Comparison of nebulized ketamine and ketamine with clonidine in postoperative sore throat

Abstract

Background: Postoperative sore throat (POST) consider a minor ailment in patients receiving general anesthesia with endotracheal intubation, seen in 21-65% cases but it causes significant distress and increases postoperative morbidity and patient dissatisfaction. This study was done to compare nebulized ketamine and ketamine with clonidine to treat POST.Methods: This was a prospective, randomized, double-blind control clinical study. After approval from institution ethical and scientific committee, study was conducted in between May 2015-April 2016. Written and informed consent was obtained from 100 patients of either sex aged between 20-65 years. ASA I-II, undergoing surgery in supine position lasting up to two hour. Patients were randomized into two groups Group K (n=50) nebulized with 50 mg ketamine (1cc) + 3cc NS =4cc, Group KC (n=50) nebulized with ketamine 50mg (1cc) + clonidine 150µg (1cc) + 2cc NS for 15 min, before general anaesthesia with endotracheal intubation. The POST and hemodynamic variable were monitored before nebulization, after nebulization, before induction, on arrival to PACU and at 4, 8, 12, 24 hours post operatively. POST was graded on 4 point scale (0-3).Results: Overall incidence of POST was 46% (Group K-40%, KC-6%). The Incidence and severity of POST were significantly attenuated in Group KC in comparison to Group K at 4 hours (P= 0.002), 8 hours (P=0.000), 12 hours (P= 0.000) and at 24 hours (P=0.000).Conclusions: Preoperative nebulization with clonidine and ketamine mixture compared to ketamine is more effective in dealing with postoperative sore throat with no adverse effects.

Dose-dependent effectiveness of ketamine nebulisation in preventing post-operative sore throat due to tracheal intubation.

“…Our results are comparable to a study by Jain et al in their nebulization group at 8 and 24hrs. 14 A study by Amingad, has shown fewer patients having no sore throat at 0 and 24hrs as compared to our study which could be attributed to the usage of 2% lignocaine local anaesthetic jelly applied over the endotracheal tube cuff and intra-operative i.v. dexamethasone used in their nebulized ketamine group.…”

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

“…In all, 15 studies reported that there were no systemic or local adverse events . One study reported that there were no differences in adverse events between topical ketamine and non‐analgesic methods .…”

“…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]…”

“…76 In total, 27 studies used a four-level classification system to rate the presence and severity of postoperative sore th roat [36][37][38][39][40][41][44][45][46][47][48]54,56,59,60,[62][63][64][65][66][67][68][69][70]72,74,75 and 10 reported its incidence. 42,49,50,52,55,57,58,61,71,73 Six studies and two used a visual analogue scale 44,51,55,57,71,76 and numerical rating scale, 43,53 respectively, to rate severity. We sent e-mails to 36 study authors for further information and 10 responded.…”

“…In all, 15 studies reported that there were no systemic or local adverse events. 36,37,39,[41][42][43]46,48,49,51,57,61,66,72,77 One study reported that there were no differences in adverse events between topical ketamine and non-analgesic methods. 56 Another study reported that there were no psychomimetic effects related to ketamine.…”