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Background and Aims: Postoperative sore throat (POST) is a common complication following general anesthesia with tracheal intubation that increases patient morbidity. We evaluated the effect of preoperative administration of IV paracetamol and a combination of paracetamol with nebulized or IV dexamethasone on the incidence of POST (primary objective), hoarseness of voice and cough (secondary objectives) in adult patients. Methods: In a randomized, double‑blind study in a tertiary care hospital, 150 patients undergoing laparoscopic cholecystectomy under general anesthesia with tracheal intubation were divided into three groups (n = 50): Group P received IV paracetamol 1 g infusion; Group I received IV dexamethasone 8 mg and IV paracetamol 1 g infusion; and Group N received nebulized dexamethasone 8 mg and IV Paracetamol 1 g infusion. The incidence and severity of POST, hoarseness and cough were assessed at various time‑points for 24 hours after surgery. Results: The overall incidence of POST was 72%, 18%, and 24% in groups P, I, and N, respectively; P < .0001. The severity of POST was significantly less in groups I and N compared with group P; both P < .0001. The incidence of postoperative hoarseness was comparable between the three groups; P = 0.216. The incidence and severity of postoperative cough were significantly higher in group P compared with group I; P = 0.016. Statistical calculations were done using SPSS 21 version program for Windows. Conclusions: Prophylactic administration of both nebulized and IV dexamethasone 8 mg in combination with IV paracetamol was effective in decreasing the incidence and severity of POST in adult patients undergoing laparoscopic cholecystectomy under general anesthesia with tracheal intubation. [ABSTRACT FROM AUTHOR]

Background: Laryngoscopy and tracheal intubation lead to sympathetic stimulation resulting in hemodynamic fluctuations. We compared local anesthetic ropivacaine 0.75% with alpha agonist dexmedetomidine through ultrasonic nebulization for direct local action of the drug in the airway. Methods: In our randomized study, 180 patients were prospectively assigned to three groups of 60 each: group R (0.75%), group D (1 microgram/kg), and group C (control). The primary objective was to determine whether nebulized ropivacaine or nebulized dexmedetomidine can cause a reduction in stress response to laryngoscopy and intubation. The secondary objectives were to compare the hemodynamic parameters at extubation, cough response at extubation, and postoperative sore throat. Results: A total of 165 patients were analyzed. Demographically, all the groups were similar. Group R and group D were found to significantly attenuate the heart rate (HR) at intubation and extubation when compared to group C (P < 0.05). A significant reduction in mean arterial pressure (MAP) was seen (P < 0.05; group D: 90 ± 18.4 mmHg, group C: 99.5 ± 15.9 mmHg, group R: 92.4 ± 16.1 mmHg). There was a significant reduction in cough response in both groups in comparison with group C at 0 minutes (P value; group C vs group D: <.0001; group C vs group R:.01) and 5 minutes (P value; group C vs group D: <.0001; group C vs group R: <.0001). Conclusion: Preinduction topical use of ropivacaine or dexmedetomidine, through the nebulization route, effectively attenuated the pressor responses when compared to placebo. [ABSTRACT FROM AUTHOR]

Background and Aims: Magnesium sulphate and zinc sulphate have been reported to attenuate postoperative sore throat (POST). The study aims to compare the effect of preoperative magnesium sulphate and zinc sulphate gargle on the incidence and severity of POST following endotracheal intubation within 24 h. Methods: After ethics committee approval, 132 patients were randomly allocated to three groups (M, Z and D). Fifteen minutes before laryngoscopy and tracheal intubation, patients assigned to groups M and Z received a solution for gargle containing magnesium sulphate 20 mg/kg and zinc sulphate containing 40 mg of elemental zinc dissolved in 20 ml of 5% dextrose solution, respectively. Group D received 20 ml of 5% dextrose solution. Incidence and severity of POST (4-point score: Grade 0- no sore throat, Grade 1- mild sore throat, Grade 2- moderate sore throat, Grade 3- severe sore throat) was assessed for 24 h after extubation. Statistica, Version 8.0 (StatSoft, Inc., Tulsa, Oklahoma, USA) was used for analysing the data. Results: The lowest incidence of POST in group M was 13.6% (95% confidence interval [CI] 3.5–23.7) compared to 0% in group Z, whereas the highest incidence recorded in group M was 25% (95% CI 12.2–37.7) in contrast to 13.6% (95% CI 3.5–23.7) in group Z during the first 24 h after operation. It was observed that the incidence of mild POST (POST score 1) was significantly lower (P < 0.05) in group Z compared to group M in the first 4 h postoperatively. Conclusion: Zinc sulphate gargle before laryngoscopy and tracheal intubation is more effective for reducing the incidence of POST than magnesium sulphate gargle. [ABSTRACT FROM AUTHOR]

Background: Ear, nose, and throat (ENT) complaints are quite common, representing almost 25% of adults and 50% of pediatric patients visiting primary health-care clinic. However, the duration of undergraduate courses does not correlate with how frequent ENT complaints are, as it does not exceed three weeks in the majority of medical school curriculums. Moreover, this is detrimental as all graduating physicians, regardless of their specialties, will be dealing with ENT complaints in their future practice. Objective: To assess medical students' basic ENT knowledge and to estimate their competency in approaching and managing common otolaryngology cases. Methods: This is a multi-institutional, cross-sectional study that included 1124 medical students from all public universities in Riyadh City, Saudi Arabia. Data were collected using an online survey with a validated questionnaire from a previous similar study. Results: The level of knowledge among the medical students correlates positively with their comfort level in performing head and neck examinations, as well as confronting and diagnosing ENT cases (P < 0.001). Medical interns displayed higher knowledge scores than medical students; females displayed higher average knowledge scores than their male counterparts (P < 0.05, P < 0.001, respectively). Participants who had 3-4 days per week in ENT services, and those with the intention of pursuing a career in ENT, demonstrated higher knowledge scores (P < 0.001). Conclusion: This study demonstrates that participants who spend more time in an ENT service have better knowledge scores than those with less time in the field; this indicates the need for a more extended, focused, and better-structured ENT curriculum for medical graduates to become more efficient in handling ENT cases. [ABSTRACT FROM AUTHOR]

Background Postoperative sore throat (POST) is commonly reported by patients after endotracheal intubation. This study was conducted to compare the efficacy of intravenous lidocaine and dexamethasone in the prevention of such problem. Patients and methods We included a total of 394 cases who were randomly divided using the closed-envelope method into two groups: group D that included 197 cases who received intravenous dexamethasone (8 mg), and group L that included the remaining 197 cases who received intravenous lidocaine (1.5 mg/kg). Both the incidence and risk factors for POST were assessed. Results Sore throat was reported by 115 (58.4%) cases in group L, whereas it was reported by 82 (41.6%) cases of cases in the other group. There was a marked reduction of sore-throat sensation in group D (P<0.001). Logistic regression revealed that the presence of blood on suction was a significant risk factor for developing sore throat after intubation. Conclusion Intravenous administration of dexamethasone appears to be more promising than lidocaine in decreasing the incidence of POST. [ABSTRACT FROM AUTHOR]

The effectiveness of forest honey in Total Nasal Symptom Score (TNSS) improvement in allergic rhinitis patients and index Scoring Atopic Dermatitis (SCORAD) in Atopic Dermatitis (AD) patients were discovered. It was an experimental study with a pretest–posttest design. A total of 20 people with atopy (15 people with allergic rhinitis and five people with AD) were given forest honey in the morning (1 ml × 10 ml dose) for 8 weeks and 20 atopy patients without forest honey. TNSS and SCORAD index were evaluated before the intervention, week 2, week 4, and after the intervention (week 8). The mean TNSS before treatment was higher in the honey group, namely 7.73, and a significant decrease after 8 weeks of intervention, namely 2.73 with P = 0.000. The nonhoney group showed that there was no significant difference after 8 weeks with P = 0.888. The SCORAD values of the honey and nonhoney groups had significantly different values from week 0 to week 4 (P = 0.003) and week 0 to week 8 (P = 0.003). Forest honey can give as an additional therapy for patients with allergic rhinitis and AD. [ABSTRACT FROM AUTHOR]

