| Abstract |
Background
The trauma to the upper airway is a frequent incident in individuals undergoing surgical procedures under general anaesthesia. This occurrence is due to the act of endotracheal intubation. Patient-related factors, intubation technique, operator’s experience and other anaesthetic-related circumstances can lead to injuries. Patients may complain about a variety of symptoms whose management can be challenging. The most usual postsurgical patients’ complaints seem to be dysphonia, dysphagia and sore throat.
Objective
The aim of the MSc thesis is the study of the incidence and the risk factors of trauma to the upper airway related to endotracheal intubation (ETI) in ear, nose and throat surgical procedures. An additional objective is the investigation of interrelationship of trauma to the upper airway with patients’ characteristics and dysphonia, dysphagia and sore throat.
Methods
This study is a prospective cross-sectional, single-center, six month-duration study conducted at “Benizeleio-Pananeio” General Hospital of Heraklion to evaluate the incidence of trauma to the upper airway related to endotracheal intubation in ENT surgical procedures. 100 adult patients participated in this study, who underwent ENT surgical procedures from June 2021 to January 2022, except from patient who underwent tonsillectomy. Clinical examination of the oral cavity and the upper airway was conducted pre- and post-operatively. The patients’ demographics and details related to anaesthesia procedure, operation and post-surgical period were recorded. They filled up the Voice Handicap Index (VHI-30), Eating Assessment Tool (EAT-10) and Visual analog scale (VAS) self- administered questionnaires in order to evaluate the voice disorders, the dysphagia and the sore throat. Data processing was carried out with the SPSS Software (Statistical Package for Social Sciences) version 26. The significance level was set at 0.05.
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Results
22% of participants developed laryngeal trauma. In 19 patients showed hyperemia and edema, one patient was observed with diffuse swelling of the mucosa of the laryngeal ventricles and two patients presented unilateral vocal cord paralysis. 25% of participants developed mild injuries to the oral cavity, grade 1. The co-existed laryngeal and oral cavity injuries rose in 6%. The patients who showed laryngeal trauma were significantly older than those who had no trauma (55,95±12,51 versus 42,83±15,48, p=0,0004). The duration of surgical procedure, the duration of ETI and the kind of operation presented significant correlation with the laryngeal injury (p= 0,0144, p=0,0469 and p=0,0026, respectively). The trauma to the upper airway was not related to higher VAS, VHI ή EAT-10 score.
Conclusion
The trauma to the upper airway is indicated as a common, but mild, consequence of endotracheal intubation in surgical procedures. Studies with greater number of patients are necessary for unveiling the risk factors related to the airway management and the surgical operation.
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