Efficacy of preoxygenation with end-tidal oxygen when using different oxygen concentrations in patients undergoing general surgery: a single-center retrospective observational study.

BACKGROUND: Preoxygenation is a simple but very important procedure for preventing arterial desaturation. A higher fraction of inspired oxygen (FiO2) increases atelectasis and 80% oxygen results in significantly less atelectasis than 100% oxygen. We investigated whether there was a difference in the duration of adequate preoxygenation when using 100% and 80% oxygen. The proportion of patients for whom >3 min was required to achieve adequate preoxygenation was also investigated. METHODS: The VitalDB database of patients underwent general surgery between February 1, 2021 and November 12, 2021 was reviewed. The time between the start of preoxygenation and the point where a 10% difference between FiO2 and end-tidal oxygen (EtO2) was defined as the preoxygenation time. The patients were classified into 100% and 80% groups according to the oxygen concentration. Propensity score matching (PSM) was performed to control for potential confounding factors. RESULTS: Only 330 of the 1,377 patients had sufficient data for analysis: 179 in the 80% group and 151 in the 100% group. After PSM, 143 patients in each group were analyzed. The median preoxygenation time was 143 s [interquartile range (IQR): 120.5-181.5 s] and 144 s (IQR: 109.75-186.25 s) in the 80% and 100% groups, respectively [P=0.605; median difference =-1 s; 95% confidence interval (CI): -13 to 10]. Of the patients, 27% required >3 min for adequate preoxygenation. CONCLUSIONS: No difference in preoxygenation time was found between the 80% and 100% groups. For some patients, breathing for 3 min is not sufficient for adequate preoxygenation. EtO2 monitoring aids evaluation of whether preoxygenation was adequate.

Successful extracorporeal membrane oxygenation in a patient with central airway obstruction due to an endotracheal mass.

Extracorporeal membrane oxygenation (ECMO) assists blood circulation and gas exchange via a heart-lung machine. ECMO is used mainly in intensive care units as bridging therapy until heart and respiratory failure can be addressed or until transplantation can be performed. ECMO is sometimes used during surgery under general anaesthesia, depending on the patient's underlying diseases and the nature of the operation. If the oxygen supply and carbon dioxide removal capacity are limited, venovenous (VV)-ECMO can be helpful. Here, we describe the use of VV-ECMO for surgical resection of an endotracheal mass through rigid bronchoscopy in a patient who developed decompensating dyspnoea due to central airway obstruction (CAO).

Sedation for magnetic resonance imaging in the prone position - A report of four cases.

BACKGROUND: Magnetic resonance imaging (MRI) is a useful tool, but it can be difficult to perform in those with claustrophobia as it requires being enclosed in a noisy cylindrical space. Being in the prone position is essential to spread breast tissue. However, sedation in a prone position is challenging because of the possibility of respiratory depression and the difficulty in manipulating the airway. CASE: Four patients with claustrophobia were sedated using dexmedetomidine, has minimal effect on respiration. Dexmedetomidine also enables the patient's cooperation in assuming the prone position while infusing loading time. But dexmedetomidine requires a longer time to reach moderate sedation, an intermittent bolus of midazolam was required for rapid induction of moderate sedation. All exams were conducted successfully without any complications. CONCLUSIONS: Administering dexmedetomidine and a midazolam bolus at the appropriate dose and timing will render MRI examinations in the prone position safe and satisfactory, without respiratory complications.

A novel application of Transnasal Humidified Rapid Insufflation Ventilatory Exchange via the oral route in morbidly obese patient during monitored anesthesia care - A case report.

BACKGROUND: Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is used to improve oxygenation, with the added benefit of a smaller increase in CO2 if self-respiration is maintained with THRIVE. Despite these advantages, the use of THRIVE through a nasal cannula is limited in situations such as epistaxis or a basal skull fracture. CASE: We successful used THRIVE, through the oral route under general anesthesia with spontaneous breathing in a morbidly obese patient (weight, 148 kg; height, 183 cm; body mass index, 44.2 kg/m2) who received transnasal steroid injections due to subglottic stenosis. CONCLUSIONS: THRIVE through the oral route may be an effective novel option, although further studies are needed.

SWATH-MS analysis of cerebrospinal fluid to generate a robust battery of biomarkers for Alzheimer's disease.

