Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparison of the Effect of Lidocaine and Ketamine Gargle and a Single Dose of Altadine Tablets on Sore Throat in Patients Under General Anesthesia After Endotracheal Intubation

Document Type : Original Article(s)

Authors
Seyed Mohammad Reza Safavi 1
Azim Honarmand 1
Yasman Aran 2
1 Professor, Anesthesiology and Critical Care Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Isfahan University of Medical Science, Isfahan, Iran
10.48305/jims.v43.i815.0520
Abstract
Background: One of the most important complications of general anesthesia and intubation is sore throat. This study aimed to compare the effect of gargling with ketamine and lidocaine to that of a single dose of Altadine tablets on sore throat after endotracheal intubation in patients under general anesthesia.
Methods: The present study is a single-blind randomized clinical trial that was performed on 299 patients undergoing general anesthesia by endotracheal intubation in 2021-2022. Patients were randomly divided into 4 groups receiving gargles of lidocaine, gargles of ketamine, sucking an altadine lozenge and a distilled water gargle. The patient's sore throat was measured in recovery ward and at 2, 6 and 24 hours after extubation by 11 ‐ point numeric rating scale (11 ‐ point NRS) and Visual Analogue Scale (VAS). Complications such as frequency of cough, time to starting the first feed, the timing and amount of analgesic consumption, the duration of sore throat and patient satisfaction were also recorded in the questionnaire.
Findings: Both NRS and VAS scores were significantly reduced in all groups during the study. Also, the NRS score was significantly lower in the lidocaine and ketamine groups than in the other groups at 2 and 6 hours after surgery (P < 0.001). The prevalence of cough (P = 0.01), time to starting the first feed (P = 0.03), amount of analgesic consumed and duration of sore throat (P = 0.01) were lower in the lidocaine and ketamine groups than in the other groups.
Conclusion: The use of lidocaine and ketamine was associated with a reduction in sore throat and duration of sore throat in patients. The prevalence of other complications such as cough was also lower in these patients.

Highlights

Seyed Mohammad Reza Safavi: Google Scholar

Azim Honarmand: Google Scholar 

Keywords
Sore Throat
Lidocaine
Ketamine
Altadine
Anesthesia
Patients

Subjects

  1. Furniss SS, Sneyd JR. Safe sedation in modern cardiological practice. Heart 2015; 101(19): 1526-30.
  2. Sahinovic MM, Struys MM, Absalom AR. Clinical pharmacokinetics and pharmacodynamics of propofol. Clin Pharmacokinet 2018; 57(12): 1539-58.
  3. Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines. Reg Anesth Pain Med 2018; 43(3): 263-309.
  4. Chidambaran V, Costandi A, D’Mello A. Propofol: a review of its role in pediatric anesthesia and sedation. CNS Drugs 2015; 29(7): 543-63.
  5. Feng AY, Kaye AD, Kaye RJ, Belani K, Urman RD. Novel propofol derivatives and implications for anesthesia practice. J Anaesthesiol Clin Pharmacol 2017; 33(1): 9-15.
  6. Lapinsky SE. Endotracheal intubation in the ICU. Crit Care 2015; 19(1): 258.
  7. De Jong A, Rolle A, Pensier J, Capdevila M, Jaber S. First-attempt success is associated with fewer complications related to intubation in the intensive care unit. Intensive Care Med 2020; 46(6): 1278-80.
  8. El‐Boghdadly K, Bailey C, Wiles M. Postoperative sore throat: a systematic review. Anaesthesia 2016; 71(6): 706-17.
  9. Inoue S, Abe R, Tanaka Y, Kawaguchi M. Tracheal intubation by trainees does not alter the incidence or duration of postoperative sore throat and hoarseness: a teaching hospital-based propensity score analysis. Br J Anaesth 2015; 115(3): 463-9.
  10. Singh NP, Makkar JK, Cappellani RB, Sinha A, Lakshminarasimhachar A, Singh PM. Efficacy of topical agents for prevention of postoperative sore throat after single lumen tracheal intubation: a Bayesian network meta-analysis. Can J Anaesth 2020; 67(11): 1624-42.
  11. Kuriyama A, Maeda H. Preoperative intravenous dexamethasone prevents tracheal intubation-related sore throat in adult surgical patients: a systematic review and meta-analysis. Can J Anesth/J Can Anesth 2019; 66(5): 562-75.
  12. Chang J-E, Min S-W, Kim C-S, Han S-H, Kwon Y-S, Hwang J-Y. Effect of prophylactic benzydamine hydrochloride on postoperative sore throat and hoarseness after tracheal intubation using a double-lumen endobronchial tube: a randomized controlled trial. Can J Anaesth 2015; 62(10): 1097-103.
  13. Tanaka Y, Nakayama T, Nishimori M, Tsujimura Y, Kawaguchi M, Sato Y. Lidocaine for preventing postoperative sore throat. Cochrane Database Syst Rev 2015; 2015(7): CD004081.
  14. Teymourian H, Mohajerani SA, Farahbod A. Magnesium and ketamine gargle and postoperative sore throat. Anesth Pain Med 2015; 5(3): e22367 .
  15. Chigbu DI, Coyne AM. Update and clinical utility of alcaftadine ophthalmic solution 0.25% in the treatment of allergic conjunctivitis. Clin Ophthalmol 2015; 9: 1215-25.
  16. Kuriyama A, Nakanishi M, Kamei J, Sun R, Ninomiya K, Hino M. Topical application of ketamine to prevent postoperative sore throat in adults: a systematic review and meta‐analysis. Acta Anaesthesiol Scand 2020; 64(5): 579-91.
  17. Aigbedia S, Tobi K, Amadasun F. A comparative study of ketamine gargle and lidocaine jelly application for the prevention of postoperative throat pain following general anaesthesia with endotracheal intubation. Niger J Clin Pract 2017; 20(6): 677-85.
  18. Kajal K, Dharmu D, Bhukkal I, Yaddanapudi S, Soni SL, Kumar M, et al. Comparison of three different methods of attenuating postoperative sore throat, cough, and hoarseness of voice in patients undergoing tracheal intubation. Anesth Essays Res 2019; 13(3): 572-6.
  19. Charan SD, Khilji MY, Jain R, Devra V, Saxena M. Inhalation of ketamine in different doses to decrease the severity of postoperative sore throat in surgeries under general anesthesia patients. Anesth Essays Res 2018; 12(3): 625-9.
  20. Segaran S, Bacthavasalame AT, Venkatesh RR, Zachariah M, George SK, Kandasamy R. Comparison of nebulized ketamine with nebulized magnesium sulfate on the incidence of postoperative sore throat. Anesth Essays Res 2018; 12(4): 885-90.
  21. 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.
Journal of Isfahan Medical School
Volume 43, Issue 815
3rd Week, July
July and August 2025
Pages 520-526

  • Receive Date 13 May 2025
  • Accept Date 23 June 2025