Dexamethasone to decrease post-anesthesia sore throat (POST) and hoarseness-which is the most effective route: intravenous, topical, or nebulization? A prospective randomized trial

Abstract

Background and Aims Postoperative sore throat (POST) is common after endotracheal intubation making patients uncomfortable and anxious in postoperative period. The present study was undertaken to compare efficacy of equal dose of dexamethasone in preventing POST via three different routes, i.e., intravenous, topical, and nebulization before surgery. Methods and Results The present prospective double-blind randomized parallel group trial included 190 patients of either sex above 18 years, American Society of Anesthesiologists (ASA) physical status I–II posted for laparoscopic cholecystectomy. The patients were divided into three groups. Patients in group N were nebulized with 8 mg dexamethasone prior to surgery, patients in group I received intravenous dexamethasone (8 mg) before induction of anesthesia, while patients in group C were intubated with endotracheal tube which was pretreated (cuff soaked in dexamethasone 8 mg). The severity of POST and hoarseness of voice was determined by interviewing patients after 24-h of completion of surgery. Incidence of POST decreased in all patients with maximum decrease in group N (18%), while 30.8% in group I and 30.4% in group C. This decrease was not statistically significant when compared to group I (p 0.14) as well as group C (p 0.15). Incidence of hoarseness significantly decreased in group N (15.6%) as compared to group I (40.3%) as well as group C (39.1%). This decrease was statistically significant when compared to group I (p 0.005) as well as group C (p 0.009). Conclusions Topical dexamethasone (group C) is as effective as intravenous dexamethasone in decreasing incidence of POST, while both the techniques are not effective in decreasing hoarseness of voice. Nebulization is most effective method in decreasing POST as well as hoarseness. Trial Registration CTRI/2017/08/009524 dated 29 August 2017 prospectively.

Effect of fluticasone-impregnated throat packs on postoperative sore throat (POST) and hoarseness of voice: A randomized clinical trial

“…However, many prior studies have shown that the incidence of POST may be up to 70% and that of hoarseness is reported to range from 4-43%. [1][2][3][4] Even though the incidence of POST and hoarseness of voice was lower in the fluticasone group than in the control group in this study, there was never a postoperative difference that was statistically significant. This study is comparable to one by Park SY et al, 37 which compared the incidence of POST in patients with tracheal tubes impregnated with triamcinolone acetonide (n=72) and chlorhexidine (n=72) during intubation.…”

“…Postoperative sore throat (POST), which ranges from 12.1% to 70%, is one of the commonest consequences of intubation, while hoarseness of voice varies from 4-43%. [1][2][3] The eighth worst possible post-anesthesia effect is POST, which imparts a strongly negative influence on the overall experience of surgery and stay in the hospital postoperatively. 4 POST is caused by a number of different factors, including vocal cord damage, congestive blood loss, and damage to the epithelium and mucosal cells caused by airway secretion.…”

Dexamethasone in anesthesia practice: A narrative review

“…Topical dexamethasone has been found to be as effective as intravenous dexamethasone; however, nebulization has been found to be the most effective technique. [ 36 ]…”

Comparison of Postoperative Sore Throat and Hoarseness Between Two Different Sizes of Endotracheal Tube in Females after General Anesthesia

“…The endotracheal tube is very much crucial to achieve the airway control during GA. [1] Despite rapid advancement in anesthetic techniques, [2] throat complications for example, sore throat and hoarseness after surgery are common complications of GA with tracheal intubation. [3,4] The POST (postoperative sore throat) causes cough while cough after surgery leads to stress at stitch site that increases the pain at operation site [5] and hence further boosts the patient's dissatisfaction and discomfort. Also, it adds to the patient morbidity and can affect patient's activities after leaving the hospital.…”

“…The POST incidence could be <90% and that of the hoarseness described in different researches ranges from 4-43 percent. [5] The sore throat etiology is still not known clearly [8] however it seems to be an inflaming process since tracheal mucosa was found to exude inflaming mediators after the intubation. [9,10] Several influencing factors have been recognized while the most significant one appears to be ETT size utilized, anesthetic spray usage, cuff pressure, female gender, anesthesia duration, succinylcholine usage, surgical positioning, simultaneous usage of the nasogastric tube, oropharyngeal aggressive suctioning and technique to manage the airway (i.e.…”