Group I (Intravenous Dexamethasone)- Nebulization with 0.9% saline (5ml) and intravenous injection of Dexamethasone 0.2 mg/kg diluted to a total volume of 5 ml with 0.9% saline

Group N Nebulization with Dexamethasone 0.2 mg/kg diluted to a total volume of 5 ml with 0.9% saline and 0.9% saline (5 ml)

Anaesthesia management will be as per standard institutional protocol Induction of anaesthesia will be with opioids like fentanyl 2 microgram/kg midazolam 0.03 mg/kg and intravenous anaesthetic drugs like propofol 2-3 mg/kg Trachea will be intubated 3 minutes after administering a non-depolarising neuromuscular blocking agent by a conventionally trained anesthesiologist to minimize injury due to inexperience or inadequately relaxed vocal cords Low-pressure high-volume cuffed wire-reinforced armoured endotracheal tube will be used for intubation according to the patient’s gender and build 7-7.5 mm ID(internal diameter) and 8-8.5 mm Internal diameter for females and males respectively Anaesthesia will be maintained with oxygen air plus inhaled anaesthetic agent [Isoflurane/ sevoflurane 1-1.5 MAC(minimum alveolar concentration)]supplemented with intravenous agents like propofol fentanyl etc After intubation we will inflate the cuff with the minimum room air required to prevent an audible air leak with a cuff pressure less than 25 cm of H₂O measured using a cuff pressure monitor The number of attempts for intubation time taken for intubation and any difficulty/ trauma during intubation/ laryngoscopy will be noted The fixation distance of the endotracheal tube at the angle of the mouth will be noted We will not insert a Nasogastric tube The patient will be made prone per standard protocol and the endotracheal tube cuff pressure will be rechecked to ensure it is less than 25 cm H₂O

During the change of position from supine to prone the breathing circuit will be disconnected to avoid drag on the endotracheal tube At the end of the operation PONV(post operative nause and vomiting) prophylaxis will be given with Injection Ondansetron 0.1 mg/kg The patient will be made supine Displacement of the endotracheal tube if any will be noted The ETT(endotracheal tube) cuff pressure will be rechecked After surgery with the patient adequately anaesthetised the oropharynx will be cautiously toileted with a 12-14Fr disposable soft suction catheter reversal of neuromuscular blockade will be done by IV Neostigmine 0.05 mg/kg along with IV Glycopyrrolate 0.01mg/kg after return of spontaneous ventilation The trachea will be extubated as per standard protocol.We will note the demographic data the time needed for intubation [time from start of laryngoscopy to confirmation of EtCO2(end tidal carbondioxide) on monitor] intubation period (time from intubation to extubation) grade of laryngoscopic view using the Cormack Lehane score number of attempts of intubation incidence of bucking or coughing during tracheal intubation application of external laryngeal pressure to facilitate endotracheal intubation blood in the secretions or endotracheal tube and recovery time (time from the end of the operation to extubation)

Postoperatively at 2 6 12 and 24 hours, the patients will be asked for the presence of postoperative sore throat and hoarseness of voice (which is the change in the quality of speech/voice perceived by the patient themselves or the bystander in the postoperative period or presence of aphonia) dysphagia (known as the difficulty or discomfort in swallowing liquid or solid or both) and stridor (which is a harsh sound during breathing)