Postoperative Airway Management and Sore Throat Prevention

Postoperative sore throat remains one of the most frequent complaints following general anaesthesia, affecting up to half of all patients undergoing tracheal intubation. Its aetiology is multifactorial, encompassing mechanical trauma during insertion, mucosal ischaemia from cuff pressure, and inflammatory responses. Effective airway management seeks to balance secure ventilation with minimised tissue injury. Innovations in device design—from low-pressure cuffs and video-laryngoscopes to flexible fibreoptic bronchoscopes—have reduced mucosal stress, while technique refinements such as controlled advancement of tubes and optimised head-positioning diminish friction and focal pressure. Pharmacological measures, including intracuff lidocaine, topical corticosteroids and non-steroidal anti-inflammatory drugs, further attenuate inflammation and discomfort. Preventive strategies benefit patient satisfaction, shorten recovery times and lower healthcare costs. An integrated approach, combining ergonomic equipment, refined procedural protocols and targeted pharmacotherapy, continues to evolve, with global studies underscoring the importance of tailored interventions to uphold safety and comfort in peri-operative care.

Research from Nature Portfolio

Recent studies have demonstrated that the rate at which an endotracheal tube is advanced over a fibreoptic bronchoscope has a direct impact on postoperative throat symptoms. In a randomised trial, patients who received slower tube advancement experienced significantly milder sore throat at three and twenty-four hours after surgery compared with those subject to standard advancement speeds. Although hoarseness and cough were unaffected, the finding highlights a simple yet effective refinement to fibreoptic-guided intubation protocols that may be widely adopted to reduce mucosal trauma without additional equipment.

Postoperative Airway Management and Sore Throat Prevention publication trend

The graph below shows the total number of articles in postoperative airway management and sore throat prevention across all publications each year (not limited to Nature Index journals).

Technical terms

Endotracheal tube (ETT): A flexible medical tube inserted through the mouth or nose into the trachea to secure the airway and permit mechanical ventilation.

Tracheal intubation: The process of placing an endotracheal tube into the trachea to maintain airway patency during anaesthesia or respiratory support.

Fiberoptic-guided intubation: A technique using a fibreoptic bronchoscope to visualise the airway and guide the ETT, reducing force and potential tissue damage.

Intracuff lidocaine: Administration of lidocaine solution within the cuff of an endotracheal tube to provide local anaesthesia and lower cuff pressure against the tracheal mucosa.

Video-laryngoscope: A laryngoscope equipped with a camera and video display to enhance glottic visualisation and reduce the force required for successful intubation.

References

1. Postoperative sore throat: prophylaxis and treatment. Frontiers in Pharmacology (2023).
2. Effect of different head position during tracheal intubation on postoperative sore throat: a randomized clinical trial. Annals of Medicine (2025).
3. Slow advancement of the endotracheal tube during fiberoptic-guided tracheal intubation reduces the severity of postoperative sore throat. Scientific Reports (2023).
4. Effect of Intracuff Lidocaine on Postoperative Sore Throat and the Emergence Phenomenon: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLOS ONE (2015).