a lower incidence of POST compared with the use of GVL.

Trial registration

Retrospectively registered, NCT06515808, date of registration: 23/07/2024.

Peer Review reports

Introduction

Tracheal intubation is a key component of general anesthesia. This technique maintains and protects the airway and provides easy access for suctioning tracheal secretions during and at the end of surgery. Postoperative sore throat (POST) is a common side effect after intubation. According to the literature, POST occurs in 6.6–90% of patients who undergo general anesthesia [1,2,3,4,5]. POST may affect postoperative recovery and patient satisfaction [6,7,8]. Among the factors associated with the incidence or severity of POST are intubation technique, lubricant type, cuff pressure, and length of surgery or anesthesia [6, 9,10,11,12]. Multiple randomized controlled trials (RCTs) have indicated that chewing gums [13], administering dexamethasone before surgery [14, 15], maintaining an appropriate endotracheal tube cuff pressure [16], thermally softening the endotracheal tube [17], and instilling 2% alkalinized lignocaine into the endotracheal tube cuff may reduce the incidence and severity of POST [18]. Several studies have also examined the effect of different intubation tools, such as Macintosh Blade (direct laryngoscopy, DL), GlideScope (GlideScope video laryngoscopy, GVL), McGrath laryngoscope, and Pentax Airway Scope (AWS), on the incidence and severity of POST. In addition, multiple RCTs have indicated that, compared with DL, GVL is associated with a lower incidence and severity of POST [19,20,21]. In addition, AWS is associated with a lower incidence of POST compared with GVL [22]. Despite these findings, multiple studies have yielded conflicting results. Cirilla II et al. [23] revealed that intubating with GVL was not associated with reduced incidence of POST compared with DL. Certain studies have indicated that GVL and AWS are associated with a similar incidence of POST [24, 25], and another study has indicated that intubation with DL or AWS does not affect the incidence of POST [26]. Further research is required to identify the contributing factors of POST in improving the quality of general anesthesia. In this study, we hypothesized that the use of video laryngoscopy (VL) is associated with a lower incidence of POST compared with the use of DL. We also examined the effects of GVL and AWS on the incidence of POST.

Materials and methods

This study was approved by the Institutional Review Board of the Fu Jen Catholic University Hospital (approval no. FJUH111171, approval date: April 30, 2022). Given the retrospective nature of this study, the requirement for informed consent was waived by the committee. Patient data, such as chart numbers, dates of surgery, and names were omitted during data collection and analysis to ensure patient privacy. Data was collected from a prospectively maintained quality improvement database on all patients who underwent anesthesia in our department. Patients who underwent inpatient surgeries and general anesthesia with endotracheal tubes, intubated with DL, AWS or GVL, during the period from January 1, 2018, to December 30, 2019, were included for the analysis. Patients meeting the following criteria were excluded: (1) having difficult airway, (2) receiving laryngeal surgery, such as laryngeal biopsy, laryngeal microsurgery, laryngoplasty or vocal cord surgery, (3) not being extubated at the end of anesthesia, (4) being pregnant, (5) being under 20 years of age, (6) undergoing gynecological surgeries, due to previous literature stating that gynecological procedures was associated with high POST rates [27], (7) undergoing thyroid surgeries, due to the fact that special neuromonitoring endotracheal tubes may be used and up to 68% of incidence of POST after thyroid surgeries was reported [28], (8) having an American Society of Anesthesiologists (ASA) physical status class greater than 3. Difficult airways can be divided into expected difficult airways and unexpected difficult airways. Expected difficult airways are defined by the presence of the following: (1) abnormal cervical spine movement or temporomandibular joint movement, (2) airway-compromising masses such as tumors, cysts, or hematomas, (3) a Mallampati score greater than 3, (4) a thyromental distance of less than 6 cm, (5) a lesion below vocal cord or (6) a previously identified difficult airway. Unexpected difficult airways are defined as follows: (1) difficult mask ventilation, and (2) difficult vocal cord visualization after multiple attempts (> 3 attempts) of laryngoscopy. The data of our study were collected using a questionnaire administered by nurse anesthetists during postoperative patient visits. This questionnaire was validated by a specialized medical committee at our institute and was designed to collect data on quality enhancement markers, including POST, postoperative nausea and vomiting, intraoperative awareness, skin or soft tissue injury, and overall satisfaction scores, after general anesthesia. In our hospital, these data are routinely collected for the purposes of quality enhancement and detection of potential postoperative complications. A dedicated team reviews the data on a daily basis to identify missing or incorrect information. All patients included in this study underwent inpatient surgeries. Data on patients who underwent inpatient surgeries was collected approximately 12 to 24 h after surgeries were completed.

