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Ayalew SB, Daniel T, Samuel H, Endeshaw AS, Bayu HT. Comparison between intravenous lidocaine and dexamethasone in reducing postoperative sore throat after endotracheal extubation at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia; a prospective cohort study. BMC Anesthesiol 2024; 24:259. [PMID: 39075339 PMCID: PMC11285459 DOI: 10.1186/s12871-024-02634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 07/11/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Post-operative sore throat is the common complaint and uncomfortable side effect in patients receiving general anesthesia with endotracheal intubation. Drugs with analgesic and anti-inflammatory properties, like steroids and local anesthetics, are the best options for postoperative sore throat prophylaxis. Therefore, this study aimed to compare the effects of intravenous lidocaine and dexamethasone in reducing postoperative sore throat following endotracheal extubation at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, from January 1 to March 30, 2023 G.C. METHODS A prospective cohort study was carried out at Tikur Anbessa Specialized Hospital. Data from 50 patients in the lidocaine (1.5 mg/kg), 50 in the dexamethasone (8 mg), and 49 in the control groups were analyzed. The data were collected using observation based on structured questionnaires. A systematic random sampling technique was applied to select respondents. The data were entered into EpiData version 4.6.0.6 and transferred to STATA version 17 statistical software for analysis. A comparison of continuous data among the groups were performed using a one-way ANOVA test for parametric data. The Kruskal-Wallis rank test was used for non-parametric data. Associations between variables were tested using chi-squared test, Fisher's exact test, and binary logistic regression. Bivariable and multivariable logistic regression was used to determine degree of association. RESULTS The incidence of POST was 40%, 32%, and 57.1% in the lidocaine, dexamethasone, and control groups, respectively (P = .0356). Dexamethasone reduced the incidence of POST during the first 24 h (AOR: 0.374, 95% CI: 0.149-0.939). However, no difference was observed in the severity of POST at 3 h (p = 0.130), 6 h (p = 0.096), 12 h (p = 0.313), and 24 h (p = 0.525) of the post-extubation period among the three groups. IV lidocaine did not effectively reduce the incidence and severity of postoperative sore throat at different time intervals. CONCLUSION AND RECOMMENDATION: Intravenous dexamethasone is more effective than intravenous lidocaine in reducing the incidence of postoperative sore throat among the groups. Based on these findings, intravenous dexamethasone is recommended to decrease the incidence of postoperative sore throat.
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Affiliation(s)
- Samuel Belay Ayalew
- Department of Anesthesia, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Tinbite Daniel
- Department of Anesthesia, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hirbo Samuel
- Department of Anesthesia, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amanuel Sisay Endeshaw
- Department of Anesthesia, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Habtu Tsehayu Bayu
- Department of Anesthesia, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Bhanwra A, Palta S, Saroa R, Saxena P, Bhanwra S, Jain A. Role of preoperative zinc, magnesium and budesonide gargles in Postoperative Sore Throat (POST) - a randomised control trial. BMC Anesthesiol 2024; 24:164. [PMID: 38693477 PMCID: PMC11061912 DOI: 10.1186/s12871-024-02534-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 04/09/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Post-operative sore throat (POST) has an incidence ranging from 21 to 80%. To prevent the development of POST, several pharmacological measures have been tried. Aim of this study was to compare the efficacy of preoperative zinc, magnesium and budesonide gargles in reducing the incidence and severity of POST in patients who underwent endotracheal intubation for elective surgeries. METHODS We conducted a prospective, randomized, double-blind, controlled equivalence trial in 180 patients admitted for elective surgical procedures under general anaesthesia. Patients were randomised into three groups; group Z received 40 mg Zinc, group M received 250 mg Magnesium Sulphate and group B received 200 µg Budesonide in the form of 30 ml tasteless and colourless gargle solutions. Sore throat assessment and haemodynamic recording was done postoperatively at immediate recovery (0 h) and 2, 4, 6, 8, 12 and 24 h post-operatively. POST was graded on a four-point scale (0-3). RESULTS POST score was comparable at all recorded time points i.e. 0,2,4,6,8,12 and 24 h. Maximum incidence was seen at 8 h in group B (33.3%) and the minimum incidence was at 24 h in group Z (10%) (p > 0.05). It was found that the incidence of POST was more in the surgeries lasting longer than 2 h in all groups. This difference was found to be statistically significant in Groups M and B. The incidence of POST was found to be comparable between laparoscopic and open procedures. CONCLUSION Magnesium, zinc and budesonide have an equivocal effect in the prevention of POST at different time points. The incidence of sore throat increases significantly in surgeries lasting more than two hours if magnesium or budesonide have been used as premedicant. Duration of surgery is an independent predictor for POST. TRIAL REGISTRATION CTRI/2021/05/033741 Date-24/05/2021(Clinical Trial Registry of India).
