Effect of nebulized ketamine versus betamethasone gel on postoperative pharyngo-laryngeal complications after proseal laryngeal mask insertion in day case surgery

Background
General anesthesia with laryngeal mask airway can lead to trauma of the airway mucosa resulting in postoperative pharyngo-laryngeal complications. We compared between the effects of betamethasone gel applied over proseal laryngeal mask and nebulized ketamine in reducing pharyngo-laryngeal complications such as sore throat, hoarseness of voice, dysphagia, and cough during the first, 12 postoperative hours after elective day case surgical procedures.
Patients and methods
In all, 120 patients (aged 16–45 year) American Society of Anesthesiologists physical status I and II, scheduled for elective day case surgery with proseal laryngeal mask, were enrolled into this prospective, randomized, double-blinded study. The patients were randomly allocated into four groups of 30 participants each: group C received nebulized saline and lubricant gel over laryngeal mask; group B received nebulized saline and 0.05% betamethasone gel over laryngeal mask; group K received nebulized ketamine (1 mg/kg) and lubricant gel over laryngeal mask; group KB received nebulized ketamine (1 mg/kg) and 0.05% betamethasone gel over laryngeal mask. The incidence and the severity of postoperative sore throat, hoarseness of voice, dysphagia, and cough were graded at 30 min, 2, 4, 8, and 12 h.
Results
The incidence and severity of postoperative sore throat, hoarseness of voice, dysphagia, and cough were significantly lower in groups KB, K, and B, compared with control group (<0.05). The incidence and severity of postoperative sore throat, hoarseness of voice, dysphagia, and cough were lower in group KB compared with groups K and B at all times after removal of laryngeal mask up to 12 h without significant difference.
Conclusion
The prophylactic use of betamethasone gel or nebulized ketamine significantly reduced the incidence and severity of postoperative pharyngo-laryngeal complication. Betamethasone gel and nebulized ketamine were significantly more effective than using each of these drugs alone.