J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Review

Volume 14, Number 2, February 2022, pages 88-94

A Literature Review of Factors Related to Postoperative Sore Throat

**Table 1.** Studies Included in the Analysis
Author	Number of patients	Comparison groups (POST incidence rate, median)	Results
POST: postoperative sore throat; ASA-PS: American Society of Anesthesiologists physical status; LMA: laryngeal mask airway; AWS: airway scope; ILM: intubating laryngeal mask; FAST: Foley Airway Stylet Tool; IT: introducer tool; ETT: endotracheal tube; FM: facemask; RLT: reusable laryngeal tube; DLT: disposable laryngeal tube; PLA: Cobra perilaryngeal airway; LM-BL: blind intubation through the intubating laryngeal mask; ILM-LW: light wand-guided intubation through the intubating laryngeal mask; RAE: right angle endotracheal; BMI: body mass index; PONV: postoperative nausea and vomiting.
Shariffuddin et al, 2017 [24]	147 patients	Ambu^®AuraGain™ (10%)	There was a significant reduction in the incidence of POST in the Ambu^®AuraGain™^group
	ASA-PS = I - III	LMA Supreme™ (38%)
Tan et al, 2005 [20]	135 patients	LMA Classic™ (41%)	SoftSeal™ group had the highest incidence of mucosal trauma; LMAUnique™ group had the lowest incidence of POST
	ASA-PS = I - II	LMA Unique™ (14%)
		SoftSeal™ (42%)
Teoh et al, 2009 [30]	140 patients	Pentax AWS (0%)	Mucosal bleeding, lip bleeding, and POST were significantly more common in the Glidescope group.
	ASA-PS = I - II	Glidescope (18.6%)
Bein et al, 2004 [21]	80 patients	ILM (3, 0 - 6)	The incidences of POST and hoarseness were lower in the Bonfils group.
	ASA-PS = I - III	Bonfils (0, 0 - 4)
Chen et al, 2014 [19]	144 patients	FAST (21.2%)	The incidence of POST was higher in the FAST group.
	ASA-PS = I - II	IT (6.8%)
Higgins et al, 2002 [2]	5,264 patients	ETT (45.5%)	Age, gender, ASA, BMI, duration of surgery, type of airway management, and surgical technique were factors.
	ASA-PS = I - III	LMA (17.5%)
		FM (3.3%)
		Women: men = 13.4%: 9.1%
Biro et al, 2005 [29]	809 patients	POST occurrence (40%)	Female, history of smoking or lung disease, anesthesia for prolonged denture, PONV, and bloodstains on the intubation tube were related factors.
		No POST occurrence (60%)
Jaensson et al, 2014 [25]	297 patients	ETT (32%)	ETT had a higher incidence of POST than LMA; there was no significant difference in the incidence of POST between ETT and LAM.
	ASA-PS = I - III	LMA (19%)
Griffiths et al, 2013 [26]	102 patients	ETT (32.7%)	There was no significant difference in POST occurrence between the two groups.
	ASA-PS = I - II	LMA ProSeal (23.5%)
Amini et al, 2007 [27]	100 patients	RLT (8 patients)	Cuff pressure at the end of surgery was significantly lower in the DLT group.
	ASA-PS = I - II	DLT (12 patients)	There was no significant difference in POST occurrence between the two groups.
Andrews et al, 2009 [22]	90 patients	Cobra PLA™ (17 patients)	Insertion time was longer in Cobra PLA.
	ASA-PS = I - IV	LMA (8 patients)	There was no significant difference in POST occurrence between the two groups.
Kihara et al, 2000 [23]	120 patients	ILM-BL (5%)	There was no difference in POST incidence and severity or hoarseness in the two groups.
	ASA-PS = I - II	ILM-LW (6.6%)
Bennett et al, 2000 [28]	126 patients	Contents of the cuff	There was no significant difference in the occurrence of POST.
	ASA-PS = I - II	Air (15.6%)	There was no significant difference between intubation time and cuff pressure and the occurrence of POST.
		Saline solution (14.5%)	Gastric tube insertion was a confounding factor in the occurrence of POST.
Lomax et al, 2011 [31]	110 patients	GlideRite^® (2: 0 - 3)	There was no significant difference in the incidence of POST.
	ASA-PS = I - II	Pre-rotated RAE™ (2: 0 - 5)
Schaefer et al, 1994 [32]	100 patients	Laryngoscopic (16%)	There was no significant difference in complications between the two groups.
	ASA-PS = I - II	Fiber optic (14%)

