Magnesium and Ketamine Gargle and Postoperative Sore Throat

Abstract

Background:Postoperative sore throat is one of the most common complications after endotracheal intubation. Both Ketamine and magnesium can block N-methyl-D-aspartic acid (NMDA) receptors and provide central and local analgesia.Objectives:To compare the effect of magnesium sulfate and ketamine gargle on the incidence and severity of postoperative sore throat.Patients and Methods:A total of 100 patients candidate for emergency acute appendicitis surgery were enrolled in the study. Patients in ketamine group received ketamine gargle (0.5 mg/kg) and magnesium group received magnesium sulfate gargle (20 mg/kg up to 30 mL dextrose water 20%) 15 minutes before the operation. Patient complaint of postoperative sore throat, and its severity measured by visual analogue scale (VAS) were recorded at baseline in recovery room, and then 2, 4, and 24 hours after operation.Results:There were no significant differences between age, sex, and body mass index (BMI) between two groups of patients. Hemodynamics of patients, including blood pressure, respiratory rate, oxygen saturation %, and conscious state were not significantly different (P > 0.05). Number of patients with sore throat were significantly lower in magnesium group compared to ketamine group at 2 (P = 0.032), 4 (P = 0.02), and 24 hours (P = 0.01) after the operation. Sore throat pain score (VAS) was significantly lower in magnesium group compared to ketamine group at 2 (P = 0.019), 4 (P = 0.028), and 24 hours (P = 0.014) after the operation.Conclusions:Magnesium at low dose decreases sore throat and pain severity more effectively compared to ketamine gargle.

Analgesic effect and safety of single-dose intra-articular magnesium after arthroscopic surgery: a systematic review and meta-analysis

“…Mg could be effective in pain relief by exerting the antinociceptive effect46, inhibiting TNF-α47, and modulating hypesthesia and hyperalgesia4849, by blocking the NMDA receptor. The pain relief effect of Mg has been illustrated by several studies in many cases, such as postoperative sore throat50, tourniquet pain51, major non-laparoscopic gastrointestinal surgery52, diabetic neuropathic pain53, cardiac surgery54, and cancer-related neuropathic pain55. The present study also demonstrated that the single-dose IA Mg was effective in pain relief after arthroscopic surgery.…”

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

“…Two and 37 studies included patients with an ASA status of I‐III and I‐II, respectively, while the remaining two did not report ASA status . In all, 19 studies detailed the type of surgery, and 32 studies excluded patients who underwent surgeries on the neck or pharynx . The median sample size was 90 (range, 40‐200).…”

“…One study compared two doses (50 and 25 mg) . The dose was titrated based on patient body weight in five studies (0.5 mg/kg) . Non‐analgesic comparators included saline (21 studies), water (nine studies), and no pretreatment (two studies).…”

“…Two and 37 studies included patients with an ASA status of I-III 44,65 and I-II, respectively, while the remaining two did not report ASA status. 37,57 In all, 19 studies detailed the type of surgery, [36][37][38][39]41,43,46,47,50,51,54,55,59,60,65,69,71,74,76 and 32 studies excluded patients who underwent surgeries on the neck or pharynx. [36][37][38][39][41][42][43][45][46][47][48][49][50][51][52]54,55,57,59,60,62,[65][66][67][68][69][70]…”

“…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]…”