Introduction
POST is one of the most common, uncomfortable, distressing sequelae after tracheal extubation.1, 2, 3, 4 These effects are because of irritation and inflammation of the tracheal mucosa.3 The incidence of POST depends on factors such as history of smoking, lung disease, size of ETT, cuff pressure, placement of NG tube.5 As steroids are known for their anti-inflammatory action betamethasone gel application on cuff of ETT might reduce the incidence of POST.6 KY Jelly is a water based lubricant which is biologically inert and contains no colour or perfume have also been shown to reduce the incidence of POST.7
Materials and Methods
After obtained institutional ethical committee approval and written informed consent from all the patients 60 patients of either sex aged between 18-60yrs belonging to ASA physical status class 1 and 2 undergoing elective surgery under general anaesthesia with tracheal intubation were included. Patients with ASA physical status class 3 and 4, patients with recent history of respiratory tract infection, pregnant patients, Patients with cardiac, hepatic and renal disease, patients with NG tube or throat pack inserted, patients requiring rapid sequence intubation, operating in prone or lithotomy positions, head and neck surgeries, presence of blood in oropharyngeal suction or endotracheal tube after extubation, patients with history of smoking, duration of surgery lasting for more than 2 hours and patients who refused to give consent were excluded from the study. POST was assessed at 1, 3, 6, 12, 24 hrs post operatively using VAS score at rest and with efforts.
Score 0- No sore throat
Score 1-3- Mild sore throat
Score 4-6-Moderate sore throat
Score 7-10- Severe sore throat
Pre – anaesthetic evaluation was done in all the patients. patients were randomised using chit methods of similar size and shape. Patients were asked to pick the chit and the chit was handed over to the nursing assistant who was not blinded to the study and who helped in applying the betamethasone gel or KY jelly over the cuff of the ETT and the tube was handed over to the investigator who is blinded to the study.
The patients were allocated into two groups of 30 each
Group 1- Betamethasone group
Group 2- KY jelly group
On the day before surgery patients were premedicated with alprazolam 0.5mg and pantoprazol 40mg per oral preoperatively. After arrival in the operation room an IV line is secured with 18G cannula and monitors were applied ECG, NIBP, pulse oximeter. Patients premedicated with glycopyrolate 0.01mg/kg, and fentanyl 2mcg/kg after preoxygenation for 3 mins with 100% oxygen, anaesthesia will be induced with propofol 2mg/kg IV, orotracheal intubation facilitated by vecuronium 0.1mg/kg ETT with low pressure high volume cuff(portex) was used Laryngoscopy was performed by experienced anaesthesiologist in both groups using standard 3 and 4 macintosh metal blades. Male patients received either an 8 or 8.5mm ID ETT and female patients received either 7 or 7.5mm ID ETT. The tracheal tube cuff was inflated to 25cm of H2O. Intracuff pressure was adjusted every 30mins to 25cm of H20 by using a cuff manometer.
Anaesthesia was maintained with 0.5-2% isoflurane with 33%oxygen in nitrous oxide. Intra operatively the following parameters were monitored MAP, SPO2, EtCO2.at the end of surgery residual neuromuscular block was reversed with neostigmin 0.05mg/kg and glycopyrrolate 0.01mg/kg. POST was assessed at 1,3,6,12,24hrs post operatively at rest and with efforts.
Results
No patients were excluded from the study. Patients characteristics like age, sex, ASA PS grade and duration of surgery were comparable between both the groups there was no statistical significance found. The incidence of POST at rest and with efforts like swallowing and talking were significantly lower in the betamethasone group when compared to KY jelly group which showed statistical significance(p<0.05).
Table 1
Table 2
| ASA Garde | Group | Total | |
| Group A | Group B | ||
| 1 | 18 | 14 | 32 |
| 60.0% | 46.7% | 53.3% | |
| 2 | 12 | 16 | 28 |
| 40.0% | 53.3% | 46.7% | |
| Total | 30 | 30 | 60 |
| 100.0% | 100.0% | 100.0% | |
Table 3
| Sex | Group | Total | |
| Group A | Group B | ||
| Male | 15 | 13 | 28 |
| 50.0% | 43.3% | 46.7% | |
| Female | 15 | 17 | 32 |
| 50.0% | 56.7% | 53.3% | |
| Total | 30 | 30 | 60 |
| 100.0% | 100.0% | 100.0% | |
Table 4
| Group A | Group B | t value | p value | |||
| Mean | SD | Mean | SD | |||
| Age (in years) | 33.73 | 10.979 | 37.93 | 11.304 | -1.460 | 0.150 |
| Duration of Surgery (in Mins) | 78.00 | 25.175 | 88.50 | 28.772 | -1.504 | 0.138 |
Table 5
Table 6
Table 7
Discussion
We found that the incidence of POST was significantly less when betamethasone gel was applied over the cuff of the endotracheal tube when compared to KY jelly application on the cuff of endo tracheal tube. But KY jelly application also reduces the incidence of POST independently as shown by statistical significance as it is a water soluble lubricant jelly.
The incidence of post operative sore throat, cough, and hoarseness of voice is distressingly high in patients who have received general anaesthesia with endotracheal intubation. Many factors including the diameter of the tube, intubation procedure, bucking/coughing on the tube during emergence and excessive pharyngeal suctioning during extubation have been described to influence the incidence of POST. 4, 5, 6, 7
We compared betamethasone gel with KY jelly, KY jelly is a lubricant jelly which is also known to reduces the incidence of POST.
The limitation of our study was we included Only ASA-PS class 1 and 2 only and the duration of surgery was short. The correlation with bucking and coughing during extubation was not evaluated in this study. And we could not measure the amount of the jelly put on the cuff of the ETT.