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Talapatra A, Mathew S, Kanakalakshmi ST, Rani R. Effect of fluticasone-impregnated throat packs on postoperative sore throat (POST) and hoarseness of voice: A randomized clinical trial. F1000Res 2023; 12:1352. [PMID: 38434667 PMCID: PMC10905143 DOI: 10.12688/f1000research.139742.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 03/05/2024] Open
Abstract
Background: Post-operative sore throat (POST) is one of the most common complaints post-endotracheal intubation and can be decreased through various interventions. This study aimed to determine the effect of fluticasone-impregnated versus saline throat packs on the occurrence and severity of POST and voice hoarseness. Methods: This prospective, randomized, double-blinded trial was conducted on patients undergoing nasosinus surgeries at Kasturba Medical College and Hospital. Patients were randomized to groups based on a computer-generated table of random numbers post-intubation after placing a definite length of oropharyngeal packs into group F (fluticasone) who received four puffs of fluticasone furoate-soaked throat packs and group C (control) wherein normal saline-soaked throat packs were used. Determining the incidence of POST and voice hoarseness was the primary outcome; severity of POST and voice hoarseness, patient satisfaction scores at 24 hours post-surgery and adverse events were secondary outcomes. Results: Overall, 86 patients were randomized and 43 patients were included in each group. Incidence of POST (%) and voice hoarseness (%) were 55.8, 55.6, 55.8, 53.4 and 30.2, 28, 28, 28 in group C. Incidence of POST (%) and voice hoarseness (%) were 37.2, 37.2, 37.2, 34.8 and 14, 14, 14,14 in group F at 1, 2, 6 and 24 hours, respectively, however, the p values were not found to be significant at any time interval. There was no significant difference in terms of severity of POST and voice hoarseness, patient satisfaction scores between the groups and there were no reported adverse events. Conclusions: In patients undergoing nasosinus surgery under general anesthesia with endotracheal intubation, fluticasone furoate-impregnated throat packs failed to show any significant reduction in the incidence and severity of POST as well as hoarseness of voice, and even though it was not statistically significant, the fluticasone impregnated group had higher patient satisfaction scores. Registration: CTRI ( CTRI/2020/09/027946; 22/09/2020).
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Affiliation(s)
- Arjun Talapatra
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shaji Mathew
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Sushma Thimmaiah Kanakalakshmi
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Rama Rani
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Chawaka HJ, Teshome ZB. The Underreported Postoperative Suffering after Thyroid Surgery: Dysphagia, Dysphonia, and Neck Pain-A Cross-Sectional Study. Anesthesiol Res Pract 2023; 2023:1312980. [PMID: 37583794 PMCID: PMC10425250 DOI: 10.1155/2023/1312980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/25/2022] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
Background and Aims Postoperative voice change, difficulty of swallowing, throat pain, and neck pain are the most commonly complaint after thyroid surgery. However, little emphasis is given to the problem, especially a place where the surgical and anesthesia services' unmet need is highly observed, i.e., the problem gets little attention especially in the countries where the gaps of surgery and anesthesia services are observed. Hence, this study aims to determine the magnitude and associated factors of voice change and related complaints after thyroid surgery. Methods A cross-sectional study was conducted on 151 patients who had had thyroid surgery from June 1 to December 30, 2021. Data were retrieved during the postoperative period after the patient regains consciousness. Result Out of 151 participants, 98 (64.9%) patients complained of either voice change or difficulty of swallowing and neck pain after thyroid surgery within 24 hours. Majority (58.3%) of the participants aged more than 30 years with a mean age of 33.7 ± 8.3 years and females 102 (67.5%). Neck pain is the most (52.3%) complained suffering after thyroid surgery, followed by voice change 38.4% and difficulty in swallowing 37.7%. Difficulty in swallowing after thyroid surgery significantly associated with a patient who frequently experience intraoperative hypotension (AOR = 23.24, 95% CI 4.6-116.7, and p = 0.01), type of surgical procedure (total thyroidectomy) (AOR = 8.62, 95% CI 1.21-61.50, and p = 0.03), and larger ETT size (AOR = 4.92, 95% CI 1.34-18.01, and p = 0.02). Postoperative voice change is associated with larger endotracheal tube (AOR = 15.47, 95% CI 3.4-69.5, and p ≤ 0.001), surgery lasting more than 2 hours (AOR = 7.34, 95% CI 1.5-35.1, and p = 0.01), and intraoperative hypotension (AOR = 23.24, 95% CI 4.6-116.7, and p ≤ 0.001). Conclusion The complaint of postthyroidectomy neck pain and throat discomfort is higher than 64.9%. Intraoperative hypotension, blood loss, higher ETT size utilization, and duration of surgical procedure are the identified possible risk factors and have to be minimized as much as possible. Patient reassurance has to be considered during the postoperative time.
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Venkitesh A, Angel Nelson A, Shetti AN. The Effect of Endotracheal Tube Cuff Shape on Post-extubation Sore Throat in Critically Ill Patients in a Rural Tertiary Care Hospital. Cureus 2023; 15:e42519. [PMID: 37637631 PMCID: PMC10457499 DOI: 10.7759/cureus.42519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Patients admitted to the critical care unit often require extended periods of mechanical ventilation. After extubation, patients often report discomfort in their throats, coughing, and hoarseness of voice. These symptoms have been linked to the shape of the cuff on the endotracheal tube and are described in terms of the surface area of the cuff in contact with the trachea. METHODS During this pilot study, 160 adults receiving intensive primary care were randomly assigned to one of two groups (Gathering A or Gathering B; 80 patients each). Intubated patients were separated into two groups: Group C consisted of those who wore a looser, barrel-shaped sleeve, and Group T consisted of those who wore a more restrictive sleeve. The severity of post-extubation side effects was assessed, including sore throat, dry voice, and hack, and the occurrence of these symptoms was also documented. RESULT Neither the number of intubation attempts nor the experience level of the residents who performed them differed significantly between the two groups (p > 0.05). A smaller percentage of patients in Gathering T experienced sore throats in the first, 12th, and 24th hours after extubation compared to patients in Group C at these same time points (p = 0.05). With time passing, fewer people in Group C and Group T experienced hoarseness of voice after extubation. There is a declining trend in the incidence of cough post-extubation in Group T, as compared to an initial increase in the trend for cough post-extubation with a gradual decline as time progressed in Group C. CONCLUSION There is an overall decrease in the incidence of post-extubation emergence phenomena with tapered shape cuffed endotracheal tubes when compared with conventional cylindrical type cuffed endotracheal tubes.
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Affiliation(s)
- Akshaya Venkitesh
- Department of Anatomy, Dr. Balasaheb Vikhe Patil Rural Medical College, Pravara Institute of Medical Sciences (PIMS), Loni, IND
| | - Anson Angel Nelson
- Department of Anatomy, Dr. Balasaheb Vikhe Patil Rural Medical College, Pravara Institute of Medical Sciences (PIMS), Loni, IND
| | - Akshaya N Shetti
- Department of Anaesthesiology, Dr. Balasaheb Vikhe Patil Rural Medical College, Pravara Institute of Medical Sciences (PIMS), Loni, IND
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Ittoop AL, Gupta P, Jain G, Tyagi N, Eda J, Shajahan S. Reduction in postoperative sore throat by preoperative nebulization with dexmedetomidine, ketamine or saline: A prospective, randomized-controlled trial. J Anaesthesiol Clin Pharmacol 2023; 39:201-207. [PMID: 37564855 PMCID: PMC10410028 DOI: 10.4103/joacp.joacp_245_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/14/2021] [Accepted: 06/25/2021] [Indexed: 08/12/2023] Open
Abstract
Background and Aims Postoperative sore throat (POST) is a minor but distressing complication following general anesthesia. The current literature on the effect of preoperative nebulization with dexmedetomidine, or ketamine on POST is, however, sparse. So, we compared the effect of preoperative nebulization with these drugs on POST. Material and Methods One hundred and thirty-two American Society of Anaesthesiology (ASA) grade I-II patients undergoing elective laparoscopic surgeries under general anesthesia were randomized into three equal groups: D, K, or C to receive dexmedetomidine, ketamine, or saline as preoperative nebulization, respectively. The primary objective was to compare the incidence and severity of POST, as inferred from the patient interviews at 2, 6, 12, 24-h postoperatively. Results Group D had a significantly lower incidence (29.5%) and severity (12: mild; 1: moderate) of POST compared to group K (54.5% [21: mild; 3: moderate]) and group C (56.8% [19: mild; 6: moderate]), at 2-h postoperatively. The same trend was observed at 6-h postoperatively (group D: 22.7% [9: mild; 1: moderate]); group K: (40.9% [17: mild; 1: moderate]); group C (50% [17: mild; 5: moderate]). The mean arterial pressure was significantly lower in group D at 15 min intraoperatively (84.09 mmHg, P = 0.018) and immediate postoperatively (97.60 mmHg, P = 0.034). The postoperative sedation, nausea, and vomiting was not statistically significant. Conclusion Preoperative nebulization with dexmedetomidine is effective in the reduction of the incidence and severity of early POST.
