EFFECTIVENESS OF NEBULIZED DEXAMETHASONE V/S NEBULIZED

DEXMEDETOMIDINE IN PREVENTION OF POST OPERATIVE SORE

THROAT AFTER GENERAL ENDOTRACHEAL ANAESTHESIA” was

conducted at McGann Teaching District Hospital attached to Shimoga Institute of

Medical Sciences, Shivamogga from October 2022 to March 2024.The study was

conducted on 100 subjects undergoing elective surgeries requiring general anaesthesia

with endotracheal intubation technique, after obtaining clearance from Institutional

Ethical Committee and Informed Consent was taken from all the subjects involved in

the study.

100 patients scheduled for various elective surgical procedures belonging to

ASA physical status 1 and 2; age group of 18-60 years were included in the present

study. Patients with pre operative sore throat or cold ;undergoing intraoral surgeries;

patients with Asthma/COPD; known allergies to study drug ;Pregnant patients

;Anticipated difficult airway were excluded from the study.

The patients were randomly allocated into two groups of 50 each:

Group 1- received nebulization of 8mg(2ml) of Dexamethasone diluted to 5ml

using Normal saline.

Group 2- received nebulization of 50 microgram(0.5ml) of Dexmedetomidine

diluted to 5ml using Normal saline.Pre-anaesthetic evaluation was done on the previous day and informed consent

was obtained. IV line was secured. The study drug was given by nebulization for 15

minutes in the preoperative room.Pre nebulization and post nebulization hemodynamic

parameters were noted. Patients were shifted to operating room. ASA standard monitors

(ECG,Pulse oximeter, NIBP, Temperature and end tidal CO2 ) were attached. 15

minutes after the completion of nebulization, General anaesthesia was provided.

Premedication with injection midazolam 0.02mg/kg, injection fentanyl 2 microgram/kg

and induction with injection propofol 2mg/kg after preoxygenation with 100 % O2 for

3 minutes through face mask was done. Tracheal intubation was facilitated with

injection vecuronium 0.1mg/kg IV. All patients were intubated with sterile cuffed

polyvinyl chloride tubes of appropriate size. The tracheal cuff was then inflated with

air to cuff pressure of 20cm H2O and thereafter cuff pressure was checked every 15

minutes to maintain the same pressure till the end of surgery.

After confirmation of tracheal tube position anaesthesia was maintained with

O2, N2O, isoflurane and intermittent doses of vecuronium and ventilated using IPPV.

Injection ondansetron 4mg IV was given 30 minutes before the end of the procedure.

At the end of the surgery gentle suctioning of oropharynx was done. Then inspiratory

O2 concentration was kept at 100%. The residual neuromuscular block was reversed

with 50microgram /kg of neostigmine and 10microgram/kg glycopyrrolate and patient

was extubated.

 After extubation, patient was shifted to recovery room where patients was

assessed for sore throat at 0th hour, then at 2nd, 6th, 12th, 24th hr in post operative ward

and graded on 4 point scale (0-3).The hemodynamic parameters such as HR,SBP,DBP and MAP were recorded

before nebulisation, after nebulisation,before intubation, immediately after intubation-

0

th minute, 2nd minute and 5th minute post-intubation.

There was no significant statistical difference at 0th, 2nd, 12th, 24th hour in terms

of incidence and severity of postoperative sore throat.

There was statistically significant fall in heart rate in Dexmedetomidine group

compared to Dexamethasone group after nebulisation during all time intervals in the

study period except second minute after intubation.

There was statistically significant fall in systolic blood pressure and mean

arterial pressure , 2nd minute after intubation in Dexmedetomidine group compared to

Dexamethasone group.

There was no statistically significant difference with respect to diastolic blood

pressure in both the groups at all time intervals in the study period.

Hence, Dexmedetomidine 50mcg given as nebulization preoperatively 15

minutes before induction of anaesthesia is as effective as nebulized Dexamethasone

8mg in prevention of post operative sore throat without any significant bradycardia and

hypotension. Nebulized dexmedetomidine also has an added advantage of attenuation

of haemodynamic stress response to laryngoscopy and endotracheal intubation.