Anesthesia induction and emergence

Only patients who underwent general anesthesia were included in the study. Anesthesia was induced by attending anesthesiologists and nurse anesthetists. The medication used during induction and the type of equipment used for intubation were decided by the attending anesthesiologists. The commonly used agents during induction included, propofol (2 mg/kg), citosol (3–5 mg/kg), cisatracurium (0.15 mg/kg), rocuronium (0.5–1 mg/kg), fentanyl (1–2 mcg/kg), glycopyrrolate (0.2 mg), dexamethasone (4 mg) and lidocaine (1 mg/kg). Commonly used reversal agents included neostigmine (0.04–0.07 mg/kg) with an appropriate dose of glycopyrrolate or sugammadex (2–4 mg/kg). After paralyzing the patients, intubation was performed by the attending anesthesiologists, and extubation was performed by the nurse anesthetists when train-of-four ratio is greater than 0.9 under the supervision of the attending anesthesiologists. An endotracheal tube with an internal diameter of 7.5 mm with a cuff was used for male patients and an endotracheal tube with an internal diameter of 7.0 mm with a cuff was used for female patients. Cuff pressure was maintained at 20–30 cmH2O. After surgery, the patients were transferred to the postanesthesia care unit for post-anesthesia care. Our institute primarily uses a GlideScope AVL system and a Pentax AWS S100 airway scope.

Outcome measures

POST was defined by the presence of a self-reported foreign body sensation or a painful sensation in the throat. It was evaluated approximately 12–24 h after surgery by nurse anesthetists during routine postoperative visits to determine the quality of anesthesia. Hoarseness was defined as self-reported changes in voice qualities. Other parameters such as mucosal injury and overall satisfaction rate reported by patients were collected. Mucosal injuries were defined as apparent injuries to oral, laryngeal or tongue mucosa following tracheal intubation. The overall satisfaction rate was categorized from 1 to 5 with 1 being the least satisfied and 5 being the most satisfied.

Statistical analysis

Previous research has indicated that the difference in the incidence of POST between patients receiving DL and GVL is approximately 16% at 6 h and 20% at 24 h postoperatively [19]. In this study, we estimated a difference of 10% in the incidence of POST between patients receiving DL and VL. To identify this difference with a statistical power of 0.8 and a P value less than 0.05, at least 712 patients should be included in each group.

Chi-square test was used for analysis of dichotomous data. Student’s t test was used for analysis of normally distributed data, and the Mann-Whitney U test was used for analysis of nonparametric ordinal data. Odds ratios were calculated, and P values less than 0.05 were considered statistically significant. Since we excluded high risk procedures for POST, we performed mixed-effects generalized linear model analysis to better determine the relations of each factor to POST. All statistical analyses were conducted using IBM SPSS Statistics version 26.0 (IBM, Armonk, NY, USA).

Results

A total of 11,117 patients, intubated with DL, AWS and GVL, underwent general anesthesia with endotracheal tubes from January 1, 2018, to December 30, 2019. After exclusion, a total of 9881 patients were included in the study: 4482 patients in the DL group and 5399 patients in the VL group (Fig. 1). The VL group was subdivided into two groups depending on the use of VL during induction: a GVL group (3225 patients) and an AWS group (2174 patients). As shown in Tables 1 and 2, no difference was observed between DL and VL groups or between GVL and AWS groups in terms of age, ASA physical status class, body mass index (BMI), duration of anesthesia, and surgery type. Dexamethasone was administered to 646 patients (14.41%) in the DL group, 440 patients (13.64%) in the GVL group, and 299 (13.75%) patients in the AWS group.

