Low-Dose Nebulized Dexamethasone Effective in Reducing Postoperative Sore Throat, Study Reveals
India: A recent study has demonstrated that administering a low dose of nebulized dexamethasone before surgery can significantly reduce the incidence and severity of postoperative sore throat (POST) in patients undergoing general anaesthesia.
The research, aimed at evaluating the effectiveness of this intervention, found that a 4 mg dose of dexamethasone was notably more effective than a placebo in mitigating POST, with no observed side effects. The study is scheduled for publication in the Oct-Dec 2024 issue of Apollo Medicine and is now available online ahead of its print release.
"Anaesthesia as a branch is a paradigm of various services offered under one roof. The main goal of an anesthetist is to make the patient feel most comfortable in an OT environment. This involves psychological management, physiological management, and pain management, all of which are done pharmacologically. Postoperative sore throat is one of the complications that occur in 21%-65% of anaesthetized persons," the lead author Dr. Arvinpreet Kaur, Department of Anaesthesia, Maharishi Markandeshwar Institute of Medical Science and Research (MMIMSR), Mullana, Haryana, India, told Medical Dialogues.
Discussing the study’s aim, she noted, “We aimed to utilize the most widely available medication in the smallest effective dose to alleviate sore throat symptoms. While various treatments have been explored, including lozenges, ketamine gargles, lignocaine jelly, and different forms of steroids, our focus was on dexamethasone. Administered at a dose of 4 mg via nebulization, dexamethasone is not only convenient for patients but also readily accessible for anesthetists in any setting, from remote clinics to major hospitals.”
Dr Kour and colleagues came together to conduct this study in the Anaesthesiology Department of Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR) Mullana, Ambala, after institutional ethical committee approval and written, with informed consent was secured from patients between March 2021 and March 2022, with Group S comprising 25 patients and Group D also consisting of 25 patients.
Group D: Patients were administered 4 mg of dexamethasone along with 4 mL of normal saline (totaling 5 mL) via a nebulization mask connected to a wall-mounted oxygen supply.
Group S: Patients were given 5 mL of normal saline nebulization (total volume 5 mL) through a nebulization mask, with the oxygen connected to the wall-mounted supply.
Study findings reveal:
· 24 hours after extubation, none of the patients in Group D exhibited postoperative sore throat, whereas 8 patients (32%) in Group S experienced postoperative sore throat.
· The occurrence of postoperative sore throat varied between the two groups, and the difference was statistically significant.
Talking about the significance of this study, Dr. Kaur said “It would be so helpful and fruitful if more research is done using different doses and methods of administration of dexamethasone or various other modalities to prevent sore throat.”
Mentioning the mode of action of dexamethasone and normal saline, she added, “Dexamethasone is a potent synthetic glucocorticoid possessing anti-inflammatory effects. Various previous studies have used 8mg doses effectively for nebulisation which has decreased the incidence of sore throat postoperatively. In our study, we have used less dose which is 4mg for the same and luckily have not encountered any side effects. Normal saline on the other hand has been used as a placebo to make the study more effective and relevant.”
Reference: Parvez A, Gupta R, Kour A, Singh A. A Study to Evaluate the Efficacy of Preoperative Low-dose Nebulised Dexamethasone in Decreasing the Incidence of Postoperative Sore Throat in Patients Undergoing Surgery Under General Anaesthesia. Apollo Medicine. 2024;0(0). doi:10.1177/09760016241255847
