Comparative study between benzydamine hydrochloride gel, lidocaine 5% gel and lidocaine 10% spray on endotracheal tube cuff as regards postoperative sore throat / Estudo comparativo entre cloridrato de benzidamina em gel, lidocaína a 5% em gel e lidocaína a 10% em spray no balonete do tubo endotraqueal em relação à dor de garganta pós-operatória

ABSTRACT Postoperative sore throat is a common complication after endotracheal intubation. After tracheal intubation, the incidence of sore throat varies from 14.4% to 50%. The aim of the study was to compare between benzydamine hydrochloride gel, lidocaine 5% gel and lidocaine 10% spray on the endotracheal tube cuff as regards postoperative sore throat. The present study was carried out on 124 patients admitted to Alexandria university hospitals for lumbar fixation surgery requiring general anesthesia. Patients were randomly allocated into 4 groups. Benzydamine hydrochloride gel, 5% lidocaine hydrochloride gel, 10% lidocaine hydrochloride spray, or normal saline were applied on endotracheal tube cuffs before endotracheal intubation. The patients were examined for sore throat (none, mild, moderate, or severe) at 0, 1, 6, 12, and 24 h after extubation. The results were collected, analyzed and presented in table and figure. The highest incidence of postoperative sore throat occurred at 6 h after extubation in all groups. There was a significantly lower incidence of postoperative sore throat in the benzydamine group than 5% lidocaine gel, 10% lidocaine spray, and normal saline groups. The benzydamine group had significantly decreased severity of postoperative sore throat compared with the 10% lidocaine, 5% lidocaine, and normal saline groups at observation time point. Compared with the 5% lidocaine the 10% lidocaine group had significantly increased incidence and severity of postoperative sore throat after extubation. Compared with normal saline the 10% lidocaine group had increased incidence of postoperative sore throat. There were no significant differences among groups in local or systemic side effects. So in conclusion, benzydamine hydrochloride gel on the endotracheal tube cuff is a simple and effective method to reduce the incidence and severity of postoperative sore throat. Application of 10% lidocaine spray should be avoided because of worsening of postoperative sore throat where incidence increased but not the severity in relation to 5% lidocaine gel. Applying 5% lidocaine on the endotracheal tube cuff does not prevent postoperative sore throat but its application is better than lidocaine 10% spray or saline.

RESUMO A dor de garganta pós-operatória (DGPO) é uma complicação comum após a intubação traqueal. Em seguida a esse procedimento, a incidência de dor de garganta varia de 14,4 a 50%. O objetivo do estudo foi comparar os efeitos da aplicação de cloridrato de benzidamina em gel, lidocaína a 5% em gel e lidocaína a 10% em spray no balonete do tubo endotraqueal, no que diz respeito à dor de garganta pós-operatória. O presente estudo foi feito com 124 pacientes internados em hospitais universitários de Alexandria para cirurgia de fixação lombar que necessitavam de anestesia geral. Os pacientes foram aleatoriamente alocados em quatro grupos. Procedeu-se à aplicação de cloridrato de benzidamina em gel, cloridrato de lidocaína a 5% em gel, cloridrato de lidocaína a 10% em spray ou salina normal nos balonetes do TET antes da intubação endotraqueal. Os pacientes foram examinados para dor de garganta (nenhuma, leve, moderada ou intensa) a 0, uma, seis, 12 e 24 horas após a extubação. Os resultados foram coletados, analisados e apresentados em tabelas e figuras. A maior incidência de DGPO ocorreu seis horas após a extubação em todos os grupos. Houve incidência significativamente menor de DGPO no grupo de benzidamina versus grupos de lidocaína a 5% em gel, lidocaína a 10% em spray e salina normal. O grupo tratado com benzidamina exibiu redução significativa na intensidade da DGPO, em comparação com os grupos de lidocaína a 10%, lidocaína a 5% e salina normal no ponto no tempo de observação. Em comparação com lidocaína a 5%, o grupo tratado com lidocaína a 10% exibiu incidência e intensidade significativamente aumentadas na DGPO após a extubação. Em comparação com salina normal, o grupo tratado com lidocaína a 10% exibiu maior incidência de DGPO. Não foram observadas diferenças significativas entre grupos quanto a efeitos colaterais locais ou sistêmicos. Assim, em conclusão, o uso de cloridrato de benzidamina em gel no balonete do TET é um método simples e eficaz para reduzir a incidência e a gravidade da DGPO. Deve-se evitar a aplicação de lidocaína a 10% em spray, devido ao agravamento da DGPO, visto ter ocorrido aumento na incidência, mas não na severidade, em relação à lidocaína a 5% em gel. A aplicação de lidocaína a 5% no balonete do TET não impede a ocorrência da DGPO, mas a sua aplicação oferece melhores resultados do que lidocaína a 10% em spray, ou solução salina.

Role of Three-Dimensional Ultrasound and Three-Dimensional Doppler in Imaging of Endometrium for Diagnosis of Bleeding in Women with Post-Menopausal Bleeding.

Objective: To determine whether the Three-Dimensional Ultrasound and Three Dimensional Doppler have a role in detection of Endometrial lesions in woman with post menopausal bleeding. Methods: 36 woman in Zagazig University Obstetrics and Gynaecology Department outpatient clinics were recruited. Three-Dimensional Ultrasound and Doppler were done. Then after one week endometrial sampling was done & histological diagnosis was made. After tabulation, all data were analyzed using statistical procedures were carried with SPSS software. Result: Twenty four patients were negative for atypia or cancer and Twelve patients were positive for atypia or cancer. Mean age was 58.1 years in benign endometrium and 62.2 year in malignant endometrium (p=0.1). The mean BMI was 24 in benign and 31.75 in malignant endometrium (p<0.001). Mean endometrial thickness was 11.1 m.m in benign and 26 mm in malignant endometrium (p<0.001). The mean endometrial Volume was 5.6 cc in benign and 54.8cc in malignant endometrium (p<0.001). The VI was 2.24%and 19.5% in the two groups respectively (p<0.001). The FI was 6.7 and 27.2 in two groups respectively (p<0.001). The VFI was 3.3 and 11.5 in two groups respectively (p<0.001). In this study using endometrial volume, vascularization index percent (VI) %, flow index (FI) and vascularization-flow index (VFI) rather than endometrial thickness provided a greater sensitivity for predicting atypia or malignancy. Conclusion: The Three-Dimensional Ultrasound scanning of endometrial volume (3D-US) and Three-Dimensional Doppler Angiography (3D-DA) of the Vascular Indices (vascularization index percent, flow index, and vascularization-flow index), might predict endometrial cancer in women with postmenopausal bleeding and thickened endometrium at baseline ultrasound scanning.