Benzydamine and/or beclomethasone

[propadope]

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Does anyone apply benzydamine or beclomethasone to the endotrcheal tube cuff to prevent sore throat? A local anti inflammatory approach seems to make more sense than LTA lidocaine/lidocaine gel especially for longer procedures. There have been some studies that have supported this but I have yet to try it.

 

[UscGhost]

Does anyone apply benzydamine or beclomethasone to the endotrcheal tube cuff to prevent sore throat? A local anti inflammatory approach seems to make more sense than LTA lidocaine/lidocaine gel especially for longer procedures. There have been some studies that have supported this but I have yet to try it.

Curious. Do the studies compare ett steroids to the usual IV decadron?

 

[propadope]

Curious. Do the studies compare ett steroids to the usual IV decadron?

From what I’ve read 0.1 mg/kg is not effective although 0.2 mg/kg has some benefit

 

[CopaceticOne]

Does anyone apply benzydamine or beclomethasone to the endotrcheal tube cuff to prevent sore throat? A local anti inflammatory approach seems to make more sense than LTA lidocaine/lidocaine gel especially for longer procedures. There have been some studies that have supported this but I have yet to try it.

Do you measure your cuff pressure for every case, especially the long ones?

 

[propadope]

Do you measure your cuff pressure for every case, especially the long ones?

I used to when i had a pressure gauge/inflator (which I lost a long time ago) . Now I inflate with a syringe and leave it attached until equilibrium is reached and then check for a leak.

 

[sevoflurane]

Does anyone apply benzydamine or beclomethasone to the endotrcheal tube cuff to prevent sore throat? A local anti inflammatory approach seems to make more sense than LTA lidocaine/lidocaine gel especially for longer procedures. There have been some studies that have supported this but I have yet to try it.

No.

 

[propadope]

Curious. Do the studies compare ett steroids to the usual IV decadron?

Good point. In this study, topical and IV dexamethasone had similar effectiveness in decreasing POST with nebulization having the most effect. Regardless I still give decadron IV where appropriate for PONV and to decrease pain and swelling

https://www.academicmed.org/Uploads/Volume6Issue2/105.%20%5B2941.%20JAMP_Rohin%5D%20485-488.pdf

 

[propadope]

For context , I’m a dental anesthesiologist who provides GA in offices (I know I know flame away…). I typically give decadron and toradol whenever appropriate and don’t use muscle relaxants except sux when I need to. I also place throat packs which could be another cause of sore throat along with laryngoscopy/intubation. I do use a McGrath to minimize excessive force. That being said, the pain patient most frequently experience is the sore throat since local anesthesia is effective for pain control due to the procedure. I generally extubate awake and only use Remi as far as opioids go. Generally with longer cases I will give ketamine to prevent windup/hyperalgesia

Other possible modalities are soaking the throat pack in benzydamine/chlorhexidine, LTA with ropivocaine +/- precedex!, benzydamine on the ETT cuff, beclomethasone on the cuff or MDI preop, alkalyzed lido in the cuff, topical ketamine?! etc…

Since this is office based anesthesia I want patients up and out as quickly and safely as possible

 

[propadope]

Other potential things that could exacerbate POST would be more frequent suctioning of the oropharynx since the procedures are intraoral and the use of glycopyrrolate and atropine to dry up secretions or to prevent/ treat bradycardia. (I try to avoid when possible because patients don’t like feeling dry as a bone but my guess is that they are probably used more often in a dental setting)