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Affiliation(s)
- Amanta L. Ittoop
- Department of Anaesthesiology, 6 Level, Medical College Building, All India Institute of Medical Sciences (A. I. I. M. S), Rishikesh, Uttarakhand, India
| | - Priyanka Gupta
- Department of Anaesthesiology, 6 Level, Medical College Building, All India Institute of Medical Sciences (A. I. I. M. S), Rishikesh, Uttarakhand, India
| | - Gaurav Jain
- Department of Anaesthesiology, 6 Level, Medical College Building, All India Institute of Medical Sciences (A. I. I. M. S), Rishikesh, Uttarakhand, India
| | - Nidhi Tyagi
- Department of Anaesthesiology, 6 Level, Medical College Building, All India Institute of Medical Sciences (A. I. I. M. S), Rishikesh, Uttarakhand, India
| | - Jhansi Eda
- Department of Anaesthesiology, 6 Level, Medical College Building, All India Institute of Medical Sciences (A. I. I. M. S), Rishikesh, Uttarakhand, India
| | - Shafiq Shajahan
- Department of Anaesthesiology, 6 Level, Medical College Building, All India Institute of Medical Sciences (A. I. I. M. S), Rishikesh, Uttarakhand, India
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Molla MT, Bizuneh YB, Nigatu YA, Melesse DY. High incidence rate of postoperative sore throat in intubated children at Northwest Amhara Comprehensive Specialized Hospitals, Ethiopia. A multicenter study. Front Pediatr 2023; 11:1037238. [PMID: 36937975 PMCID: PMC10014599 DOI: 10.3389/fped.2023.1037238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
Background Postoperative sore throat is the most frequent complication in pediatric patients after general anesthesia. This study aimed to investigate the incidence of postoperative sore throat in patients undergoing general anesthesia with tracheal intubation or laryngeal mask airway. Methods A hospital-based multicenter prospective observational cohort study was conducted. Proportional allocation was done with a total of 424 patients from March 1 to June 30, 2022. The information was entered into the Epi-Data software version 4.6 and analyzed with Stata 14. Socio-demographic, surgical, and anesthetic-related characteristics were analyzed using descriptive statistics. A p-value of less than 0.2 was the cutpoint of bivariate logistic regression analysis, and p-values of less than 0.05 were regarded as statistically significant in multivariate logistic regression to determine the presence and strength of association between independent variables and postoperative sore throat. Results A total of 411 patients were included in this study, with a response rate of 96.9%. The overall proportion of patients who developed postoperative sore throat was 45% (95% CI: 40.18-49.84). Patients who had anesthesia for more than two hours (AOR = 8.23: 95% CI = 4.08-16.5), those who were intubated by undergraduate anesthesia students (AOR = 2.67: 95% CI = 1.53-4.67), and those who had been intubated using tracheal tube (AOR = 2.38: 95% CI = 1.15-4.92) were significantly associated with the level of postoperative sore throat. Conclusions and recommendations We concluded that intubated children with ETT have a high incidence of post-operative sore throat. Tracheal tube usage, intubation by undergraduate students, and more than two hours of anesthesia duration were associated factors. The incidence of sore throat can be decreased with the use of a laryngeal mask airway, intubation by a senior anesthetist, and shortening of anesthesia time.
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Affiliation(s)
- Misganaw Terefe Molla
- Department of Anesthesia, College of Medicine and Health Sciences, Bahirdar University, Bahirdar, Ethiopia
| | - Yosef Belay Bizuneh
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yonas Addisu Nigatu
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Debas Yaregal Melesse
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bali A, Dang AK, Gonzalez DA, Kumar R, Asif S. Clinical Uses of Ketamine in Children: A Narrative Review. Cureus 2022; 14:e27065. [PMID: 35989801 PMCID: PMC9389002 DOI: 10.7759/cureus.27065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/05/2022] Open
Abstract
Ketamine is a phencyclidine derivative that acts as a noncompetitive N-methyl-D-aspartate as well as a glutamate receptor antagonist. It also has other minor mechanisms that contribute to its extensive drug profile. Ketamine is a bronchodilator and maintains normal airway reflexes and, thus, permits spontaneous respiration. This, coupled with the fact that it produces potent analgesia, makes it highly suitable for children. Despite its many merits, the drug’s side effects, along with its cultural image of being a drug of abuse, a drug used in veterinary medicine, or a “date-rape drug” have sullied its reputation within the armamentarium of medicine. Even though it is widely used in developing countries, its use in Western nations has diminished. We have strived to explore the various clinical uses of ketamine in children through this article. In addition, the article also highlights how some of the fears associated with using the drug are unfounded and provides ways by which the drug’s side effects can be prevented and managed.
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7
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Kheirabadi D, Ardekani MS, Honarmand A, Safavi MR, Salmasi E. Comparison Prophylactic Effects of Gargling Different Doses of Ketamine on Attenuating Postoperative Sore Throat: A Single-Blind Randomized Controlled Trial. Int J Prev Med 2021; 12:62. [PMID: 34447504 PMCID: PMC8356970 DOI: 10.4103/ijpvm.ijpvm_147_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 02/20/2020] [Indexed: 11/18/2022] Open
Abstract
Context: Postoperative sore throat (POST) is a common annoying problem following endotracheal (ET) intubation. Aims: Comparing the impact of low and high doses of ketamine gargle on lowering POST incidence and severity. Settings and Design: 96 patients selected for septoplasty surgery under general anesthesia were investigated through a single-blind randomized controlled trial. Methods: This study was performed on three equal groups. Group K and G gargled 50 and 100 mg ketamine, respectively, solved in normal saline and group C gargled pure normal saline for 30 s at 5 min before tracheal intubation. POST severity measured immediately after the entrance to the postanesthetic care unit (PACU) and then 2 h, 4 h, 8 h, and 24 h after operation. Statistical Analysis Used: Collected data were analyzed by the Chi-square test, Mann-Whitney test, Kruskal-Wallis test, one-way analysis of variance (ANOVA) and Friedman test using SPSS version 20. Results: POST incidence and severity in group C were significantly higher than both K and G groups at all times. Although significant differences between low and high doses of ketamine were acknowledged at 8 h post-operation, 100 mg ketamine could attenuate POST severity further than 50 mg at all times. Conclusions: It seems that 100 mg outperformed 50 mg ketamine without rising complications and dissatisfaction for subjects. So, it gives us a powerful reason to suggest gargling 100 mg ketamine for lessening POST incidence and severity.
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Affiliation(s)
- Dorna Kheirabadi
- Anesthesiology and Critical Care Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Sobhan Ardekani
- General Physician, School of medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azim Honarmand
- Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Safavi
- Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elnaz Salmasi
- School of Medicine, Najaf Abad University of Medical Sciences, Isfahan, Iran
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Comparison of endotracheal tube cuff pressures inflated with saline or air in gynecological laparoscopic surgery. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.942649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Ahmad L. Impact of gargling on respiratory infections. ALL LIFE 2021. [DOI: 10.1080/26895293.2021.1893834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Lateef Ahmad
- Department of Pharmacy, University of Swabi, Anbar, Pakistan
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10
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Huh H, Go DY, Cho JE, Park J, Lee J, Kim HC. Influence of two-handed jaw thrust during tracheal intubation on postoperative sore throat: a prospective randomised study. J Int Med Res 2021; 49:300060520961237. [PMID: 33535830 PMCID: PMC7869173 DOI: 10.1177/0300060520961237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective General anaesthesia with tracheal intubation results in sore throat. We
evaluated the influence of the two-handed jaw thrust on postoperative sore
throat in patients who require tracheal intubation. Methods In this prospective, double-blind, single-centre, parallel-arm, and
randomised trial, 92 patients who were scheduled for general anaesthesia for
total hip arthroplasty were allocated to one of two groups. In the jaw
thrust group (n = 46), the two-handed jaw thrust manoeuvre was applied at
intubation. In the control group (n = 46), conventional intubation with sham
jaw thrust was performed. Incidences of airway morbidities including sore
throat, hoarseness, and cough at 2, 4, and 24 hours postoperatively were
compared. Results During the postoperative 24 hours, the incidence of sore throat (8 [17%] vs.
20 [44%]) and hoarseness were lower in the jaw thrust group (8 [17%] vs. 18
[39%]) compared with the control group. The incidence of cough during the
postoperative 24 hours was similar between the groups. Conclusions The jaw thrust manoeuvre significantly reduced sore throat and hoarseness in
patients after general anaesthesia using tracheal intubation. Clinical trial registration: NCT 03568279.
