Date of this Version

2024

Document Type

DNP Project

Abstract

Background: Postoperative sore throat (POST) is a common adverse effect of tracheal intubation for general anesthesia. Laryngoscopy, the endotracheal tube (ETT) friction during insertion, and the pressure exerted by the cuff can damage the airway mucosa and trigger an inflammatory response that ultimately leads to a sore throat. Postoperative sore throat is considered an expected complication of tracheal intubation, and anesthesia providers do not usually assess or prevent it. However, it can interfere with patients’ regular activities, such as eating, drinking, and speaking. It develops in approximately 30% to 70% of patients undergoing tracheal intubation and is ranked as 1 of the highest causes of patient dissatisfaction after surgery. It can lead to dehydration, electrolyte imbalances, impaired wound healing, prolonged discharge, and increased cost of care. This project aimed to educate anesthesia providers about the use of dexamethasone and ketamine to prevent POST based on evidence obtained from a review of the literature.

Method: The literature was systematically searched using the PubMed and CINAHL databases. Ten studies were selected to be included in the review. An educational presentation was created from the results of the literature review. Participants in the project were selected from the Florida International University Nurse Anesthesia Program alumni. Approximately 10-20 providers were emailed an invitation to participate. Those who agreed to participate were emailed a link with a pre-/post-test about the POST and the use of dexamethasone and ketamine for its prevention, as well as an educational presentation. The results were analyzed and compared using percentages.

Results: A single dose of ≥ 0.2 mg/kg IV dexamethasone administered before the induction of anesthesia decreases the incidence and severity of postoperative sore throat. Its effects are more pronounced in the late postoperative period. Nebulized dexamethasone provides an effective alternative to the IV route. A single dose of 20-40 mg of ketamine mixed with saline, administered through gargles before the induction of anesthesia, decreases the incidence and severity of postoperative sore throat. Ketamine gargles provide better outcomes in the immediate postoperative period. Ketamine can also be administered through a nebulizer without compromising its effectiveness. The synergistic effect of combining intravenous dexamethasone and ketamine offers better pain control during the first 24 hours after surgery than each drug administered alone. The most common concepts missed in the pre-educational test were the doses of dexamethasone and ketamine needed to prevent POST, alternative routes for administering these drugs, and the adverse effects associated with ketamine administration. In the post-test, all questions had a higher percentage of correct answers than the pre-test. The significant improvement in the lowest-scoring questions, accompanied by higher scores in the other areas, suggests that the educational intervention properly addressed deficiencies in providers’ knowledge.

Discussion: The administration of dexamethasone and ketamine before the induction of anesthesia can prevent the incidence and severity of POST. Combining both drugs offers better outcomes than administering only 1 medication. Anesthesia providers and patients will benefit from their incorporation into clinical practice. Limitations of this project included a small sample of reviewed articles and anesthesia providers surveyed, which could compromise the effectiveness of dexamethasone and ketamine in preventing POST and misinterpret the current knowledge of anesthesia providers about POST and its prevention.

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