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Affiliation(s)
- Aakanksha Bhanwra
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Sanjeev Palta
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Richa Saroa
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Puja Saxena
- Department of Anaesthesia and Intensive Care, Dr. B.R. Ambedkar State Institute of Medical Sciences, Sector 57, Sahibzada Ajit Singh Nagar, Punjab, 160055, India
| | - Sangeeta Bhanwra
- Department of Pharmacology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Aditi Jain
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India.
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Garg R. Nebulised/aerosolised drugs in anaesthesiology, critical care and pain practice-benefit with a professional hazard! Indian J Anaesth 2024; 68:315-316. [PMID: 38586262 PMCID: PMC10993933 DOI: 10.4103/ija.ija_206_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. A. Institute Rotary Cancer Hospital and National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
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Kampan S, Thong-On K, Sri-On J. A non-inferiority randomized controlled trial comparing nebulized ketamine to intravenous morphine for older adults in the emergency department with acute musculoskeletal pain. Age Ageing 2024; 53:afad255. [PMID: 38251742 DOI: 10.1093/ageing/afad255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE Our study aimed to investigate the analgesic efficacy of nebulized ketamine in managing acute moderate-to-severe musculoskeletal pain in older emergency department (ED) patients compared with intravenous (IV) morphine. METHODS This was a non-inferiority, double-blind, randomized controlled trial conducted at a single medical centre. The patients aged 65 and older, who presented at the ED musculoskeletal pain within 7 days and had a pain score of 5 or more on an 11-point numeric rating scale (NRS), were included in the study. The outcomes were a comparison of the NRS reduction between nebulized ketamine and IV morphine 30 minutes after treatment, incidence of adverse events and rate of rescue therapy. RESULTS The final study included 92 individuals, divided equally into two groups. At 30 minutes, the difference in mean NRS between the nebulized ketamine and IV morphine groups was insignificant (5.2 versus 5.7). The comparative mean difference in the NRS change from baseline between nebulized ketamine and IV morphine [-1.96 (95% confidence interval-CI: -2.45 to -1.46) and -2.15 (95% CI: -2.64 to -1.66) = 0.2 (95% CI: -0.49 to 0.89)] did not exceed the non-inferiority margin of 1.3. The rate of rescue therapy did not differ between the groups. The morphine group had considerably higher incidence of nausea than the control group (zero patients in the ketamine group versus eight patients (17.4%) in the morphine group; P = 0.006). CONCLUSIONS Nebulized ketamine has non-inferior analgesic efficacy compared with IV morphine for acute musculoskeletal pain in older persons, with fewer adverse effects.