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Affiliation(s)
- Hyub Huh
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Kyung Hee University Hospital at Gang Dong, Seoul, Korea
| | - Doo Yeon Go
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jang Eun Cho
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jihoon Park
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jiwon Lee
- Department of Anaesthesiology and Pain Medicine and Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun-Chang Kim
- Department of Anaesthesiology and Pain Medicine and Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Yu JH, Paik H, Ryu HG, Lee H. Effects of thermal softening of endotracheal tubes on postoperative sore throat: A randomized double-blinded trial. Acta Anaesthesiol Scand 2021; 65:213-219. [PMID: 32926423 DOI: 10.1111/aas.13705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/14/2020] [Accepted: 09/04/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Postoperative throat complications after intubation are undesirable but frequent outcomes. A randomized, double-blinded study was performed to determine whether thermal softening of endotracheal tubes reduced throat complications after intubation. METHODS Patients (n = 196) undergoing nasal surgery were randomly allocated into the control group and thermal softening groups. Sore throat and hoarseness were evaluated 1 and 24 hours after extubation. The severity of sore throat was evaluated using the numeric rating scale (NRS). The primary outcome was the incidence of sore throat 1 hour after extubation and sore throat was defined as a painful or scratchy feeling in the throat. The secondary outcomes were the incidence of hoarseness 1 hour after extubation, the incidence of sore throat and hoarseness 24 hours after extubation, severity of sore throat, and vocal cord injuries. RESULTS The incidence of sore throat 1 hour after extubation was lower in the thermal softening group than in the control group (35.1% vs 52.7%, P = .02). Moreover, thermal softening decreased the mean NRS score for sore throat in the thermal softening group by 10% an hour after extubation (thermal softening group, 1.29 [95% CI, 0.88-1.70] vs control group, 2.33 [95% CI, 1.77-2.89]; P < .01). At 24 hours after extubation, the incidence of sore throat (38.3% vs 40.7%, P = .77) and hoarseness (34.0% vs 35.2%, 0.95 [0.52-1.74], P = .74) were comparable between the two groups. CONCLUSIONS Intubation using endotracheal tubes with thermal softening significantly decreased the incidence of sore throat 1 hour after extubation when compared with endotracheal tubes without thermal softening.
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Affiliation(s)
- Je Hyuk Yu
- Department of Anesthesiology and Pain Medicine Seoul National University HospitalSeoul National University College of Medicine Seoul Korea
| | - Hye‐Sun Paik
- Department of Anesthesiology and Pain Medicine Armed Forces Capital Hospital Seongnam Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine Seoul National University HospitalSeoul National University College of Medicine Seoul Korea
| | - Hannah Lee
- Department of Anesthesiology and Pain Medicine Seoul National University HospitalSeoul National University College of Medicine Seoul Korea
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Moda N, Prasant NSN, Mohapatro S, Jena J. Comparison of preoperative nebulization with 4% lignocaine and ketamine in reduction of incidence of postoperative sore throat. Anesth Essays Res 2021; 15:316-320. [PMID: 35320968 PMCID: PMC8936864 DOI: 10.4103/aer.aer_105_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/25/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Postoperative sore throat (POST) is a common occurrence following general anesthesia with endotracheal intubation although clinicians often regard it as a minor complication. The incidence of POST is estimated to be 21%–65% in different studies. The administration of the drug through aerosol route gained popularity among anesthesiologists with good acceptance from the patients. Hence, we conducted the study with the aim to compare the efficacy of preoperative nebulization with 4% lignocaine and ketamine, in the prevention of POST. Materials and Methods: The study is a prospective, randomized double-blinded study comparing the effects of comparison between preoperative nebulization with ketamine and 4% lignocaine in preventing POST. Hemodynamic parameters, Ramsay sedation score, and visual analog scale (VAS) at 0, 6, and 24 h were observed in both groups. Results: Ketamine nebulization provides better prophylaxis against the occurrence of moderate-to-severe POST as compared to lignocaine. At 0 h, none of the patients had ST in both the groups; at 6 and 24 h, the ST was significantly higher in lignocaine group (28.9% and 8.9%) as compared to ketamine group (8.9% and 0%), with P = 0.04. Mild, moderate, and severe VAS was observed in 51%, 33%, and 16% of Group 1, respectively, while in Group 2, it was observed in 16%, 36%, and 49% of study population, respectively, and this difference was statistically significant. Conclusion: Patients undergoing surgery under general anesthesia with endotracheal intubation were benefitted from ketamine nebulization as prophylaxis against moderate-to-severe POST.
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Comparison of intravenous lidocaine and intravenous lidocaine/paracetamol in prevention of postoperative sore throat after laryngeal mask insertion. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.800727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Thomas D, Chacko L, Raphael PO. Dexmedetomidine nebulisation attenuates post-operative sore throat in patients undergoing thyroidectomy: A randomised, double-blind, comparative study with nebulised ketamine. Indian J Anaesth 2020; 64:863-868. [PMID: 33437074 PMCID: PMC7791420 DOI: 10.4103/ija.ija_406_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/15/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022] Open
Abstract
Background and Aims: Endotracheal intubation is the predominant cause of airway mucosal injury, resulting in post-operative sore throat (POST), with an incidence of 20-74%, which brings immense anguish to patients. This study was conducted to evaluate and compare the efficacy of nebulised dexmedetomidine and ketamine in decreasing POST in patients undergoing thyroidectomy. Methods: Patients were randomly allocated into two groups of 50 each; Group 1 received ketamine 50mg (1mL) with 4mL saline nebulisation, while Group 2 received dexmedetomidine 50μg (1mL) with 4mL saline nebulisation for 15 min. GA was administered 15 min after completing nebulisation. POST monitoring was done at 0,2,4,6,12 and 24h after extubation. POST was graded on a four-point scale (0-3). The statistical analysis were performed using Statistical Package for Social Sciences (SPSS) software version 17.0. Fisher Exact-t-test, Chi square test, Student t-test, Paired t test and repeated measure analysis of variance (ANOVA) were used for analysis. Results: The overall incidence of POST in this study was 17%: POST was experienced by seven patients (14.3%) in ketamine and 10 patients (20.4%) in dexmedetomidine group (P = 0.424). There was no statistically significant difference in the incidence of POST between the two groups at 0,2,4,6,12 and 24h post-operatively. Severity of sore throat was also significantly lower in both groups at all time points. A statistically significant increase in heart rate, systolic and diastolic blood pressure was noted in ketamine group, post nebulisation. Conclusion: Pre-operative dexmedetomidine nebulisation can be utilised as a safe and ideal alternative to ketamine nebulisation in attenuating POST, with less haemodynamic derangement.
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Affiliation(s)
- Derlin Thomas
- Department of Anaesthesiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Lini Chacko
- Department of Anaesthesiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Paul O Raphael
- Department of Anaesthesiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
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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; 67:1624-1642. [DOI: 10.1007/s12630-020-01792-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/16/2022] Open
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Karmali S, Rose P. Tracheal tube size in adults undergoing elective surgery - a narrative review. Anaesthesia 2020; 75:1529-1539. [PMID: 32415788 DOI: 10.1111/anae.15041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2020] [Indexed: 12/17/2022]
Abstract
Tracheal tubes are routinely used in adults undergoing elective surgery. The size of the tracheal tube, defined by its internal diameter, is often generically selected according to sex, with 7-7.5 mm and 8-8.5 mm tubes recommended in women and men, respectively. Tracheal diameter in adults is highly variable, being narrowest at the subglottis, and is affected by height and sex. The outer diameter of routinely used tracheal tubes may exceed these dimensions, traumatise the airway and increase the risk of postoperative sore throat and hoarseness. These complications disproportionately affect women and may be mitigated by using smaller tracheal tubes (6-6.5 mm). Patient safety concerns about using small tracheal tubes are based on critical care populations undergoing prolonged periods of tracheal intubation and not patients undergoing elective surgery. The internal diameter of the tube corresponds to its clinical utility. Tracheal tubes as small as 6.0 mm will accommodate routinely used intubation aids, suction devices and slim-line fibreoptic bronchoscopes. Positive pressure ventilation may be performed without increasing the risk of ventilator-induced lung injury or air trapping, even when high minute volumes are required. There is also no demonstrable increased risk of aspiration or cuff pressure damage when using smaller tracheal tubes. Small tracheal tubes may not be safe in all patients, such as those with high secretion loads and airflow limitation. A balanced view of risks and benefits should be taken appropriate to the clinical context, to select the smallest tracheal tube that permits safe peri-operative management.
