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Endotracheal Tube Sizes During Surgical Procedures in Adult Patients. A Systematic Review With Meta-Analyses and
Simone Bauer1, Louise Stenbryggen Herløv1, Jakob Hessel Andersen1,2
1Department of Anesthesiology, Zealand University Hospital, Køge, Denmark.
Acta Anaesthesiologica Scandinavica
|June 12, 2025
Summary
Choosing smaller endotracheal tubes may reduce postoperative sore throat and hoarseness in adult surgical patients. However, more high-quality research is needed due to the current evidence limitations.
Area of Science:
- Anesthesiology
- Perioperative Medicine
- Critical Care
Background:
- Endotracheal intubation is a common procedure with limited research on the impact of endotracheal tube (ETT) size on perioperative outcomes.
- Patient comfort and recovery are often overlooked aspects of ETT selection.
- This review synthesizes evidence on the benefits and harms of different ETT sizes in adults undergoing general anesthesia.
Purpose of the Study:
- To evaluate the impact of smaller versus larger ETT sizes on postoperative sore throat and hoarseness.
- To assess the influence of ETT size on airway injury, re-intubations, and adverse events.
- To provide evidence-based recommendations for ETT selection in elective surgical procedures.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Inclusion of randomized clinical trials (RCTs) comparing different ETT sizes.
- Comprehensive literature search across CENTRAL, OVID, and EMBASE databases, last updated February 10, 2025.
Main Results:
- Six RCTs with 917 patients were included.
- Smaller ETT sizes significantly reduced postoperative sore throat and hoarseness at 1 and 24 hours.
- No significant differences were observed in adverse events or airway injury between smaller and larger ETTs.
Conclusions:
- Smaller ETTs may improve patient comfort and recovery post-intubation.
- The current evidence is of very low to moderate quality with a high risk of bias.
- Further high-quality RCTs are necessary to confirm these findings and guide clinical practice.
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