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Affiliation(s)
- Sirasa Kampan
- Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok 10300, Thailand
| | - Kwannapa Thong-On
- Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok 10300, Thailand
| | - Jiraporn Sri-On
- Geriatric Emergency Research Unit, Emergency Department, Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit, Bangkok 10300, Thailand
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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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Fernandes TM, Gangakhedkar GR. A New Use for an Old Medicine: Dextromethorphan to Prevent Postoperative Sore Throat. Int J Prev Med 2021; 12:133. [PMID: 34912509 PMCID: PMC8631140 DOI: 10.4103/ijpvm.ijpvm_112_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 01/15/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Talisa M Fernandes
- Department of Anaesthesiology, Bai Jerbai Wadia Hospital, Mumbai, Maharashtra, India
| | - Gauri R Gangakhedkar
- Department of Anaesthesiology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
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Dove D, Fassassi C, Davis A, Drapkin J, Butt M, Hossain R, Kabariti S, Likourezos A, Gohel A, Favale P, Silver M, Marshall J, Motov S. Comparison of Nebulized Ketamine at Three Different Dosing Regimens for Treating Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind Clinical Trial. Ann Emerg Med 2021; 78:779-787. [PMID: 34226073 DOI: 10.1016/j.annemergmed.2021.04.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE We aimed to assess and compare the analgesic efficacies and adverse effects of ketamine administered through a breath-actuated nebulizer at 3 different dosing regimens for emergency department patients presenting with acute and chronic painful conditions. METHODS This was a prospective, randomized, double-blinded trial comparing 3 doses of nebulized ketamine (0.75 mg/kg, 1 mg/kg, and 1.5 mg/kg) administered through breath-actuated nebulizer in adult emergency department patients aged 18 years and older with moderate to severe acute and chronic pain. The primary outcome included the difference in pain scores on an 11-point numeric rating scale between all 3 groups at 30 minutes. Secondary outcomes included the need for rescue analgesia (additional doses of nebulized ketamine or intravenous morphine) and adverse events in each group at 30 and 60 minutes. RESULTS We enrolled 120 subjects (40 per group). The difference in mean pain scores at 30 minutes between the 0.75 mg/kg and 1 mg/kg groups was 0.25 (95% confidence interval [CI] 1.28 to 1.78); between the 1 mg/kg and 1.5 mg/kg groups was -0.225 (95% CI -1.76 to 1.31); and between the 0.75 mg/kg and 1.5 mg/kg groups was 0.025 (95% CI -1.51 to 1.56). No clinically concerning changes in vital signs occurred. No serious adverse events occurred in any of the groups. CONCLUSION We found no difference between all 3 doses of ketamine administered through breath-actuated nebulizer for short-term treatment of moderate to severe pain in the emergency department.
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Affiliation(s)
- Daniel Dove
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Catsim Fassassi
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Ashley Davis
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Jefferson Drapkin
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY.
| | - Mahlaqa Butt
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Rukhsana Hossain
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Sarah Kabariti
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | | | - Ankit Gohel
- Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY
| | - Patrizia Favale
- Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY
| | - Michael Silver
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - John Marshall
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Sergey Motov
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
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Sakae TM, Souza RLPD, Brand Úo JCM. Impact of topical airway anesthesia on immediate postoperative cough/bucking: a systematic review and meta-analysis. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2021; 73:91-100. [PMID: 33895219 PMCID: PMC9801204 DOI: 10.1016/j.bjane.2021.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Postoperative cough may occur after tracheal intubation, but it is indistinct which drug is best at diminishing these events. Additionally, airway reflexes are commonly accompanied by severe hemodynamics responses during emergence. OBJECTIVES To evaluate the role of topical airway anesthesia on immediate post-extubation cough/bucking and extubation time. METHODS Randomized clinical trials from MEDLINE, EMBASE, CENTRAL, and LILACS published until December 23, 2020 were included. Our primary outcome was postoperative cough/bucking incidence which was compared between local anesthetics and controls. Extubation times were likewise considered. Predisposition appraisal and subgroup, affectability investigations were likewise performed. RESULTS The pooled analysis found a 45% reduction in cough incidence after treatment with topical airway local anesthetic (RR.á=.á0.55; 95% CI: 0.42 to 0.72; p.á<.á0.001). The number needed to treat (NNT) was 4.61. The intervention showed no differences in reduction of the extubation time (mean difference = -0.07; 95% CI: -0.14 to 0.28; p.á=.á0.49). CONCLUSION Topical airway anesthesia demonstrated better than placebo or no medication in reducing immediate post-extubation cough/bucking. Further studies could have this objective to combine the different ways to perform better outcomes for patients.
