A COMPARATIVE ANALYSIS FOR REDUCTION OF POST-SURGICAL SORE THROAT BY APPLYING OF KETAMINE-NEBULIZATION & BETAMETHASONE-GEL OVER THE ENDO-TRACHEAL TUBE CUFF

Background: In general anaesthesia (GA), endo-tracheal -intubation is required to control respiration & to protect the airway. The commonest locations of injury while intubation are the larynx & trachea, which typically manifest as regional pain, inflammation & even necrosis. Aims & objectives: This research was carried out to contrast the efficaciousness of ketamine-nebulization & betamethasonegel on the cuff of the endo-tracheal -tube to alleviate post-surgical throat pain (POST). Materials & methods: This is a randomized, prospective research assessing the efficaciousness of betamethasone-gel & lignocaine-jelly ketamine-nebulisation applied over the endo-tracheal -tube cuff to decrease post-surgical sore throat nebulisation (POST). The study subjects were divided randomly into ketamine (category K), betamethasone (category B) & lignocaine category (category L). Study subjects were observed immediately after extubation (0 hr), 2 hrs, 6 hrs, 12 hrs & 24 hours after the post-surgical time for POST, which was rated on a four-point ranking. Results: In this research, the total occurrence of POST was 30 %. Out of this, POST occurred only in 20 % of study subjects in the (K) category, 23 % of study subjects in the (B) category, contrasted to 47% in the (L) (control) category. The occurrence of POST at 0 hr, 2 hrs, 6 hrs, 12 hrs, 24 hours was 10 %, 10 %, 17 %, 10 % & 7 % respectively in the ketamine-nebulisation


Introduction
In general anaesthesia, endo-tracheal -intubation is required to control respiration & to protect the airway. While the cornerstone of contemporary anesthetic practice & critical treatment has remained endo-trachealintubation, it is with complications 1,2 . There were several levels of airway damage eventuating in post-surgical sore throat (POST), speech hoarseness, cough & pain in almost all study subjects who were intubated for long-lasting or short-lasting surgical intervention 3,4 . The commonest locations of injury while intubation are the larynx & trachea, which typically manifest as regional pain, inflammation & even necrosis. In 21-65 % of study subjects undergoing general anaesthesia (GA) with endo-trachealintubation, post-surgical sore throat (POST) occurs. It can cause substantial post-surgical morbidity & patient discomfort, albeit regarded as a minor complication 5,6 . The occurrence of these complications was altered by numerous factors, including age, season, h/o smoking, individual with hyper-reactive airways, anesthetic drugs & gases used in GA, number of studies & trauma while intubation, length of intubation, size of the endo-tracheal -tube & its kind, kind of cuff & its size, surgical location, ketamine nebulization & lidocaine applying, steroid nebulization & lidocaine applying 7 . Ketamine is an NMDA receptor antagonist with a primary central nervous system location of action, & parts of the limbic system show its peripheral effect when used by the nasal, gargle & rectal routes8 ,9 . Regional inflammation & even the peripheral analgesic impact of ketamine are attenuated by the topical effect of ketamine-nebulization 10 .

Aims & Objectives
To delisting the role of nebulized ketamine for POST relief in study subjects undergoing surgical intervention under endo-tracheal -intubation general anaesthesia. To assess the function of Betamethasone-gel applied to POST relief over the endo-tracheal -tube cuff in study subjects undergoing surgical intervention under endo-tracheal -intubation general anaesthesia & to contrast it with Ketaminenebulization.

Materials & Methods
This is a randomized controlled prospective research of 180 study subjects in the 18-70-year age category of either gender with American Society of Anesthesiologists stage I & II physical status & mallampati stage 1 & 2 undergoing GA surgical intervention lasting more than 1 hour. All 180 study subjects are randomized into three categories of 60 each, after institutional ethical committee clearance & written informed consent.  After endo-tracheal -intubation, regional anesthetic factors such as Lidocaine jelly or spray are considered to be ineffectual in avoiding pain in the throat. These factors are known to limit tracheal mucosal damage & prevent cough, & as they lack anti-inflammatory effects, they cannot be successful in preventing sore throat. Studies have also shown that regional anesthetic jelly applying restricts the possible damage to the tracheal mucosa due to its lubricating properties that suppress the bucking of the tracheal channel.

Results
There are a few restrictions of our research. To explain the sedative effect of ketamine, no standardized sedation ranking was used. Monitoring of endo-tracheal -tube cuff pressure was not performed 17,18 .

Conclusion
Equally efficacious in minimizing POST is ketaminenebulisation (50 mg in 5 ml) Pre-surgical ly & the applying of 3 ml of betamethasone-gel over the endo-tracheal -tube cuff. Pre-surgical nebulisation with ketamine & betamethasone-gel applied over the cuff of the endotracheal -tube is preferable to applying of lignocaine-jelly over the cuff of the endo-tracheal -tube to decrease postsurgical sore throat. The research believes that the applying of betamethasone-gel over the endo-tracheal -tube cuff between ketamine-nebulisation & the applying of betamethasone-gel over the endo-tracheal -tube cuff is cost-efficacious, readily accessible, simple to apply & economical. It is also recommended that post-surgical throat pain be decreased.