Background and Aims: Postoperative sore throat (POST) is an undesirable event reported in up to 62% of patients receiving general anaesthesia (GA). The incidence of POST following GA using a supraglottic airway device (SAD) is approximately 50%, with symptoms persisting up to 48 h. We examined the role of preoperative lozenges containing amylmetacresol and dichlorobenzyl alcohol (AMC/DCBA) with lignocaine (Strepsils® Max Plus) in reducing the incidence and intensity of POST following GA using SAD. Methods: We conducted a prospective, double-blinded, randomised, placebo-controlled trial involving 88 adults receiving GA for elective surgery using SAD not exceeding 2 h. Patients received either Strepsils Max Plus (Strepsils-LA group) or a placebo before induction of GA. The incidence and intensity of sore throat, dysphagia and dysphonia was measured using the Verbal Rating Scale at 30 min (early) and at 24 h (late) after removal of SAD. Results: Overall POST incidence was lower in the Strepsils-LA group (27.7% versus 56.8%, P = 0.007). Patients in the Strepsils-LA group reported a significantly lower incidence of early POST (14.9% versus 37.8%, P = 0.016) with a lower mean ± standard deviation intensity score (0.17 ± 0.43 versus 0.49 ± 0.69, P = 0.016). Although the overall incidence of dysphagia was lower (23.4% versus 48.6%, P = 0.016), more patients experienced dysphonia in the Strepsils-LA group. AMC/DCBA with lignocaine lozenges showed a relative risk reduction of 50% and a number needed to treat of 4 in reducing POST. Conclusion: AMC/DCBA with lignocaine lozenges administered before GA using SAD is a simple and safe method to reduce the incidence and severity of POST. [ABSTRACT FROM AUTHOR]

Background and Aim: While administering general anesthesia requiring endotracheal intubation, it is a common practice to inflate the cuff with air. Continuous pressure exerted by cuff on mucosa may lead to postoperative complaints such as sore throat, cough, and dysphagia, which are very disturbing to the patient. Hence, we hypothesized that inflation of cuff with propofol may reduce the incidence of these complications as a result of cushioning effect as well as non-diffusion of nitrous oxide into it. Our aim was to compare the effects of inflation of endotracheal tube cuff with 0.9% saline, 4% lignocaine, and 1% propofol on the incidence of postoperative morbidity in terms of cough, sore throat, dysphonia, and dysphagia with general anesthesia using nitrous oxide. Methods: Patients scheduled for elective surgery under general anesthesia were randomly allocated into four equal groups of thirty each as per cuff inflation media: air (Group A), 0.9% saline (Group S), 4% lidocaine (Group L), and 1% propofol (Group P). The incidence of cough was noted at 15, 30 and 60 min after extubating. The occurrence and severity of postoperative sore throat (POST) was evaluated at 2, 6, and 24 h after extubating. Results: The incidence of cough was maximum in Group A and minimum in Group P (P < 0.05). The occurrence of POST was highest in Group A, followed by Group S and Group L, and least in Group P. The hemodynamic parameters were comparable with no statistical difference in all the four groups (P < 0.05). Conclusion: The intracuff 1% propofol is superior to 4% xylocaine and normal saline in the prevention of cough and sore throat postoperatively, whereas inflation of cuff with air leads to maximum incidence of these complications. [ABSTRACT FROM AUTHOR]

Context: Sore throat is a common complaint to both laryngeal mask airway (LMA) insertion and endotracheal tube intubation. Its incidence in LMA has been found to vary between 5.8% and 34%. Administration of medicated lozenges in the preoperative period is also a route available for the prevention of postoperative sore throat (POST). Aim: The aim of this double-blinded randomized controlled study was to evaluate the efficacy of turmeric-based lozenges given preoperatively in patients undergoing general anesthesia (GA) under LMA insertion for the prevention of POST. Settings and Design: This study was conducted at the Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Rama Nagar, Dehradun, over a period of 12 months. Subjects and Methods: Two hundred and fifty patients of the American Society of Anesthesiologists classes I and II posted for elective surgeries under GA with insertion of LMA were included in our study. Randomization was done by the sealed envelope technique. Turmeric extract with menthol and eucalyptus oil lozenges was given in Group A (n = 125), while plain turmeric extract with orange flavor lozenges was given in Group B (n = 125) 30 min preoperatively. The patients were assessed for POST in the recovery room post-LMA removal at 30 min, 6 h, 12 h, and 24 h. Statistical Analysis: The data were analyzed using Chi-square test, Fisher's exact test, and Student's t-test. P < 0.05 was considered statistically significant. Results: The turmeric lozenges containing 6.4 mg eucalyptus oil and 6.3 mg menthol oil along with turmeric extract 100 mg significantly reduced the incidence of POST across all time intervals (P < 0.05) as compared to orange-flavored plain turmeric lozenges containing turmeric extract 100 mg. Conclusions: POST was reduced with preoperatively administered eucalyptus oil and menthol oil containing turmeric lozenges. [ABSTRACT FROM AUTHOR]

Background and Aims: Train of four (TOF) stimulation has been recommended to be used with neuromuscular blocking agents. The incidence of excellent intubating conditions with rocuronium, when used with TOF, is lacking. This study aimed to estimate the proportion of patients having excellent intubating conditions with rocuronium 0.6 mg/kg using TOF at adductor pollicis longus at T1 and T0, time to achieve T1 or T0 and incidence of sore throat, immediate and 24 hours post-extubation. Methods: This prospective non-randomised study was carried out in 250 patients of either sex, of American Society of Anesthesiologists physical status I-II, undergoing surgery under general anaesthesia with tracheal intubation after rocuronium 0.6 mg/kg monitored by TOF. Patients were divided among T1 and T0 groups. Intubating conditions were assessed using the Copenhagen scale. Results were analysed using the Chi-square test and the Student's t-test. A P value of <0.05 was considered significant. Results: Intubating conditions were excellent in 84% patients (87.9% in group T0 and 80.1% in group T1, P = 0.216). The mean onset time was 142.98 ± 27.04 seconds in group T0 and 122.38 ± 3 0.76 seconds in group T1 (p < 0.01). The incidence of immediate (p = 0.02) and late (p = 0.01) sore throat was higher in the T1 group. Conclusion: The proportion of patients having excellent intubating conditions with rocuronium 0.6 mg/kg was higher at T0 but not statistically significant. It takes 20 seconds longer to achieve T0 as compared to T1 with a lesser incidence of immediate and late sore throat. [ABSTRACT FROM AUTHOR]

Background and aims: Insertion of a throat pack using a Macintosh laryngoscope after placing an oral Ring, Adair and Elwyn (RAE) tube fixed to the lower lip in the midline invariably results in the lateral movement of the tongue or the tube requiring repositioning. The aim was to design a laryngoscope blade that would produce minimal movement of the endotracheal tube or the tongue during the insertion of throat pack and compare it with the Macintosh laryngoscope blade. Material and Methods: A laryngoscope blade similar to the Doughty's blade of Boyle Davis mouth gag with a groove in the center of the blade was initially designed. This was made of polyvinyl chloride to enable 3-D printing. Specifications given were modified after trial and error including addition of a flange. A bench study was then done to compare the Macintosh blade with the Manipal blade with and without flange. Forty anesthesia postgraduates and staff familiar with airway management inserted throat pack with each blade in random order in a manikin already intubated with an oral RAE tube and their impressions were noted. Results: The RAE tube remained in the midline after throat packing in 97.5 and 95% with Manipal blade with and without flange as compared to 52.5% with Macintosh blade. Ease of use was affected by the lack of sturdiness of the new blades. The light was good. Most people found both blades better or the same as the Macintosh blade. Conclusion: The Manipal laryngoscope blade with and without flange are both associated with the minimal lateral movement of the endotracheal tube and are easy to use. Their sturdiness must be improved. [ABSTRACT FROM AUTHOR]

