THE EFFECT OF PROPHYLACTIC PREOPERATIVENEBULIZED KETAMINE VS. NEBULIZED DEXAMETHASONE ON POSTOPERATIVE SORE THROAT IN PATIENTS UNDERGOING SURGERY UNDER GENERAL ANESTHESIA: A RANDOMIZED, PLACEBO-CONTROLLED, DOUBLE-BLIND TRIAL
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Date
2022-08-18
Authors
Mohammad Moufeed Mahmoud
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Abstract
ABSTRACT
Background: Postoperative sore throat is a minor undesirable complication following general anesthesia with endotracheal intubation, causing discomfort and decreasing satisfaction to the delivered anesthetic care. An injury related to direct tracheal mucosa trauma and decreased humidity because of the ETT cuff pressure are the main cause behind POST, which means it’s almost unavoidable and therefore an appropriate prophylactic intervention is needed to decrease its incidence. Many studies proved promising results of ketamine and dexamethasone nebulizers to decrease and prevent the incidence and severity of POST with other laryngeal morbidities like cough and hoarseness.
Objectives: To determine if preoperative nebulization of ketamine or dexamethasone has a significant influence on POST and other laryngeal morbidities incidence and severity in patients undergoing elective surgeries under GA with ETT, and to determine if it has a significant effect on endotracheal intubation condition and hemodynamic response to laryngoscopy.
Methodology: Ninety nine patients allocated for surgeries under GA enrolled in thisprospective double-blind, randomized, placebo-controlled study. Every participant received a nebulizer for 15 minutes and just 15 minutes before the anesthesia induction as follows: 33 participants in the control group received 5 ml nebulizer of normal saline, 33 participants in the dexamethasone group received a nebulizer of 8 mg of dexamethasone in volume of 5 ml and 33 participantsin ketamine group received a nebulizer of 50 mg of ketamine in volume of 5 ml.
Results: Ketamine and dexamethasone nebulizers were effective in preventing POST (p-value < 0.001) and hoarseness postoperatively with a maximum efficacy in the ketamine group. Ketamine nebulizer was effective in preventing cough and PONV, while dexamethasone wasn’t. Also, patients in ketamine group were more satisfied in comparison to dexamethasone and saline groups (p-value < 0.001). There was a significant elevation in SBP and HR in ketamine group after nebulization but no serious systemic adverse effects were noted.
Conclusions: Nebulizing 50 mg of ketamine or 8 mg of dexamethasone is an effective way to prevent and to decrease the incidence of POST and other laryngeal morbidities with a maximum efficacy in the ketamine.
Keywords: Ketamine, Dexamethasone, Nebulizer, Sore Throat.