Fig. 1
figure 1

Flow chart of patient inclusion and exclusion

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Table 1 Demographic characteristics of patients undergoing intubation with DL and VL
Full size table
Table 2 Demographic characteristics of patients undergoing intubation with GVL and AWS
Full size table

Incidence of POST in this cohort is 15.03%. The DL group had a POST incidence of 17.49%, whereas the VL group had a POST incidence of 12.98% (P < 0.001). Similarly, the GVL group had a POST incidence of 16.25%, whereas the AWS group had a POST incidence of 8.14% (P < 0.001).

No statistical significance was observed between these groups in terms of mucosal injuries. The DL group comprised 111 patients (2.48%) with mucosal injuries, whereas the VL group comprised 125 patients (2.32%) with mucosal injuries (P = 0.601). Similarly, the GVL group comprised 74 patients (2.29%) with mucosal injuries, whereas the AWS group comprised 51 patients (2.35%) with mucosal injuries (P = 0.902).

The DL group comprised 151 patients (3.37%) with hoarseness after surgery, whereas the VL group comprised 186 patients (3.45%) with hoarseness after surgery, revealing no statistically significant difference (P = 0.836). By contrast, the GVL group comprised 128 patients (3.97%) with hoarseness after surgery, whereas the AWS group comprised 58 patients (2.67%) with hoarseness after surgery, revealing a statistically significant difference (P = 0.010).

No statistically significant differences were observed in the overall satisfaction scores between the DL and VL groups (P = 0.088) or between the GVL and AWS groups (P = 0.378). There were no serious complications reported in the study period.

To better adjust for possible confounding factors, we performed mixed-effects generalized linear model analysis. Age, sex, intubation equipment, administration of dexamethasone, BMI and anesthesia time were set as fixed effects while types of surgeries were set as random effect during analysis. Mixed-effects generalized linear model analysis revealed that older age (odds ratio [OR]: 0.995, 95% CI: 0.992–0.999, P = 0.006), AWS compared to DL (OR: 0.416, 95% CI: 0.350–0.494, P < 0.001), and male sex (OR: 0.836, 95% CI: 0.747–0.935, P = 0.002) are associated with reduced incidence of POST. By contrast, BMI (OR: 0.993, 95% CI: 0.975–1.011, P = 0.436), duration of anesthesia (OR: 1.000, 95% CI: 0.997–1.002, P = 0.756), GVL compared to DL (OR: 0.914, 95% CI: 0.809–1.032, P = 0.145), and perioperative dexamethasone administration (OR: 1.109, 95% CI: 0.947–1.299, P = 0.197) had no significant effect on the incidence of POST.

Discussion

POST may lead to several undesirable side effects, such as an inability to talk, changes in voice, and difficulties in swallowing or even coughing, and these symptoms may last for months. POST is listed as the second most common postoperative complaint after general anesthesia. The high incidence of POST, which can reach 60%, may have a negative effect on patient satisfaction and may increase the cost of treatment [29]. It is also a major cause of patient dissatisfaction with anesthetic care [30]. As a result, identifying possible risk factors may lead to reduced incidence of POST and better quality after general anesthesia.

The exact mechanism underlying POST remains unclear. Laryngoscope manipulation, intubation and suction leading to tissue or larynx trauma are thought to be the main reasons underlying POST [31]. The force exerted during stylet extraction may also be another cause for POST. According to Kusunoki et al. [32], the increased force exerted during stylet extraction is significantly associated with POST. Yoon et al. [33] reported that utilizing a stylet during intubation with a McGrath laryngoscope is not associated with POST.

Although several techniques have been proposed for reducing the incidence and severity of POST, no effective technique has yet been identified. Gaur et al. [34] reported that instilling alkalinized lignocaine instead of air into the endotracheal cuff may reduce the incidence and severity of POST by enabling the lignocaine diffusion from the cuff of endotracheal tube to tracheal and laryngeal mucosa. Sony et al. [18] proposed that instilling 2% alkalinized lignocaine into the endotracheal tube cuff may reduce the incidence of POST, with higher effectiveness than that of normal saline. Wang et al. [35] reported that chewing gums before undergoing general anesthesia through a supraglottic airway device may reduce the incidence of POST in patients undergoing gynecological surgery; gum chewing exerts such effects presumably by increasing the production of saliva, which protects the oral and pharyngeal mucosa.