Cerebrospinal fluid (CSF) Aß42 and tau protein levels are established diagnostic biomarkers of Alzheimer's disease (AD). However, their inadequacy to represent clinical efficacy in drug trials indicates the need for new biomarkers. Sequential window acquisition of all theoretical fragment ion spectra (SWATH)-based mass spectrometry (MS) is an advanced proteomic tool for large-scale, high-quality quantification. In this study, SWATH-MS showed that VGF, chromogranin-A, secretogranin-1, and opioid-binding protein/cell adhesion molecule were significantly decreased in 42 AD patients compared to 39 controls, whereas 14-3-3ζ was increased (FDR < 0.05). In addition, 16 other proteins showed substantial changes (FDR < 0.2). The expressions of the top 21 analytes were closely interconnected, but were poorly correlated with CSF Aß42, tTau, and pTau181 levels. Logistic regression analysis and data mining were used to establish the best algorithm for AD, which created novel biomarker panels with high diagnostic value (AUC = 0.889 and 0.924) and a strong correlation with clinical severity (all p < 0.001). Targeted proteomics was used to validate their usefulness in a different cohort (n = 36) that included patients with other brain disorders (all p < 0.05). This study provides a list of proteins (and combinations thereof) that could serve as new AD biomarkers.

Analysis of caudal epidurogram in single center: A preliminary study of lumbar radiculopathy management.

A caudal epidural block involves placing a needle through the sacral hiatus and delivering medication into the epidural space. The procedure is safe and simple, but failure rates can be as high as 25%. The purpose of this study was to investigate the success rate of caudal epidural block by analyzing needle placement and dye flow pattern.We retrospectively analyzed the medical records of patients who underwent caudal epidural block under spinal stenosis. A case was defined as a failure if it met at least one of the following four criteria: the epidural needle was not placed correctly inside the caudal canal; blood regurgitation or aspiration in the needle was observed; the contrast dye was injected into a blood vessel; or a large amount of the dye leaked into the sacral foramen or did not reach the L5-S1 level.At least 1 failure criterion was observed in 14 cases (17.7%), while none of the failure criteria were satisfied in 65 successful cases (82.3%).No matter how experienced the anesthesiologist may be, delivery of adequate therapeutic agent is not achieved in approximately 20% of cases. Therefore, we recommend fluoroscopy-guided needle placement and confirmation by radio-contrast epidurograpy as the best choice.

Effect of Thoracic Epidural Anesthesia in a Rat Model of Phrenic Motor Inhibition after Upper Abdominal Surgery.

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: One important example of impaired motor function after surgery is diaphragmatic dysfunction after upper abdominal surgery. In this study, the authors directly recorded efferent phrenic nerve activity and determined the effect of the upper abdominal incision. The authors hypothesized that phrenic motor output would be decreased after the upper abdominal incision; it was also hypothesized that blocking sensory input from the incision using thoracic epidural anesthesia would diminish this incision-induced change in phrenic motor activity. METHODS: Efferent phrenic activity was recorded 1 h to 10 days after upper abdominal incision in urethane-anesthetized rats. Ventilatory parameters were measured in unanesthetized rats using whole-body plethysmography at multiple time points after incision. The authors then determined the effect of thoracic epidural anesthesia on phrenic nerve activity and ventilatory parameters after incision. RESULTS: Phrenic motor output remained reduced by approximately 40% 1 h and 1 day after incision, but was not different from the sham group by postoperative day 10. One day after incision (n = 9), compared to sham-operated animals (n = 7), there was a significant decrease in spike frequency area-under-the-curve (median [interquartile range]: 54.0 [48.7 to 84.4] vs. 97.8 [88.7 to 130.3]; P = 0.0184), central respiratory rate (0.71 [0.63 to 0.79] vs. 0.86 [0.82 to 0.93]/s; P = 0.0460), and inspiratory-to-expiratory duration ratio (0.46 [0.44 to 0.55] vs. 0.78 [0.72 to 0.93]; P = 0.0023). Unlike humans, a decrease, not an increase, in breathing frequency has been observed after the abdominal incision in whole-body plethysmography. Thoracic epidural anesthesia attenuated the incision-induced changes in phrenic motor output and ventilatory parameters. CONCLUSIONS: Upper abdominal incision decreased phrenic motor output and ventilatory parameters, and this incision-induced impairment was attenuated by thoracic epidural anesthesia. The authors' results provide direct evidence that afferent inputs from the upper abdominal incision induce reflex inhibition of phrenic motor activity.

Comparison of Short-Term Complications of General and Spinal Anesthesia for Primary Unilateral Total Knee Arthroplasty.