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Affiliation(s)
- S Karmali
- Department of Anaesthesiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - P Rose
- Department of Anaesthesiology, Vancouver General Hospital, Vancouver, BC, Canada
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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; 64:579-591. [PMID: 31994169 DOI: 10.1111/aas.13553] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Postoperative sore throat is a leading undesirable postoperative outcome. Ketamine is an N-methyl-d-aspartate receptor antagonist and its topical application is used for chronic pain and oral/throat indications. We conducted a systematic review to assess the efficacy of preoperative, topical ketamine application for preventing postoperative sore throat. METHODS We searched MEDLINE, EMBASE, and CENTRAL through September 23, 2019 for randomized controlled trials in which at least one intervention was topical ketamine to prevent postoperative sore throat in adults undergoing endotracheal intubation. The primary outcome was the incidence of sore throat at 24 hours postoperatively. The comparators were non-analgesic controls (placebo, no treatment, or usual care) or active agents. We pooled the data using a random-effects model. RESULTS We included 41 randomized controlled trials involving 3784 participants. Topical ketamine was associated with reduced incidence of sore throat at 24 hours postoperatively compared to non-analgesic methods (risk ratio, 0.45; 95% CI, 0.37-0.54; P < .001). We found significant publication bias, but the results remained unchanged with a trim-and-fill analysis. Trial sequential analysis (TSA) suggested that the efficacy of topical ketamine was adequate (TSA-adjusted 95% CI, 0.33-0.56). The GRADE quality for this evidence was moderate. Topical ketamine was inferior to a combination of nebulized ketamine and clonidine in preventing postoperative sore throat. CONCLUSIONS Preoperative, topical ketamine application may be more effective than non-analgesic methods in preventing postoperative sore throat. The number of studies did not suffice to determine the place of topical ketamine among agents to prevent postoperative sore throat.
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Affiliation(s)
- Akira Kuriyama
- Emergency and Critical Care Center Kurashiki Central Hospital Okayama Japan
| | - Misuzu Nakanishi
- Emergency and Critical Care Center Kurashiki Central Hospital Okayama Japan
| | - Jun Kamei
- Emergency and Critical Care Center Kurashiki Central Hospital Okayama Japan
| | - Rao Sun
- Department of Anesthesiology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Hubei China
| | - Kohei Ninomiya
- Emergency and Critical Care Center Kurashiki Central Hospital Okayama Japan
| | - Masaaki Hino
- Emergency and Critical Care Center Kurashiki Central Hospital Okayama Japan
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Fenta E, Teshome D, Melaku D, Tesfaw A. Incidence and factors associated with postoperative sore throat for patients undergoing surgery under general anesthesia with endotracheal intubation at Debre Tabor General Hospital, North central Ethiopia: A cross-sectional study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rashwan S, Abdelmawgoud A, Badawy AA. Effect of tramadol gargle on postoperative sore throat: A double blinded randomized placebo controlled study. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2014.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Samaa Rashwan
- Departments of Anesthesia, Faculty of Medicine , Beni Suief University , Egypt
| | | | - Ahmed A. Badawy
- Departments of Anesthesia, Faculty of Medicine , Cairo University , Egypt
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Park SH, Son SG, Kim ST. Effects of benzydamine hydrochloride spray on postoperative sore throat associated with double-lumen endobronchial intubation: a double-blind, randomized controlled clinical trial. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.2.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sang Hi Park
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Seok Gon Son
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Sang Tae Kim
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Cheongju, Korea
- Department of Anesthesiology and Pain Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
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Influence of intraoperative sevoflurane or desflurane on postoperative sore throat: a prospective randomized study. J Anesth 2019; 33:209-215. [PMID: 30603828 DOI: 10.1007/s00540-018-2600-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 12/15/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE Tracheal intubation for general anesthesia causes postoperative sore throat. The purpose of this study was to evaluate the effect of sevoflurane and desflurane on prevalence of postoperative sore throat in patients after general anesthesia. METHODS Ninety-six patients scheduled for orthopedic lower extremity surgery under general anesthesia were assigned to sevoflurane group or desflurane group. In the sevoflurane group (n = 48), sevoflurane was used as a maintenance anesthetic agent. In the desflurane group (n = 48), desflurane was used. Prevalence of sore throat, number of patients with rescue analgesics, and analgesics requirements were evaluated. RESULTS The overall prevalence of postoperative sore throat in the sevoflurane group was lower than that in the desflurane group [21 (44%) vs. 32 (67%), p = 0.024]. The prevalence of sore throat at postoperative 4 h in the sevoflurane group was lower than that in the desflurane group [6 (13%) vs. 18 (38%), p = 0.005]. The number of patients requiring rescue analgesics was lower in the sevoflurane group [25 (52%) vs. 36 (75%), p = 0.020]. The requirement of diclofenac was also lower in the sevoflurane group (30 ± 37 mg vs. 47 ± 40 mg, p = 0.031). CONCLUSIONS We have shown that sevoflurane was associated with less frequent sore throat than desflurane in patients undergoing orthopedic lower extremity surgery.
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Muderris T, Tezcan G, Sancak M, Gul F, Ugur G. Oral flurbiprofen spray for postoperative sore throat and hoarseness: a prospective, randomized, double-blind, placebo-controlled study. Minerva Anestesiol 2019; 85:21-27. [DOI: 10.23736/s0375-9393.18.12703-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Kajal K, Dharmu D, Bhukkal I, Yaddanapudi S, Soni SL, Kumar M, Singla A. Comparison of Three Different Methods of Attenuating Postoperative Sore Throat, Cough, and Hoarseness of Voice in Patients Undergoing Tracheal Intubation. Anesth Essays Res 2019; 13:572-576. [PMID: 31602080 PMCID: PMC6775843 DOI: 10.4103/aer.aer_61_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context: Postoperative sore throat (POST) is a frequent and undesirable complication after general anesthesia with endotracheal intubation. Various pharmacological and non-pharmacological methods with variable success rate are used for attenuating POST. However, no single drug has been universally accepted. Aims: To compare the effect of betamethasone gel, ketamine gargles and intravenous dexamethasone on the incidence and severity of POST. Settings and Design: Prospective randomized controlled single-blinded trial conducted at a tertiary care centre. Materials and Methods: A total of 100 patients of age 18 to 70 yr, ASA class I and II, scheduled for elective surgeries under general anaesthesia were included and divided randomly in betamethasone, dexamethasone, ketamine and control groups. Endotracheal tubes were lubricated with 0.05% betamethasone gel in betamethasone group, 0.2 mg/kg of dexamethasone was administered intravenously before induction of anaesthesia in dexamethasone group, 40 mg of ketamine gargles mixed with 30 ml of saline was given 5 minutes prior to induction in ketamine group. In the control group, none of the above agents were used. During the 24 hr after the operation, we noted the occurrence and severity of POST, cough and hoarseness. Statistical Analysis Used: The demographic data, surgical time and intubation among the groups were analyzed using one-way analysis of variance. Incidence and severity of POST, cough and hoarseness of voice among the groups were analyzed utilizing Chi-square test. Results: Incidence of POST at one hour was found to be significantly less in betamethasone group (16%) and dexamethasone group (20%) in comparison to the control group (48%). The incidence of POST at 4 hours and 24 hours were found to be comparable. The frequency of hoarseness and cough at 1 hour, 4 hour and 24 hours were similar in all the groups. Conclusions: Prophylactic betamethasone gel application and intravenous dexamethasone administration before induction of anaesthesia resulted in clinically important and statistically significant decreases in the incidence of POST only in early postoperative period.
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Affiliation(s)
- Kamal Kajal
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Dharmu
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ishwar Bhukkal
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandhya Yaddanapudi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shiv Lal Soni
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mukesh Kumar
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankush Singla
- Department of Anaesthesia, Adesh Institute of Medical Sciences, Bhantinda, Punjab, India
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Shekhar S, Gupta A, Gunjan, Gupta S, Singh K. Comparison of Nebulized Ketamine and Ketamine with Clonidine in Postoperative Sore Throat. Anesth Essays Res 2019; 13:313-316. [PMID: 31198252 PMCID: PMC6545956 DOI: 10.4103/aer.aer_19_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Various nonpharmacological and pharmacological trials have been used for attenuating postoperative sore throat (POST) with no proven single modality. Ketamine has been used as a gargle or nebulization in the attenuation of POST by its action on peripheral N-methyl-D-aspartate receptors. Topical administration of clonidine elicits antinociception through α2-adrenoceptors without producing undesirable side effect. Aim: This study aims to compare between nebulized ketamine and ketamine with clonidine in POST. Materials and Methods: The effects of nebulized ketamine and ketamine with clonidine in POST have been compared in 100 patients. Patients were divided into two groups: Group K patients were nebulized with ketamine 1 mL (50 mg) plus normal saline 3 mL and Group KC patients were nebulized with ketamine 1 mL (50 mg) plus clonidine 1 mL (50 mg) plus normal saline 2 mL. Online statistical software was used for analysis of the data. Results: At 4 h, seven patients experienced sore throat in Group K while no incidence was reported in group KC (0%). At 8 h, 12 (85.7%) patients experienced sore throat in Group K and 2 (14.28%) patients in Group KC. At 12 h, 13 (81.25%) patients experienced sore throat in Group K and 3 (18.75%) patients of Group KC. At 24 h, 6 (85.71%) patients experienced sore throat in Group K and 1 (14.28%) patient in Group KC. Patients in both groups remained hemodynamically stable with no complaint of nausea, vomiting, sedation, laryngospasm, or any other side effect. Conclusion: Nebulization with ketamine plus clonidine preoperatively is more effective in reducing POST with no adverse effects as compared to preoperative nebulization with ketamine.