Table 1. Studies Included in the Analysis

Author

Number of patients

Comparison groups (POST incidence rate, median)

Results

POST: postoperative sore throat; ASA-PS: American Society of Anesthesiologists physical status; LMA: laryngeal mask airway; AWS: airway scope; ILM: intubating laryngeal mask; FAST: Foley Airway Stylet Tool; IT: introducer tool; ETT: endotracheal tube; FM: facemask; RLT: reusable laryngeal tube; DLT: disposable laryngeal tube; PLA: Cobra perilaryngeal airway; LM-BL: blind intubation through the intubating laryngeal mask; ILM-LW: light wand-guided intubation through the intubating laryngeal mask; RAE: right angle endotracheal; BMI: body mass index; PONV: postoperative nausea and vomiting.

Shariffuddin et al, 2017 [24]

147 patients

Ambu^®AuraGain™ (10%)

There was a significant reduction in the incidence of POST in the Ambu^®AuraGain™^group

ASA-PS = I - III

LMA Supreme™ (38%)

Tan et al, 2005 [20]

135 patients

LMA Classic™ (41%)

SoftSeal™ group had the highest incidence of mucosal trauma; LMAUnique™ group had the lowest incidence of POST

ASA-PS = I - II

LMA Unique™ (14%)

SoftSeal™ (42%)

Teoh et al, 2009 [30]

140 patients

Pentax AWS (0%)

Mucosal bleeding, lip bleeding, and POST were significantly more common in the Glidescope group.

ASA-PS = I - II

Glidescope (18.6%)

Bein et al, 2004 [21]

80 patients

ILM (3, 0 - 6)

The incidences of POST and hoarseness were lower in the Bonfils group.

ASA-PS = I - III

Bonfils (0, 0 - 4)

Chen et al, 2014 [19]

144 patients

FAST (21.2%)

The incidence of POST was higher in the FAST group.

ASA-PS = I - II

IT (6.8%)

Higgins et al, 2002 [2]

5,264 patients

ETT (45.5%)

Age, gender, ASA, BMI, duration of surgery, type of airway management, and surgical technique were factors.

ASA-PS = I - III

LMA (17.5%)

FM (3.3%)

Women: men = 13.4%: 9.1%

Biro et al, 2005 [29]

809 patients

POST occurrence (40%)

Female, history of smoking or lung disease, anesthesia for prolonged denture, PONV, and bloodstains on the intubation tube were related factors.

No POST occurrence (60%)

Jaensson et al, 2014 [25]

297 patients

ETT (32%)

ETT had a higher incidence of POST than LMA; there was no significant difference in the incidence of POST between ETT and LAM.

ASA-PS = I - III

LMA (19%)

Griffiths et al, 2013 [26]

102 patients

ETT (32.7%)

There was no significant difference in POST occurrence between the two groups.

ASA-PS = I - II

LMA ProSeal (23.5%)

Amini et al, 2007 [27]

100 patients

RLT (8 patients)

Cuff pressure at the end of surgery was significantly lower in the DLT group.

ASA-PS = I - II

DLT (12 patients)

There was no significant difference in POST occurrence between the two groups.

Andrews et al, 2009 [22]

90 patients

Cobra PLA™ (17 patients)

Insertion time was longer in Cobra PLA.

ASA-PS = I - IV

LMA (8 patients)

There was no significant difference in POST occurrence between the two groups.

Kihara et al, 2000 [23]

120 patients

ILM-BL (5%)

There was no difference in POST incidence and severity or hoarseness in the two groups.

ASA-PS = I - II

ILM-LW (6.6%)

Bennett et al, 2000 [28]

126 patients

Contents of the cuff

There was no significant difference in the occurrence of POST.

ASA-PS = I - II

Air (15.6%)

There was no significant difference between intubation time and cuff pressure and the occurrence of POST.

Saline solution (14.5%)

Gastric tube insertion was a confounding factor in the occurrence of POST.

Lomax et al, 2011 [31]

110 patients

GlideRite^® (2: 0 - 3)

There was no significant difference in the incidence of POST.