PURPOSE: To compare the occurrences of perioperative complications of two anesthetic techniques (general anesthesia [GA] and spinal anesthesia [SA] in patients undergoing primary unilateral total knee arthroplasty (TKA). MATERIALS AND METHODS: Patients who underwent unilateral primary TKA due to osteoarthritis from January 2005 to January 2014 were retrospectively reviewed. They were divided into two groups: GA (n=490) and SA (n=746). The operation duration, length of perioperative stay in the operation room and occurrences of adverse events in postoperative 30 days (mean, 29.7±3.1 days) were compared. Before multivariate linear or logistic regression analysis, different baseline characteristics were adjusted in the statistical models. RESULTS: There were significant intergroup differences in mean age (GA, 68.4±7.2 years; SA, 70.7±7.5 years; p<0.001) and mCCI (GA, 3±1.4; SA, 3.2±1.5; p<0.001). The GA group required longer preoperative room time (+9.4 minutes; p<0.001), postoperative room time (+12.7 minutes; p<0.001), and postoperative hospital stay (+2.5 days; p=0.001) and had more surgical site infections (5 [1%] vs. 0 [0%]; p=0.005) and blood transfusion (205 [41.8%] vs. 262 [35.1%]; p=0.01). No differences in operative duration and other adverse events were identified. CONCLUSIONS: We should cautiously consider that GA may be associated with slightly increased preoperative and postoperative room times, postoperative hospital stay, transfusion and surgical site infection rates in primary unilateral TKA.

Cerebrospinal Fluid Biomarkers for the Diagnosis of Alzheimer Disease in South Korea.

Laboratory-specific reference values for cerebrospinal fluid (CSF) Alzheimer disease (AD) biomarkers are necessary. Our objective was to apply well-known CSF biomarkers and redetermine their diagnostic cutoff values for AD in South Korea. CSF samples from matched control subjects (n=71), patients with AD dementia (ADD, n=76), and other neurological disorders with cognitive decline (OND, n=47) were obtained from 6 Korean dementia clinics according to a standardized protocol. CSF biomarker concentrations were measured using enzyme-linked immunosorbent assay. CSF biomarkers differed significantly between the ADD and control groups (P<0.001 for all), and between the ADD and OND groups (P<0.001 for all). The areas under the curve in differentiation of ADD from control subjects were 0.97 for Aß42, 0.93 for total tau (tTau), 0.86 for pTau, and 0.99 for both tTau/Aß42 and pTau/Aß42 ratios. Our revised cutoff value for Aß42 was higher than our previous one, whereas the values for the Tau proteins were similar. The tTau/Aß42 ratio had the highest accuracy, 97%. Our findings highlight the usefulness of CSF AD biomarkers in South Korea, and the necessity of continually testing the reliability of cutoff values.

Development of the Geop-Pain questionnaire for multidisciplinary assessment of pain sensitivity.

BACKGROUND: To assess the multidisciplinary aspects of pain, various self-rating questionnaires have been developed, but there have not been sufficient relevant studies on this topic in South Korea. The aim of this study was to develop a new pain sensitivity-related questionnaire in the Korean language that would be simple and would well reflect Koreans' senses. METHODS: A new pain assessment questionnaire was developed through a pre-survey on "geop", which is the Korean word expressing fear, anxiety, or catastrophizing. We named the new assessment questionnaire the Geop-Pain Questionnaire (GPQ). The GPQ was composed of 15 items divided into three categories and rated on a 5-point scale. As a preliminary study, internal consistency and test-retest reliability analyses were conducted. Subsequently, 109 individuals completed the GPQ along with three pain-related questionnaires translated into Korean (Pain Sensitivity Questionnaire [PSQ], Pain Anxiety Symptoms Scale [PASS], and Pain Catastrophizing Scale [PCS]), and the correlations were analyzed. RESULTS: All items in the GPQ showed appropriate internal consistency, and the test-retest reliability analysis showed no statistically significant differences. The correlations between the GPQ and the existing questionnaires revealed that the GPQ scores had mid-positive correlations with the PSQ scores and strong positive correlations with the PASS and PCS scores. CONCLUSIONS: This study attempted to develop a questionnaire assessing pain sensitivity multidimensionally using the Korean word geop for the first time. The self-rating GPQ showed high correlations with the existing questionnaires and demonstrated potential to be utilized as a pain prediction index in clinical practice.

The Correlation Study between Plasma Aß Proteins and Cerebrospinal Fluid Alzheimer's Disease Biomarkers.

