As approval from Institutional Human Ethical Committee has been obtained, written and informed consent will be taken from the patients undergoing surgery. Those satisfying the inclusion and exclusion criteria are randomly allocated using a computer-generated random number table to any of the two groups. 

        

 GROUP ‘N’: Nebulization with Dexamethasone 8mg in 10ml

 GROUP ‘T’: Topical Dexamethasone 8mg in 10ml

             All the patients will undergo pre-anaesthetic evaluation which includes detailed history taking, physical examination and necessary investigations like complete blood count, blood urea, serum creatinine, HIV, HBsAg etc.  

             Tab Alprazolam 0.5mg and Cap Pantoprazole 40mg are given orally at night on the day before surgery. All the patients are kept nil per oral as per standard guidelines.

GROUP ‘N’:

Patient will be shifted to pre-operative room. Intravenous line will be secured. The patient will be nebulized with 8mg Dexamethasone [total volume 10ml- 2ml dexamethasone with 8ml normal saline] 30 minutes prior to induction. Patient will be shifted to operation theatre and standard ASA monitors will be connected. Preoperative systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, respiratory rate, oxygen saturation, electrocardiogram are recorded and appropriate intravenous fluid is started. Patient will be preoxygenated with 100% oxygen for 3minutes and pre-medications will given, induced with Propofol(2mg/kg) and Atracurium(0.5mg/kg). Patient will be intubated with appropriate sized single use disposable large volume low pressure cuffed endotracheal tube.

GROUP ‘T’

Patient will be shifted to pre-operative room. Intravenous line will be secured. Patient will be shifted to operation theatre and standard ASA monitors will be connected. Preoperative systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, respiratory rate, oxygen saturation, electrocardiogram are recorded and appropriate intravenous fluid is started. The endotracheal tube will be pre-treated by dipping in 10ml syringe (after taking out the plunger and blocking the open end) containing Dexamethasone 8mg [total volume 10ml- 2ml dexamethasone with 8ml normal saline] 10 minutes prior to intubation. Patient will be preoxygenated with 100% oxygen for 3minutes and pre-medications will be given, induced with Propofol(2mg/kg) and Atracurium(0.5mg/kg). Patient will be intubated with appropriate sized single use disposable large volume low pressure cuffed endotracheal tube.

                     

  In both the groups – Group N and Group T Cormack-Lehane grading will be noted in all patients during laryngoscopy. The cuff will be inflated with room air and cuff pressure kept around 20-25cm of water. The endotracheal tube placement will be confirmed with end-tidal carbon-dioxide concentration. Anaesthesia will be maintained on 66%:33% - N2O:O2. Cuff pressure will be monitored with cuff manometer every 15 minutes and after change in patient’s position and pressure will be kept in between 20-25cm of water. Paracetamol infusion and Ondansetron will be given intravenously for post operative pain relief and post operative nausea and vomiting. Gentle suctioning will be done and spontaneous efforts of breathing will be checked. Reversal agent-Glycopyrrolate and Neostigmine will be given when patients are able to obey verbal commands and when ventilation was considered adequate, extubation will be done.

Patients will be assessed for Sore Throat, Hoarseness of voice and Cough in 1, 6, 12, 24 hours of post-operative period.