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Affiliation(s)
- Thiago Mamoru Sakae
- Clinigastro Medicina Integrada, Post PhD in Health Sciences, Crici..ma, SC, Brazil.
| | - Renato Lucas Passos de Souza
- Universidade de S.úo Paulo (USP), Faculdade de Medicina de Ribeir.úo Preto, Hospital das Cl.¡nicas, Ribeir.úo Preto, SP, Brazil
| | - Julio Cezar Mendes Brand Úo
- Postdoctoral Research Fellow, Harvard Medical School, Boston, United States; Sociedade Brasileira de Anestesiologia, Brazil
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Kumar A, Kohli A. Comeback of ketamine: resurfacing facts and dispelling myths. Korean J Anesthesiol 2021; 74:103-114. [PMID: 33423410 PMCID: PMC8024210 DOI: 10.4097/kja.20663] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 11/17/2022] Open
Abstract
Initially known as CI-581, ketamine was first synthesized in 1962 as a replacement from phencyclidine. It has since been used as an anesthetic and analgesic. In addition, it has bronchodilating, sedative, and amnestic properties, preserving airway reflexes and sympathetic nervous system tone. Since the discovery of ketamine, it has been a major topic of discussion due to controversies regarding its usage in particular sets of patients. In the past 50 years, despite its potential benefits, it is not commonly used because of concerns of "emergence phenomenon," its use as a substance of abuse, and its systemic side effects. Since 2012, three World Health Organization reviews on ketamine have addressed its international control. Researchers have been studying this wonder drug for a decade worldwide. Many myths of ketamine regarding emergence phenomenon and its use in traumatic brain injury and open eye injury have been disproved in recent times. It is becoming popular in pre-hospital settings, critical care, emergency medicine, low-dose acute pain services, and adjuvant in regional anesthesia techniques. This review highlights the current consensus on the various applications of ketamine in the literature.
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Affiliation(s)
- Abhijit Kumar
- Department of Anesthesiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Amit Kohli
- Department of Anesthesiology, Maulana Azad Medical College, New Delhi, India
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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: 12] [Impact Index Per Article: 3.0] [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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Yu J, Ren L, Min S, Yang Y, Lv F. Nebulized pharmacological agents for preventing postoperative sore throat: A systematic review and network meta-analysis. PLoS One 2020; 15:e0237174. [PMID: 32776966 PMCID: PMC7416917 DOI: 10.1371/journal.pone.0237174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022] Open
Abstract
Postoperative sore throat is one of the most common complications following endotracheal intubation. Nebulization therapy, a preferable and safety method of drug delivery, has been shown to be effective in postoperative sore throat prevention in many studies. However, the relative efficacy of various nebulized agents remains unknown. In this review, we aimed to quantify and rank order the efficacy of available nebulized agents for various postoperative sore throat-related outcomes. A comprehensive literature search of PubMed, EMBASE, CENTRAL and Google Scholar was conducted to identify eligible studies from inception to 25 May 2020. Incidence of postoperative sore throat 1hour and 24hours postoperatively and severity of postoperative sore throat 24 hours postoperatively were the primary outcomes. We conducted a Bayesian network meta-analysis to combine direct and indirect evidence to estimate the relative effects between treatments as well as the probabilities of ranking for treatments based on their protective effects. We identified 32 trials assessing 6 interventions. Overall inconsistency and heterogeneity were acceptable. Nebulized corticosteroids, magnesium, and ketamine differed from non-analgesic methods on the three primary outcomes. Based on the surface under the cumulative ranking curve, nebulized corticosteroids ranked first in almost all outcomes among the nebulized drugs. Considering only high-quality and 2-arm design studies, nebulized corticosteroids still seemed best. In conclusion, prophylactic use of nebulized corticosteroids, magnesium, and ketamine can effectively prevent postoperative sore throat, and nebulized corticosteroids appears to be the overall best approach.