Background and Aims: The diffusion of nitrous oxide (N2O) into the air-filled cuff of the classic laryngeal mask airway (LMA) may lead to an increase in cuff pressure (CP) and displacement of LMA affecting its performance. This study was conducted to evaluate the change in optimal position of LMA by fibre-optic bronchoscope, the changes in cuff pressure and oropharyngeal leak pressure (OLP), and post-operative laryngo-pharyngeal morbidity during N2O–oxygen (O2) anaesthesia in children. Methods: After ethics committee approval and written informed consent, 84 children, aged 2 to 8 years undergoing lower abdominal surgery using LMA were included. Anaesthesia was induced with sevoflurane and maintained with either 33% O2 in air (Group 1) or with 33% O2 in 67% N2O (Group 2) along with sevoflurane. The position of LMA using fibre-optic bronchoscope, CP and OLP were recorded at 30, 60 and 90 minutes and at the end of surgery. The incidence of post-operative sore throat, hoarseness of voice and dysphagia was assessed for 24 hours. Results: A mild (Grade 1) change in fibre-optic position of LMA was observed in 6 out of 42 children maintained with N2O–O2 anaesthesia. The cuff pressure was higher than baseline in group 2 at all three time points with the maximum at 90 minutes (93.23 ± 14.86 cm H2O vs. 39.78 ± 7.75 cm H2O; P < 0.05). The OLP was comparable between the groups during the initial 60 minutes and then increased in group 2. The incidence of post-operative sore throat was significantly higher in group 2 (P = 0.008). Conclusion: The diffusion of anaesthetic gases into the air-filled cuff does not change the fibre-optic position of the LMA significantly but increases the cuff pressure and incidence of post-operative laryngo-pharyngeal complications in children. [ABSTRACT FROM AUTHOR]

Background: Postoperative sore throat (POST) is a common occurrence following general anesthesia with endotracheal intubation although clinicians often regard it as a minor complication. The incidence of POST is estimated to be 21%–65% in different studies. The administration of the drug through aerosol route gained popularity among anesthesiologists with good acceptance from the patients. Hence, we conducted the study with the aim to compare the efficacy of preoperative nebulization with 4% lignocaine and ketamine, in the prevention of POST. Materials and Methods: The study is a prospective, randomized double-blinded study comparing the effects of comparison between preoperative nebulization with ketamine and 4% lignocaine in preventing POST. Hemodynamic parameters, Ramsay sedation score, and visual analog scale (VAS) at 0, 6, and 24 h were observed in both groups. Results: Ketamine nebulization provides better prophylaxis against the occurrence of moderate-to-severe POST as compared to lignocaine. At 0 h, none of the patients had ST in both the groups; at 6 and 24 h, the ST was significantly higher in lignocaine group (28.9% and 8.9%) as compared to ketamine group (8.9% and 0%), with P = 0.04. Mild, moderate, and severe VAS was observed in 51%, 33%, and 16% of Group 1, respectively, while in Group 2, it was observed in 16%, 36%, and 49% of study population, respectively, and this difference was statistically significant. Conclusion: Patients undergoing surgery under general anesthesia with endotracheal intubation were benefitted from ketamine nebulization as prophylaxis against moderate-to-severe POST. [ABSTRACT FROM AUTHOR]

Context: Postoperative sore throat (POST) is a common annoying problem following endotracheal (ET) intubation. Aims: Comparing the impact of low and high doses of ketamine gargle on lowering POST incidence and severity. Settings and Design: 96 patients selected for septoplasty surgery under general anesthesia were investigated through a single-blind randomized controlled trial. Methods: This study was performed on three equal groups. Group K and G gargled 50 and 100 mg ketamine, respectively, solved in normal saline and group C gargled pure normal saline for 30 s at 5 min before tracheal intubation. POST severity measured immediately after the entrance to the postanesthetic care unit (PACU) and then 2 h, 4 h, 8 h, and 24 h after operation. Statistical Analysis Used: Collected data were analyzed by the Chi-square test, Mann-Whitney test, Kruskal-Wallis test, one-way analysis of variance (ANOVA) and Friedman test using SPSS version 20. Results: POST incidence and severity in group C were significantly higher than both K and G groups at all times. Although significant differences between low and high doses of ketamine were acknowledged at 8 h post-operation, 100 mg ketamine could attenuate POST severity further than 50 mg at all times. Conclusions: It seems that 100 mg outperformed 50 mg ketamine without rising complications and dissatisfaction for subjects. So, it gives us a powerful reason to suggest gargling 100 mg ketamine for lessening POST incidence and severity. [ABSTRACT FROM AUTHOR]

Background: and objectives Postoperative sore throat is a common complication after endotracheal intubation, and different methods have been proposed to attenuate it. The aims were to compare the intensity of sore throat and the sedation level of preoperative nebulized ketamine, magnesium sulfate, and lidocaine in attenuating postoperative sore throat after endotracheal intubation. Patients and methods: A prospective comparative double-blind randomized study was conducted on 100 patients who were divided into four groups: group K (n=25) included patients who received nebulized ketamine 50mg (1 ml) plus 4-ml normal saline; group M (n=25) included patients who received nebulized magnesium sulfate 250mg (2.5 ml) plus 2.5-ml normal saline, group L (n=25) included patients who received nebulized lidocaine 2% 100mg (5 ml), and group C (n=25) included patients who received nebulized normal saline 5 ml (control group). So, total volume used was 5 ml. Patients were preoperatively nebulized by compressor nebulizing for 15 min. Results: Sore throat scores were statistically significant lower (0 and 1 point) in group L and group K at 0, 2, and 4 h compared with group C and group M (P<0.05). Group K showed statistically significant lower sore throat scores at 8, 12, and 24 h compared with group L, but statistically significant high sore throat scores (2, 3, and 4 points) compared with group M (P<0.05). The level of sedation assessed using A=alertness, V=response to verbal, P=response to painful stimulus, and U=unresponsive (AVPU) was statistically insignificant among groups (P>0.05). Conclusions: Preoperative nebulized 100-mg lidocaine and 50-mg ketamine relieves throat pain earlier in the first 24 h after endotracheal intubation, but it persists for shorter duration than 250-mg magnesium sulfate, without any changes in sedation level. [ABSTRACT FROM AUTHOR]

Introduction Throat pack (TP) is commonly used during oral and-maxillofacial surgeries to prevent aspiration of blood and tissue debris intraoperatively as well as during extubation. Majority of anaesthesiologists (84.3%) discussed the need for TP insertion with surgeons and were responsible for TP insertion (53.5%). [Extracted from the article]

Objectives: Patients come to the emergency department (ED) for the evaluation of foreign-body sensation in the neck. Given the dearth of clinical studies for this complaint, these patients are treated subjectively by different providers. We aim to propose a treatment approach that results in the timely diagnosis and removal of foreign bodies by comparing the common radiologic studies used in the ED for this complaint, determining the utility of consults, and providing an approach that minimizes length of stay. Methods: We conducted a retrospective cohort study of adults between January 2014 and December 2015 presenting to LIJ and NSUH EDs with a chief complaint of foreign-body sensation in the pharynx, larynx, or esophagus. Fifty unique cases were studied. Consultations with ear, nose, and throat (ENT) and/or gastrointestinal, any imaging studies used, and time until discharge from the hospital were the primary exposures studied. The time for each diagnostic path for successful removal of a foreign body was compared for each case. Results: Three common diagnostic approaches were identified. The most common pathway (six cases) had an ENT consult for removal of the foreign body, with an average time to discharge of 188 min. Another common pathway (four cases) began with a neck X-ray followed by an ENT consult, with an average time of 327 min. The third common approach (6 cases) involved no imaging studies or consults, with an average time of 166 min. Neck X-ray (20 cases) was found to have a sensitivity of 43% and a specificity of 83%. The sensitivity of neck computed tomography (CT) (15 cases) had a sensitivity of 91% and a specificity of 50%. Chest X-ray (15 cases) was found to have a sensitivity of just 17%. Chest CT (3 cases) had a sensitivity of 67%. Conclusion: Based on our data, we recommend that an attempt to localize the foreign body be completed by the emergency physician. If an initial attempt does not resolve the sensation, an ENT consult to remove the possible object should be initiated. Only after failure by ENT should radiological imaging be considered. [ABSTRACT FROM AUTHOR]

Background and Aims: Postoperative sore throat (POST) continues to be a common concern following endotracheal intubation. Objectives of the present study were to compare the effects of intracuff dexamethasone on the incidence and severity of POST, postoperative hoarseness of voice (POHV) and cough (POC). Material and Methods: This prospective, randomized, double blinded study was conducted in 60 patients undergoing short laparoscopic surgery lasting <2 h. Patients were randomly allocated into Group A and B. After intubation, endotracheal tube (ETT) cuffs were filled with saline in group A and with 0.1 mg/kg dexamethasone in group B. All patients received general anesthesia as per a standardized protocol. Incidence and severity of POST, POC, and POHV were assessed. Results: As compared to group A, the number of patients who had sore throat was significantly low in group B at 2, 6, 12, and 24 h (P < 0.001). Though more number of patients in group A had postop cough at all time points and postop hoarseness of voice at 2,6, and 12 h, the difference was statistically significant only at 2 h and 6 h for both. Severity as well as the incidence of POST, POC, and POHV showed a downward trend in both groups with time. In group B, no patient had POST after 12 h, POC after 6 h, and none complained of POHV in the postoperative period. Conclusion: Intracuff dexamethasone 0.1 mg/kg significantly reduces incidence and severity of POST, POC, and POHV which occur following general anesthesia with endotracheal intubation in patients undergoing short pelvic laparoscopic procedures lasting <2 h. [ABSTRACT FROM AUTHOR]

