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

Abstract

Background:Sore throat and hoarseness are the most frequent subjective complaints after tracheal intubation for general anesthesia. We conducted a prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of intravenous (IV) dexamethasone plus ketamine gargle for reducing the incidence and severity of post-operative sore throat (POST) and hoarseness.Materials and Methods:140 patients (aged 16-65 year) scheduled for elective surgery were enrolled. Patients were randomly allocated into four groups of 35 subjects each: Group K, gargled 40 mg ketamine in 30 ml saline; Group D, were infused 0.2 mg/kg IV dexamethasone; Group KD, gargled 40 mg ketamine in 30 ml saline plus 0.2 mg/kg IV dexamethasone; Group P (placebo) that received saline (gargle and IV). POST was graded at 0, 2, 4, 8, 16 and 24 h after operation on a four-point scale (0-3).Results:The incidence and severity of POST were significantly lower in Group KD, compared with the other groups at all times after tracheal extubation for up to 24 h (P < 0.05). Also the incidence and severity of hoarseness were significantly lower in each Groups of KD and K and D compared with group placebo (P < 0.05).Conclusion:The prophylactic use of 0.2 mg/kg of IV dexamethasone plus ketamine gargle significantly reduced the incidence and severity of POST compared with using each of these drugs alone or using placebo.

The impact of prophylactic dexamethasone on postoperative sore throat: an updated systematic review and meta-analysis

“…Data on incidence of POST comparing dexamethasone plus a different drug vs dexamethasone were reported in three trials. 16 , 18 , 26 Compared with dexamethasone, a statistical decrease in the incidence of POST at 24 hours was found in patients treated with dexamethasone plus a different drug (OR 0.40, 95% CI 0.21–0.77, P =0.006; Figure 4 ). No statistical heterogeneity was found among studies ( P =0.24, I 2 =31%).…”

“…The incidence of hoarseness was reported in six RCTs. 15 , 17 , 18 , 20 , 24 , 25 , 27 Compared with placebo, a significant reduction in the incidence of hoarseness was found in patients treated with dexamethasone with or without concomitant drugs (OR 0.42, 95% CI 0.31–0.58, P <0.00001; Figure 5 ). No statistical heterogeneity was found among studies ( P =0.16, I 2 =32%).…”

“…Timing of dexamethasone administration varied from 30 minutes before tracheal intubation to 30 minutes after tracheal intubation. Controls included placebo, ondansetron, 16 magnesium sulfate, 17 ketamine gargle, 18 betamethasone gel, 19 and ketorolac 20 or a combination of these medications. Regarding the methodological quality of the RCTs, all showed low overall risks of bias ( Table 2 ).…”

“…The incidence of POST in patients receiving dexamethasone vs a different drug, including ondansetron, 16 magnesium sulfate, 17 ketamine gargle, 18 betamethasone gel, 19 or ketorolac, 20 was described in five RCTs. Compared with these different drugs, no statistical difference in the incidence of POST at 24 hours was found in patients receiving dexamethasone (OR 0.70, 95% CI 0.46–1.07, P =0.10; Figure 3 ).…”

Inhalation of ketamine in different doses to decrease the severity of postoperative sore throat in surgeries under general anesthesia patients

“…Postoperative sore throat (POST) occurs in 21%–65% of patients receiving general anesthesia (GA) with tracheal intubation. [ 1 ] Many studies have been carried out to assess the beneficial effects of gargling with ketamine to prevention of POST,[ 2 3 ] but ketamine nebulization has few advantages over gargling. In previous studies, ketamine was used as 50 mg single dose for nebulization and reveals that it decreases the severity and incidence of POST.…”