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Affiliation(s)
- Jian Yu
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Ren
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Su Min
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - You Yang
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Lv
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Sarkar T, Mandal T. Preoperative oral zinc tablet decreases incidence of postoperative sore throat. Indian J Anaesth 2020; 64:409-414. [PMID: 32724250 PMCID: PMC7286391 DOI: 10.4103/ija.ija_959_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/26/2020] [Accepted: 04/09/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Postoperative sore throat (POST) is very frequently reported after endotracheal intubation. Zinc lozenge has been shown to reduce POST. The aim of this study was to evaluate the effect of dispersible zinc tablet on POST. Methods Eighty-eight patients undergoing surgery with endotracheal intubation were randomly allocated into two groups, to either receive dispersible zinc tablet 40 mg (zinc group) or placebo tablet (control group), 30 min preoperatively. Assessment for incidence and severity was performed for POST, on a 4-point scale (0-3) at 0, 30 min, 2, 4, and 24 h postoperatively. The primary outcome was incidence of POST at 4 h postoperatively. Secondary outcome was severity of POST at the 5 evaluation time points postoperatively. Mann-Whitney U test, Fisher's exact, and Chi-square test were used as applicable. Results At 4 h, there was a significantly lower incidence of POST in zinc group (6.8%) than the control group (31.8%) with a P value of 0.003. Three patients in placebo group complained of severe POST compared to none in the zinc group. The severity of POST was significantly lower in Zinc group than Placebo group at 0 min (P = 0.003), 30 min (P = 0.002), 2 h (P < 0.001), and 4 h (P = 0.001). Conclusion Preoperative administration of 40 mg dispersible zinc tablet effectively reduces the incidence and severity of POST in the immediate postoperative period.
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Affiliation(s)
- Tanmay Sarkar
- Department of Anaesthesiology, North Bengal Medical College, Darjeeling, West Bengal, India
| | - Tanuka Mandal
- Department of Anaesthesiology, North Bengal Medical College, Darjeeling, West Bengal, India
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Şahbaz M, Khorshid L. The Effect of Cold Vapor and Ice Cube Absorption in the Early Postoperative Period on Sore Throat and Hoarseness Induced by Intubation. J Perianesth Nurs 2020; 35:518-524. [PMID: 32402773 DOI: 10.1016/j.jopan.2019.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to determine the effect of cold vapor and ice cube absorption in the early postoperative period on sore throat and hoarseness induced by intubation. DESIGN This is a randomized controlled experimental study. METHODS Four groups (n = 30) were involved in the study: cold vapor application (group 1), ice cube absorption (group 2), ice cube absorption along with cold vapor application (group 3), and a control group (group 4). The sample consisted of 120 participants. The data were collected using the visual analog scale (VAS) and Stout's hoarseness scale postextubation (zeroth hour) and at the second, sixth, and 24th hours. FINDINGS After the interventions, the mean VAS scores for sore throat at the sixth postoperative hour were found to be 1.50 ± 1.71, 1.16 ± 1.08, and 1.30 ± 1.62 in group 1, group 2, and group 3, respectively. The mean VAS score for sore throat of group 4 was found to be 3.70 ± 1.89. The decrease in the VAS score for the sixth postoperative hour was ranked from highest to lowest as follows: ice cube absorption group, ice cube absorption along with cold vapor application group, and cold vapor application group. There was no significant difference between application groups in terms of mean VAS scores; however, it was found that mean VAS scores of all application groups were lower than that of control group, and there was a significant difference between them (P < .05). We found that at the sixth postoperative hour after intervention, 33.3% of group 1, 36.7% of group 2, 30% of group 3, and 46.7% of group 4 had hoarseness. No significant difference was found between groups, in terms of hoarseness scores of patients in the sixth postoperative hour after intervention (P > .05). CONCLUSIONS Cold vapor application, ice cube absorption, and ice cube absorption along with cold vapor application were effective in reducing sore throat but were ineffective as treatment for hoarseness.