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Affiliation(s)
- Shashank Shekhar
- Department of Anaesthesiology and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Ankesh Gupta
- Department of Anaesthesiology and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Gunjan
- Department of Anaesthesiology and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Sonali Gupta
- Department of Public Health Dentistry, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
| | - Kunal Singh
- Department of Anaesthesiology and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Singh NP, Makkar JK, Wourms V, Zorrilla-Vaca A, Cappellani RB, Singh PM. Role of topical magnesium in post-operative sore throat: A systematic review and meta-analysis of randomised controlled trials. Indian J Anaesth 2019; 63:520-529. [PMID: 31391614 PMCID: PMC6644199 DOI: 10.4103/ija.ija_856_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background and Aims: Post-operative sore throat (POST) is a common undesirable consequence of tracheal intubation. Magnesium, an N-methyl-D-aspartate receptor antagonist, has anti-nociceptive and anti-inflammatory properties, and has been found to be useful in POST prevention in various trials. We conducted this systematic review and meta-analysis to study the efficacy of topical magnesium in preventing POST in adult patients undergoing surgery under general anaesthesia with single lumen tracheal tube. Methods: Comprehensive literature search was performed in PubMed, Google Scholar, EMBASE, Scopus and the Cochrane central registers of controlled trial databases through July, 2018 and data were pooled using fixed effect modelling followed by random-effect methods (after assessing heterogeneity with fixed modelling). The primary outcome was the incidence of POST at 24 h after surgery/extubation. Comparative results were deliberated as pooled mean difference for continuous variables and Mantel–Haenszel (MH) odds ratio for dichotomous variables. Statistical analysis was done using Comprehensive Meta-Analysis-Version 3 (Biostat Inc., USA). Results: Seven trials involving 726 study participants were included in the final analysis. Incidence of POST at 24 hours was significantly lower in magnesium group (26/363) in comparison to active and non-active control group (89/363); P = 0.00- RR 0.22 (95%CI = 0.12-0.39, I2 = 0%). No significant adverse events were reported with the use of topical magnesium. Conclusion: Prophylactic use of topical magnesium before the induction of general anaesthesia seems to be an effective measure to decrease the incidence of POST.
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Affiliation(s)
- Narinder P Singh
- Department of Anesthesia Perioperative and Pain Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeetinder K Makkar
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vincent Wourms
- Department of Anesthesia Perioperative and Pain Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrés Zorrilla-Vaca
- School of Medicine, Faculty of Health, Universidad del Valle, Hospital Universidad del Valle, Cali, Colombia
| | - Ronald B Cappellani
- Department of Anesthesia Perioperative and Pain Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Preet M Singh
- Department of Anesthesia, Washington University, St Louis, MO, USA
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Park JH, Lee YC, Lee J, Kim H, Kim HC. The influence of high-dose intraoperative remifentanil on postoperative sore throat: a prospective randomized study: A CONSORT compliant article. Medicine (Baltimore) 2018; 97:e13510. [PMID: 30558006 PMCID: PMC6320118 DOI: 10.1097/md.0000000000013510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Endotracheal intubation for general anesthesia causes postoperative sore throat (POST). This study is designed to evaluate the effect of high-dose remifentanil on the incidence of POST in patients after general anesthesia. METHODS Ninety-two patients scheduled for orthopedic lower extremity surgery under general anesthesia were randomly assigned into 1 of 2 groups. In the high-dose remifentanil (HR) group (n = 46), remifentanil was infused at a rate of 0.25 μg/kg/min and subsequently increased or decreased by 0.05 μg/kg/min per clinical demand. In the low-dose remifentanil (LR) group (n = 46), remifentanil was infused at a rate of 0.05 μg/kg/min. The incidence of POST was monitored at 0, 2, 4, and 24 hours postoperatively. Complications regarding opioids were compared between groups. RESULTS The overall incidence of POST was higher in the HR group compared with that in the LR group [33 (72%) vs 18 (39%), P = .022]. The incidence of POST at 0, 2, and 24 hours after surgery was higher in the HR group compared with that in the LR group (P < .001, P = .001, and P = .001, respectively). The incidence of postoperative nausea, vomiting, drowsiness, and headache was similar between the groups. The incidence of postoperative shivering was higher in the HR group than in the LR group [10 (22%) vs 2 (4%), difference 17%, 95% CI 2%-33%, P = .027]. CONCLUSION A relatively large dose of intraoperative remifentanil increased the incidence of POST in patients for orthopedic surgery under general anesthesia. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT03173339.
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Affiliation(s)
- Ji-Hoon Park
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
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Kendall MC, Pisano DV, Cohen AD, Gorgone M, McCormick ZL, Malgieri CJ. Selected highlights from clinical anesthesia and pain management. J Clin Anesth 2018; 51:108-117. [DOI: 10.1016/j.jclinane.2018.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022]
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Kim E, Yang SM, Kwak SG, Park S, Bahk JH, Seo JH. Tracheal tubes lubricated with water to reduce sore throat after intubation: A randomized non-inferiority trial. PLoS One 2018; 13:e0204846. [PMID: 30286145 PMCID: PMC6171884 DOI: 10.1371/journal.pone.0204846] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/11/2018] [Indexed: 11/25/2022] Open
Abstract
Background Sore throat is common after tracheal intubation. Water can be used to lubricate tracheal tubes, but its benefit has not been validated. We thus did a randomised non-inferiority trial to test the hypothesis that a tube lubricated with water does not reduce sore throat after tracheal intubation. Methods We randomized female or male patients (n = 296) undergoing surgery in the ears or eyes to receive either a tube lubricated with water or a tube without lubrication for intubation. We assessed sore throat at 0, 2, 4, and 24 h after surgery; pharyngeal injury at 2 and 24 h after surgery; and respiratory infections within 7 days after surgery. For the incidence of sore throat within 24 h after surgery (primary outcome), the two-sided 90% confidence interval of the risk difference was compared with the prespecified non-inferiority margin of 15%. Other outcomes were analyzed with two-sided superiority tests. Results The incidence of sore throat within 24 h after surgery was 80/147 (54.4%) in the non-lubricated tube group and 83/149 (55.7%) in the water-lubricated tube group (risk difference -1.3%, 90% confidence interval -10.9% to 8.3%). Because the confidence interval was below the non-inferiority margin, the incidence of sore throat was not higher in the non-lubricated tube group than in the water-lubricated tube group. There was no significant association between groups in the sore throat, pharyngeal injury, and respiratory infection at each assessment time. Conclusions The tube lubricated with water did not reduce sore throat and pharyngeal injury after tracheal intubation compared to the tube without lubrication.
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Affiliation(s)
- Eugene Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong Mi Yang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, Daegu Catholic University College of Medicine, Daegu, Republic of Korea
| | - Seoyeong Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyon Bahk
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hwa Seo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Kayina CA, Salhotra R, Sethi AK, Mohta M, Sharma AK. Postintubation Sequels: Influence of Fluticasone and Technique of Intra-Operative Muscle Relaxation. Anesth Essays Res 2018; 12:891-896. [PMID: 30662126 PMCID: PMC6319072 DOI: 10.4103/aer.aer_157_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Postintubation sequels (PIS) are a cause of serious concern in the postoperative period. AIM The aim of this study is to find the influence of preoperative inhaled steroid and technique of muscle relaxation on PIS. SETTINGS AND DESIGN This prospective, exploratory pilot study was conducted on 120 adult American Society of Anesthesiologist physical status Class I and II patients undergoing general anesthesia (GA) with muscle relaxation and cuffed endotracheal tube (ETT) insertion. PATIENTS AND METHODS Patients were randomized into four groups as follows: intermittent muscle relaxation with preanesthetic inhalation of either distilled water puffs (Group ID) or fluticasone puffs (Group IF); continuous infusion of muscle relaxant with preanesthetic inhalation of either distilled water puffs (Group CD) or fluticasone puffs (Group CF). After induction of GA, ETT was inserted. The intra-cuff pressure was maintained constant. The trachea was extubated in the light plane in intermittent groups and in the deep plane in continuous groups. STATISTICAL ANALYSIS Qualitative parameters were compared using the Chi-square test and quantitative parameters using repeated measure ANOVA followed by Tukey's test. RESULTS Group CF had significantly less incidence of sore throat and hoarseness compared to groups ID and IF. The severity of sore throat was more in groups ID and IF than in groups CF and CD (P < 0.002). The severity of hoarseness was least in group CF (23.3%) and highest in group IF (90%). None of the patients had a cough in group CF. The incidence and severity of dysphagia were significantly less in group CF as compared to other groups (P < 0.005 and P < 0.008, respectively). CONCLUSION Continuous infusion of muscle relaxant with extubation in deep plane of anesthesia with preanesthetic inhalation of fluticasone puffs results in lesser incidence and severity of PIS.
