Postoperative Sore Throat After Tracheal Intubation: An Updated Narrative Review and Call for Action

Zheping Chen,1,2,* Zhenxiang Zuo,3,4,* Le Zhang,2,4 Moxuan Gong,2,5 Yuyang Ye,2,4 Yanwu Jin,2,4,6 Xin Zhao2,4 1Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Translational Research Institute of Brain and Brain-Like Intelligence, Clinical Research Center for Anesthesiology and Perioperative Medicine, Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, 200434, People’s Republic of China; 2Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People’s Republic of China; 3Department of Gastroenterology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People’s Republic of China; 4The Second Clinical College, Shandong University, Jinan, Shandong, 250033, People’s Republic of China; 5Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200041, People’s Republic of China; 6Department of Anesthesiology and Perioperative Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan, Shandong, 250100, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yanwu Jin; Xin Zhao, Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Bei Yuan Street, Jinan, Shandong, 250033, People’s Republic of China, Tel +86-17660085535 ; +86-17660085551, Email [email protected]; [email protected]: Postoperative sore throat (POST) represents a common airway complication closely related to endotracheal tube (ETT), exhibiting a higher incidence following tracheal intubation compared to other airway apparatuses. Nevertheless, considering its mild and self-limiting character, POST is often overlooked. This study provides an updated narrative review on the latest perspectives regarding POST, including a comprehensive summary of its mechanisms, risk factors, clinical assessment methods, prevention and treatment strategies. Additionally, directions for future research are proposed.Methods: A comprehensive search was conducted using keywords such as “postoperative sore throat” and “tracheal intubation” in PubMed, Web of Science, and Cochrane databases from their inception to October 2024. Two groups of reviewers independently performed data search and cleaning after standard training. To address gaps in knowledge or potential biases, the literature was thoroughly screened based on established criteria, and a comprehensive synthesis, analysis, and summary of the relevant findings was conducted.Results: The precise cause of POST remains unknown, and its potential mechanism is believed to involve secondary inflammation triggered by irritation, mechanical trauma, tracheal intubation, and cuff inflation. The risk factors for POST encompass preoperative, intraoperative, and postoperative factors. Currently, effective prevention methods for POST consist of pharmacological interventions, non-pharmacological interventions, and traditional Chinese medicine (TCM) therapy. In terms of pharmacological interventions, non-steroidal anti-inflammatory drugs (NSAIDs) and steroid can effectively prevent the occurrence of POST through their anti-inflammatory properties. However, given the unavoidable side effects of medications, non-pharmacological interventions and non-invasive methods may offer greater benefits for POST and related hoarseness. For example, proficient and gentle intubation techniques can prevent mechanical injury caused by repeated intubation attempts. Currently, several studies have demonstrated the potential role of TCM in managing POST. Nonetheless, the precise mechanisms underlying its effects remain to be elucidated, and the available clinical evidence is still limited.Conclusion: Given that POST is prevalent following tracheal intubation but frequently overlooked, we advocate heightened awareness of its occurrence and progression, and recommend integrating the prevention and management of POST into routine clinical practice.Keywords: postoperative sore throat, tracheal intubation, risk factor, prevention