Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, People's Republic of China.
Department of Medical Quality Management, Nanfang Hospital, Southern Medical University, Guangzhou, 510630, People's Republic of China.
Drug Des Devel Ther. 2023 Oct 19;17:3139-3149. doi: 10.2147/DDDT.S430077. eCollection 2023.
Postoperative sore throat is a frequent adverse event after double-lumen endobronchial tube (DLT) intubation. The aim of this study was to investigate whether esketamine gargle has a preventive effect on the incidence of postoperative sore throat in patients undergoing DLT intubation.
This trial included 140 patients undergoing elective thoracic surgery at the third affiliated hospital of Sun Yat-Sen University. Patients were randomly allocated into the following two groups of 70 patients each: the control group, gargling with saline of 30 mL, and the esketamine group, gargling with an esketamine solution of 30 mL (2 mL/50 mg esketamine in 28 mL saline), 5 min prior to anaesthesia induction. The primary outcome was the incidence of sore throat 24 h after surgery. The main secondary outcomes included the incidence of sore throat and hoarseness at 1 h and 48 h after surgery, as well as the intraoperative haemodynamic responses.
The incidence of sore throat was significantly higher in the control group (47.1%, 33/70 patients) compared with the esketamine group (12.9%, 9/70 patients) at 24 h after surgery (RD, 0.41; 95% confidence interval, 0.26-0.57; p < 0.001). Furthermore, the incidence of sore throat at 1 h (p = 0.027), 24 h (p = 0.019), and seventh day (p = 0.031) as well as hoarseness at 1 h (p = 0.027), 24 h (p = 0.019), and 48 h (p = 0.031) after surgery were reduced in the esketamine group. Significant differences were seen in the peak levels of systolic blood pressure, mean arterial blood pressure, and heart rate between the groups during the intubation (p < 0.05). Besides, no patient developed an adverse reaction to esketamine.
Preoperative gargling of esketamine can provide an effect against sore throat after DLT intubation without adverse side effects and effectively inhibit sharp elevations in heart rate and blood pressure during double-lumen intubation procedures.
双腔支气管导管（DLT）插管后咽喉痛是一种常见的不良事件。本研究旨在探讨氯胺酮漱口是否对接受 DLT 插管的患者术后咽喉痛的发生率有预防作用。
本试验纳入了中山大学附属第三医院 140 例择期胸外科手术患者。患者随机分为两组，每组 70 例：对照组，用 30ml 生理盐水漱口；氯胺酮组，用 30ml 氯胺酮溶液（2ml/50mg 氯胺酮加入 28ml 生理盐水）漱口，在麻醉诱导前 5min。主要结局是术后 24 小时咽喉痛的发生率。主要次要结局包括术后 1h 和 48h 咽喉痛和声音嘶哑的发生率，以及术中血流动力学反应。
术后 24 小时，对照组（47.1%，33/70 例）咽喉痛的发生率明显高于氯胺酮组（12.9%，9/70 例）（RD，0.41；95%置信区间，0.26-0.57；p<0.001）。此外，氯胺酮组术后 1h（p=0.027）、24h（p=0.019）和第 7 天（p=0.031）咽喉痛的发生率以及术后 1h（p=0.027）、24h（p=0.019）和 48h（p=0.031）声音嘶哑的发生率均降低。插管期间两组收缩压、平均动脉压和心率的峰值水平差异有统计学意义（p<0.05）。此外，没有患者出现氯胺酮不良反应。
术前氯胺酮漱口可预防 DLT 插管后咽喉痛，无不良反应，并有效抑制双腔插管过程中心率和血压的急剧升高。
