| Methodology of Study After obtaining institutional ethical committee approval, a randomized comparative study will be carried out. A written and informed consent will be taken from the patient after explaining the purpose, the procedure and risks involved with the study. 63 patients of ASA 1 and ASA 2 aged between 18 and 60 years scheduled for elective surgeries under general anaesthesia will be selected based on inclusion or exclusion criteria as mentioned above. All patients will be subjected to detailed preanesthetic evaluation. Routine and specific investigations will be done as per patients clinical evaluation along with optimization. All patients will be evaluated a day before the surgery. Patients will be kept NPO as per the ASA guidelines before the procedure. Eligible patients will be randomly allocated using computer formulated randomization technique and opaque sealed envelopes by anesthesiology technician who will not take part in the study. After opening those envelopes, the nebulization solution will be prepared by anesthesia assistant (who will not take part in the study) according to the assigned group. GROUP A- Patient will receive nebulization dexmedetomidine 50 mcg/ml mixed with 4ml normal saline to a total volume of 5ml given over 15 minutes GROUP B- patient will receive nebulization dexamethasone 8mg (2ml) mixed with normal saline to a total volume of 5ml given over 15 minutes GROUP C- patient will receive nebulisation with normal saline 5ml given over 15mins Patients will be unaware of their treatment as the nebulized substances are colorless, odourless and tasteless. Upon arrival at the operating room’s waiting area, patients will undergo re-examination for identification, diagnosis and intravenous access. The drug will be delivered using nebulization mask that will last for 15minutes with the help of a wall attached oxygen driven source (8L, 50psi) according to the respective treatment group. Heart rate, blood pressure and oxygen saturation will be recorded before and every 3 minutes during nebulization. Presence of bradycardia, hypotension, respiratory depression, and sedation will be noted. After 15minutes of nebulization, patient will be shifted to OT and standard ASA monitors will be attached. Patient will be induced with fentanyl 2 µg/kg, propofol 2 mg/kg and vecuronium 0.1mg/kg. A Senior Anesthesiologist will perform intubation via direct laryngoscopy. The ETT cuff will be inflated with air to 20-25 cmH2O pressure with a sterile single lumen cuffed polyvinyl chloride (PVC) validated with a manometer and connected to the anesthesia machine. ETT size, laryngoscopy duration and blood on laryngoscope blade will be documented. Intracuff pressure will be monitored every 30minutes to maintain 20-25 cm H20 pressure. Anaesthesia will be maintained using 33% oxygen in Nitrous oxide and Isoflurane.
Once the surgery is completed, the oropharynx will be gently suctioned using a soft suction catheter and patient will be assessed for extubation and reversed with IV Neostigmine 50mcg/kg and IV Glycopyrrolate 10mcg/kg. Data of patients going into mechanical ventilation post- operative will be excluded from the study. Ondansetron will be administered to prevent postoperative nausea and vomiting (PONV)as per the hospital guidelines . Hemodynamic data will be assessed before intubation, 1 min after intubation, and every 3 min for the first 15 min post-intubation. During surgery, vitals will be recorded every 15 minutes. Following surgery, vitals will be recorded in PACU. Any side effects will be recorded for 24 hours post extubation. Post operative cough will be graded as follows: 0- No cough of any time since the operation, 1- Minimum,2- Moderate, 3- Severe. Post operative hoarseness of voice will be graded as follows: 0- No complaint of hoarseness at any time since the operation,1- Minimal, 2-Moderate,3 - Severe POST evaluation will be conducted at 0, 2, 6,12, and 24 hours after surgery, utilizing a four-point scale will be done by a PACU nursing staff who will be oblivious to the group allocated to the patient • 0- NIL • 1- Mild sore throat (sore throat only when asked) • 2- Moderate sore throat (sore throat even without asking) • 3- Severe sore throat (change of voice or hoarseness with throat pain). If moderate or severe POST persists even after 24 hours, lukewarm saline gargle and decongestants will be started. Whoever has persistent symptoms, an Oto-rhino-laryngologist consultation will be done.
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