Intravenous dexamethasone versus ketamine gargle versus intravenous dexamethasone combined with ketamine gargle for evaluation of post-operative sore throat and hoarseness: A randomized, placebo-controlled, double blind clinical trial

Authors

Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, 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 (IV) dexamethasone plus ketamine gargle for reducing the incidence and severity of post-operative sore throat (POST) and hoarseness.
Materials and Methods : 140 patients (aged 16-65 year) scheduled for elective surgery were enrolled. Patients were randomly allocated into four groups of 35 subjects each: Group K, gargled 40 mg ketamine in 30 ml saline; Group D, were infused 0.2 mg/kg IV dexamethasone; Group KD, gargled 40 mg ketamine in 30 ml saline plus 0.2 mg/kg IV dexamethasone; Group P (placebo) that received saline (gargle and IV). POST was graded at 0, 2, 4, 8, 16 and 24 h after operation on a four-point scale (0-3).
Results : 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 h (P < 0.05). Also the incidence and severity of hoarseness were significantly lower in each Groups of KD and K and D compared with group placebo (P < 0.05).
Conclusion: The prophylactic use of 0.2 mg/kg of IV dexamethasone plus ketamine gargle significantly reduced the incidence and severity of POST compared with using each of these drugs alone or using placebo.

Keywords

1.
Chandler M. Tracheal intubation and sore throat: A mechanical explanation. Anaesthesia 2002;57:155-61.  Back to cited text no. 1
    
2.
Yamanaka H, Hayashi Y, Watanabe Y, Uematu H, Mashimo T. Prolonged hoarseness and arytenoid cartilage dislocation after tracheal intubation. Br J Anaesth 2009;103:452-5.  Back to cited text no. 2
    
3.
Bein B, Carstensen S, Gleim M, Claus L, Tonner PH, Steinfath M, et al. A comparison of the proseal laryngeal mask airway, the laryngeal tube S and the oesophageal-tracheal combitube during routine surgical procedures. Eur J Anaesthesiol 2005;22:341-6.  Back to cited text no. 3
    
4.
Ahmed A, Abbasi S, Ghafoor HB, Ishaq M. Postoperative sore throat after elective surgical procedures. J Ayub Med Coll Abbottabad 2007;19:12-4.  Back to cited text no. 4
    
5.
Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory surgery. Br J Anaesth 2002;88:582-4.  Back to cited text no. 5
    
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;98:1049-56.  Back to cited text no. 6
    
7.
Navarro LH, Braz JR, Nakamura G, Lima RM, Silva Fde P, Módolo NS. Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: A randomized clinical trial. Sao Paulo Med J 2007;125:322-8.  Back to cited text no. 7
    
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;99:1253-7.  Back to cited text no. 8
    
9.
McIntosh CA, Macario A. Managing quality in an anesthesia department. Curr Opin Anaesthesiol 2009;22:223-31.  Back to cited text no. 9
    
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;100:215-8.  Back to cited text no. 10
    
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;107:1814-8.  Back to cited text no. 11
    
12.
Elhakim M, Siam A, Rashed I, Hamdy MH. Topical tenoxicam from pharyngeal pack reduces postoperative sore throat. Acta Anaesthesiol Scand 2000;44:733-6.  Back to cited text no. 12
    
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;51:239-43.  Back to cited text no. 13
    
14.
Kazemi A, Amini A. The effect of betamethasone gel in reducing sore throat, cough, and hoarseness after laryngo-tracheal intubation. Middle East J Anesthesiol 2007;19:197-204.  Back to cited text no. 14
    
15.
Honarmand A, Safavi M. Beclomethasone inhaler versus intravenous lidocaine in the prevention of postoperative airway and throat complaints: A randomized, controlled trial. Ann Saudi Med 2008;28:11-6.  Back to cited text no. 15
    
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;18:179-83.  Back to cited text no. 16
    
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;101:290-3.  Back to cited text no. 17
    
18.
Canbay O, Celebi N, Sahin A, Celiker V, Ozgen S, Aypar U. Ketamine gargle for attenuating postoperative sore throat. Br J Anaesth 2008;100:490-3.  Back to cited text no. 18
    
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;92:541-3.  Back to cited text no. 19
    
20.
Thomas S, Beevi S. Dexamethasone reduces the severity of postoperative sore throat. Can J Anaesth 2007;54:897-901.  Back to cited text no. 20
    
21.
Berrino L, Oliva P, Massimo F, Aurilio C, Maione S, Grella A, et al. Antinociceptive effect in mice of intraperitoneal N-methyl-D-aspartate receptor antagonists in the formalin test. Eur J Pain 2003;7:131-7.  Back to cited text no. 21
    
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.  Back to cited text no. 22
    
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;21:259-71.  Back to cited text no. 23
    
24.
Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia 1993;48:961-4.  Back to cited text no. 24
    
25.
Elhakim M, Ali NM, Rashed I, Riad MK, Refat M. Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy. Can J Anaesth 2003;50:392-7.  Back to cited text no. 25
    
26.
Schmelzeisen R, Frölich JC. Prevention of postoperative swelling and pain by dexamethasone after operative removal of impacted third molar teeth. Eur J Clin Pharmacol 1993;44:275-7.  Back to cited text no. 26
    
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;89:200-3.  Back to cited text no. 27
    
28.
Wei JL, Kasperbauer JL, Weaver AL, Boggust AJ. Efficacy of single-dose dexamethasone as adjuvant therapy for acute pharyngitis. Laryngoscope 2002;112:87-93.  Back to cited text no. 28
    
29.
Roy M, Bailey B, Amre DK, Girodias JB, Bussières 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;158:250-4.  Back to cited text no. 29
    
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:R72.  Back to cited text no. 30
    
31.
Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984;39:1105-11.  Back to cited text no. 31
    
32.
Das PK, Thomas WJ. Complication of pharyngeal suction. Anaesth Intensive Care 1980;8:375-6.  Back to cited text no. 32
    
33.
American Society of Anesthesiologists Task Force on Postanesthetic Care. Practice guidelines for postanesthetic care: A report by the American society of anesthesiologists task force on postanesthetic care. Anesthesiology 2002;96:742-52.  Back to cited text no. 33
    
34.
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;10:244-51.  Back to cited text no. 34
    
35.
Stout DM, Bishop MJ, Dwersteg JF, Cullen BF. Correlation of endotracheal tube size with sore throat and hoarseness following general anesthesia. Anesthesiology 1987;67:419-21.  Back to cited text no. 35
    
36.
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;95:1120-4.  Back to cited text no. 36
    
37.
Carlton SM, Coggeshall RE. Inflammation-induced changes in peripheral glutamate receptor populations. Brain Res 1999;820:63-70.  Back to cited text no. 37
    
38.
Carlton SM, Zhou S, Coggeshall RE. Evidence for the interaction of glutamate and NK1 receptors in the periphery. Brain Res 1998;790:160-9.  Back to cited text no. 38
    
39.
Deming MV, Oech SR. Steroid and antihistaminic therapy for post intubation subglottic edema in infants and children. Anesthesiology 1961;22:933-6.  Back to cited text no. 39
    
40.
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. 8 th ed. New York: Pergamon Press; 1990. p. 1431-62.  Back to cited text no. 40