Maintaining tracheal cuff pressure may reduce the incidence of POST. When an endoscopic photographic technique is used, a tracheal tube cuff pressure exceeding 30 cmH2O may reduce blood flow to tracheal mucosa, and a tracheal tube cuff pressure of approximately 50 cmH2O for 15 min may lead to tracheal mucosal ischemia. Therefore, the tracheal cuff pressure should not exceed 30 cmH2O [36]. Excessive tracheal cuff inflation may lead to tracheal mucosal injuries, which subsequently lead to POST, and may affect the perfusion of tracheal mucosa, resulting in major complications such as necrosis or tracheal rupture [37]. Liu et al. [38] reported that 34% of patients who had a cuff pressure between 15 and 25 cmH2O and were monitored using a manometer developed POST, whereas 44% of those in the control group, who underwent pilot balloon palpation, developed POST (P = 0.033). Manual evaluation of cuff pressure often leads to overinflation and excessive pressure [39]. Kovacevic et al. [40] argued that maintaining cuff pressure at 20–30 cmH2O may reduce the symptoms of sore throat in patients who undergo elective surgery with general anesthesia. Puthenveettil et al. [41] reported an association between a cuff pressure of 25 cmH2O and a lower incidence of POST compared with clinically guided inflation in patients undergoing laparoscopic gynecological surgery. Zhu et al. [42] compared various pressure monitoring systems and argued that maintaining an adequate cuff pressure may reduce the incidence of POST. In summary, cuff pressure should be monitored using a manometer instead of manual palpation and should be maintained at 20–30 cmH2O [7, 38, 40, 41]. At our institute, most patients undergo at least one measurement of cuff pressure, with pressure maintained at 20–30 cmH2O. Therefore, in our cohort, the effect of cuff pressure on the incidence of POST may not explain the difference observed between groups.

POST may result from either a direct or indirect trauma to the tracheal mucosa by the laryngoscope or endotracheal tube [31]. Nevertheless, the potential effects of different laryngoscopes on the incidence and severity of POST remain unclear. In an RCT, Najafi et al. [19] reported that the use of GVL was associated with a low incidence of sore throat and hoarseness in the first 24 h after surgery. Similarly, Aqil et al. [20] indicated that the use of GVL was associated with a low incidence and severity of POST compared to DL. Teoh et al. [43] reported that, compared with AWS, there was more mucosal bleeding (P = 0.366), lip bleeding (P = 0.620) and significantly more POST (P < 0.001) in GVL group. Jeong et al. [24] indicated that no difference in the incidence of POST between patients receiving DL, GVL, and AWS. Nishikawa et al. [44] reported that AWS was associated with a low incidence of POST (2 out of 20 patients with AWS and 6 out of 20 patients with DL, P = 0.23), although the differences did not reach statistical significance. In a systematic review, Lewis et al. [45] reported that no significant difference in between patients receiving VL and DL. As mentioned earlier, previous studies have yielded conflicting results, and the actual effect of VL on the incidence of POST remains unclear.

Previous studies have also been conducted comparing the outcomes of POST and hoarseness with either GlideScope intubation or direct laryngoscopy in patients with normal airways [19, 23]. However, our study differs from previous studies in terms of the following. First, our study was retrospective in nature. Second, our study cohort was considerably larger than the cohorts included in previous randomized controlled trials. Third, in the study of Cirilla II et al., [23] intubation were performed not only by attending anesthesiologists but also by certified nurse anesthetists and anesthesia residents. Given that the degree of experience may affect the outcomes of intubation, in our study, all intubation procedures were performed by anesthesiologists with at least 3 years of experience as attending anesthesiologists. Because of the popularity of using GlideScope and Macintosh blades in Taiwan and at our institute, our anesthesiologists were well trained in intubation with these blades. Fourth, our study is similar to that of Cirilla II et al. in that the incidence of POST was evaluated within 24 h by using a yes-or-no questionnaire. In Najafi et al., [19] POST was evaluated at fixed time points (6 and 24 h postoperatively). Conducting POST evaluations at fixed time points can enable understanding of its evolution, progression, and onset, in our study, we evaluated POST at 12 to 24 h after general anesthesia. This was a limitation of our study. Fifth, intubating with GlideScope was associated with reduced incidence of POST in the study of Najafi et al., but our results indicate that intubation with GlideScope is not associated with a reduced incidence of POST, consistent with the findings of Cirilla II et al. Notably, the endotracheal tube used in Najafi et al. was larger than that used in ours (with an internal diameter of 7.5 mm for women and 8.0 mm for men in study of Najafi et al.). A larger cuff size is considered to be a risk factor for POST [46]. We were unable to identify information on tube size in Cirilla II et al. Discrepancies in tracheal tube size may explain the varying results between our study and that of Najafi et al. Sixth, we conducted a regression analysis to determine the effect of each factor on the incidence of POST. These factors included body mass index, dexamethasone administration, age, sex, and intubation tools. Development of POST is multifactorial, and this regression analysis clarified the effect of each of these factors.