ASA-PS = I - II

Pre-rotated RAE™ (2: 0 - 5)

Schaefer et al, 1994 [32]

100 patients

Laryngoscopic (16%)

There was no significant difference in complications between the two groups.

ASA-PS = I - II

Fiber optic (14%)

**Table 2.** Relationship Between Anesthesia Techniques and Postoperative Sore Throat
Author	Time to secure airway	POST occurrence status
POST: postoperative sore throat; FAST: Foley Airway Stylet Tool; IT: introducer tool; LMA: laryngeal mask airway; AWS: airway scope; PLA: Cobra perilaryngeal airway; ILM-BL: blind intubation through the intubating laryngeal mask; ILM-LW: light wand-guided intubation through the intubating laryngeal mask.
Chen et al, 2014 [19]	FAST: 17.1 ± 6.1 s	FAST (21.2%), IT (6.8%)
	IT: 12.6 ± 4.7 s
Tan et al, 2005 [20]	LMA Classic™: 32.9 s (15 - 65 s)	LMA Classic™ (41%)
	LMA Unique™: 39.6 s (16 - 130 s)	LMA Unique™ (14%)
	SoftSeal™: 49.4 s (13 - 300 s)	SoftSeal™ (42%)
Bein et al, 2004 [21]	Bonfils, mean: 40 s	Bonfils, median: 4 (0 - 4)
	LMA, mean: 28 s	LMA, median: 3 (0 - 6)
Teoh et al, 2009 [30]	Pentax AWS, mean: 18.9 s	Pentax AWS: (0%)
	Glidescope, mean: 27.8 s	Glidescope: (18.6%)
Andrews et al, 2009 [22]	Cobra PLA™: 39 ± 21 s	Cobra PLA™ (17 patients)
	LMA: 27 ± 10 s	LMA: (8 patients)
Kihara et al, 2005 [23]	ILM-BL: 66 s	ILM-BL (5%)
	ILM-LW: 46 s	ILM-LW (6.6%)
Shariffuddin et al, 2017 [24]	Three levels of tube insertion ease (easy, acceptable, and difficult)	Ambu^®AuraGain™ (10%)
	Ambu^®AuraGain™ (48%:40%:12%)	LMASupreme™ (38%)
	LMASupreme™ (74%:18%:10%)

Table 2. Relationship Between Anesthesia Techniques and Postoperative Sore Throat

Author

Time to secure airway

POST occurrence status

POST: postoperative sore throat; FAST: Foley Airway Stylet Tool; IT: introducer tool; LMA: laryngeal mask airway; AWS: airway scope; PLA: Cobra perilaryngeal airway; ILM-BL: blind intubation through the intubating laryngeal mask; ILM-LW: light wand-guided intubation through the intubating laryngeal mask.

Chen et al, 2014 [19]

FAST: 17.1 ± 6.1 s

FAST (21.2%), IT (6.8%)

IT: 12.6 ± 4.7 s

Tan et al, 2005 [20]

LMA Classic™: 32.9 s (15 - 65 s)

LMA Classic™ (41%)

LMA Unique™: 39.6 s (16 - 130 s)

LMA Unique™ (14%)

SoftSeal™: 49.4 s (13 - 300 s)

SoftSeal™ (42%)

Bein et al, 2004 [21]

Bonfils, mean: 40 s

Bonfils, median: 4 (0 - 4)

LMA, mean: 28 s

LMA, median: 3 (0 - 6)

Teoh et al, 2009 [30]

Pentax AWS, mean: 18.9 s

Pentax AWS: (0%)

Glidescope, mean: 27.8 s

Glidescope: (18.6%)

Andrews et al, 2009 [22]

Cobra PLA™: 39 ± 21 s

Cobra PLA™ (17 patients)

LMA: 27 ± 10 s

LMA: (8 patients)

Kihara et al, 2005 [23]

ILM-BL: 66 s

ILM-BL (5%)

ILM-LW: 46 s

ILM-LW (6.6%)

Shariffuddin et al, 2017 [24]

Three levels of tube insertion ease (easy, acceptable, and difficult)

Ambu^®AuraGain™ (10%)

Ambu^®AuraGain™ (48%:40%:12%)

LMASupreme™ (38%)

LMASupreme™ (74%:18%:10%)

