Tracheal tube size in adults undergoing elective surgery – a narrative review
- 16 May 2020
- journal article
- review article
- Published by Wiley in Anaesthesia
- Vol. 75 (11), 1529-1539
- https://doi.org/10.1111/anae.15041
Abstract
Tracheal tubes are routinely used in adults undergoing elective surgery. The size of the tracheal tube, defined by its internal diameter, is often generically selected according to sex, with 7–7.5 mm and 8–8.5 mm tubes recommended in women and men, respectively. Tracheal diameter in adults is highly variable, being narrowest at the subglottis, and is affected by height and sex. The outer diameter of routinely used tracheal tubes may exceed these dimensions, traumatise the airway and increase the risk of postoperative sore throat and hoarseness. These complications disproportionately affect women and may be mitigated by using smaller tracheal tubes (6–6.5 mm). Patient safety concerns about using small tracheal tubes are based on critical care populations undergoing prolonged periods of tracheal intubation and not patients undergoing elective surgery. The internal diameter of the tube corresponds to its clinical utility. Tracheal tubes as small as 6.0 mm will accommodate routinely used intubation aids, suction devices and slim‐line fibreoptic bronchoscopes. Positive pressure ventilation may be performed without increasing the risk of ventilator‐induced lung injury or air trapping, even when high minute volumes are required. There is also no demonstrable increased risk of aspiration or cuff pressure damage when using smaller tracheal tubes. Small tracheal tubes may not be safe in all patients, such as those with high secretion loads and airflow limitation. A balanced view of risks and benefits should be taken appropriate to the clinical context, to select the smallest tracheal tube that permits safe peri‐operative management.This publication has 108 references indexed in Scilit:
- The Size of Endotracheal Tube and Sore Throat after Surgery: A Systematic Review and Meta-AnalysisPLOS ONE, 2013
- Size matters: choosing the right tracheal tubeAnaesthesia, 2012
- Gender differences in risk factors for airway symptoms following tracheal intubationActa Anaesthesiologica Scandinavica, 2012
- A smaller endotracheal tube combined with intravenous lidocaine decreases post‐operative sore throat – a randomized controlled trialActa Anaesthesiologica Scandinavica, 2012
- The effect of tracheal tube size on air leak around the cuffsKorean Journal of Anesthesiology, 2011
- Endotracheal tube size and sore throat following surgery: a randomized‐controlled studyActa Anaesthesiologica Scandinavica, 2010
- Post tracheostomy and post intubation tracheal stenosis: Report of 31 cases and review of the literatureBMC Pulmonary Medicine, 2008
- Correlation of Endotracheal Tube Size with Sore Throat and Hoarseness Following General AnesthesiaAnesthesiology, 1987
- A study of post‐intubation laryngeal dysfunctionThe Laryngoscope, 1985