This study was designed to examine the effects of different intubation tools on POST in a large cohort of patients. First, our results are consistent with those of previous studies, indicating that AWS is associated with a lower incidence of POST compared with GVL. This outcome can be explained by the intrinsic design of AWS and its ability to elucidate the expected trajectory of tube advancement with the aiming marker provided on the screen and thus mitigate the likelihood of mechanical trauma or irritation to surrounding tissue. It may be also explained by the fact that, unlike GVL intubation, AWS intubation requires no stylet insertion and extraction. Despite these findings, the difference between the effects of GVL and AWS is not as significant as those reported in the literature. Previous studies have indicated a 20% difference in incidence of POST between patients receiving AWS and GVL, but these studies primarily comprise substantially small cohorts. In this study, our cohort comprised 9,881 patients. Therefore, the data presented in our research may reflect the condition in the real world better. Second, our results indicated a reduction in the incidence of POST when VL (GVL or AWS) was used for intubation in patients without difficult airway. Mixed-effects generalized linear model analysis revealed that AWS compared to DL (OR: 0.416, 95% CI: 0.350–0.494, P < 0.001) is associated with a reduced incidence of POST and GVL was not associated with reduced incidence of POST (OR: 0.914, 95% CI: 0.809–1.032, P = 0.145). AWS is better in reducing the incidence of POST compared to DL and GVL, presumably because of its intrinsic design and the fact that no stylet is needed during intubation. Third, our results indicated that AWS was associated with a lower incidence of postoperative hoarseness compared with GVL. The development of postoperative hoarseness is multifactorial, such as instrument manipulation, surgery or anesthesia duration, positional changes, male sex, and Mallampati score greater than 3 [47]. In this study, we observed no difference between our patients in terms of sex and surgery or anesthesia duration and patients with difficult airway were excluded. Therefore, instrument manipulation and the presence of a foreign body (endotracheal tube) around the vocal cord during surgery were presumably the main reasons underlying the development of postoperative hoarseness. In addition, we discovered that AWS was associated with a lower incidence of postoperative hoarseness compared with GVL (P = 0.010), presumably because of its intrinsic design, which mitigates the risk of mechanical trauma during intubation. Fourth, our results indicated that, against expectations, dexamethasone administration at induction of anesthesia was not associated with reduced incidence of POST, presumably because the dose of dexamethasone administered at our institute is not based on body weight. Instead, dexamethasone is usually administered as a single ampule (4 mg) as part of a routine induction regimen. Dexamethasone is a potent glucocorticoid with an anti-inflammatory effect, and it is believed to be effective in preventing POST [48]. According to Park et al., [49] in patients undergoing double-lumen intubation, 0.1 mg/kg dexamethasone administered preoperatively can reduce the incidence of POST and hoarseness 1 h but not 24 h postoperatively, whereas 0.2 mg/kg dexamethasone can reduce the incidence of POST and hoarseness both 1 h and 24 h postoperatively. Bagchi et al. [14] argued that 0.2 mg/kg dexamethasone can reduce the incidence of POST by 30% 1 h postoperatively, with an efficacy of 60%. By contrast, Ruangsin et al. [50] discovered that 4 mg of dexamethasone administered preoperatively did not reduce the incidence of POST. At our institute, the dose of dexamethasone administered was 4 mg, and this dose was not adjusted based on each patient’s body weight. This dose corresponds to a concentration below 0.2 mg/kg, which is typically required to prevent POST. Therefore, our regression analysis results may not indicate the actual effect of dexamethasone.