Foreign body sensation in throat is a common complaint by patients at the outpatient department in routine clinical practice. Long-standing tonsillolith is an uncommon cause for foreign body sensation in throat. Tonsilloliths are also called as tonsillar calculi or tonsillar stones or throat stone which form in the crypts of the faucial or palatine tonsils. They are usually small in size. The exact etiopathogenesis for the formation of tonsillolith is not known. It may protrude out of the tonsillar crypt and provide foreign body sensation in throat and usually not harmful to the body. It is a common cause for bad breath or halitosis in adult patients with tonsillolith. Finding giant tonsilloliths is rare in clinical practice. Here, we report a case of a giant tonsillolith in left palatine tonsil which was associated with long standing foreign body sensation in throat. Here, we report a 62-year-old man presenting for giant tonsilloliths with complaint of long-standing foreign body sensation in throat. [ABSTRACT FROM AUTHOR]

Efficacy of topical agents for prevention of postoperative sore throat after single lumen tracheal intubation: A Bayesian network meta-analysis. Dear Editor, The incidence of postoperative sore throat (POST) is estimated to be to 62% following general anesthesia. [Extracted from the article]

Background and Aims: Endotracheal intubation is the predominant cause of airway mucosal injury, resulting in post-operative sore throat (POST), with an incidence of 20-74%, which brings immense anguish to patients. This study was conducted to evaluate and compare the efficacy of nebulised dexmedetomidine and ketamine in decreasing POST in patients undergoing thyroidectomy. Methods: Patients were randomly allocated into two groups of 50 each; Group 1 received ketamine 50mg (1mL) with 4mL saline nebulisation, while Group 2 received dexmedetomidine 50μg (1mL) with 4mL saline nebulisation for 15 min. GA was administered 15 min after completing nebulisation. POST monitoring was done at 0,2,4,6,12 and 24h after extubation. POST was graded on a four-point scale (0-3). The statistical analysis were performed using Statistical Package for Social Sciences (SPSS) software version 17.0. Fisher Exact-t-test, Chi square test, Student t-test, Paired t test and repeated measure analysis of variance (ANOVA) were used for analysis. Results: The overall incidence of POST in this study was 17%: POST was experienced by seven patients (14.3%) in ketamine and 10 patients (20.4%) in dexmedetomidine group (P = 0.424). There was no statistically significant difference in the incidence of POST between the two groups at 0,2,4,6,12 and 24h post-operatively. Severity of sore throat was also significantly lower in both groups at all time points. A statistically significant increase in heart rate, systolic and diastolic blood pressure was noted in ketamine group, post nebulisation. Conclusion: Pre-operative dexmedetomidine nebulisation can be utilised as a safe and ideal alternative to ketamine nebulisation in attenuating POST, with less haemodynamic derangement. [ABSTRACT FROM AUTHOR]

Background: Sore throat is one of the commonest symptoms that patients present to a primary care physician. We describe the epidemiology of sore throat and performance of an algorithm to predict viral sore throat in a part of India. Methods: Children below 10 years of age were followed in 4 villages of Haryana, India from Aug 2012 to Aug 2014 through weekly domiciliary visits by trained field workers who screened for symptoms of acute respiratory infection (ARI) including sore throat. Nasal and throat swabs were obtained from a random sample of sore throat cases by nurses and sent in appropriate transport media for real-time polymerase chain reaction for detection of viral nucleic acid. Incidence of sore throat and viral sore throat are reported as number of sore throat episodes per 1000 child-years (EPTCY) with 95% confidence-interval (CI). Symptoms, associated with viral sore throat were identified by logistic regression, combined into a clinical score and Receiver Operating Characteristic curve was plotted. Results: Over a two-year period, 3765 children were followed up for 5578 child years. 1069 episodes of sore throat were reported, and swabs were collected from 8% of the cases randomly. The incidence of sore throat and viral sore throat was 191.7 (95%CI: 180.5-203.6) and 60.1 (95%CI: 55.1-68.2) EPTCY, respectively. Fever (aOR 5.40,95%CI: 1.16-25.18) and running nose (aOR 10.16,95%CI: 1.01-102.42) was significantly associated with viral sore throat. The clinical score (fever, running nose, and headache) had an overall sensitivity of 86.2% (68.3-96.1%), specificity of 62% (47.2-75.3%) and AUC of 0.78 (0.67-0.87) in predicting viral sore throat. Conclusion: Viruses contributed to one-third of burden of sore throat and clinical score can be used in primary care settings to aid antibiotic prescription by physicians. [ABSTRACT FROM AUTHOR]

Background and Aims: Postoperative sore throat (POST) is very frequently reported after endotracheal intubation. Zinc lozenge has been shown to reduce POST. The aim of this study was to evaluate the effect of dispersible zinc tablet on POST. Methods: Eighty-eight patients undergoing surgery with endotracheal intubation were randomly allocated into two groups, to either receive dispersible zinc tablet 40 mg (zinc group) or placebo tablet (control group), 30 min preoperatively. Assessment for incidence and severity was performed for POST, on a 4-point scale (0–3) at 0, 30 min, 2, 4, and 24 h postoperatively. The primary outcome was incidence of POST at 4 h postoperatively. Secondary outcome was severity of POST at the 5 evaluation time points postoperatively. Mann–Whitney U test, Fisher's exact, and Chi-square test were used as applicable. Results: At 4 h, there was a significantly lower incidence of POST in zinc group (6.8%) than the control group (31.8%) with a P value of 0.003. Three patients in placebo group complained of severe POST compared to none in the zinc group. The severity of POST was significantly lower in Zinc group than Placebo group at 0 min (P = 0.003), 30 min (P = 0.002), 2 h (P < 0.001), and 4 h (P = 0.001). Conclusion: Preoperative administration of 40 mg dispersible zinc tablet effectively reduces the incidence and severity of POST in the immediate postoperative period. [ABSTRACT FROM AUTHOR]

Background and Aims: Post‑operative sore throat (POST) is a common undesirable consequence of tracheal intubation. Magnesium, an N‑methyl‑D‑aspartate receptor antagonist, has anti‑nociceptive and anti‑inflammatory properties, and has been found to be useful in POST prevention in various trials. We conducted this systematic review and meta‑analysis to study the efficacy of topical magnesium in preventing POST in adult patients undergoing surgery under general anaesthesia with single lumen tracheal tube. Methods: Comprehensive literature search was performed in PubMed, Google Scholar, EMBASE, Scopus and the Cochrane central registers of controlled trial databases through July, 2018 and data were pooled using fixed effect modelling followed by random‑effect methods (after assessing heterogeneity with fixed modelling). The primary outcome was the incidence of POST at 24 h after surgery/extubation. Comparative results were deliberated as pooled mean difference for continuous variables and Mantel–Haenszel (MH) odds ratio for dichotomous variables. Statistical analysis was done using Comprehensive Meta‑Analysis‑Version 3 (Biostat Inc., USA). Results: Seven trials involving 726 study participants were included in the final analysis. Incidence of POST at 24 hours was significantly lower in magnesium group (26/363) in comparison to active and non‑active control group (89/363); P = 0.00‑ RR 0.22 (95%CI = 0.12‑0.39, I² = 0%). No significant adverse events were reported with the use of topical magnesium. Conclusion: Prophylactic use of topical magnesium before the induction of general anaesthesia seems to be an effective measure to decrease the incidence of POST. [ABSTRACT FROM AUTHOR]

