Thomas Derlin, Bejoy Revathy, Zabrin Nimeeliya, Beevi Suhura
Department of Anesthesiology, Azeezia Institute of Medical Sciences and Research, Kollam, Kerala, India.
Saudi J Anaesth. 2018 Jul-Sep;12(3):440-445. doi: 10.4103/sja.SJA_47_18.
Endotracheal intubation is the prominent cause of airway mucosal injury which results in postoperative sore throat (POST), with an incidence of 21%-65%. Although this complication is minor, if left unresolved, it produces significant agony and annoyance to the patient. This study was conducted to evaluate the efficacy of nebulized ketamine in decreasing POST.
After written informed consent, 96 patients of the American Society of Anesthesiologists physical status (PS) 1-2 between 18 and 60 years, of either sex undergoing general anesthesia (GA) with tracheal intubation were enrolled in this prospective, randomized, placebo-control, and double-blind controlled trial. Patients were randomized into two groups; Group 1 received ketamine 50 mg (1.0 ml) with 4.0 ml of saline nebulization, while Group 2 received saline nebulization 5.0 ml for 15 min. GA was administered 15 min after completing nebulization. On reaching postanesthesia care unit, POST monitoring was done at 0, 2, 4, 6, 12, and 24 h after extubation. POST was graded on a four-point scale (0-3).
The overall incidence of POST in this study was 25%: POST was experienced by 7 patients (14.6%) in ketamine and 17 patients (35.4%) in saline group (Fisher's exact = 0.018). There was statistically significant reduction in the incidence of POST in ketamine group when compared to saline, at 2, 4, 6,12, and 24 h postoperatively ( < 0.05*). Severity of sore throat was also higher in saline group when compared to ketamine at 4 h ( = 0.030*) and 6 h ( = 0.016*) postextubation.
Preoperative ketamine nebulization effectively reduced the incidence and severity of POST, with no adverse effects.
气管插管是导致气道黏膜损伤的主要原因，进而引发术后咽痛（POST），其发生率为21%-65%。尽管这种并发症并不严重，但如果不加以解决，会给患者带来极大的痛苦和困扰。本研究旨在评估雾化氯胺酮在降低POST发生率方面的疗效。
在获得书面知情同意后，96例年龄在18至60岁之间、美国麻醉医师协会身体状况（PS）为1-2级、接受气管插管全身麻醉（GA）的患者被纳入这项前瞻性、随机、安慰剂对照、双盲对照试验。患者被随机分为两组；第1组接受50毫克（1.0毫升）氯胺酮与4.0毫升生理盐水雾化，而第2组接受5.0毫升生理盐水雾化15分钟。雾化完成15分钟后给予全身麻醉。到达麻醉后护理单元后，在拔管后0、2、4、6、12和24小时进行POST监测。POST采用四点量表（0-3）进行分级。
本研究中POST的总体发生率为25%：氯胺酮组有7例患者（14.6%）出现POST，生理盐水组有17例患者（35.4%）出现POST（Fisher精确检验= 0.018）。与生理盐水组相比，氯胺酮组术后2、4、6、12和24小时POST的发生率有统计学显著降低（< 0.05*）。拔管后4小时（= 0.030*）和6小时（= 0.016*）时，生理盐水组咽痛的严重程度也高于氯胺酮组。
术前雾化氯胺酮可有效降低POST的发生率和严重程度，且无不良反应。
