Efficacy of intracuff dexamethasone in reducing the incidence of post-operative sore throat: an original article

Background: Postoperative sore throat is the most common and most distressing complaint of patients after general anaesthesia with cuffed endotracheal tube. By this study our aim was to assess the efficacy of intracuff dexamethasone in reducing the incidence of this distressing postoperative symptom.Methods: Patients were divided into two groups D and N depending on cuff filling with dexamethasone and normal saline respectively. The cuff was prefilled with dexamethasone or normal saline  one hour prior to intubation to allow time for cuff to be saturated following which the cuff was deflated. General anaesthesia was administered and patients were intubated, and cuff inflated with drug according to group allocated. Patients were assessed and graded for sore throat using VAS scale both at rest and with swallowing. Assessment was done one hour, six, 12 and 24hours post operatively. Presence of hoarseness of voice and cough was assessed on a 2-point scale 0=absent and 1=present, 24hrs after surgery.Results: The incidence of sore throat at 24hours postoperative was reduced in group D than in group N. 4 patients (8%) in group D had sore throat while 27 patients (57%) in group N had sore throat at 24hours. This was statistically significant (p<0.05). The cough incidence was reduced in group D while there was no difference in incidence of hoarseness of voice between the two groups.Conclusions: Intracuff dexamethasone decreases the incidence of postoperative sore throat when compared to intracuff normal saline. Dexamethasone also reduces postoperative cough incidence but does not reduce the incidence of hoarseness of voice.

Comparison of Epidural Levo Bupivacaine (0.5%) with Racemic Bupivacaine (0.5%) for Lower Abdominal Surgery

Introduction: Levobupivacaine, the pure S (-) isomer ofbupivacaine, is attributed to have less cardiotoxicity whencompared to racemic bupivacaine. Levobupivacaine increasethe margin of safety for epidural anaesthesia. Study aimed toinvestigate the clinical efficacy of levoupivacaine comparedwith racemic bupivacaine for epidural anaesthesia.Material and Methods: We conducted an observationalmulticentric study comparing sensory and motor blockproduced by 0.5% levobupivacaine (17 ml, 85 mg) withthat of 0.5% racemic bupivacaine in 60 patients undergoingelective lower abdominal surgery under epidural anaesthesia.Result: No statistically significant difference was foundbetween the groups in terms of sensory and motor blockade.The time to onset of adequate sensory block (T10dermatome)was similar in both treatment groups (6.20+/-2.23 min forlevobupivacaine and 6.17+/-2.61 min for bupivacaine).Average peak block height reached was T4 for both group.Time for sensory block to reach T6 level was comparable.(10.97+/-2.89 for bupivacaine and 11.23 +/-5.99 forlevobupivacaine.) Time for regression of sensory block to T10level was similar (224.17+/-30 for bupivacaine and 224.83 +/-23 for levobupivacaine). There was no difference in theonset and intensity of motor block between two groups.Conclusion: 0.5% levobupivacaine and 0.5% bupivacaineproduced effective epidural anaesthesia and their effects wereclinically indistinguishable. Levobupivacaine could be a goodalternative to bupivacaine in patients administered epiduralanaesthesia

Relationship of rheumatoid factor positivity to prevalence of joint manifestations in type 2 diabetes which are unrelated to rheumatoid arthritis.

Background: The present study was designed to investigate the relationship of rheumatoid factor positivity to the prevalence of joint manifestations in type 2 diabetes which are not attributable to rheumatoid arthritis. Methods: We evaluated 192 type 2 diabetes patients with rheumatological complications and age and sex matched non-diabetic controls for rheumatoid factor (RF) positivity. Diabetic patients with frozen shoulder, LJM syndrome, carpal tunnel syndrome, trigger finger, DISH and Dupuytren’s contracture were evaluated for RF positivity. Results: RF was positive in 47 patients (24.4%) when compared to controls (4.2%). RF positivity was associated with an increased prevalence of joint manifestations in diabetic group when compared to controls. RF positivity was not related to the duration of diabetes nor was it related to long term glycemic control. Conclusion: RF positivity resulted in an increased prevalence of joint manifestations in diabetes, which were unrelated to rheumatoid arthritis.