Context: Postoperative sore throat (POST) is a frequent and undesirable complication after general anesthesia with endotracheal intubation. Various pharmacological and non-pharmacological methods with variable success rate are used for attenuating POST. However, no single drug has been universally accepted. Aims: To compare the effect of betamethasone gel, ketamine gargles and intravenous dexamethasone on the incidence and severity of POST. Settings and Design: Prospective randomized controlled single-blinded trial conducted at a tertiary care centre. Materials and Methods: A total of 100 patients of age 18 to 70 yr, ASA class I and II, scheduled for elective surgeries under general anaesthesia were included and divided randomly in betamethasone, dexamethasone, ketamine and control groups. Endotracheal tubes were lubricated with 0.05% betamethasone gel in betamethasone group, 0.2 mg/kg of dexamethasone was administered intravenously before induction of anaesthesia in dexamethasone group, 40 mg of ketamine gargles mixed with 30 ml of saline was given 5 minutes prior to induction in ketamine group. In the control group, none of the above agents were used. During the 24 hr after the operation, we noted the occurrence and severity of POST, cough and hoarseness. Statistical Analysis Used: The demographic data, surgical time and intubation among the groups were analyzed using one-way analysis of variance. Incidence and severity of POST, cough and hoarseness of voice among the groups were analyzed utilizing Chi-square test. Results: Incidence of POST at one hour was found to be significantly less in betamethasone group (16%) and dexamethasone group (20%) in comparison to the control group (48%). The incidence of POST at 4 hours and 24 hours were found to be comparable. The frequency of hoarseness and cough at 1 hour, 4 hour and 24 hours were similar in all the groups. Conclusions: Prophylactic betamethasone gel application and intravenous dexamethasone administration before induction of anaesthesia resulted in clinically important and statistically significant decreases in the incidence of POST only in early postoperative period. [ABSTRACT FROM AUTHOR]

Background: Various airway gadgets have been devised to overcome difficult airway scenario in anesthesia practice. It includes simple rigid laryngoscope to complex fiber-optic intubating devices; however, there is weak evidence to support the superiority of one device over the other. Aims and Objective: The ease of intubation, time and the hemodynamic variability between two groups during intubation are considered as the primary outcome measures. Materials and Methods: In this prospective study, 60 patients of either sex undergoing elective surgery who required tracheal intubation were included. All the patients of age between 20 and 50 years with the American Society of Anesthesiologists Classes I and II were divided into the following two groups: Group AT (n = 30): the intubation was performed using AT laryngoscope and Group-MC (n = 30); the intubation was performed using MC laryngoscope. The following intubating parameters were recorded: ease of intubation (Grade-I–IV), mean time of laryngoscopy and intubation, Cormack–Lehane grade, and the percentage of glottis opening (POGO) score. The vital parameters such as heart rate (HR) and mean arterial blood pressure (MABP) were recorded only after premedication, and it was taken as the baseline value. These parameters were again recorded at 1 min, 3 min, 5 min, and 10 min after laryngoscopy and intubation. The incidences of sore throat were recorded just before discharge from the recovery room till 24 h of surgery. All these parameters were compared between these two groups using the Student's t-test and Chi-square test. Results: There was no significant difference in age, sex, weight, and Mallampati grading between the two groups. More than 30% of patients in Group AT were intubated without an external aid than the Group MC (P < 0.05). In Group AT, the mean time of intubation was 13.5 ± 5.72 s when compared to 15.63 ± 7.28 s in Group MC (P > 0.05). The Cormack–Lehane grade and POGO score were better in the AT group than that of the MC group. The HR at 1 min in Group AT was 101.83 ± 14.50 and in Group MC, it was 108.93 ± 12.86 (P < 0.05) and after 3 min, it was 98.66 ± 12.60 and 111.53 ± 11.67 (P < 0.05), respectively. The MABP was 107.17 ± 9.03 in Group AT compared to 116 ± 10.12 in Group MC (P < 0.05) at 1 min postintubation. The incidences of sore throat were similar in both the groups. Conclusion: The AT laryngoscope is better than MC in terms of the ease of intubation, better glottis view, and hemodynamic stability. However, the incidences of sore throat in both groups were comparable. [ABSTRACT FROM AUTHOR]

Background: Use of Baska Mask, since a supraglottic airway device, could result in low incidence of postoperative pharyngolaryngeal complications. Aims: The objectives were to compare the effect of Baska Mask versus endotracheal intubation on the incidence and severity of postoperative sore throat (POST), postoperative hoarseness of voice (POHV), and postoperative cough (POC). Settings and Design: This prospective randomized study was conducted in a tertiary care teaching institute in 120 patients undergoing short laparoscopic surgeries. Subjects and Methods: Airway was secured using with low-pressure, high-volume cuffed endotracheal tube in Group T and with Baska Mask in Group B. POST, POC, and POHV were assessed at 2, 6, 12, and 24 h after surgery. Those with Grade III score throat were managed by gargling with dispersible aspirin 75 mg. Statistical Analysis Used: Pearson's Chi-square test, Fisher's exact test, and independent sample t-test were used as applicable. Results: Group B patients required significantly more attempts at securing airway. Incidence of POST was significantly higher in Group T as compared to that Group B at 2, 6, 12, and 24 h after surgery. POC was significantly more in Group T at 2, 6, and 12 h. No patient in Group B had POC at 12 and 24 h. POHV showed significantly higher incidence in Group T at 2 and 6 h. No patient in Group B had hoarseness at 6, 12, and 24 h. Conclusion: Use of Baska Mask as compared to endotracheal intubation significantly reduces the incidence and severity of pharyngolaryngeal complications such as POST, POC, and POHV in patients undergoing short laparoscopic surgeries. [ABSTRACT FROM AUTHOR]

Objective: Alkaptonuria (AKU) is a rare inborn error of metabolism that is characterized as a multisystem disease with specific ear, nose, and throat (ENT) manifestations. The present study reports ENT findings in pediatric and adult AKU patients from Jordan. Materials and Methods: A full ENT examination and audiological assessment were conducted among the patients attending the AKU Research Office in our University. Results: The results showed that 88% of both pediatrics and adult patients had ENT signs or symptoms; while, the pediatric age group had only one sign that is the discoloration of the cerumen. The adult group had more than one sign, including the discoloration of cerumen and pinna, hearing loss, and discoloration of the gum and teeth. Conclusion: Discoloration of the cerumen is a common sign in pediatric patients; therefore, it is considered as an important early clinical sign for the diagnosis of AKU. Annual follow-up of pediatric patients with audiological assessment is needed to clarify the association between AKU and hearing loss. Otolaryngologist should be aware of these signs for early diagnosis and provide patients early treatment with nitisinone. [ABSTRACT FROM AUTHOR]

Aims: Facial candling is one of the traditional treatments that is claimed to be able to help in curing or reducing various allergy and inflammation conditions such as allergic rhinitis. We aimed to explore the perceptions of participants with allergic rhinitis toward their disease conditions and facial candling treatment. Materials and Methods: The study used a qualitative exploratory design, comprising 12 in-depth interviews. A semi-structured topic guide was used to explore all relevant aspects of the topic, which were audio recorded, transcribed verbatim. All the interviews were conducted in a few beauty salons in purposively selected city areas in the state of Kedah, Malaysia. Results: Of the 12 patients, seven (58%) reported a positive experience of facial candling treatment, with improvement in the condition of their allergic rhinitis. Specific themes about the experience of facial candling treatment that were identified within the transcript data included knowledge about facial candling, options for disease treatment, effectiveness of facial candling, sources of information, comparison, application of treatment, treatment budget, and safety. The major strength lies in the fact that reasons for using facial candling were uncovered from the perspectives of people with allergic rhinitis through the in-depth interviews. Conclusions: The motives of these participants for using facial candling are mainly due to cultural influence and its low cost of treatment. There were mixed responses from the participants about the usefulness of facial candling. Most of the respondents had not assessed the safety of prolonged use of facial candling and regarded it as a safe procedure as this has been practiced for generations. [ABSTRACT FROM AUTHOR]

