{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T23:54:32Z","timestamp":1789170872792,"version":"build-2803163510"},"reference-count":45,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Endotracheal tube (ETT) intubation during general anesthesia (GA) is commonly associated with postoperative sore throat. This study aimed to evaluate whether thermal-softened ETTs reduce the postoperative sore throat incidence in patients undergoing elective surgery under GA. Methods: We conducted a comprehensive search of the literature across PubMed, Cochrane Library, and EMBASE to identify randomized controlled trials (RCTs) evaluating the effect of thermal-softened ETTs on postoperative sore throat in patients undergoing elective surgeries under GA. The primary outcome was postoperative sore throat incidence, while secondary outcomes included hoarseness, vocal cord lesions, and time to intubation. Data were extracted independently by two authors, and the risk of bias was assessed using the Revised Cochrane risk of bias tool (version 2.0). A meta-analysis was then performed using the random-effects model, with the results expressed as risk ratios (RRs) and mean difference (MDs). Results: Eight studies, with a total of 970 participants, were included. Thermal-softened ETTs significantly reduced postoperative sore throat incidence (RR: 0.60, 95% CI: 0.44 to 0.82, p = 0.001). Subgroup analysis showed no difference for single-lumen tubes (RR: 0.76, 95% CI: 0.45 to 1.26, p = 0.28), but remained significant for double-lumen tubes (RR: 0.5, 95% CI: 0.39 to 0.65, p &lt; 0.00001). No significant difference was found in hoarseness (RR: 0.86, 95% CI: 0.64 to 1.17, p = 0.34), but a lower incidence of vocal cord lesions (RR: 0.52, 95% CI: 0.40 to 0.68, p &lt; 0.00001) was observed. No difference was found in the time to intubation (MD: \u22126.51, 95% CI: \u221220.04 to 7.02, p = 0.35). Conclusions: Thermal-softened ETTs may reduce the incidence of postoperative sore throat and vocal cord lesions but have no significant effect on hoarseness or intubation time.<\/jats:p>","DOI":"10.3390\/jcm14113620","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T07:04:28Z","timestamp":1747897468000},"page":"3620","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Effect of Thermal-Softened Endotracheal Tubes on Postoperative Sore Throat and Other Complications\u2014A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"given":"Hui-Zen","family":"Hee","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao District, New Taipei City 220, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen-Hsi","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao District, New Taipei City 220, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Wei","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao District, New Taipei City 220, Taiwan"},{"name":"Department of Mechanical Engineering, Yuan Ze University, Taoyuan 320, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1111\/anae.13438","article-title":"Postoperative sore throat: A systematic review","volume":"71","author":"Bailey","year":"2016","journal-title":"Anaesthesia"},{"key":"ref_2","first-page":"1085","article-title":"Which Clinical Anesthesia Outcomes Are Both Common and Important to Avoid? The Perspective of a Panel of Expert Anesthesiologists","volume":"88","author":"Macario","year":"1999","journal-title":"Anesth. Analg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"88","DOI":"10.14740\/jocmr4665","article-title":"A Literature Review of Factors Related to Postoperative Sore Throat","volume":"14","author":"Mitobe","year":"2022","journal-title":"J. Clin. Med. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1093\/bja\/aeh098","article-title":"Sore throat and hoarseness after total intravenous anaesthesia","volume":"92","author":"Maruyama","year":"2004","journal-title":"Br. J. Anaesth."},{"key":"ref_5","first-page":"463","article-title":"Risk factors of post-operative sore throat and hoarseness","volume":"100","author":"Chinachoti","year":"2017","journal-title":"J. Med. Assoc. Thai"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1213\/01.ANE.0000181290.37527.CE","article-title":"Does the Timing of Tracheal Intubation Based on Neuromuscular Monitoring Decrease Laryngeal Injury? A Randomized, Prospective, Controlled Trial","volume":"102","author":"Mencke","year":"2006","journal-title":"Anesth. Analg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1213\/ANE.0000000000005521","article-title":"Comparative Efficacy of 6 Topical Pharmacological Agents for Preventive Interventions of Postoperative Sore Throat After Tracheal Intubation: A Systematic Review and Network Meta-analysis","volume":"133","author":"Wang","year":"2021","journal-title":"Anesth. Analg."