BACKGROUND AND PURPOSE: Alzheimer's disease (AD) is characterized by the accumulation of amyloid-ß proteins (Aß). In this study we explored the correlation of plasma Aß40 and Aß42 concentrations with Aß42, total tau (tTau) and phosphorylated tau 181 (pTau181) levels in cerebrospinal fluid (CSF) in AD and control subjects to further understand the characteristics of plasma Aß proteins levels. METHODS: The consecutive subjects (44 AD and 47 controls) in this study were recruited. The plasma levels of Aß40 and Aß42 were measured using a commercially available sandwich enzyme-linked immunosorbent assay (ELISA) kits. And the corresponding CSFs were analyzed in terms of Aß42, tTau and pTau181 concentrations using INNOTEST ELISA kits. Further, the albumin levels were measured both in serum and CSF and albumin ratio was obtained to check the integrity of blood-brain barrier. RESULTS: CSF Aß42 concentrations were significantly decreased while tTau and pTau181 levels were significantly increased in AD subjects. The plasma levels of Aß42 were significantly lower (p=0.007), while the Aß40/Aß42 ratio was significantly higher (p<0.001) in AD patients than in controls. The overall plasma Aß42 levels showed a positive correlation with those of CSF Aß42 (p=0.001), but not with the others in CSF. In subgroup analysis, the CSF Aß42 demonstrated positive correlation with not only plasma Aß42 but also Aß40 levels in controls. However, no significant relationship was noted between plasma and CSF Aß proteins in AD group. CONCLUSIONS: The plasma Aß42 and Aß40 concentrations were shown to have a close relationship with CSF Aß42 levels in controls, but not in AD subjects. Our results suggest that the correlation between plasma Aß40 and CSF Aß42 levels is perturbed in AD.

Current practice in hemodynamic monitoring and management in high-risk surgery patients: a national survey of Korean anesthesiologists.

BACKGROUND: Hemodynamic optimization improves postoperative outcomes in high-risk surgery patients. The monitoring of cardiac output (CO) and dynamic parameters of fluid responsiveness can guide hemodynamic optimization. We conducted a survey to assess the current hemodynamic monitoring and management practices of Korean anesthesiologists during high-risk surgery. METHODS: E-mails containing a link to our survey, which consisted of 33 questions relating to hemodynamic monitoring during high-risk surgery, were sent to 3,943 members of the Korean Society of Anesthesiologists (KSA). The survey web page was open from December 30, 2011 to March 31, 2012. RESULTS: A total of 139 anesthesiologists responded during the survey period. Invasive arterial pressure (97.2%) and central venous pressure (93.4%) were routinely monitored. CO was monitored in 58.5% of patients; stroke volume variations were monitored in 50.9% of patients. However, CO was consistently optimized by < 20% of anesthesiologists. An arterial pressure waveform-derived CO monitor was the most frequently used device to monitor CO (79.0%). Blood pressure, urine output, central venous pressure, and clinical experience were considered to be the best indicators of volume expansion than CO or dynamic parameters of fluid responsiveness. CONCLUSIONS: The survey revealed that KSA members frequently monitor CO and dynamic parameters of fluid responsiveness during high-risk surgery. However, static indices were used more often to judge volume expansion. The current study reveals that CO is not frequently optimized despite the relatively high incidence of CO monitoring during high-risk surgery in Korea.

The Effect of Low-dose Ketamine on Post-caesarean Delivery Analgesia after Spinal Anesthesia.

BACKGROUND: Ketamine, an N-methyl-D-aspartate receptor antagonist, might play a role in postoperative analgesia, but its effect on postoperative pain after caesarean section varies with study design. We investigated whether the preemptive administration of low-dose intravenous ketamine decreases postoperative opioid requirement and postoperative pain in parturients receiving intravenous fentanyl with patient-controlled analgesia (PCA) following caesarean section. METHODS: Spinal anesthesia was performed in 40 parturients scheduled for elective caesarean section. Patients in the ketamine group received a 0.5 mg/kg ketamine bolus intravenously followed by 0.25 mg/kg/h continuous infusion during the operation. The control group received the same volume of normal saline. Immediately after surgery, the patients were connected to a PCA device set to deliver 25-µg fentanyl as an intravenous bolus with a 15-min lockout interval and no continuous dose. Postoperative pain was assessed using the cumulative dose of fentanyl and visual analog scale (VAS) scores at 2, 6, 24, and 48 h postoperatively. RESULTS: Significantly less fentanyl was used in the ketamine group 2 h after surgery (P = 0.033), but the difference was not significant at 6, 12, and 24 h postoperatively. No significant differences were observed between the VAS scores of the two groups at 2, 6, 12, and 24 h postoperatively. CONCLUSIONS: Intraoperative low-dose ketamine did not have a preemptive analgesic effect and was not effective as an adjuvant to decrease opioid requirement or postoperative pain score in parturients receiving intravenous PCA with fentanyl after caesarean section.

