Evaluation of preoperative Strepsils lozenges on incidence of postextubation cough and sore throat in smokers undergoing anesthesia with endotracheal intubation

Post-operative sore throat [POST] is an undesirable side effect of endotracheal intubation. Pharmacological and non-pharmacological measures have been utilized for minimizing the morbidity caused by POST. We have tested use of Strepsils lozenges in providing effi cacy for decreasing POST in smokers presenting for surgery under general anesthesia with endotracheal intubation. 100 patients, 20-65 years, American Society of Anesthesiologists [ASA] physical status I and II, either sex, history of smoking, posted for elective surgical procedure of more than 1 hour, requiring general anesthesia with endotracheal intubation were included and randomly divided into groups [n = 50] to receive Strepsils [Group A] and sugar candy [Group B]. The patients were assessed for cough, sore throat, and hoarseness of voice after extubation, 30 min, 12 hrs, and 24 hrs after extubation. At extubation no cough was seen in 39 [78%] patients [group A] compared to 23 [46%] patients [Group B], and mild cough in 22% [Group A] and 52% [Group B]. Incidence of sore throat at extubation was lower in group A compared to Group B [P = 0.04]. At other times of observations [30 min,12 hrs and 24 hrs] there was a significant decrease in incidence of sore throat in Group A compared to Group B [P = 0.000]. Hoarseness of voice was not observed in any patient in either group. Use of preoperative Strepsils lozenges decreases incidence of POST and maybe utilized as a simple and cost-effective measure for decreasing the symptoms of POST and increasing the satisfaction of patients.

Clinical vs. bispectral index-guided propofol induction of anesthesia: a comparative study

Clinically optimized focusing of drug administration to specific need of patient with bispectral index [BIS] monitoring results in reduced dose and faster recovery of consciousness. This study was planned with an aim to study and compare the conventional clinical end point or BIS on the requirement of dosage of propofol, hemodynamic effects, and BIS alterations following propofol induction. 70 patients, ASA I and II, 20-60 years undergoing elective surgical procedure under general anesthesia with endotracheal intubation were selected and divided into two groups. Group A received [inj.] fentanyl [2 micro g/kg], followed 3 min later by inj. propofol at the rate of 30 mg/kg/hr infusion till the loss of response to verbal command while group B received inj. fentanyl [2 micro g/kg], followed 3 min later by inj. propofol at the rate of 30 mg/kg/hr infusion. The end point of hypnosis was when the BIS value was sustained for 1 min at 48 +/- 2. The patients were intubated. Total induction dose of propofol was noted in each group. The value of BIS and hemodynamic parameters [heart rate, systolic/diastolic blood pressure] were noted at the time of loss of consciousness, at the time of intubation, and 1 min after intubation, thereafter every minute for first 10 min and thereafter every 10 min till end of surgery. Any involuntary muscle activity such as jerky movements, dystonic posturing, and opisthotonos were also recorded. The mean dose of propofol used in groups A and B were 1.85 +/- 0.48 mg/kg and 1.79 +/- 0.41 mg/kg, respectively. The dosage used in group B were less but not clinically significant [P=0.575]. On comparing the dosage of propofol in males among the groups there was a significantly lower dosage of propofol required in group B [2.06 +/- 0.45 mg/kg and 1.83 +/- 0.32 mg/kg, respectively, P=0.016]. This decrease however was not seen in female patients dosage being 1.65 +/- 0.44 mg/kg and 1.75 +/- 0.49 mg/kg, respectively [P=0.372]. The hemodynamic variables including heart rate, systolic/diastolic blood pressure and BIS were comparable within the group at induction, post-induction, and intubation. However, there was a significant increase in all the parameters at postintubation readings [P<0.001]. No significant difference in the induction dose of propofol was observed when assessed clinically [loss of verbal response] or by BIS monitoring. Traditional teaching to titrate the dose of propofol and depth of anesthesia during intubation by loss of verbal response is as good as BIS value monitoring