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Affiliation(s)
| | - Rashmi Salhotra
- Department of Anaesthesiology and Critical Care, UCMS and GTBH, Delhi, India
| | - Ashok K. Sethi
- Department of Anaesthesiology and Critical Care, UCMS and GTBH, Delhi, India
| | - Medha Mohta
- Department of Anaesthesiology and Critical Care, UCMS and GTBH, Delhi, India
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Pouwels S, Stepaniak PS, Buise MP, Bouwman RA, Nienhuijs SW. The RAQET Study: the Effect of Eating a Popsicle Directly After Bariatric Surgery on the Quality of Patient Recovery; a Randomised Controlled Trial. Indian J Surg 2018; 80:245-251. [PMID: 29973755 PMCID: PMC6014958 DOI: 10.1007/s12262-016-1560-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 10/07/2016] [Indexed: 11/30/2022] Open
Abstract
Quality of recovery could be influenced positively if there is less postoperative sore throat (POST). Eating a popsicle might attenuate this sore throat. Especially for bariatric surgery, early recovery is important. Adding popsicles to the postoperative protocol could be beneficial. Our hypothesis is that offering a popsicle in the recovery room to patients after bariatric surgery will decrease POST and will increase quality of postoperative recovery. Patients undergoing elective bariatric surgery, between the 23 February 2015 and 3 April, were randomised to either the popsicle group or control group. Primary endpoint was the incidence of POST and secondly if a reduction in POST influences quality of recovery at the first day postoperative measured with the Bariatric Quality Of Recovery (BQoR) questionnaire. One hundred and thirty-three patients were assessed for eligibility. For the final analysis, 44 patients in the intervention and 65 in the control group were available. Eating a popsicle after bariatric surgery had no significant effect on the incidence of POST. Significant effects (in favour of the popsicle group) were seen in muscle pain score (p = 0.047) and sore mouth score (p = 0.012). Popsicle intragroup analysis revealed that eating the whole popsicle (compared to partially eating the popsicle) has positive effects on nausea (p = 0.059), feeling cold (p = 0.008), and mean total comfort score (p = 0.011). Of the patients who became nauseous and/or had to vomit because of the popsicle, n = 4 had more severe pain (p = 0.04) and the mean pain score was higher (p = 0.09). The present study demonstrates that offering a popsicle early during recovery after bariatric surgery is feasible without adverse effects, although eating popsicle did not reduce postoperative sore throat. There are possible beneficial effects, such as reduced muscle pains and less sore mouth, that may enhance the quality of recovery. More research is necessary to further substantiate the effect of eating popsicles on the quality of recovery in this patient population. TRIAL REGISTRATION Registration number: NTR4943 (http://www.trialregister.nl).
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Affiliation(s)
- Sjaak Pouwels
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
- Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, The Netherlands
| | - Pieter S. Stepaniak
- Department of Operating Rooms, Catharina Hospital, Eindhoven, The Netherlands
| | - Marc P. Buise
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - R. Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Simon W. Nienhuijs
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
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COMPARATIVE STUDY BETWEEN INTRAVENOUS DEXAMETHASONE VERSUS KETAMINE GARGLE VERSUS INTRAVENOUS DEXAMETHASONE COMBINED WITH KETAMINE GARGLE FOR EVALUATION OF POST-OPERATIVE SORE THROAT AND HOARSENESS IN MIDDLE EAR SURGERY. ACTA ACUST UNITED AC 2018. [DOI: 10.14260/jemds/2018/370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Ivan Ezquerra-Romano I, Lawn W, Krupitsky E, Morgan CJA. Ketamine for the treatment of addiction: Evidence and potential mechanisms. Neuropharmacology 2018; 142:72-82. [PMID: 29339294 DOI: 10.1016/j.neuropharm.2018.01.017] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 12/14/2022]
Abstract
Ketamine is a dissociative anaesthetic drug which acts on the central nervous system chiefly through antagonism of the n-methyl-d-aspartate (NMDA) receptor. Recently, ketamine has attracted attention as a rapid-acting anti-depressant but other studies have also reported its efficacy in reducing problematic alcohol and drug use. This review explores the preclinical and clinical research into ketamine's ability to treat addiction. Despite methodological limitations and the relative infancy of the field, results thus far are promising. Ketamine has been shown to effectively prolong abstinence from alcohol and heroin in detoxified alcoholics and heroin dependent individuals, respectively. Moreover, ketamine reduced craving for and self-administration of cocaine in non-treatment seeking cocaine users. However, further randomised controlled trials are urgently needed to confirm ketamine's efficacy. Possible mechanisms by which ketamine may work within addiction include: enhancement of neuroplasticity and neurogenesis, disruption of relevant functional neural networks, treating depressive symptoms, blocking reconsolidation of drug-related memories, provoking mystical experiences and enhancing psychological therapy efficacy. Identifying the mechanisms by which ketamine exerts its therapeutic effects in addiction, from the many possible candidates, is crucial for advancing this treatment and may have broader implications understanding other psychedelic therapies. In conclusion, ketamine shows great promise as a treatment for various addictions, but well-controlled research is urgently needed. This article is part of the Special Issue entitled 'Psychedelics: New Doors, Altered Perceptions'.
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Affiliation(s)
- I Ivan Ezquerra-Romano
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London, UK
| | - W Lawn
- Clinical Psychopharmacology Unit, University College London, Gower Street, London, UK
| | - E Krupitsky
- St.-Petersburg Pavlov State Medical University and Bekhterev Research Psychoneurological Institute, St. Petersburg, Russia
| | - C J A Morgan
- Clinical Psychopharmacology Unit, University College London, Gower Street, London, UK; Psychopharmacology and Addiction Research Centre, University of Exeter, Exeter, UK.
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Rajan S, Tosh P, Paul J, Kumar L. Effect of inhaled budesonide suspension, administered using a metered dose inhaler, on post-operative sore throat, hoarseness of voice and cough. Indian J Anaesth 2018; 62:66-71. [PMID: 29416153 PMCID: PMC5787894 DOI: 10.4103/ija.ija_382_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background and Aims: Post-operative sore throat (POST) is often considered an inevitable consequence of tracheal intubation. This study was performed to compare the effect of inhaled budesonide suspension, administered using a metered dose inhaler, on the incidence and severity of POST. Methods: In this prospective randomised study, 46 patients undergoing laparoscopic surgeries lasting <2 h were randomly allotted into two equal groups. Group A received 200 μg budesonide inhalation suspension, using a metered dose inhaler, 10 min before intubation, and repeated 6 h after extubation. No such intervention was performed in Group B. The primary outcome was the incidence and severity of POST. Secondary outocomes included the incidence of post-operative hoarseness and cough. Pearson's Chi-square test, Fisher's exact test and Independent sample t-test were used as applicable. Results: Compared to Group B, significantly fewer patients had POST in Group A at 2, 6, 12 and 24 h (P < 0.001). Although more patients in Group B had post-operative hoarseness of voice and cough at all-time points, the difference was statistically significant only at 12 h and 24 h for post-operative hoarseness and at 2 h and 12 h for post-operative cough. Severity as well as the incidence of POST showed downward trends in both groups over time, and by 24 h no patient in Group A had sore throat. Conclusion: Inhaled budesonide suspension is effective in significantly reducing the incidence and severity of POST.
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Affiliation(s)
- Sunil Rajan
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Pulak Tosh
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Jerry Paul
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Lakshmi Kumar
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Thomas D, Bejoy R, Zabrin N, Beevi S. Preoperative ketamine nebulization attenuates the incidence and severity of postoperative sore throat: A randomized controlled clinical trial. Saudi J Anaesth 2018; 12:440-445. [PMID: 30100844 PMCID: PMC6044170 DOI: 10.4103/sja.sja_47_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Endotracheal intubation is the prominent cause of airway mucosal injury which results in postoperative sore throat (POST), with an incidence of 21%–65%. Although this complication is minor, if left unresolved, it produces significant agony and annoyance to the patient. This study was conducted to evaluate the efficacy of nebulized ketamine in decreasing POST. Materials and Methods: After written informed consent, 96 patients of the American Society of Anesthesiologists physical status (PS) 1–2 between 18 and 60 years, of either sex undergoing general anesthesia (GA) with tracheal intubation were enrolled in this prospective, randomized, placebo-control, and double-blind controlled trial. Patients were randomized into two groups; Group 1 received ketamine 50 mg (1.0 ml) with 4.0 ml of saline nebulization, while Group 2 received saline nebulization 5.0 ml for 15 min. GA was administered 15 min after completing nebulization. On reaching postanesthesia care unit, POST monitoring was done at 0, 2, 4, 6, 12, and 24 h after extubation. POST was graded on a four-point scale (0–3). Results: The overall incidence of POST in this study was 25%: POST was experienced by 7 patients (14.6%) in ketamine and 17 patients (35.4%) in saline group (Fisher's exact P = 0.018). There was statistically significant reduction in the incidence of POST in ketamine group when compared to saline, at 2, 4, 6,12, and 24 h postoperatively (P < 0.05*). Severity of sore throat was also higher in saline group when compared to ketamine at 4 h (P = 0.030*) and 6 h (P = 0.016*) postextubation. Conclusion: Preoperative ketamine nebulization effectively reduced the incidence and severity of POST, with no adverse effects.