},{"key":"ref_8","first-page":"188","article-title":"Novel preoperative pharmacologic methods of preventing postoperative sore throat due to tracheal intubation","volume":"82","author":"Kalil","year":"2014","journal-title":"Aana J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"137","DOI":"10.14235\/bas.galenos.2023.12754","article-title":"Non-pharmacological methods in the management of postoperative sore throat in patients undergoing endotracheal intubation: A systematic review","volume":"12","year":"2024","journal-title":"Bezmialem Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"103728","DOI":"10.1016\/j.iccn.2024.103728","article-title":"Effect of peri-intubation non-pharmacological interventions on postoperative laryngeal symptoms: A systematic review with meta-analysis and meta-regression","volume":"84","author":"Celik","year":"2024","journal-title":"Intensive Crit. Care Nurs."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e29999","DOI":"10.1097\/MD.0000000000029999","article-title":"Appropriate tube temperature for fiberoptic bronchoscope-guided intubation of thermally softened double-lumen endotracheal tubes: A CONSORT-compliant article","volume":"101","author":"Yu","year":"2022","journal-title":"Medicine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1213\/ANE.0000000000003822","article-title":"Is Tube Thermosoftening Helpful for Videolaryngoscope-Guided Nasotracheal Intubation?: A Randomized Controlled Trial","volume":"129","author":"Kim","year":"2019","journal-title":"Anesth. Analg."},{"key":"ref_15","first-page":"147","article-title":"Warming endotracheal tube in blind nasotracheal intubation throughout maxillofacial surgeries","volume":"5","author":"Hosseinzadeh","year":"2013","journal-title":"J. Cardiovasc. Thorac. Res."},{"key":"ref_16","first-page":"279","article-title":"Evaluating effectiveness of warming endotracheal tube in blind nasotracheal intubation in maxillofacial surgery","volume":"29","author":"Pasha","year":"2015","journal-title":"J. Postgrad. Med. Inst."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e123910","DOI":"10.5812\/aapm-123910","article-title":"The Effect of Softening of Endotracheal Tubes on the Decrement of Postoperative Hoarseness and Sore Throat","volume":"12","author":"Mohseni","year":"2022","journal-title":"Anesthesiol. Pain Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"158","DOI":"10.17085\/apm.2019.14.2.158","article-title":"Effect of a combination of 2% lidocaine jelly and thermally softened endotracheal tube on postoperative sore throat","volume":"14","author":"Song","year":"2019","journal-title":"Anesth. Pain Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/aas.13705","article-title":"Effects of thermal softening of endotracheal tubes on postoperative sore throat: A randomized double-blinded trial","volume":"65","author":"Yu","year":"2021","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3109","DOI":"10.1053\/j.jvca.2022.04.017","article-title":"Effects of Thermal Softening of Double-Lumen Endobronchial Tubes on the Prevention of Postoperative Sore Throat in Smokers: A Randomized Controlled Trial","volume":"36","author":"Bi","year":"2022","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1093\/bja\/aev414","article-title":"The effects of thermal softening of double-lumen endobronchial tubes on postoperative sore throat, hoarseness and vocal cord injuries: A prospective double-blind randomized trial","volume":"116","author":"Seo","year":"2016","journal-title":"Br. J. Anaesth."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Yan, W., Cai, J., Zhu, C., Chen, Y., Fang, J., Xu, H., Zheng, X., Zhou, Y., Xie, Y., and Zhang, M. (2023). Effect of thermal softening of double-lumen endobronchial tubes on postoperative sore throat in patients with prior SARS-CoV-2 infection: A randomized controlled trial. BMC Anesthesiol., 23.","DOI":"10.1186\/s12871-023-02363-y"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1213\/ANE.0b013e3181f2ecc7","article-title":"Correlations Between Controlled Endotracheal Tube Cuff Pressure and Postprocedural Complications: A Multicenter Study","volume":"111","author":"Liu","year":"2010","journal-title":"Anesth. Analg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1046\/j.1365-2044.1999.00780.x","article-title":"Postoperative sore throat: Cause, prevention and treatment","volume":"54","author":"McHardy","year":"1999","journal-title":"Anaesthesia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.bja.2019.11.033","article-title":"Intravenous lidocaine to prevent postoperative airway complications in adults: A systematic review and meta-analysis","volume":"124","author":"Yang","year":"2020","journal-title":"Br. J. Anaesth."