Comparison of usefulness of ketamine and magnesium sulfate nebulizations for attenuating postoperative sore throat, hoarseness of voice, and cough

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.

Topical application of ketamine to prevent postoperative sore throat in adults: A systematic review and meta‐analysis

“…The mean age of the participants in the included studies ranged from 24.5 to 51.8 years, with the reported proportions of women ranging from 15.7% to 100% (Table ). Two and 37 studies included patients with an ASA status of I‐III and I‐II, respectively, while the remaining two did not report ASA status . In all, 19 studies detailed the type of surgery, and 32 studies excluded patients who underwent surgeries on the neck or pharynx .…”

“…In all, 30 including 2278 participants provided data on the incidence of sore throat at 24 hours after surgery/extubation . Topical application of ketamine was associated with a reduced incidence of postoperative sore throat compared to non‐analgesic methods (159/1161 vs 384/1117; RR, 0.45; 95% CI, 0.37‐0.54; P < .001; I 2 = 23.0%; Figure ).…”

“…Two and 37 studies included patients with an ASA status of I-III 44,65 and I-II, respectively, while the remaining two did not report ASA status. 37,57 In all, 19 studies detailed the type of surgery, [36][37][38][39]41,43,46,47,50,51,54,55,59,60,65,69,71,74,76 and 32 studies excluded patients who underwent surgeries on the neck or pharynx. [36][37][38][39][41][42][43][45][46][47][48][49][50][51][52]54,55,57,59,60,62,[65][66][67][68][69][70]…”

“…Ketamine was topically administered as a single dose prior to surgery in all studies. Ketamine was administered as nebulization and gargle in 13 40,49,56,58,60,61,63,65,67,68,70,72,74 and 26 trials, [36][37][38][39][41][42][43][44][45][46][47][48][50][51][52][53]55,57,59,62,64,66,69,71,73,75,76 respectively, and in the other one, the endotracheal tube was lubricated with ketamine. 54 The dose of ketamine was fixed in 36 studies (50 mg, 23 studies 37,39,44,[48][49][50][51][52][53]…”

“…A total of 14 studies examined both non-analgesic and active comparators. [42][43][44]46,53,57,60,63,65,68,69,73,75,76 In all, 22 studies were reported from India, six from Iran, 43,46,[54][55][56]76 three each from China 40,44,71 and Egypt, 42,57,68 two each from Indonesia 47,59 and Nepal, 39,77 and one each from Malaysia, 38 South Korea, 51 and Turkey. 36 All but six studies were reported in English: three in Chinese, 40,44,71 two in Indonesian, 47,59 and one in Persian.…”