Complete atrioventricular nodal block after propofol administration in an elderly patient undergoing total knee replacement arthroplasty -A case report-.

Complete atrioventricular (AV) block is defined as a dissociation of atrial and ventricular activities. Complete AV block that occurs during the perioperative period is difficult to reverse and usually requires implantation of a pacemaker. Propofol does not affect a normal AV conduction system but may act as a trigger for AV block. It can also potentiate vagal stimulation factors and reduce sympathetic activity. We report a case of complete AV block that may have been related to administration of propofol.

Effect of epidural magnesium on the incidence of chronic postoperative pain after video-assisted thoracic surgery.

OBJECTIVE: The aim of this study was to determine whether the epidural administration of magnesium during the perioperative period decreased the incidence of chronic postoperative pain (CPOP) at 3 months after video-assisted thoracic surgery. DESIGN: Prospective, randomized, and blinded. SETTING: A university hospital. PARTICIPANTS: Patients. INTERVENTIONS: Before the induction of anesthesia, the patients were assigned randomly to receive normal saline, 5 mL, (group C, n = 72) or magnesium sulfate, 100 mg (group M, n = 72), epidurally. At the end of surgery, group C received a continuous infusion of a mixture of 0.2% ropivacaine, 226 mL, and fentanyl, 1,200 µg, through a patient-controlled epidural analgesia pump for 48 hours. In group M, magnesium sulfate, 500 mg, was added to the infusion. MEASUREMENTS AND MAIN RESULTS: The incidence and severity of CPOP were assessed by a telephone survey 3 months after surgery. Patients were asked whether they experienced pain and to rank the severity of the pain using a 3-point scale (1, mild; 2, moderate; 3, severe). The incidences of CPOP were 42.4% in group C and 49.1% in group M. The severities of pain in the patients with CPOP were 1.0 (1-2) in group C and 1.0 (1-2) in group M. The incidence and severity of CPOP did not differ between the 2 groups. CONCLUSIONS: The epidural administration of magnesium from before the induction of anesthesia to 48 hours postoperatively did not decrease significantly the incidence or severity of CPOP in patients undergoing video-assisted thoracic surgery.

Ultrasound-guided interscalene brachial plexus block in a pediatric patient with acute hepatitis -A case report-.

The interscalene brachial plexus block is not commonly used in pediatric regional anesthesia. The increasing popularity of ultrasound has allowed more anesthesiologists to perform regional anesthesia with high success rates in pediatric patients with the direct visualization of the target nerve and spread of local anesthetics. We present a case of interscalene brachial plexus block under ultrasound guidance in a 17-month-old child with acute drug-induced hepatitis who required fixation of a fracture of the lateral humeral condyle.

A questionnaire study investigating the prevalence of chronic postoperative pain.

BACKGROUND: Chronic postoperative pain (CPOP) is defined as pain of at least 2 months duration after a surgical procedure. Until recently, it has been a neglected topic, because it can occur after a wide spectrum of operations; however, little is known regarding its underlying mechanism, prevalence, risk factors, and treatments. We investigated characteristics of CPOP after various operations via a questionnaire. METHODS: Patients were contacted at > 2 months after surgery, irrespective of sex, type of operation or anesthesia method, and a follow-up pain questionnaire was administered by phone. RESULTS: One hundred forty-five of 400 patients (36.3%) described CPOP. The prevalence of CPOP was significantly lower in laparoscopic surgery (29/159, 18.2%) than open surgery (116/241, 48.1%). The prevalence of CPOP was higher with the use of PCA (patient controlled analgesia), (45.3%) than without PCA (24.6%). There were no significant differences regarding sex, anesthetic method, or duration of operation. CONCLUSIONS: Our results indicate that the prevalence of CPOP may be related to use of an endoscope and PCA. However, it is difficult to completely explain the correlation, because this is a complex area of research. More research is needed to improve the quality of pain relief.

A comparison of sufentanil and fentanyl for patient-controlled epidural analgesia in arthroplasty.

