Content provided in partnership with

Health Care Industry

Using betamethasone gel to reduce intubation discomfort

AORN Journal, April, 2008 by George Allen

British Journal of Anaesthesia

February 2008

A sore throat, a cough, and hoarseness of voice are common and uncomfortable postoperative occurrences associated with tracheal intubation. Although local-anesthetic jelly can limit potential damage to the tracheal mucosa by suppressing bucking on the tracheal tube, its ability to prevent postoperative sore throat is inconclusive since it does not possess any intrinsic anti-inflammatory properties. Because steroids are known for their anti-inflammatory action, it is possible that betamethasone gel, a topical steroid preparation, applied to the tracheal tube might reduce the incidence of postoperative sore throat, cough, and hoarseness. Previous studies have been underpowered or have compared only betamethasone gel and placebos. The purpose of this prospective, randomized, double-blind, controlled study was to compare the ability of betamethasone gel or lidocaine jelly applied to the tracheal tube and cuff to reduce the incidence of sore throat, cough, and hoarseness during the first 24 postoperative hours.

Most Popular Articles in Health: Fuel your workout: exercisers who eat before they work out have more energy ...; Soothe a dry, itchy scalp: 5 easy expert solutions; Cocktails and calories: Beer, wine and liquor calories can really add up. ...; The sour truth about apple cider vinegar - evaluation of therapeutic use; The, six best supplements you've never heard of: these secret weapons can ...; More »

One hundred fifty patients between the ages of 18 and 50 years with an American Society of Anesthesiologists classification of I or II who were undergoing elective surgery expected to last between 30 and 240 minutes under general anesthesia with orotracheal intubation were enrolled in the study. Participants were randomly assigned to either the betamethasone group, the lidocaine group, or the control group. Patients were excluded if

* they were undergoing surgeries of the oral cavity and pharynx,

* they were anticipated to have a difficult airway,

* they had upper respiratory tract infections,

* they were undergoing steroid therapy,

* the procedure was expected to last longer than 240 minutes,

* more than two attempts at intubation were made, or

* a nasogastric tube or throat pack was used.

All patients were premedicated with oral diazepam 10 mg and ranitidine 150 mg two hours before surgery. At induction of anesthesia, 2.5 mL of betamethasone gel 0.05%, 2.5 mL of lidocaine 2% jelly, or nothing was applied on the external surface of the tracheal tube from the distal end of the cuff to a distance of 15 cm from the tip. The betamethasone gel or lidocaine jelly was spread uniformly with sterile precautions. The patients were intubated, and anesthesia was administered following a standard procedure.

At the end of surgery, the patients were extubated, and each patient was assessed for sore throat, cough, and hoarseness by the anesthesiologist in charge of the postanesthesia care unit at one, six, 12, and 24 hours after surgery. Common statistical procedures including analysis of variance, Fisher F test, post hoc Tukey's t test, and the chi square test were used to analyze the differences between the groups.

FINDINGS, Patient characteristics and duration of surgery were comparable between the groups. In the first 24 hours after surgery, the incidence of sore throat, cough, and hoarseness was significantly lower in the betamethasone group compared with the lidocaine group and the control group (P < .05). The incidence of postoperative

* sore throat was 40%, 100%, and 100%;

* cough was 6%, 40%, and 28%; and

* hoarseness was 4.1%, 32.9%, and 50% for the betamethasone, lidocaine, and control groups, respectively.

CLINICAL IMPLICATIONS. The results of this study revealed that the wide application of betamethasone gel on the tracheal tube decreases the incidence and severity of postoperative sore throat, cough, and hoarseness. Perioperative nurses and managers should encourage their anesthesia care providers to consider using betamethasone gel for intubation.

Sumathi PA, Shenoy T, Ambareesha M, Krishna HM. Controlled comparison between betamethasone gel and lidocaine jelly applied over tracheal tube to reduce postoperative sore throat, cough, and hoarseness of voice. Br J Anaesth. 2008;100(2):215-218.

GEORGE ALLEN

PHD, RN, CNOR, CIC

DIRECTOR OF INFECTION CONTROL

DOWNSTATE MEDICAL CENTER

BROOKLYN, NY

Health Care Industry

Using betamethasone gel to reduce intubation discomfort

AORN Journal, April, 2008 by George Allen

Find Research Guides for:

Find Featured Titles for: Arts

Most Popular Articles in Health

Most Popular Publications in Health