Effect of intratracheal dexmedetomidine combined with ropivacaine on postoperative sore throat: a prospective randomised double-blinded controlled trial

Abstract

Background The present study aimed to investigate whether intratracheal dexmedetomidine combined with ropivacaine reduces the severity and incidence of postoperative sore throat after tracheal intubation under general anaesthesia. Methods Two hundred patients with American Society of Anaesthesiologists physical status I-II who were subjected to general anaesthesia were randomly divided into four groups, namely, Group D, Group R, Group DR and Group S; these groups received intratracheal dexmedetomidine (1 µg/kg), 0.8% ropivacaine (40 mg), dexmedetomidine (1 µg/kg) combined with 0.8% ropivacaine (40 mg) and normal saline before endotracheal intubation, respectively. The primary outcomes were the incidence and grade of sore throat and hoarseness at 2 h and 24 h after surgery. Moreover, the modified Observer's Assessment of Alertness/Sedation Scale results were recorded at each time point. The secondary outcomes were intraoperative haemodynamic fluctuations, intraoperative anaesthetic drug requirements, and adverse reactions during and after surgery. The patients’ vital signs before induction, before superficial anaesthesia, after superficial anaesthesia, before intubation, after intubation, and 1 min after intubation were recorded. The use of anaesthetic drugs and occurrence of adverse effects were also recorded. Results The incidence and severity of sore throat were significantly lower in Group DR than in the other three groups 2 h after the operation, but they were only significantly lower in Group DR than in the control group 24 h after the operation. Moreover, compared with Group S and Group D, Group DR exhibited more stable haemodynamics during intubation. The doses of remifentanil and propofol were significantly lower in Group DR than in the other groups. Conclusion The combined use of dexmedetomidine and ropivacaine for surface anaesthesia before intubation significantly reduced the incidence and severity of postoperative sore throat. This treatment also decreased anaesthetic drug requirements and intraoperative haemodynamic fluctuations and caused no adverse effects. Trial registration This clinical research was registered at the Chinese Clinical Trial Registry (ChiCTR1900022907, Registration date 30/04/2019).

Effect of Different Administration Routes of Dexmedetomidine on Postoperative Delirium in Elderly Patients Undergoing Elective Spinal Surgery: A Prospective Randomized Double-Blinded Controlled Trial

“…32 In addition, we found that the highest incidence of delirium occurred on the first day after surgery (Figure 2), which was consistent with the view that the rate of delirium is highest during the early postoperative period. 33 In line with a previous report, 16 this study confirmed that intratracheal dexmedetomidine reduced the incidence of sore throat at 2 hours after surgery. This was probably because dexmedetomidine prolonged the duration of ropivacaine and improved the efficacy of postoperative local analgesia.…”

“…Keshri et al 27 reported that a loading dose of 0.5 µg/kg intravenous dexmedetomidine has the minimum side effects in reducing the hemodynamic stress response in geriatric patients undergoing spine surgery when compared with 1 µg/kg dexmedetomidine. The dose of intratracheal dexmedetomidine was 1 µg/kg for patients aged 20 to 65 in our previous study, 16 and the intratracheal route of dexmedetomidine is rapidly absorbed through the bronchial and alveolar capillary network. 28 Considering its safety and effectiveness in elderly patients aged 60 years or above in this study, the final dose for the IV route and intratracheal route of dexmedetomidine is equal to 0.6 µg/kg.…”

“…After 3 minutes of assisted breathing, a disposable laryngo-tracheal mucosal atomization device was used to spray 5 mL of drug onto the tracheal mucosa to allow surface anesthesia. 16 The intratracheal drug (diluted to 5 mL) used in the IV group, and the IN group was 0.8% ropivacaine (40 mg). For patients in the IE group, the intratracheal drug was dexmedetomidine (0.6 µg/kg) mixed with 0.8% ropivacaine (40 mg) diluted to 5 mL.…”

“…Our previous study indicated that the incidence and severity of postoperative sore throat (POST) and anesthetic drug requirements were significantly decreased for intratracheal dexmedetomidine combined with ropivacaine. 16 In addition, intranasal dexmedetomidine was found to be effective, convenient, and well-tolerated, and the intranasal availability was high. 17,18 The absorption and mechanism of dexmedetomidine differ across various routes of administration.…”

Can low dose of intratracheal dexmedetomidine be used to attenuate peri-extubation cough? - A prospective, double-blinded, randomized clinical trial

“…A recent meta-analysis concluded that though drugs such as lidocaine—intravenous (IV), intracuff, topical, or intratracheal (IT), dexmedetomidine IV, and opioids IV such as remifentanil and fentanyl showed better odds of reducing moderate to severe cough at extubation and among these options, IV dexmedetomidine has emerged as the most favourable drug in terms of highest cumulative rank for decreasing the frequency of moderate to severe emergence. [ 2 ] More recently, the use of IT route of dose 0.5 mcg/kg for the administration of dexmedetomidine has been introduced[ 3 4 ] but there is a paucity of studies which have used IT dexmedetomidine. Further, there are no dose comparing studies comparing different doses of IT dexmedetomidine for alleviating cough at extubation.…”