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Affiliation(s)
- Derlin Thomas
- Department of Anesthesiology, Azeezia Institute of Medical Sciences and Research, Kollam, Kerala, India
| | - Revathy Bejoy
- Department of Anesthesiology, Azeezia Institute of Medical Sciences and Research, Kollam, Kerala, India
| | - Nimeeliya Zabrin
- Department of Anesthesiology, Azeezia Institute of Medical Sciences and Research, Kollam, Kerala, India
| | - Suhura Beevi
- Department of Anesthesiology, Azeezia Institute of Medical Sciences and Research, Kollam, Kerala, India
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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; 12:625-629. [PMID: 30283166 PMCID: PMC6157218 DOI: 10.4103/aer.aer_65_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context: Postoperative sore throat (POST) occurs in 21%–65% of patients. Nebulization of ketamine reduces POST. Aims: The aim of this study is to see the effectiveness of nebulized ketamine in different doses to reduce POST and observe adverse effects, if any. Settings and Design: This was a prospective, randomized, and double-blind controlled trial. One hundred and fifty patients of the American Society of Anesthesiologists physical status Classes I and II, in the age group of 18–60 years, of either sex, undergoing surgery under general anesthesia were randomized into three groups. Subjects and Methods: Patients had nebulized with 5 ml solution (Group K1 – 1 ml of ketamine [50 mg/ml] +4 ml normal saline, Group K2 – 0.5 ml of ketamine [50 mg/ml] +4.5 normal saline, and Group S – 5 ml normal saline). Preoperative, intraoperative, and postoperative hemodynamic monitoring was done. The POST monitoring was done at 2, 4, 8, 12, and 24 h postoperatively. POST was graded on a four-point scale (0–3). Statistical Analysis Used: Chi-square test using MSTAT software for POST and ANOVA test using INDOSTAT software for hemodynamics were used in this study. Results: The overall incidence of POST in the present study was 29.33% (44/150). In Group S, the incidence of POST was observed to be 46% (23/50). In Group K1, the incidence was 20% (10/50), and in Group K2, it was 22% (11/50) (P ≤ 0.05), and intraoperative vital signs were more stable at all time intervals. Conclusions: We concluded that both doses (25 and 50 mg) of nebulized ketamine were almost equally effective in preventing POST, with no adverse effects.
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Affiliation(s)
- Shivpal Dan Charan
- Department of Anaesthesiology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Mohd Yunus Khilji
- Department of Anaesthesiology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Rashmi Jain
- Department of Anaesthesiology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Vishal Devra
- Department of Anaesthesiology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Madhu Saxena
- Department of Anaesthesiology, Sardar Patel Medical College, Bikaner, Rajasthan, India
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EFFICACY OF KETAMINE GARGLE FOR ATTENUATING POSTOPERATIVE SORE THROAT IN PATIENTS UNDERGOING GENERAL ANAESTHESIA WITH ENDOTRACHEAL INTUBATION. ACTA ACUST UNITED AC 2017. [DOI: 10.14260/jemds/2017/1238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Combined intraoperative paracetamol and preoperative dexamethasone reduces postoperative sore throat: a prospective randomized study. J Anesth 2017; 31:869-877. [PMID: 28980140 DOI: 10.1007/s00540-017-2411-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Postoperative sore throat (POST) after general anesthesia with endotracheal intubation is a common and undesirable complication. In this study, we evaluated the combined effects of paracetamol and dexamethasone on the prevention of POST in patients after general anesthesia. METHODS A total of 226 patients scheduled for urologic surgery under general anesthesia were randomly assigned to one of two groups. In the DexaPara group (n = 113), dexamethasone (10 mg) and paracetamol (1000 mg) was infused. In the Dexa group (n = 113), dexamethasone (10 mg) alone was given. POST, hoarseness, and dysphagia were monitored. The postoperative wound pain score and perioperative opioid requirements were compared. In addition, complications related to opioids were compared between the groups. RESULTS The overall incidence of POST was lower in the DexaPara group than in the Dexa group [42 (37%) vs. 72 (64%), p < 0.001]. The incidence of POST while resting at postoperative 1 and 6 h was lower in the DexaPara group than in the Dexa group (p = 0.008 and p = 0.004, respectively). The incidence of postoperative nausea, vomiting, drowsiness, shivering, and headache was comparable between the groups. CONCLUSIONS Paracetamol and dexamethasone infusion reduced the incidence of POST without serious complications in patients for urologic surgery under general anesthesia.
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Chang JE, Kim H, Han SH, Lee JM, Ji S, Hwang JY. Effect of Endotracheal Tube Cuff Shape on Postoperative Sore Throat After Endotracheal Intubation. Anesth Analg 2017; 125:1240-1245. [DOI: 10.1213/ane.0000000000001933] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Nebulized ketamine for successful management of difficult airway. J Clin Anesth 2017; 41:71-72. [DOI: 10.1016/j.jclinane.2017.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 06/24/2017] [Indexed: 11/23/2022]
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40
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Effects of Aroma Gargling, Cold Water Gargling, and Wet Gauze Application on Thirst, Halitosis, and Sore Throat of Patients After Spine Surgery. Holist Nurs Pract 2017; 31:253-259. [DOI: 10.1097/hnp.0000000000000219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rajan S, Malayil GJ, Varghese R, Kumar L. Comparison of Usefulness of Ketamine and Magnesium Sulfate Nebulizations for Attenuating Postoperative Sore Throat, Hoarseness of Voice, and Cough. Anesth Essays Res 2017; 11:287-293. [PMID: 28663608 PMCID: PMC5490122 DOI: 10.4103/0259-1162.181427] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Postoperative sore throat (POST) is a complication that is unresolved in patients undergoing endotracheal intubation. AIM To compare the effects of ketamine and magnesium sulfate nebulizations in two strengths, on the incidence and severity of POST, hoarseness, and cough. SETTINGS AND DESIGN Sixty surgical patients undergoing elective abdominal and lower limb surgeries under combined epidural and general anesthesia were included in this prospective, randomized, double-blinded study. SUBJECTS AND METHODS Patients in each group were nebulized with the respective study drug 15 min prior to the surgery, i.e., ketamine in Group K, magnesium sulfate 250 mg, and 500 mg in Group M1 and Group M2, respectively, and normal saline as control in Group C. A standardized anesthesia protocol was followed for all patients. After extubation, the patients were asked to grade POST, hoarseness, and cough at 0, 2, 4, 12, and 24 h. STATISTICAL ANALYSIS USED One-way analysis of variance, Chi-square test, Fisher's exact test, paired t-tests, and Wilcoxon's signed-rank test as applicable. RESULTS Ketamine and magnesium sulfate 500 mg demonstrated a statistically significant decrease in POST at 0, 2, and 4 h, and postoperative hoarseness at 0 h. There was decrease in the incidence and severity of sore throat, hoarseness, and cough at all periods in the study groups as compared with control. CONCLUSION Nebulization with ketamine 50 mg and magnesium sulfate 500 mg, 15 min before induction of general anesthesia and intubation, reduce the incidence and severity of POST and hoarseness of voice.
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Affiliation(s)
- Sunil Rajan
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - George Jacob Malayil
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Rekha Varghese
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Lakshmi Kumar
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Jafari H, Ariaeifar MR, Yazdani Charati J, Soleimani A, Nasiri Formi E. The Effect of Green Tea Gargle Solution on Sore Throat After Coronary Artery Bypass Grafting: A Randomized Clinical Trial. Anesth Pain Med 2016; 6:e32108. [PMID: 27642569 PMCID: PMC5018145 DOI: 10.5812/aapm.32108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/01/2016] [Accepted: 02/19/2016] [Indexed: 12/04/2022] Open
Abstract
Background Tracheal intubation is an essential method of keeping the airway open in patients under general anesthesia. Sore throat is a prevalent complication after endotracheal intubation. Objectives The aim of this study was to investigate the effect of green tea gargling on sore throat after coronary artery bypass grafting (CABG). Patients and Methods This was a single-blind, randomized clinical trial, in which 121 patients who had undergone CABG were divided into two groups: those who gargled distilled water and those who gargled a green tea solution. An hour after extubation, the patients of the intervention group were asked to gargle 30 cc of green tea, and the patients of the control group were asked to gargle 30 cc of distilled water, every 6 hours for up to 24 hours (four times per patient). A sore throat questionnaire was filled out 6, 12, and 24 hours after endotracheal extubation. Results The results showed that there were no significant differences between the two groups with regard to patient age, sex, body mass index, smoking background, and duration of anesthesia. There was no significant difference between the two groups in terms of sore throat before the intervention (P = 0.461) and 6 hours after the intervention (P = 0.901). However, a significant difference was observed between the two groups in terms of sore throat 12 hours (P = 0.047) and 24 hours (P < 0.001) after removing the endotracheal tube. Conclusions Gargling a green tea solution, an anti-inflammatory, natural, and harmless substance, can reduce the pain of sore throat in patients after endotracheal extubation.