Fifth, our results indicated that age (OR: 0.995, 95% confidence interval [CI]: 0.992–0.999, P = 0.006) was inversely related to the risk of developing POST after anesthesia, which was compatible with previous systematic review [7]. Higgins et al. [27] also reported similar results that age was inversely related to the risk of POST after ambulatory surgery. According to previous literature, this may be explained by the intensity and unpleasantness of the pain stimulus being significantly rated lower in the older population than in younger population [51]. Furthermore, the threshold of pain perception is increased and sensitivity to pain is reduced in older populations [52]. Sixth, our results indicated that male sex (OR: 0.836, 95% CI: 0.747–0.935, P = 0.002) is associated with lower incidence of POST. This could be explained by previous studies indicating that there is sex-related variation in pain perception [53]. Women may experience more severe clinical pain compared to men, which may be related to multiple factors such as sex hormones, endogenous opioid function and genetic factors [54]. Seventh, the duration of anesthesia is not related to the incidence of POST. It could be explained by the fact that the mean duration of anesthesia in this cohort was less than two hours in DL, GVL and AWS groups. Chen et al. [55] reported that anesthesia longer than 2 h is a risk factor for POST. The overall incidence of POST in our cohort is relatively low (15.03%) compared to other studies.

The study has several limitations. First, this study is limited by its retrospective nature. Data on potential factors relevant to POST development, such as intubation attempts, size of Macintosh blade, Mallampati score, cricoid manipulation during intubation, or postoperative use of analgesics were not included. Second, neither the progression of POSTseverity over time nor the actual onset time of POST was documented in the database. The exact time interval between the end of anesthesia and postoperative visit could not be obtained in our database. Therefore, we were unable to examine the severity of POST and the incidence of POST at varying time points after surgeries. Previous literature revealed that the incidence of POST could vary over time [20]. Thus, there could be a potential bias on the actual incidence of POST. Third, the rationale for selecting specific intubation tools was not explained. The choice of intubation equipment was entirely left to attending anesthesiologists’ discretion. Airway anatomy evaluation may play a key role in determining which airway instrument to use. However, patients with difficult airway anatomy or difficult intubation were excluded. Therefore, the patients included in analysis had a normal airway anatomy and the choice of intubation equipment was not affected by this factor. There are nine anesthesiologists, who are all adequately trained in the use of the three intubation tools examined in this study. Therefore, the decision of which intubation tools to use was based on the attending anesthesiologists’ preferences and the availability of equipment at the time of anesthesia induction. Fifth, patient coughing, bucking, or excessive suctioning at the end of anesthesia, which may lead to POST, was not documented. Sixth, the dose of dexamethasone administered in our institute was 4 mg and was not adjusted based on each patient’s body weight. The results from mixed-effects general linear model analysis may not reveal the actual effect of dexamethasone.

Conclusion

The overall incidence of POST in our study is 15.03%. DL is associated with a higher incidence of POST compared with VL, and GVL is associated with a higher incidence of POST compared with AWS. Compared with AWS, GVL is associated with a higher incidence of hoarseness after anesthesia. None of these intubation tools have a significant effect on the incidence of mucosal injuries and overall satisfaction score. Further large-scale prospective randomized trials are required to validate our results.

Data availability

The data that support the findings of this study are not openly available due to institutional privacy guidelines but may be available from the corresponding author upon written request identifying the requestor, and the purpose and proposed use of the shared data.

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  1. Department of Anesthesiology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, No.69, Guizi Rd., Taishan Dist., New Taipei City 24352, Taiwan

    Chun-Hsien Fu & Chao-Hsien Sung

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Chun-Hsien, Fu: Study design, statistical analysis, essay writing. Chao-Hsien, Sung: Study design, statistical analysis, essay writing.

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Fu, CH., Sung, CH. Effects of GlideScope, Pentax Airway Scope, and Macintosh Blade on the incidence of postoperative sore throat: a cohort study of 9,881 patients. BMC Anesthesiol 24, 409 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12871-024-02798-x

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BMC Anesthesiology

ISSN: 1471-2253

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