Effect of different head position during tracheal intubation on postoperative sore throat: a randomized clinical trial

Introduction Postoperative sore throat is the most frequently complaint after tracheal intubation. We aimed to determine whether changing patients’ head position during intubation reduces the incidence of postoperative sore throat.Methods We randomized 130 patients receiving oral tracheal intubation...

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Main Authors: Tao Shan, Huimin Zhang, Xiao Zhou, Hongguang Bao, Liu Han, Chuan Su, Qilian Tan, Jun Yin, Tao Dan
Format: Article
Language:English
Published: Taylor & Francis Group 2025-12-01
Series:Annals of Medicine
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Online Access:https://www.tandfonline.com/doi/10.1080/07853890.2025.2464943
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author Tao Shan
Huimin Zhang
Xiao Zhou
Hongguang Bao
Liu Han
Chuan Su
Qilian Tan
Jun Yin
Tao Dan
author_facet Tao Shan
Huimin Zhang
Xiao Zhou
Hongguang Bao
Liu Han
Chuan Su
Qilian Tan
Jun Yin
Tao Dan
author_sort Tao Shan
collection DOAJ
description Introduction Postoperative sore throat is the most frequently complaint after tracheal intubation. We aimed to determine whether changing patients’ head position during intubation reduces the incidence of postoperative sore throat.Methods We randomized 130 patients receiving oral tracheal intubation into one of the two groups: the sniffing position group and elevation position group. Patients in the sniffing position group maintained sniffing position consistently during intubation, while those in the elevation position group transitioned from the sniffing position to the elevation position during tube advancement to the trachea. The primary outcome was incidence of airway trauma and postoperative sore throat (none/mild/moderate/severe) 1 h after surgery. The secondary outcomes were the incidence of postoperative sore throat at 6 h,12 h and 24 h, and hoarseness at 1 h, 6 h,12 h and 24 h postoperatively.Results One hundred twenty-eight patients completed our trial. There were no differences in the baseline characteristics of the patients between the sniffing position and elevation position group [51 (14.8) vs 53 (15.5) for age, 25/39 vs 26/38 for sex (male/female)]. No difference in basic airway condition was observed. Transitioning patient’s head from sniffing to elevation position during tube advancement to tracheal resulted in a significantly lower incidence of airway trauma [10/64 vs 23/64, risk ratio (95% CI): 0.76 (0.61–0.94), p = 0.009], postoperative sore throat and hoarseness compared with maintaining the sniffing position at 1 h [10/64 vs 30/64, risk ratio (95% CI): 0.63 (0.49–0.81), p < 0.001 for sore throat; 22/64 vs 34/64, risk ratio (95% CI): 0.71 (0.52–0.98), p = 0.044 for hoarseness] and 6 h [4/64 vs 17/64, risk ratio (95% CI): 0.78 (0.67–0.92), p = 0.006 for sore throat; 12/64 vs 27/64, risk ratio (95% CI): 0.71 (0.56–0.91), p = 0.002 for hoarseness]. There were no significant differences in postoperative sore throat and hoarseness at 12 and 24 h between the two groups.Conclusions Transitioning patients’ head position from the sniffing position to a head elevation position during tube advancement into tracheal could significantly reduce the incidence of airway trauma, postoperative sore throat and hoarseness.Trial registration number ChiCTR2300073198
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spelling doaj-art-0a3b58017ffa4946be767f69ec25c0232025-08-20T03:05:29ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602025-12-0157110.1080/07853890.2025.2464943Effect of different head position during tracheal intubation on postoperative sore throat: a randomized clinical trialTao Shan0Huimin Zhang1Xiao Zhou2Hongguang Bao3Liu Han4Chuan Su5Qilian Tan6Jun Yin7Tao Dan8Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, ChinaDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, ChinaDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, ChinaDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, ChinaDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, ChinaCenter for Global Health, Department of Pathogen Biology and Immunology, Jiangsu Key Laboratory of Pathogen Biology, State Key Lab of Reproductive Medicine, Nanjing Medical University, Nanjing, ChinaDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, ChinaDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, ChinaDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, ChinaIntroduction Postoperative sore throat is the most frequently complaint after tracheal intubation. We aimed to determine whether changing patients’ head position during intubation reduces the incidence of postoperative sore throat.Methods We randomized 130 patients receiving oral tracheal intubation into one of the two groups: the sniffing position group and elevation position group. Patients in the sniffing position group maintained sniffing position consistently during intubation, while those in the elevation position group transitioned from the sniffing position to the elevation position during tube advancement to the trachea. The primary outcome was incidence of airway trauma and postoperative sore throat (none/mild/moderate/severe) 1 h after surgery. The secondary outcomes were the incidence of postoperative sore throat at 6 h,12 h and 24 h, and hoarseness at 1 h, 6 h,12 h and 24 h postoperatively.Results One hundred twenty-eight patients completed our trial. There were no differences in the baseline characteristics of the patients between the sniffing position and elevation position group [51 (14.8) vs 53 (15.5) for age, 25/39 vs 26/38 for sex (male/female)]. No difference in basic airway condition was observed. Transitioning patient’s head from sniffing to elevation position during tube advancement to tracheal resulted in a significantly lower incidence of airway trauma [10/64 vs 23/64, risk ratio (95% CI): 0.76 (0.61–0.94), p = 0.009], postoperative sore throat and hoarseness compared with maintaining the sniffing position at 1 h [10/64 vs 30/64, risk ratio (95% CI): 0.63 (0.49–0.81), p < 0.001 for sore throat; 22/64 vs 34/64, risk ratio (95% CI): 0.71 (0.52–0.98), p = 0.044 for hoarseness] and 6 h [4/64 vs 17/64, risk ratio (95% CI): 0.78 (0.67–0.92), p = 0.006 for sore throat; 12/64 vs 27/64, risk ratio (95% CI): 0.71 (0.56–0.91), p = 0.002 for hoarseness]. There were no significant differences in postoperative sore throat and hoarseness at 12 and 24 h between the two groups.Conclusions Transitioning patients’ head position from the sniffing position to a head elevation position during tube advancement into tracheal could significantly reduce the incidence of airway trauma, postoperative sore throat and hoarseness.Trial registration number ChiCTR2300073198https://www.tandfonline.com/doi/10.1080/07853890.2025.2464943Airway managementintubationpositionpostoperative complicationssore throat
spellingShingle Tao Shan
Huimin Zhang
Xiao Zhou
Hongguang Bao
Liu Han
Chuan Su
Qilian Tan
Jun Yin
Tao Dan
Effect of different head position during tracheal intubation on postoperative sore throat: a randomized clinical trial
Annals of Medicine
Airway management
intubation
position
postoperative complications
sore throat
title Effect of different head position during tracheal intubation on postoperative sore throat: a randomized clinical trial
title_full Effect of different head position during tracheal intubation on postoperative sore throat: a randomized clinical trial
title_fullStr Effect of different head position during tracheal intubation on postoperative sore throat: a randomized clinical trial
title_full_unstemmed Effect of different head position during tracheal intubation on postoperative sore throat: a randomized clinical trial
title_short Effect of different head position during tracheal intubation on postoperative sore throat: a randomized clinical trial
title_sort effect of different head position during tracheal intubation on postoperative sore throat a randomized clinical trial
topic Airway management
intubation
position
postoperative complications
sore throat
url https://www.tandfonline.com/doi/10.1080/07853890.2025.2464943
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