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Affiliation(s)
- Muazzez Şahbaz
- Department of Fundamentals of Nursing, Nursing Faculty, Aydın Adnan Menderes University, Aydın, Turkey.
| | - Leyla Khorshid
- Department of Fundamentals of Nursing, Nursing Faculty, Ege University, İzmir, Turkey
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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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Drapkin J, Masoudi A, Butt M, Hossain R, Likourezos A, Motov S. Administration of Nebulized Ketamine for Managing Acute Pain in the Emergency Department: A Case Series. Clin Pract Cases Emerg Med 2020; 4:16-20. [PMID: 32064416 PMCID: PMC7012556 DOI: 10.5811/cpcem.2019.10.44582] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/01/2019] [Accepted: 10/17/2019] [Indexed: 02/06/2023] Open
Abstract
Ketamine administration in sub-dissociative doses in the emergency department (ED) results in effective pain relief in patients with acute traumatic and non-traumatic pain, chronic pain, and opioid-tolerant pain. This case series describes five adult ED patients who received nebulized ketamine for predominantly acute traumatic pain. Three patients received nebulized ketamine at 1.5 milligrams per kilogram (mg/kg) dose, one patient at 0.75 mg/kg, and one patient at 1 mg/kg. All five patients experienced a decrease in pain from the baseline up to 120 minutes. The inhalation route of ketamine delivery via breath-actuated nebulizer may have utility for managing pain in the ED.
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Affiliation(s)
- Jefferson Drapkin
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Aidin Masoudi
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Mahlaqa Butt
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Rukhsana Hossain
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Antonios Likourezos
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Sergey Motov
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
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18
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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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Elkoundi A, Bentalha A, El Koraichi A, El Kettani SEC. Nebulized ketamine to avoid mechanical ventilation in a pediatric patient with severe asthma exacerbation. Am J Emerg Med 2018; 36:734.e3-734.e4. [PMID: 29321114 DOI: 10.1016/j.ajem.2018.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/06/2018] [Indexed: 12/28/2022] Open
Abstract
Asthma is a major cause of morbidity and mortality despite advances in outpatient treatment. Sometimes, children fail to respond to standard treatment and can potentially require mechanical ventilation. We describe a case of a 26-month-old girl with a severe asthma exacerbation successfully managed by ketamine administration via nebulization route that permitted to avoid mechanical ventilation. Nebulized ketamine might be a reasonable option to avoid mechanical ventilation in children who fail to respond to standard treatment of severe asthma exacerbation.
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Affiliation(s)
- Abdelghafour Elkoundi
- Pediatric Intensive Care Unit, Children Hospital of Rabat, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco.