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"15","DOI":"10.4097\/kjae.2010.58.1.15","article-title":"Prophylactic effect of dexamethasone in reducing postoperative sore throat","volume":"58","author":"Park","year":"2010","journal-title":"Korean J. Anesthesiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1213\/ANE.0000000000003842","article-title":"Effect of Intravenous Lidocaine, Dexamethasone, and Their Combination on Postoperative Sore Throat: A Randomized Controlled Trial","volume":"129","author":"Subedi","year":"2019","journal-title":"Anesth. Analg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jrsm.1411","article-title":"Risk-of-bias Visualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments","volume":"12","author":"McGuinness","year":"2020","journal-title":"Res. Synth. Methods"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1093\/bja\/88.4.582","article-title":"Postoperative sore throat after ambulatory surgery","volume":"88","author":"Higgins","year":"2002","journal-title":"Br. J. Anaesth."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jopan.2024.03.022","article-title":"Prediction of Postoperative Sore Throat in Patients After Day-case Surgery With General Anesthesia: A Retrospective Study","volume":"40","author":"Zhou","year":"2025","journal-title":"J. PeriAnesthesia Nurs."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1097\/00000542-198709000-00025","article-title":"Correlation of endotracheal tube size with sore throat and hoarseness following general anesthesia","volume":"67","author":"Stout","year":"1987","journal-title":"Anesthesiology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"25","DOI":"10.4103\/jlv.JLV_5_16","article-title":"Postintubation recurrent laryngeal nerve palsy: A review","volume":"7","author":"Matta","year":"2017","journal-title":"J. Laryngol. Voice"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.jvoice.2004.11.002","article-title":"Arytenoid Cartilage Dislocation: A 20-year Experience","volume":"19","author":"Rubin","year":"2005","journal-title":"J. Voice"},{"key":"ref_35","unstructured":"Wei, R., and De Jesus, O. (2023). Tapia syndrome. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1093\/bja\/aex228","article-title":"Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: A Cochrane Systematic Review","volume":"119","author":"Lewis","year":"2017","journal-title":"BJA Br. J. Anaesth."},{"key":"ref_37","unstructured":"Benumof, J. (1996). Airway Management: Principles and Practice, Mosby."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Wu, L., Shen, L., Zhang, Y., Zhang, X., and Huang, Y. (2018). Association between the use of a stylet in endotracheal intubation and postoperative arytenoid dislocation: A case-control study. BMC Anesthesiol., 18.","DOI":"10.1186\/s12871-018-0521-9"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1007\/s00266-011-9849-y","article-title":"Tapia\u2019s syndrome: An unexpected but real complication of rhinoplasty: Case report and literature review","volume":"36","author":"Lykoudis","year":"2012","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1093\/bja\/aet203","article-title":"Comparison of techniques for double-lumen endobronchial intubation: 90 or 180 rotation during advancement through the glottis","volume":"111","author":"Seo","year":"2013","journal-title":"Br. J. Anaesth."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Risse, J., Schubert, A.-K., Wiesmann, T., Huelshoff, A., Stay, D., Zentgraf, M., Kirschbaum, A., Wulf, H., Feldmann, C., and Meggiolaro, K.M. (2020). Videolaryngoscopy versus direct laryngoscopy for double-lumen endotracheal tube intubation in thoracic surgery\u2014A randomised controlled clinical trial. BMC Anesthesiol., 20.","DOI":"10.1186\/s12871-020-01067-x"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1213\/00000539-200009000-00038","article-title":"Thermosoftening Treatment of the Nasotracheal Tube Before Intubation Can Reduce Epistaxis and Nasal Damage","volume":"91","author":"Kim","year":"2000","journal-title":"Anesth. Analg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"143","DOI":"10.4103\/joacp.JOACP_140_20","article-title":"Blind nasal intubation in a \u2018breathing\u2019 manikin\u2014An idea","volume":"38","author":"Kumar","year":"2022","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Borenstein, M., Hedges, L.V., Higgins, J.P., and Rothstein, H.R. (2021). Introduction to Meta-Analysis, John Wiley & Sons.","DOI":"10.1002\/9781119558378"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2344\/anpr-69-01-05","article-title":"Risk Factors for Postoperative Sore Throat After Nasotracheal Intubation","volume":"69","author":"Tsukamoto","year":"2022","journal-title":"Anesth. Prog."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3620\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:38:11Z","timestamp":1760031491000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3620"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,22]]},"references-count":45,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14113620"],"URL":"https:\/\/doi.org\/10.3390\/jcm14113620","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,22]]}}}