BACKGROUND: The use of lipid soluble opioids such as fentanyl, alfentanil and sufentanil are recently on the increase for patient-controlled epidural analgesia (PCEA). In this study, the effects and adequate dose of sufentanil in arthroplasty were investigated. METHODS: Eighty patients scheduled for arthroplasty were enrolled for the study. Seventy-one patients (ASA physical status I-III) were randomly allocated into four groups. All groups received 0.1% ropivacaine through PCEA and each group received either fentanyl (group F: fentanyl 4 µg/ml) or sufentanil (group S1: sufentanil 0.5 µg/ml, group S2: sufentanil 0.75 µg/ml, and group S3: sufentanil 1.0 µg/ml). Postoperative pain scores were evaluated using VAS (visual analog scale, 0-10) and side effects such as hypotension, nausea/vomiting, pruritus and the degree of satisfaction were evaluated at 1, 6, 12, 24, 48 hours after surgery. RESULTS: Postoperative pain score (VAS) decreased gradually and the highest VAS score was recorded at 1 hour postoperative for all four groups. There were no differences in the degree of satisfaction and postoperative pain score between all groups. The incidence of pruritus was significantly lower in group S1 than in groups S2 and S3. CONCLUSIONS: The incidence of side effects were significantly lower in group S1 (0.1% ropivacaine plus sufentanil 0.5 µg/ml). Therefore, 0.5 µg/ml of sufentanil through PCEA is the recommended dose for postoperative pain control in arthroplasty.

Application of triamcinolone acetonide paste to the endotracheal tube reduces postoperative sore throat: a randomized controlled trial.

PURPOSE: This study was performed to examine whether applying triamcinolone acetonide paste as a lubricant to endotracheal tubes (ETTs) reduces the incidence and severity of postoperative sore throat (POST) more effectively than applying chlorhexidine gluconate jelly. METHODS: This was a randomized controlled clinical trial. Patients enrolled in the study were ages 20 to 70 yr, American Society of Anesthesiologists' physical status I and II, and scheduled for elective laparoscopic cholecystectomy. The patients were divided randomly into two groups, the chlorhexidine group and the triamcinolone group. Prior to endotracheal intubation, ETTs in the chlorhexidine group were lubricated with 0.1% chlorhexidine gluconate jelly, whereas the ETTs in the triamcinolone group were lubricated with 0.1% triamcinolone acetonide paste 0.5 mg. During the 24 hr after the operation, we recorded the incidence and severity of POST and the incidence of cough, hoarseness, dysphagia, nausea, and dry throat. RESULTS: Of the 150 patients initially enrolled, 143 patients were included in the study. The incidence of POST was significantly lower in the triamcinolone group compared with the chlorhexidine group (difference = 52.4%; 95% confidence interval, 36.8% to 64.2%; P < 0.001). The severity score for the triamcinolone group was significantly lower than that for the chlorhexidine group. The frequencies of coughing, hoarseness, dysphagia, nausea, and dry throat were similar in the two groups for the first 24 hr after surgery. CONCLUSIONS: Triamcinolone acetonide paste applied along the length of the ETT resulted in clinically important and statistically significant decreases in the incidence and severity of POST compared with the application of chlorhexidine jelly. (ClinicalTrials.gov number, NCT00908817).

Prophylactic effect of dexamethasone in reducing postoperative sore throat.

BACKGROUND: This study was performed to compare the effectiveness of prophylactic dexamethasone and postintubation dexamethasone in reducing the incidence and severity of postoperative sore throat (POST). METHODS: This was a prospective, randomized, double-blind clinical trial. The study population consisted of 70 patients between 20 and 60 years old who were classified as American Society of Anesthesiologists I-II and were scheduled for elective laparoscopic cholecystectomy. The patients were divided randomly into two groups. Patients in the prophylactic and postintubation groups received intravenous injection of 10 mg of dexamethasone 30 min before or after tracheal intubation, respectively. The patients were interviewed 1, 6, and 24 h after the operation. The incidence and severity of POST were recorded. RESULTS: The severity scores of POST at 1 and 6 h after the operation were significantly lower in the prophylactic group than in the postintubation group. There were no significant differences in the incidence of POST during the 24 h after the operation between the two groups (22/32 in the prophylactic group vs. 27/34 in the postintubation group, P = 0.403). CONCLUSIONS: Intravenous injection of 10 mg of dexamethasone was more effective in reducing the severity of POST when administered before tracheal intubation compared with after tracheal intubation.