| | - Aziza Bentalha
- Pediatric Intensive Care Unit, Children Hospital of Rabat, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco
| | - Alae El Koraichi
- Pediatric Intensive Care Unit, Children Hospital of Rabat, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco
| | - Salma Ech-Cherif El Kettani
- Pediatric Intensive Care Unit, Children Hospital of Rabat, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco
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20
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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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Abstract
BACKGROUND Esketamine is traditionally administered via intravenous or intramuscular routes. In this study we developed a pharmacokinetic model of inhalation of nebulized esketamine with special emphasis on pulmonary absorption and bioavailability. METHODS Three increasing doses of inhaled esketamine (dose escalation from 25 to 100 mg) were applied followed by a single intravenous dose (20 mg) in 19 healthy volunteers using a nebulizer system and arterial concentrations of esketamine and esnorketamine were obtained. A multicompartmental pharmacokinetic model was developed using population nonlinear mixed-effects analyses. RESULTS The pharmacokinetic model consisted of three esketamine, two esnorketamine disposition and three metabolism compartments. The inhalation data were best described by adding two absorption pathways, an immediate and a slower pathway, with rate constant 0.05 ± 0.01 min (median ± SE of the estimate). The amount of esketamine inhaled was reduced due to dose-independent and dose-dependent reduced bioavailability. The former was 70% ± 5%, and the latter was described by a sigmoid EMAX model characterized by the plasma concentration at which absorption was impaired by 50% (406 ± 46 ng/ml). Over the concentration range tested, up to 50% of inhaled esketamine is lost due to the reduced dose-independent and dose-dependent bioavailability. CONCLUSIONS We successfully modeled the inhalation of nebulized esketamine in healthy volunteers. Nebulized esketamine is inhaled with a substantial reduction in bioavailability. Although the reduction in dose-independent bioavailability is best explained by retention of drug and particle exhalation, the reduction in dose-dependent bioavailability is probably due to sedation-related loss of drug into the air.
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Chattopadhyay S, Das A, Nandy S, RoyBasunia S, Mitra T, Halder PS, Chhaule S, Mandal SK. Postoperative Sore Throat Prevention in Ambulatory Surgery: A Comparison between Preoperative Aspirin and Magnesium Sulfate Gargle - A Prospective, Randomized, Double-blind Study. Anesth Essays Res 2017; 11:94-100. [PMID: 28298764 PMCID: PMC5341650 DOI: 10.4103/0259-1162.186602] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Postoperative sore throat (POST) frequently hampers the positive feedback of ambulatory surgery in spite of so many measures. This study was carried out to compare the efficacy of preoperative magnesium sulfate and aspirin gargle in preventing POST after ambulatory surgery. Materials and Methods: It was a prospective, randomized, and double-blinded study. Fifty-six adult patients of either sex, aged 25–50, of American Society of Anesthesiologists physical status I–II, scheduled for day care surgery, were randomly allocated to Group A ([n = 28] receiving aspirin gargle [325 mg tablet]) and Group M ([n = 28] receiving magnesium sulfate [20 mg/kg] gargle). In both groups, the medications were made into 20 mL of (5% dextrose) solution. Patients were asked to gargle with this mixture for 30 s, 15 min before induction of anesthesia. Episodes of POST were measured at 0, 2, 4, 6, 9, 12, and 16 h postoperatively with a four-point scale. Results: Both groups had a similar demographic profile with comparable oxygen saturation, hemodynamics, and consciousness status at immediate postoperative period. Number of patients with sore throat was significantly lower in magnesium group compared to aspirin group at 0 h (P = 0.0376), 2 h (P = 0.0429), 4 h (P = 0.0394) after the operation. POST pain score (visual analog scale) was significantly (P < 0.05) lower in magnesium group compared to aspirin group after the operation at 0, 2, 4 h after operation. Conclusion: It is evident that preoperative magnesium sulfate gargle significantly attenuated the incidence and severity of POST, especially in the early postoperative period, with no adverse effects in patients undergoing day care surgery under general anesthesia.
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Affiliation(s)
- Surajit Chattopadhyay
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Anjan Das
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Sabyasachi Nandy
- Department of Anaesthesiology, N.R.S Medical College and Hospital, Kolkata, West Bengal, India
| | - Sandip RoyBasunia
- Department of Anaesthesiology, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Tapobrata Mitra
- Department of Anaesthesiology, Murshidabad Medical College, Berhampore, West Bengal, India
| | - Partha Sarathi Halder
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Subinay Chhaule
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Subrata Kumar Mandal
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
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24
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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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