Comparison of the incidence of postoperative sore throat between patients undergoing videolaryngoscope-guided versus Macintosh laryngoscope-guided double-lumen intubation: a systematic review and meta-analysis

Postoperative sore throat is a common complication of tracheal intubation, especially double-lumen tube intubation, after general anesthesia. Several studies have been conducted to compare the incidence of postoperative sore throat among patients un-dergoing videolaryngoscope-guided double-lumen intubation with that among patients undergoing Macintosh laryngoscope-guided double-lumen intubation. We purported to summarize all the existing evidences to explore the effect of videolaryngoscope and Macintosh laryngoscope on postoperative sore throat in patients with double-lumen intubation. PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure databases were searched for all randomized controlled trials published before 01 June 2021 that compared videolaryngoscopy with Macintosh laryngoscopy for prevention of postoperative sore throat among patients undergoing double-lumen intubation. The results showed that, 9 studies involving 695 patients were included in our meta-analysis. There was no significant difference about the incidence of postoperative hoarseness (risk ratio: 0.80; 95% confidence interval: 0.49–1.32; p-value = 0.38; I2 = 83%), tube malposition (risk ratio: 0.75; 95% confidence interval: 0.07–7.60; p-value = 0.80; I2 = 71%) and the success rate at the first attempt (risk ratio: 1.03; 95% confidence interval: 0.96–1.10; p-value = 0.42; I2 = 70%) between the two groups. We found that the videolaryngoscopy provided much lower incidence of oral injury (risk ratio: 0.49; 95% confidence interval: 0.27–0.89; p-value = 0.02; I2 = 7%) compared with Macintosh laryngoscopy. There was no significant difference in the incidence of postoperative sore throat (risk ratio: 0.74; 95% confidence interval: 0.42–1.32; p-value = 0.31; I2 = 87%) between the two groups. The sensitivity analysis excluding one study suggested that the incidence of postoperative sore throat was lower in the videolaryngoscopy group (risk ratio: 0.64; 95% confidence interval: 0.46–0.89; p-value = 0.008; I2 = 19%). The subgroup analysis suggested that the incidence of postoperative sore throat was lower in the videolaryngoscopy group in studies performed by experienced anesthetists (risk ratio: 0.62; 95% confidence interval: 0.45–0.87; p-value = 0.005; I2 = 5%). The current evidence demonstrates that, experienced anesthetist under the guidance of videolaryngoscope can significantly reduce the risk of postoperative sore throat in patients with double-lumen intubation. Using the videolaryngoscope resulted in a lower incidence of oral injury-related complications. However, there was no advantage in using a videolaryngoscope over Macintosh laryngoscope in the reduction of postoperative hoarseness, tube malposition and the success rate at first attempt.

Videolaryngoscope; Macintosh laryngoscope; Tracheal intubation; Double-lumen tube; Postoperative sore throat

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