Background: Postintubation sequels (PIS) are a cause of serious concern in the postoperative period. Aim: The aim of this study is to find the influence of preoperative inhaled steroid and technique of muscle relaxation on PIS. Settings and Design: This prospective, exploratory pilot study was conducted on 120 adult American Society of Anesthesiologist physical status Class I and II patients undergoing general anesthesia (GA) with muscle relaxation and cuffed endotracheal tube (ETT) insertion. Patients and Methods: Patients were randomized into four groups as follows: intermittent muscle relaxation with preanesthetic inhalation of either distilled water puffs (Group ID) or fluticasone puffs (Group IF); continuous infusion of muscle relaxant with preanesthetic inhalation of either distilled water puffs (Group CD) or fluticasone puffs (Group CF). After induction of GA, ETT was inserted. The intra-cuff pressure was maintained constant. The trachea was extubated in the light plane in intermittent groups and in the deep plane in continuous groups. Statistical Analysis: Qualitative parameters were compared using the Chi-square test and quantitative parameters using repeated measure ANOVA followed by Tukey's test. Results: Group CF had significantly less incidence of sore throat and hoarseness compared to groups ID and IF. The severity of sore throat was more in groups ID and IF than in groups CF and CD (P < 0.002). The severity of hoarseness was least in group CF (23.3%) and highest in group IF (90%). None of the patients had a cough in group CF. The incidence and severity of dysphagia were significantly less in group CF as compared to other groups (P < 0.005 and P < 0.008, respectively). Conclusion: Continuous infusion of muscle relaxant with extubation in deep plane of anesthesia with preanesthetic inhalation of fluticasone puffs results in lesser incidence and severity of PIS. [ABSTRACT FROM AUTHOR]

Background: Postoperative sore throat (POST) is a known complication following general anesthesia requiring endotracheal intubation. Its incidence ranges from 21% to 65% and remains the eighth most undesirable postoperative event. Various measures have been tried to decrease the incidence of sore throat with various success rates. Aim: This study aimed at reducing the incidence of POST with ketamine and magnesium sulfate nebulization. Settings and Design: This study is a prospective randomized, double-blinded study. Materials and Methods: After Institutional Ethics Committee approval and written informed consent, 80 patients who fulfilled the inclusion and exclusion criteria were randomly divided into two groups to receive magnesium sulfate 250 mg in 5 ml saline in Group A and ketamine 50 mg in 5 ml saline nebulization in Group B before the start of general anesthesia. All patients received standard anesthesia protocol. After extubation, all patients were enquired about the incidence and severity of sore throat at 0, 2, 4, 6, and 24 h. Statistical Analysis Used: Paired t-test and Wilcoxon signed-rank test were used to compare hemodynamic variables and Chi-square test to compare the incidence and severity of sore throat. Results: There were no differences in the demographic profile, duration of laryngoscopy, time taken to intubate, and duration of surgery between the two groups. The incidence and severity of sore throat were significantly decreased in ketamine group at 4 and 6 h when compared to magnesium sulfate group. Conclusion: Nebulization with ketamine 50 mg significantly decreases the incidence of POST when compared to magnesium sulfate 250 mg. [ABSTRACT FROM AUTHOR]

Background and Aims: Coughing and sore throat postoperatively are common clinical problems during general anesthesia which can be avoided by various methods including topicalization of airway with local anesthetics, endotracheal tube cuff (ETT) inflation with local anesthetics, use of intravenous drugs such as dexamethasone, maintaining ETT cuff pressure, intubation by an experienced anethesiologist, etc. The aims of the study were to compare postextubation coughing response, mean number of cuff deflations required intraoperatively, and postoperative airway morbidity in terms of sore throat (2 h and 18–24 h), hoarseness of voice, and dysphagia following inflation of ETT cuff with air, anesthetic gas mixture, saline, and 2% lignocaine during general anesthesia. Material and Methods: One hundred and four patients were randomized into 1 of 4 groups depending on whether air, anesthetic gas mixture, saline, or 2% lignocaine was used to inflate the cuff of ETT using computer-generated randomization table. Results: There was no significant difference in the postextubation cough response among the four groups. The mean number of times the ETT cuff was deflated was significantly in favor of liquid media comapred to gaseous media (P < 0.001). The incidence of sore throat at 2 h and at 18–24 h, hoarseness of voice, and dysphagia were comparable in all groups. Conclusion: ETT cuff inflation with air, anesthetic gas mixture, 2% lignocaine, and saline are comparable in terms of incidence of postextubation cough and postoperative airway morbidity symptoms such as sore throat, hoarseness of voice, and dysphagia. [ABSTRACT FROM AUTHOR]

Context: Postoperative sore throat (POST) occurs in 21%–65% of patients. Nebulization of ketamine reduces POST. Aims: The aim of this study is to see the effectiveness of nebulized ketamine in different doses to reduce POST and observe adverse effects, if any. Settings and Design: This was a prospective, randomized, and double-blind controlled trial. One hundred and fifty patients of the American Society of Anesthesiologists physical status Classes I and II, in the age group of 18–60 years, of either sex, undergoing surgery under general anesthesia were randomized into three groups. Subjects and Methods: Patients had nebulized with 5 ml solution (Group K1 – 1 ml of ketamine [50 mg/ml] +4 ml normal saline, Group K2 – 0.5 ml of ketamine [50 mg/ml] +4.5 normal saline, and Group S – 5 ml normal saline). Preoperative, intraoperative, and postoperative hemodynamic monitoring was done. The POST monitoring was done at 2, 4, 8, 12, and 24 h postoperatively. POST was graded on a four-point scale (0–3). Statistical Analysis Used: Chi-square test using MSTAT software for POST and ANOVA test using INDOSTAT software for hemodynamics were used in this study. Results: The overall incidence of POST in the present study was 29.33% (44/150). In Group S, the incidence of POST was observed to be 46% (23/50). In Group K1, the incidence was 20% (10/50), and in Group K2, it was 22% (11/50) (P ≤ 0.05), and intraoperative vital signs were more stable at all time intervals. Conclusions: We concluded that both doses (25 and 50 mg) of nebulized ketamine were almost equally effective in preventing POST, with no adverse effects. [ABSTRACT FROM AUTHOR]

Context: Postoperative sore throat (POST) is a very common complaint following tracheal intubation. Although it resolves spontaneously, efforts must be taken to reduce it. Aims: This study aims to compare the effect of cuff inflation using manometer versus conventional technique on the incidence of POST. Secondary objectives were to assess the incidence postoperative hoarseness and cough. Settings and Design: A total of 120 patients were included in this prospective observational comparative study. Subjects and Methods: After approval from the hospital ethics committee, consenting American Society of Anesthesiologists physical status Class I and II patients, scheduled for gynecologic laparoscopic surgery under general anesthesia, were included. They were randomly allocated by closed envelope technique to either Group A where the cuff pressure was adjusted to 25 cmH2O using a manometer or Group B where cuff inflation was guided clinically. Patients were monitored for sore throat, hoarseness of voice, and cough postoperatively. Statistical Analysis Used: To calculate the incidence of sore throat, hoarseness, and cough, descriptive statistics were applied. For checking association of sore throat and cuff pressure, Chi-square test and for comparing numerical values independent sample t-test were applied. Results: The incidence of POST was significantly less in Group A than in B (P < 0.001) up to 24 h. Incidence of hoarseness was less in Group A and incidence of cough was higher in Group B, but these differences were not statistically significant. Conclusion: Cuff inflation guided by manometer significantly reduces the incidence of POST. [ABSTRACT FROM AUTHOR]

Background and Objective: We wished to compare the endotracheal tube (ETT) cuff pressure inflated with air or alkalinized lignocaine during anesthesia and evaluate clinical symptoms such as coughing and sore throat (postoperative sore throat [POST]) following tracheal extubation. Materials and Methods: This was a prospective randomized controlled study conducted in a tertiary care set up over a period of 1 year. We included 100 patients in age group of 18-65 years posted for elective surgeries of duration more than 90 min under general anesthesia with N2O-O2 mixture. Patients were randomized using computer-generated randomization table into air and lignocaine group. The ETT cuff was inflated with air or alkalinized lignocaine (2% lignocaine with 7.5% sodium bicarbonate, in the proportions of 19.0:1.0 ml) to the volume that prevented air leak using cuff pressure manometer. After extubation, an independent observer blinded to study group recorded the presence or absence of coughing and POST at immediately, 1 h and 24 h postoperatively. Results: Demographic data, baseline characteristics (American Society of Anesthesiologists grade, intracuff volume/cuff pressure at start of surgery), and duration of anesthesia were comparable among study groups (P > 0.05). Cuff pressure and volume achieved in the end of surgery were much higher in air group as compared to lignocaine group (P < 0.05). Incidence of coughing and POST at immediately, 1 h and 24 h postoperatively was significantly higher in air group compared to lignocaine group. Impact of duration of anesthesia on rise in cuff pressure was significantly higher in air group and its effect on cuff-induced laryngotracheal morbidity was significant in both air and lignocaine group. Conclusion: This study showed the significance of use of alkalinized 2% lignocaine in prevention of rise of cuff pressure and incidence of coughing and POST. Duration of anesthesia has also a significant effect on incidence of postoperative trachea-laryngeal morbidity. [ABSTRACT FROM AUTHOR]

