Effect of endotracheal tube size on vocal outcomes after thyroidectomy: A randomized clinical trial

IMPORTANCE The optimum size of endotracheal tube (ETT) for general anesthesia remains unresolved. Choice of ETT sizemay be of particular relevance to thyroid surgery because of the increased risk of laryngeal trauma and concerns regarding postoperative vocal outcomes. OBJECTIVE To test our hypothesis that intubation with a smaller ETT would lead to reduced postoperative vocal impairment and associated reduced laryngoscopic evidence of laryngeal trauma compared with intubation with a standard-size ETT. DESIGN, SETTING, AND PARTICIPANTS This double-blind randomized clinical trial studied patients 18 years and older undergoing elective thyroidectomy at an academic teaching hospital from October 15, 2012, through June 13, 2013. INTERVENTIONS Patients were randomized to group 1 (standard-size ETT, 8.0mmfor men and 7.5mmfor women; n = 24) or group 2 (small ETT, 7.0mmfor men and 6.5mmfor women; n = 25). Patients were assessed preoperatively and at 24 hours and 3 weeks postoperatively. MAIN OUTCOMES AND MEASURES Fiberoptic videolaryngoscopy with modified scoring system, voice assessment using the GRBAS (grade, roughness, breathiness, asthenia, strain) rating scale, vocal self-assessment using the 30-item Voice Handicap Index, and subjective pain score. RESULTS At 24 hours, no significant differences were found between patients in groups 1 and 2 in change in GRBAS scores, change in laryngoscopic score (1.71 vs 1.76, P = .90), or postoperative pain score (3.3 vs 3.2, P = .91). At 3 weeks, no significant differences were found in changes in the 30-item Voice Handicap Index score (-2.2 vs -1.3, P = .74), GRBAS scores, or laryngoscopic score (0.25 vs 0.16, P = .67). CONCLUSIONS AND RELEVANCE We did not find evidence that smaller ETT size for thyroidectomy has any significant effect on postoperative vocal outcomes, incidence of laryngeal trauma as assessed by laryngoscopy, or pain scores. However, because of the small sample size, our study may have been underpowered to detect small differences.