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Affiliation(s)
- Hedayat Jafari
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Reza Ariaeifar
- Student Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Corresponding author: Mohammad Reza Ariaeifar, Student Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Tel: +98-9150065246, Fax: +98-5138784714. E-mail:
| | - Jamshid Yazdani Charati
- Department of Biostatistics, School of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Aria Soleimani
- Department of Anesthesiology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ebrahim Nasiri Formi
- Department of Anesthesiology, School of Paramedical, Mazandaran University of Medical Sciences, Sari, Iran
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Bulut H, Erden S, Demir SG, Çakar B, Erdoğan Z, Demir N, Ay A, Aydın E. The Effect of Cold Vapor Applied for Sore Throat in the Early Postoperative Period. J Perianesth Nurs 2016; 31:291-7. [PMID: 27444760 DOI: 10.1016/j.jopan.2014.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/01/2014] [Accepted: 10/05/2014] [Indexed: 10/22/2022]
Abstract
PURPOSE This study was conducted for the purpose of determining the effect of cold vapor applied for sore throat in the early postoperative stage. DESIGN A quasi-experimental design was used. METHODS The study sample consisted of 60 patients who underwent lumbar disc herniation surgery in the Neurosurgery Clinic of Gazi University Health Research and Practice Center in Ankara, Turkey. The study involved two intervention groups and one control group. The study data were collected through questionnaire and observation forms. FINDINGS 65% (n = 39) of patients experienced sore throat. There were no statistical differences between the groups in terms of sore throat and hoarseness (P > .05); however, a significant difference was determined in the group to whom oxygen together with cold vapor was applied for dry throat (4th and 8th hours) and swallowing difficulties(8th and 12th hours) (P < .05). CONCLUSIONS Cold vapor did not have an effect on sore throat on its own; however, it decreased hoarseness and swallowing difficulties when applied together with oxygen.
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Yadav M, Chalumuru N, Gopinath R. Effect of magnesium sulfate nebulization on the incidence of postoperative sore throat. J Anaesthesiol Clin Pharmacol 2016; 32:168-71. [PMID: 27275043 PMCID: PMC4874068 DOI: 10.4103/0970-9185.173367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background and Aims: Postoperative sore throat (POST) is a well-recognized complication after general anesthesia (GA). Numerous nonpharmacological and pharmacological measures have been used for attenuating POST with variable success. The present study was conducted to compare the efficiency of preoperative nebulization of normal saline and magnesium sulfate in reducing the incidence of POST following GA. Materials and Methods: Following institutional ethical committee approval and written informed consent, a prospective randomized double-blinded study was conducted in 100 cases divided into two equal groups. Patients included in the study were of either gender belonging to American Society of Anesthesiologist (ASA) status 1 or 2 undergoing elective surgery of approximately 2 h or more duration requiring tracheal intubation. Patients in Group A are nebulized with 3 ml of normal saline and the patients in Group B are nebulized with 3 ml of 225 mg isotonic nebulized magnesium sulfate for 15 min, 5 min before induction of anesthesia. The incidence of POST at rest and on swallowing and any undue complaints at 0, 2, 4, and 24 h in the postoperative period are evaluated. Results: There is no significant difference in POST at rest during 0th, 2nd and 4th h between normal saline and MgSO4. Significant difference is seen at 24th h, where MgSO4 lessens POST. There is no significant difference in POST on swallowing during 0th and 2nd h between normal saline and MgSO4. Significant difference is seen at 4th h, where MgSO4 has been shown to lessen POST. Conclusions: MgSO4 significantly reduces the incidence of POST compared to normal saline.
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Affiliation(s)
- Monu Yadav
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Nitish Chalumuru
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ramachandran Gopinath
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Lee SH, Lee YC, Lee JH, Choi SR, Lee SC, Lee JH, Chung CJ. The prophylactic effect of dexamethasone on postoperative sore throat in prone position surgery. Korean J Anesthesiol 2016; 69:255-61. [PMID: 27274371 PMCID: PMC4891538 DOI: 10.4097/kjae.2016.69.3.255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 02/01/2016] [Accepted: 02/05/2016] [Indexed: 02/08/2023] Open
Abstract
Background Sore throat and hoarseness are common complications after general anesthesia with tracheal intubation. The position for patients can affect the incidence of postoperative sore throat (POST) by causing displacement of the endotracheal tube. This study investigated the prophylactic effect of dexamethasone in prone position surgeries. Methods One hundred-fifty patients undergoing lumbar spine surgery (18-75 yr) were randomly allocated into the normal saline group (group P, n = 50), dexamethasone 0.1 mg/kg group (group D1, n = 50) or dexamethasone 0.2 mg/kg group (group D2, n = 50). The incidence and severity of POST, hoarseness, and cough were measured using direct interview at 1, 6, and 24 h after tracheal extubation. The severity of POST, hoarseness, and cough were graded using a 4-point scale. Results At 1, 6, and 24 h after extubation, the incidence of sore throat was significantly lower in group D1 (1 h; P = 0.015, 6 h; P < 0.001, 24 h; P = 0.038) and group D2 (1 h; P < 0.001, 6 h; P < 0.001, 24 h; P = 0.017) compared to group P. There were less number of patients in the groups D1 and D2 than group P suffering from moderate grade of POST at 1, 24 h after extubation. The incidence of hoarseness at 1, 6, and 24 h after extubation was significantly lower in groups D2 than group P (P < 0.001). There were no significant differences in the incidence of cough among the three groups. Conclusions The prophylactic use of dexamethasone 0.1 mg/kg and 0.2 mg/kg in prone surgery reduces the incidence of postoperative sore throat and dexamethasone 0.2 mg/kg decreases the incidence of hoarseness.
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Affiliation(s)
- Sang Ho Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - Yoon Chan Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - Ji Hyeon Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - So Ron Choi
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - Seung-Cheol Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - Jong Hwan Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - Chan Jong Chung
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
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47
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Mukhopadhyay S, Mukhopadhyay S, Bhattacharya D, Bandyopadhyay BK, Mukherjee M, Ganguly R. Clinical performance of cuffed versus uncuffed preformed endotracheal tube in pediatric patients undergoing cleft palate surgery. Saudi J Anaesth 2016; 10:202-7. [PMID: 27051374 PMCID: PMC4799615 DOI: 10.4103/1658-354x.168842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Uncuffed endotracheal tubes are commonly used in children but due to several decade preferred in paediatric oral surgery. Due to lack of conclusive evidences in this regard, we have conducted this study to compare post-operative morbidity following use of cuffed and uncuffed endotracheal tubes in paediatric patients undergoing cleft lip-palate surgery. Methods: This randomised controlled trial was conducted on children aged 2 to 12 years.110 patients were allocated in two parallel groups using computer generated list of random numbers. Post operative extubation stridor, sore throat, time to first oral intake and regaining of normal voice were compared between two groups. Results: The incidence of sore throat was significantly more (P value > 0.005) in patients of uncuffed group compared to cuffed group. The time to first oral intake and time to regain normal voice were significantly earlier in cuffed group compared to the other. Conclusion: With standard care, preformed cuffed ET tube has shown reduced incidence of post operative sore throat. Cuffed group has earlier oral intake and normal voice regain compared to uncuffed group.
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Affiliation(s)
- S Mukhopadhyay
- Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - S Mukhopadhyay
- Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - D Bhattacharya
- Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - B K Bandyopadhyay
- Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - M Mukherjee
- Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - R Ganguly
- Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
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48
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El-Boghdadly K, Bailey CR, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia 2016; 71:706-17. [DOI: 10.1111/anae.13438] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 12/14/2022]
Affiliation(s)
- K. El-Boghdadly
- Department of Anesthesia; Toronto Western Hospital; Toronto Ontario Canada
| | - C. R. Bailey
- Department of Anaesthetics; Evelina London Children's Hospital; Guys and St. Thomas’ NHS Foundation Trust; London UK
| | - M. D. Wiles
- Department of Anaesthetics; Sheffield Teaching Hospital NHS Foundation Trust; Sheffield UK
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49
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The effects of thermal softening of double-lumen endobronchial tubes on postoperative sore throat, hoarseness and vocal cord injuries: a prospective double-blind randomized trial. Br J Anaesth 2016; 116:282-8. [DOI: 10.1093/bja/aev414] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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50
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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; 62:1097-103. [DOI: 10.1007/s12630-015-0432-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 04/21/2015] [Accepted: 06/29/2015] [Indexed: 10/23/2022] Open
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