Intravenous Dexamethasone vs. Ketamine Gargle vs. Intravenous Dexamethasone Combined with Ketamine Gargle for Evaluation of Post-Operative Sore Throat and Hoarseness: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Anesthesia, Ayatollah Kashani Hospital, Isfahan, Iran

4 Department of Nursing, Ayatollah Kashani Hospital, Isfahan, Iran

Abstract

Background: Sore throat and hoarseness are the most frequent subjective complaints after tracheal intubation for general anesthesia. We conducted a prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of intravenous dexamethasone plus ketamine gargle for reducing the incidence and severity of post-operative sore throat (POST) and hoarseness.Methods: 140 patients (aged 16-65 years) scheduled for elective surgery were enrolled. Patients were randomly allocated into four groups of 35 subjects: group K gargled 40 mg ketamine in 30 ml saline; group D were infused 0.2 mg/kg intravenous (IV) dexamethasone; group KD gargled 40 mg ketamine in 30 ml saline plus 0.2 mg/kg intravenous dexamethasone; and group P (placebo) received saline (gargle and IV). POST was graded at 0, 2, 4, 8, 16 and 24 hours after operation on a four-point scale (0–3).Findings: The incidence and severity of POST were significantly lower in group KD, compared with the other groups at all times after tracheal extubation for up to 24 hours (P < 0.05). Also, the incidence and severity of hoarseness were significantly lower in groups of KD, K and D compared with group P (P < 0.05).Conclusion: The prophylactic use of 0.2 mg/kg of intravenous dexamethasone plus ketamine gargle significantly reduced the incidence and severity of POST compared with using each of these drugs alone or using placebo.