Context: Postoperative sore throat (POST) is a complication that is unresolved in patients undergoing endotracheal intubation. Aim: To compare the effects of ketamine and magnesium sulfate nebulizations in two strengths, on the incidence and severity of POST, hoarseness, and cough. Settings and Design: Sixty surgical patients undergoing elective abdominal and lower limb surgeries under combined epidural and general anesthesia were included in this prospective, randomized, double-blinded study. Subjects and Methods: Patients in each group were nebulized with the respective study drug 15 min prior to the surgery, i.e., ketamine in Group K, magnesium sulfate 250 mg, and 500 mg in Group M1 and Group M2, respectively, and normal saline as control in Group C. A standardized anesthesia protocol was followed for all patients. After extubation, the patients were asked to grade POST, hoarseness, and cough at 0, 2, 4, 12, and 24 h. Statistical Analysis Used: One-way analysis of variance, Chi-square test, Fisher's exact test, paired t-tests, and Wilcoxon's signed-rank test as applicable. Results: Ketamine and magnesium sulfate 500 mg demonstrated a statistically significant decrease in POST at 0, 2, and 4 h, and postoperative hoarseness at 0 h. There was decrease in the incidence and severity of sore throat, hoarseness, and cough at all periods in the study groups as compared with control. Conclusion: Nebulization with ketamine 50 mg and magnesium sulfate 500 mg, 15 min before induction of general anesthesia and intubation, reduce the incidence and severity of POST and hoarseness of voice. [ABSTRACT FROM AUTHOR]

Background: Postoperative sore throat (POST) frequently hampers the positive feedback of ambulatory surgery in spite of so many measures. This study was carried out to compare the efficacy of preoperative magnesium sulfate and aspirin gargle in preventing POST after ambulatory surgery. Materials and Methods: It was a prospective, randomized, and double-blinded study. Fifty-six adult patients of either sex, aged 25-50, of American Society of Anesthesiologists physical status I-II, scheduled for day care surgery, were randomly allocated to Group A ([n = 28] receiving aspirin gargle [325 mg tablet]) and Group M ([n = 28] receiving magnesium sulfate [20 mg/kg] gargle). In both groups, the medications were made into 20 mL of (5% dextrose) solution. Patients were asked to gargle with this mixture for 30 s, 15 min before induction of anesthesia. Episodes of POST were measured at 0, 2, 4, 6, 9, 12, and 16 h postoperatively with a four-point scale. Results: Both groups had a similar demographic profile with comparable oxygen saturation, hemodynamics, and consciousness status at immediate postoperative period. Number of patients with sore throat was significantly lower in magnesium group compared to aspirin group at 0 h (P = 0.0376), 2 h (P = 0.0429), 4 h (P = 0.0394) after the operation. POST pain score (visual analog scale) was significantly (P < 0.05) lower in magnesium group compared to aspirin group after the operation at 0, 2, 4 h after operation. Conclusion: It is evident that preoperative magnesium sulfate gargle significantly attenuated the incidence and severity of POST, especially in the early postoperative period, with no adverse effects in patients undergoing day care surgery under general anesthesia. [ABSTRACT FROM AUTHOR]

Management of homicidal cut-throat injuries requires a multi-disciplinary approach. The role of an anesthesiologist in instituting an airway using an endotracheal intubation or tracheostomy before wound exploration and repair of transected tissues, is challenging, as, such injuries are most of the time associated with distortion of the normal anatomy of the airway. We hereby report a case of 60-year-old lady diagnosed as homicidal cut-throat injury with vocal cords exposed externally and injury of thyroid cartilage and pharyngeal muscles. Patients with cut-throat injury may present with airway compromise, aspiration, and acute blood loss with hypoxemia because of injury to the airway and major vessels. Securing an airway becomes the first priority in patients with cut-throat injuries. It could be done by an endotracheal intubation, cricothyroidotomy, or by an emergency tracheostomy. For the effective management of patients with a cut-throat injury, there is a need for a multidisciplinary approach by a team consisting of an otorhinolaryngologist, anesthesiologist, and a psychiatrist. [ABSTRACT FROM AUTHOR]

Background: Postoperative sore throat (POST) is the most common airway-related complaint of patients after endotracheal intubation. Postextubation coughing during emergence from general anesthesia (GA) is an important problem. Objectives: To compare the effects of topical benzydamine hydrochloride and 2% lignocaine on reducing the incidence and severity of POST, hoarseness, and coughing after general endotracheal anesthesia. Materials and Methods: Patients were randomly allocated into three groups of 30 patients each. In Group B (topical benzydamine hydrochloride), Group L (2% lignocaine gel), Group N (normal saline) was applied to the cuffed endotracheal tube (ETT) before intubation. Results: The trend of the severity of sore throat, hoarseness of voice, and cough during the first 24 h after the GA in benzydamine recipients was significantly lower than the other two groups (P < 0.05). Conclusions: It was observed that the incidence of POST, hoarseness of voice, and cough was significantly less when cuff of ETT was lubricated with topical benzydamine hydrochloride as compared with 2% lignocaine gel. [ABSTRACT FROM AUTHOR]

Schwannomas are benign encapsulated neurogenic tumors, arising from Schwann cells embedded in neurilemal sheath as multinucleated syncytial network. Head and neck schwannomas account for 25%-45% of all schwannomas, majority developing in parapharyngeal space. Laryngeal schwannoma in itself is a rarity, and a glottic origin further complicates its diagnosis. To the best of our knowledge, this is the second case of glottic schwannoma being reported in medical literature. Symptomatology is attributable to mass effect of a slow-growing laryngeal tumor, ranging from sore throat to stridor. The gold standard method for their excision is still debatable. For small tumors, endoscopic or direct laryngoscopic approach is preferred, but for large glottic tumors, external approach is advocated for better exposure and facilitating mucosal grafting. Index case is being presented not only for its rare site of origin, but also to stress on the importance of meticulous histopathological examination to advocate appropriate treatment. [ABSTRACT FROM AUTHOR]

Background: Sore throat, cough and hoarseness of voice are common postoperative throat complications that follow general anaesthesia with tracheal intubation. Objective: This prospective study was designed to compare the efficacies of lidocaine jelly and betamethasone gel in the prevention of postoperative sore throat, cough and hoarseness after general anaesthesia with tracheal intubation. Materials and Methods: Ninety ASA I and II consenting patients aged 18-65 years were recruited and randomly allocated into three groups of 30 each. The outer surface of the tracheal tube used in intubating patient was lubricated with one of three agents (2% lidocaine jelly, 0.05% betamethasone gel or KY jelly) from the distal tip of the tube to the 15 cm mark. The incidence and severity of sore throat, cough and hoarseness were then assessed by a blinded interviewer at the 6th, 24th and 48th h postoperative. Results: The highest incidence of throat complaints was recorded during the first evaluation at the 6th h postoperative. The incidence of sore throat was 36.7%, 66.7% and 80%; cough was 13.3%, 26.7% and 43.3%; and hoarseness was 23.3%, 30% and 46.7%, for the betamethasone, lidocaine and KY jelly groups, respectively. Betamethasone gel demonstrated significant superiority over lidocaine and KY jellies in the prevention of sore throat (P = 0.002), cough (P = 0.03) and hoarseness (P = 0.03) throughout the study. Duration of tracheal intubation longer than 2 h was associated with significant increase in the incidence of throat complaints (P < 0.001). Conclusion: Application of betamethasone gel on endotracheal tube effectively reduces incidence of postoperative sore throat, cough and hoarseness after tracheal intubation compared to lidocaine jelly. [ABSTRACT FROM AUTHOR]