**Table 3.** Relationship Between Cuff Pressure and Postoperative Sore Throat
Author	Cuff pressure	Occurrence of POST
POST: postoperative sore throat; LT-R: reusable laryngeal tube; LT-D: disposable laryngeal tube.
Amini et al, 2007 [27]	LT-R: 55.1 cm H₂O	LT-R (8 patients)
	LT-D: 61.7 cm H₂O	LT-D (12 patients)
Bennett et al, 2000 [28]	The air group: in the air group mean intra-cuff pressure increased significantly (start: 14.0 mm Hg, end: 40.9 mm Hg)	Air (15.6%), saline solution (14.5%)
	The saline solution group: in the saline group there was no significant increase (start: 12.7 mm Hg, end: 14.6 mm Hg).

Table 3. Relationship Between Cuff Pressure and Postoperative Sore Throat

Author

Cuff pressure

Occurrence of POST

POST: postoperative sore throat; LT-R: reusable laryngeal tube; LT-D: disposable laryngeal tube.

Amini et al, 2007 [27]

LT-R: 55.1 cm H₂O

LT-R (8 patients)

LT-D: 61.7 cm H₂O

LT-D (12 patients)

Bennett et al, 2000 [28]

The air group: in the air group mean intra-cuff pressure increased significantly (start: 14.0 mm Hg, end: 40.9 mm Hg)

Air (15.6%), saline solution (14.5%)

The saline solution group: in the saline group there was no significant increase (start: 12.7 mm Hg, end: 14.6 mm Hg).

**Table 4.** Predictors of Postoperative Sore Throat
Author	Predictors	OR	95% CI	P value
POST: postoperative sore throat; ASA-PS: American Society of Anesthesiologists physical status; ETT: endotracheal tube; FM: facemask; LMA: laryngeal mask airway; PONV: postoperative nausea and vomiting; OR: odds ratio; CI: confidence interval.
Higgins et al, 2002 [2]	Age (in 10-year increments)	0.92	0.85 - 0.98	0.05
	Sex, male/female	0.76	0.59 - 0.99	0.05
	ASA-PS III vs. I/II	0.45	0.21 - 0.94	0.05
	Postoperative stay, every 30 min	1.05	1.01 - 1.10	0.05
	Succinylcholine	1.67	1.25 - 2.23	0.0005
	ETT vs. FM	12.4	8.83 - 17.39	0.0001
	LMA vs. FM	5.26	3.79 - 7.29	0.0001
	Ophthalmic surgery	0.58	0.40 - 0.84	0.01
	Gynecologic surgery	1.52	1.14 - 2.03	0.01
Biro et al, 2005 [29]	Female	1.66		0.003
	Bloodstain on intubation tube	4.81		0.001
	Artificial tooth	0.46		0.001
	History of respiratory disease	3.12		0.02
	Young patients (per year)	0.98		0.001
	Anesthesia time	1.27		0.001
	History of PONV	0.29		0.001

Table 4. Predictors of Postoperative Sore Throat

Author

Predictors

95% CI

P value

POST: postoperative sore throat; ASA-PS: American Society of Anesthesiologists physical status; ETT: endotracheal tube; FM: facemask; LMA: laryngeal mask airway; PONV: postoperative nausea and vomiting; OR: odds ratio; CI: confidence interval.

Higgins et al, 2002 [2]

Age (in 10-year increments)

0.92

0.85 - 0.98

0.05

Sex, male/female

0.76

0.59 - 0.99

0.05

ASA-PS III vs. I/II

0.45

0.21 - 0.94

0.05

Postoperative stay, every 30 min

1.05

1.01 - 1.10

0.05

Succinylcholine

1.67

1.25 - 2.23

0.0005

ETT vs. FM

12.4

8.83 - 17.39

0.0001

LMA vs. FM

5.26

3.79 - 7.29

0.0001

Ophthalmic surgery

0.58

0.40 - 0.84

0.01

Gynecologic surgery

1.52

1.14 - 2.03

0.01

Biro et al, 2005 [29]

Female

1.66

0.003

Bloodstain on intubation tube

4.81

0.001

Artificial tooth

0.46

0.001

History of respiratory disease

3.12

0.02

Young patients (per year)

0.98

0.001

Anesthesia time

1.27

0.001

History of PONV

0.29

0.001