Single or in combo: Dexamethasone reduces risk of postoperative sore throat during intubation

Delhi: Dexamethasone when used alone or in combination with lidocaine effectively reduced the incidence of a postoperative sore throat (POST), hoarseness and cough in patients requiring prolonged tracheal intubation, according to a recent study published in the journal Anesthesia & Analgesia.

Sore throat after tracheal intubation is one of the most common postoperative problems causing dissatisfaction to patients. As a matter of fact, it is amongst the 10 most undesirable adverse effects related to general anaesthesia.

"Irritation and inflammation of the airway caused by pressure exerted on the tracheal wall by the endotracheal tube (ETT), mucosal dehydration and trauma during intubation are thought to be the reasons for POST," write the authors.

Both nonpharmacological and pharmacological measures have been attempted to reduce the severity and incidence of POST with variable success. Lidocaine and dexamethasone have been used independently for this purpose but no study has assessed the combined effects of the two.

Asish Subedi, Department of Anesthesiology and Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal, and colleagues conducted this prospective, double-blind, randomized controlled study that primarily aimed to compare the effect of a dexamethasone or lidocaine with placebo on the incidence of POST in patients requiring endotracheal intubation (>90 minutes) for general anesthesia. And secondarily, to compare the incidence and severity of POST hoarseness and cough among the 4 groups (dexamethasone, lidocaine, dexamethasone/lidocaine combination, and placebo).

The study enrolled 180 patients requiring general anaesthesia with endotracheal intubation for >90 minutes. 1 of the 4 intravenous agents were administered just before induction of anaesthesia: lidocaine (1.5 mg/kg^-) in group L, dexamethasone (8 mg) in group D, lidocaine (1.5 mg/kg) with dexamethasone (8 mg) in group DL, and placebo as normal saline in group NS. Incidence and severity of a sore throat, cough, and hoarseness of voice were assessed up to 24 hours postoperatively.

The primary outcome was the incidence of POST, and the main effects of dexamethasone and lidocaine were the primary interest. Data of 45 patients in D, 44 in L, 44 in DL, and 43 in NS groups were analyzed. On analysis they found that:

• The incidence of a sore throat was 36%, 43%, 25%, and 56% in group D, L, DL, and NS, respectively.


• Dexamethasone with or without lidocaine reduced the incidence of the POST.


• Lidocaine was not effective in reducing POST.


• No difference was observed in the severity of a sore throat, incidence and severity of a cough, and hoarseness among the groups.

Dexamethasone, with or without lidocaine, was effective in reducing POST incidence in patients requiring prolonged tracheal intubation -- is the bottom line of the study.

To read the complete study follow the link: doi: 10.1213/ANE.0000000000003842