Background and Aims:Post-operative sore throat (POST) occurs in 21-65% of patients. Ketamine used earlier as gargle for reducing POST has limitations. The aim of this study was to see if nebulised ketamine reduces POST.Methods:We conducted a prospective, randomised, placebo-control, and double-blind controlled trial. After written informed consent, 100 patients belonging to American Society of Anaesthesiologists physical status I-II in the age group 20-60 years, of either sex undergoing surgery under general anaesthesia (GA) were enrolled. Patients were randomised into two groups; group saline (S) received saline nebulisation 5.0 ml and group ketamine (K) received ketamine 50 mg (1.0 ml) with 4.0 ml of saline nebulisation for 15 min. GA was induced 10 min after completion of nebulisation in the patients. The POST and haemodynamic monitoring were done pre-nebulization, pre-induction, on reaching post-anaesthesia care unit, and at 2, 4, 6, 8, 12 and 24 h post-operatively. POST was graded on a four-point scale (0-3).Results:The overall incidence of POST was 33%; 23 patients (46%) in saline and 10 patients (20%) in ketamine group experienced POST (Fisher's exact P = 0.01). The use of ketamine nebulization attenuated POST at 2 h and 4 h post-operatively (P < 0.05). The primary outcome was incidence of POST at 4 h; 13 patients in group S versus 4 patients in group K (P = 0.03) experienced POST at 4 h. The moderate sore throat occurred in 6 patients in group S and none in group K at 2 h, post-operatively (P = 0.02).Conclusion:Ketamine nebulization significantly attenuated the incidence and severity of POST, especially in the early post-operative period, with no adverse effects.
Background:Dexmedetomidine, a selective α2 agonist has shown promising results when used as a premedicant. This prospective randomized study evaluated the efficacy of two different premedication regimens in achieving a smooth conduct of anesthesia and optimum pain relief in pediatric cataract surgeries. Methods:90 ASA I or II children, aged 1-6 years, scheduled for elective cataract surgeries were randomized to receive either 0.25 mg kg-1oral midazolam and 1µg kg-1 of intranasal dexmedetomidine (Group MD; n=45) or 0.5mg/kg oral midazolam followed by 0.02ml kg-1 intranasal saline drops (Group MS; n=45) 45 min prior to surgery. Drug acceptance, anxiety at parental separation and quality of mask induction was evaluated. Subtenon block was given to all the children. Intraoperative use of narcotics was avoided and used only as rescue drug. Primary outcome of the study was number of patients requiring rescue analgesia over 24-hour period. The secondary outcomes were time to first rescue analgesia, frequency of rescue analgesia, incidence of OCR and PONV.Results:90% of the children in Group MD achieved MOAA/S ≤ 4 at 30 minutes versus 95% in Group MS. Drug acceptability, parental separation and mask acceptance were similar in both groups. Incidence of PONV and children who required rescue analgesia was less in MD group compared with MS group. There was no event of OCR in both groups. Conclusion: Premedication with combined IND and low dose oral midazolam is superior in decreasing postoperative analgesic requirements when compared to routine oral midazolam premedication alone in pediatric cataract surgeries under general anesthesia.
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