Context: Postoperative throat complaints such as postoperative sore throat (POST), dysphagia, and hoarseness frequently arises after tracheal intubation and throat packing for patient undergoing general anesthesia. This condition is very disturbing to patient. Avoiding POST is a major priority for these patients because preventing postoperative complications contributes to patient satisfaction. Aims: To describe and analyze the postoperative throat effects of nasopharyngeal packing and oropharyngeal packing in patients undergoing nasal surgery. Settings and Design: A randomized comparative study. Subjects and Methods: After obtaining approval of Ethical Committee 40 patients were included in study. After this patient were randomly allocated into two groups of 20 each. Group A - in which the oropharynx was packed and Group B - in which the nasopharynx was packed. General anesthesia were given and throat packing was done and patients were interviewed postoperatively for any throat complications such as sore throat, difficulty in swallowing (dysphagia), hoarseness of voice, throat irritation, and any other symptom pertaining to the study were noted and data were analyzed. Statistical Analysis Used: T-test to compare the age, while Chi-square test and Fisher's exact test were used to compare sex distribution, sore throat, dysphagia, hoarseness, and throat irritation. Results: Results showed statistically significant difference in incidence and severity of POST in Group A patients when compared to Group B patients to be more. Patients in Group A had a higher incidence of dysphagia when compared to their Group B counterparts. With respect to the incidence of hoarseness and throat irritation, there was no statistical significance between the groups. Conclusion: We concluded that the site of pharyngeal packing influences the incidence and severity of POST and as well as the incidence of dysphagia after general anesthesia. The use of nasopharyngeal packing in the patients undergoing nasal surgeries might lead to a reduction of the same. [ABSTRACT FROM AUTHOR]

Background and Aims: Post.operative sore throat (POST) occurs in 21.65% of patients. Ketamine used earlier as gargle for reducing POST has limitations. The aim of this study was to see if nebulised ketamine reduces POST. Methods: We conducted a prospective, randomised, placebo.control, and double.blind controlled trial. After written informed consent, 100 patients belonging to American Society of Anaesthesiologists physical status I.II in the age group 20.60 years, of either sex undergoing surgery under general anaesthesia (GA) were enrolled. Patients were randomised into two groups; group saline (S) received saline nebulisation 5.0 ml and group ketamine (K) received ketamine 50 mg (1.0 ml) with 4.0 ml of saline nebulisation for 15 min. GA was induced 10 min after completion of nebulisation in the patients. The POST and haemodynamic monitoring were done pre.nebulization, pre.induction, on reaching post.anaesthesia care unit, and at 2, 4, 6, 8, 12 and 24 h post.operatively. POST was graded on a four.point scale (0.3). Results: The overall incidence of POST was 33%; 23 patients (46%) in saline and 10 patients (20%) in ketamine group experienced POST (Fisherfs exact P = 0.01). The use of ketamine nebulization attenuated POST at 2 h and 4 h post.operatively (P < 0.05). The primary outcome was incidence of POST at 4 h; 13 patients in group S versus 4 patients in group K (P = 0.03) experienced POST at 4 h. The moderate sore throat occurred in 6 patients in group S and none in group K at 2 h, post.operatively (P = 0.02). Conclusion: Ketamine nebulization significantly attenuated the incidence and severity of POST, especially in the early post.operative period, with no adverse effects. [ABSTRACT FROM AUTHOR]

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 efficacy for decreasing POST in smokers presenting for surgery under general anesthesia with endotracheal intubation. Materials and Methods: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

AIM: Many Trials using sequential and concurrent chemo radiotherapy have been done so far and has established the role of concurrent chemo radiotherapy in treatment of inoperable carcinoma esophagus. In this study, we have compared the results of concurrent chemo radiotherapy with sequential chemo radiotherapy. We have treated inoperable carcinoma esophagus in both the settings and present here the comparison of results in the two settings. MATERIALS AND METHODS: There were 26 patients of carcinoma esophagus in sequential and 31 in concurrent chemo radiotherapy arm. In sequential arm methotrexate and Cisplatin followed by radiotherapy was given whereas in concurrent arm, Cisplatin was given once weekly along with radiotherapy. RESULTS: The 2 year survival was 38% in sequential and 35.5% in the concurrent setting and the median survival was 19.5 and 18 months respectively in the two arms. The toxicities in both the arms were comparable. P value of 0.4774 with confidence interval of 95% was obtained, which is not significant. Dysphagia was improved earlier in sequential than in the concurrent arm. CONCLUSION: As the results and toxicities in both the arms are almost similar with better symptom control, so larger randomized trials are required to assess the response and the use of methotrexate in sequential chemo radiotherapy can be further explored. [ABSTRACT FROM AUTHOR]

Background: Sore throat and hoarseness are common complications of endotracheal intubation. It may be very distressing for the patient and may lead to sleep disturbances and unpleasant memories. Materials and Methods: This prospective double-blinded randomized control trial was aimed to determine the efficacy of prophylactic intravenous dexamethasone to reduce the incidence of postoperative sore throat at 1 hour after tracheal extubation. Ninety six patients of either sex aged between 18 to 60 years scheduled for elective surgeries needing general anesthesia with endotracheal intubation, were randomly allocated into two groups A and B. The patients received either intravenous 0.2 mg/ kg dexamethasone (group A, n = 48) or normal saline (group B, n = 47) just before induction. Trachea was intubated with appropriate size disposable endotracheal tubes for securing the airway. Follow up for the incidence of sore throat, cough and hoarseness was done at 1, 6 and 24 hours post-extubation. Results: At 1 hour post-extubation, the incidence of sore throat in the control group was 48.9% compared with 18.8% in the dexamethasone group (P<0.002). Conclusions: Prophylactic intravenous dexamethasone in a dose of 0.2 mg/kg can reduce the incidence of postoperative sore throat at 1 hour post-extubation by around 30%, with the efficacy being around 60%. [ABSTRACT FROM AUTHOR]

Background: Foreign body (FB) injury in children is becoming increasingly common in developing countries. Children tend to be curious and exploratory hence the easily accessible orifices tend to be at risk of this form of injury. This study is to determine the prevalence, treatment outcome and complication of foreign body injury to the ear, nose and throat in children. Materials and Methods: A retrospective study of all pediatric patients with FB in the ear, nose and throat (ENT) seen at the ENT surgery department and children emergency ward of our institution from January 2004 to December 2008. Demographic and clinical data were obtained from records of the patients and analyzed. Results: There were 202 children with ENT injuries within the period under study, 181 (89.60%) had FB injuries. There were 94 males (51.93%), 87 females (48.07%) male:female ratio of 1.1:1. Age ranged from 2 months -15 years with a mean of 3.71 ± 2.59 years, a mode of 3 years. Most of the patients were below age seven years, highest in the range 0-3 years (61.8%). The nose recorded the highest injury 88 (48.62%). Commonest FB was ornamental bead 51 (28.17%) found both in the ear and the nose. Fish bone constituted the highest FB in the laryngotracheobronchial (LTB) tree and the oesophagus. Twenty-three cases (12.7%) had emergency tracheostomy done. Conclusion: Foreign body injuries constitute a significant portion of pediatric ENT trauma in clinical practice. The under 3 years are most affected. There is need for more public education of parents and care givers so as to prevent this avoidable injury. [ABSTRACT FROM AUTHOR]

Objectives: Throat pain is a common postoperative complaint. In this study, we aimed to determine its incidence of throat pain after rhinoplasty by general anesthesia (GA) or conscious sedation (CS). Methods: We evaluated throat pain in postanesthesia care unit, 4, 12 and 24 hours after surgery using a numerical rating scale (NRS) in a clinical trial. A total number of 252 consecutive females aging over 18 years undergoing GA or CS for elective rhinoplasty entered the study after implementing inclusion and exclusion criteria. A logistic regression model was used to predict having throat pain. Results: The incidence of throat pain after CS and GA in postanesthesia care unit, 4, 12 and 24 hours after rhinoplasty were 34.9% vs. 34.9% (P = 0.99), 27.0% vs. 33.3% (P = 0.27), 14.3% vs. 22.2% (P = 0.10), 10.3% vs. 15.9% (P = 0.19), respectively. The odds ratio for throat pain was statistically significant for nausea/vomiting in postanesthesia care unit (OR = 11.1, 95% CI: 5.7-21.8; P lt; 0.0001). Conclusions: Method of anesthesia had no independent role in predicting throat pain. Although larynx of subjects undergoing general anesthesia is manipulated by tracheal intubation, sedation has its specific risks for promoting throat pain after surgery. Therefore, neither CS nor GA is superior in terms of throat pain. [ABSTRACT FROM AUTHOR]