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  1. McHardy FE, Chung F. Postoperative sore throat: cause, prevention and treatment. Anaesthesia 1999; 54(5): 444-53.
  2. Jones MW, Catling S, Evans E, Green DH, Green JR. Hoarseness after tracheal intubation. Anaesthesia 1992; 47(3): 213-6.
  3. Oczenski W, Krenn H, Dahaba AA, Binder M, El-Schahawi-Kienzl I, Kohout S, et al. Complications following the use of the Combitube, tracheal tube and laryngeal mask airway. Anaesthesia 1999; 54(12): 1161-5.
  4. Christensen AM, Willemoes-Larsen H, Lundby L, Jakobsen KB. Postoperative throat complaints after tracheal intubation. Br J Anaesth 1994; 73(6): 786-7.
  5. Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory surgery. Br J Anaesth 2002; 88(4): 582-4.
  6. Mencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert PK, et al. Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology 2003; 98(5): 1049-56.
  7. Loeser EA, Bennett GM, Orr DL, Stanley TH. Reduction of postoperative sore throat with new endotracheal tube cuffs. Anesthesiology 1980; 52(3): 257-9.
  8. Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg 2004; 99(4): 1253-7, table.
  9. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89(3): 652-8.
  10. Sumathi PA, Shenoy T, Ambareesha M, Krishna HM. Controlled comparison between betamethasone gel and lidocaine jelly applied over tracheal tube to reduce postoperative sore throat, cough, and hoarseness of voice. Br J Anaesth 2008; 100(2): 215-8.
  11. Park SH, Han SH, Do SH, Kim JW, Rhee KY, Kim JH. Prophylactic dexamethasone decreases the incidence of sore throat and hoarseness after tracheal extubation with a double-lumen endobronchial tube. Anesth Analg 2008; 107(6): 1814-8.
  12. Elhakim M, Siam A, Rashed I, Hamdy MH. Topical tenoxicam from pharyngeal pack reduces postoperative sore throat. Acta Anaesthesiol Scand 2000; 44(6): 733-6.
  13. Gulhas N, Canpolat H, Cicek M, Yologlu S, Togal T, Durmus M, et al. Dexpanthenol pastille and benzydamine hydrochloride spray for the prevention of post-operative sore throat. Acta Anaesthesiol Scand 2007; 51(2): 239-43.
  14. Ayoub CM, Ghobashy A, Koch ME, McGrimley L, Pascale V, Qadir S, et al. Widespread application of topical steroids to decrease sore throat, hoarseness, and cough after tracheal intubation. Anesth Analg 1998; 87(3): 714-6.
  15. el Hakim M. Beclomethasone prevents postoperative sore throat. Acta Anaesthesiol Scand 1993; 37(3): 250-2.
  16. Al-Qahtani AS, Messahel FM. Quality improvement in anesthetic practice--incidence of sore throat after using small tracheal tube. Middle East J Anesthesiol 2005; 18(1): 179-83.
  17. Ogata J, Minami K, Horishita T, Shiraishi M, Okamoto T, Terada T, et al. Gargling with sodium azulene sulfonate reduces the postoperative sore throat after intubation of the trachea. Anesth Analg 2005; 101(1): 290-3, table.
  18. Canbay O, Celebi N, Sahin A, Celiker V, Ozgen S, Aypar U. Ketamine gargle for attenuating postoperative sore throat. Br J Anaesth 2008; 100(4): 490-3.
  19. Maruyama K, Sakai H, Miyazawa H, Toda N, Iinuma Y, Mochizuki N, et al. Sore throat and hoarseness after total intravenous anaesthesia. Br J Anaesth 2004; 92(4): 541-3.
  20. Thomas S, Beevi S. Dexamethasone reduces the severity of postoperative sore throat. Can J Anaesth 2007; 54(11): 897-901.
  21. Davidson EM, Carlton SM. Intraplantar injection of dextrorphan, ketamine or memantine attenuates formalin-induced behaviors. Brain Res 1998; 785(1): 136-42.
  22. Zhu MM, Zhou QH, Zhu MH, Rong HB, Xu YM, Qian YN, et al. Effects of nebulized ketamine on allergen-induced airway hyperresponsiveness and inflammation in actively sensitized Brown-Norway rats. J Inflamm (Lond) 2007; 4: 10.
  23. Chizh BA. Low dose ketamine: a therapeutic and research tool to explore N-methyl-D-aspartate (NMDA) receptor-mediated plasticity in pain pathways. J Psychopharmacol 2007; 21(3): 259-71.
  24. Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia 1993; 48(11): 961-4.
  25. Elhakim M, Ali NM, Rashed I, Riad MK, Refat M. Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy. Can J Anaesth 2003; 50(4): 392-7.
  26. Schmelzeisen R, Frolich JC. Prevention of postoperative swelling and pain by dexamethasone after operative removal of impacted third molar teeth. Eur J Clin Pharmacol 1993; 44(3): 275-7.
  27. Wang JJ, Ho ST, Lee SC, Liu YC, Liu YH, Liao YC. The prophylactic effect of dexamethasone on postoperative nausea and vomiting in women undergoing thyroidectomy: a comparison of droperidol with saline. Anesth Analg 1999; 89(1): 200-3.
  28. Wei JL, Kasperbauer JL, Weaver AL, Boggust AJ. Efficacy of single-dose dexamethasone as adjuvant therapy for acute pharyngitis. Laryngoscope 2002; 112(1): 87-93.
  29. Roy M, Bailey B, Amre DK, Girodias JB, Bussieres JF, Gaudreault P. Dexamethasone for the treatment of sore throat in children with suspected infectious mononucleosis: a randomized, double-blind, placebo-controlled, clinical trial. Arch Pediatr Adolesc Med 2004; 158(3): 250-4.
  30. Lee CH, Peng MJ, Wu CL. Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study. Crit Care 2007; 11(4): R72.
  31. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39(11): 1105-11.
  32. Das PK, Thomas WJ. Complication of pharyngeal suction. Anaesth Intensive Care 1980; 8(3): 375-6.
  33. Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, et al. Validity and reliability of the Observer's Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol 1990; 10(4): 244-51.
  34. Stout DM, Bishop MJ, Dwersteg JF, Cullen BF. Correlation of endotracheal tube size with sore throat and hoarseness following general anesthesia. Anesthesiology 1987; 67(3): 419-21.
  35. Combes X, Schauvliege F, Peyrouset O, Motamed C, Kirov K, Dhonneur G, et al. Intracuff pressure and tracheal morbidity: influence of filling with saline during nitrous oxide anesthesia. Anesthesiology 2001; 95(5): 1120-4.
  36. Carlton SM, Coggeshall RE. Inflammation-induced changes in peripheral glutamate receptor populations. Brain Res 1999; 820(1-2): 63-70.
  37. Carlton SM, Zhou S, Coggeshall RE. Evidence for the interaction of glutamate and NK1 receptors in the periphery. Brain Res 1998; 790(1-2): 160-9.
  38. DEMING MV, OECH SR. Steroid and antihistaminic therapy for post intubation subglottic edema in infants and children. Anesthesiology 1961; 22: 933-6.
  39. Haynes RC. Adrenocorticotropic hormones; adrenocortical steroids and their synthetic analogues; inhibitors of the synthesis and actions of adrenocortical hormones. In: Goodman A, Rall T, Nies A, editors. The pharmacological basis of therapeutics. 8th ed. New York, NY: Pergamon Press; 1990. p. 1431-62.