Beclomethasone inhaler versus intravenous lidocaine in the prevention of postoperative airway and throat complaints: a randomized, controlled trial

Abstract

BACKGROUND AND OBJECTIVEPrevious reports indicate that inhaled corticosteroids attenuate airway inflammation. Beclomethasone inhaler was highly effective in the prevention of postoperative airway symptoms. Intravenous lidocaine prior to endotracheal intubation has also been shown to decrease the incidence of postoperative sore throat and cough. The aim of the present study was to compare the effect of beclomethasone inhaler with various clinically used dosages of intravenous lidocaine prior to endotracheal intubation on the incidence and severity of postoperative sore throat, cough, sputum, hoarseness, and dysphagia.PATIENTS AND METHODSOne hundred twenty patients undergoing elective operations were assigned to one of four treatments: intravenous lidocaine 1mg/kg (Group L1, n=30), intravenous lidocaine 1.5 mg/kg (Group L2, n=30), beclomethasone inhaler 50 μg (Group B, n=30) or intravenous normal saline (Group C, n=30). The incidence and severity of sore throat, cough, sputum, hoarseness, and dysphagia were compared between the beclomethasone inhaler and intravenous lidocaine groups before they left the operating room, 1 hour later, at time of the first postoperative drink or meal (for assessment of dysphagia), and on the morning after surgery.RESULTSIn the evaluation of postoperative symptoms, the incidence and severity of sore throat were significantly lower in Group L2 and B than Group C (P<.05) at all time intervals. One and 20 hours after emergence from anesthesia, the incidence and severity of cough were significantly lower in Group L2 and B than Group C (P<.05). The incidence and severity of sore throat or cough was not significantly different between Groups L2 and B. Throughout the study, the incidence and severity of sputum were significantly lower in Group B than group C (P<.05).CONCLUSIONBeclomethasone inhaler is comparable with intravenous lidocaine prior to intubation in decreasing postoperative sore throat and cough. In addition, beclomethasone inhaler decreases the incidence and severity of postoperative sputum.

Intravenous lidocaine to prevent postoperative airway complications in adults: a systematic review and meta-analysis

“…14,24e26,38e49 All studies were RCTs with placebo or no treatment control arms. Three trials were conducted in Japan, 43,44,47 three in India, 24,25,42 three in Iran, 40,45,46 and one in each of the following countries: Saudi Arabia, 38 Denmark, 26 USA, 39 Korea, 41 China, 14 Turkey, 48 and Spain. 49 The mean age of participants ranged from 22.5 to 63.0 yr, and the proportion of males ranged from 24% to 68%.…”

“…14,24e26,38e49 Seven trials used a dose of i.v. lidocaine at 1 mg kg À1 , 24,38,41e45 seven trials used a dose of 1.5 mg kg À1 or higher, 14,25,26,39,46,48,49 and two trials had two intervention arms with a dose of 1 and 1.5 mg kg À1 or higher 40,47 (Table 1).…”

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

“…It had been rated by patients as the eighth most adverse effect in the post-operative period. [ 5 8 9 10 11 ] Despite attempts to reduce its incidence and severity,[ 12 13 14 15 ] there are currently no effective therapies for the prevention of POST and hoarseness in patients. Various trials have been used for reducing POST with variable success.…”

“…Like, smaller-sized endotracheal tubes, careful airway instrumentation, intubation after full relaxation, minimizing intracuff pressure, gentle oropharyngeal suctioning, and extubation when the tracheal tube cuff is fully deflated that have been reported to decrease the incidence of POST. [ 16 ] The pharmacological methods include, using azulene sulphate,[ 15 17 ] ketamine gargle,[ 18 ] steroid gels,[ 10 ] and steroid injections. [ 11 19 20 ] Experimental studies point out that peripherally administered N-methyl-D-aspartate (NMDA) receptor antagonists are involved with anti-nociception,[ 21 ] and anti-inflammatory cascade.…”

Comparing the effect of ketamine and benzydamine gargling with placebo on post-operative sore throat: A randomized controlled trial

“…[ 6 ] Gargling with sodium azulene sulfonate, fluticasone propionate oral inhalation, beclomethasone inhalation description, and intravenous dexamethasone injection and were all recommended as pharmaceutical prophylactic approaches to reduce post-operative sore throat (POST). [ 7 8 9 10 ]…”