The effect of prophylactic preoperative nebulized ketamine vs. nebulized dexamethasone on postoperative sore throat in patients undergoing surgery under general anesthesia. A randomized, placebo-controlled, double-blind trial

Aidah Alkaissi¹*, Mohammad Moufeed Mahmoud², Nouraldin Almasri³

¹An-Najah National University, Faculty of  Nursing, Nablus, Palestine.

² An-Najah National University, Faculty of  Graduate Studies, Nablus, Palestine.

³ Rafidia Hospital, Ministry of Health, Nablus, Palestine.

Background:
Post-operative sore throat (POST) is a common minor complication following general anesthesia with endotracheal intubation, leading to patient discomfort and decreased satisfaction with anesthetic care. The main causes are direct trauma to the tracheal mucosa and reduced humidity related to endotracheal tube (ETT) cuff pressure. Several studies have shown promising results for ketamine and dexamethasone nebulization in reducing the incidence and severity of POST and associated laryngeal morbidities such as cough and hoarseness.

Objectives:
This study aimed to determine whether preoperative nebulization with ketamine or dexamethasone significantly reduces the incidence and severity of POST and other laryngeal morbidities in patients undergoing elective surgeries under general anesthesia with ETT. It also assessed the impact on intubation conditions and hemodynamic responses during laryngoscopy.

Methodology:
In a double-blind, randomized, placebo-controlled prospective study, ninety-nine patients scheduled for surgery under general anesthesia were enrolled. Participants were randomized into three groups: control (5 ml normal saline), dexamethasone (8 mg/5 ml), and ketamine (50 mg/5 ml), each receiving nebulization for 15 minutes prior to anesthesia induction.

Results:
Both ketamine and dexamethasone nebulizers were effective in preventing POST (p < 0.001) and postoperative hoarseness, with ketamine showing maximum efficacy. Ketamine also prevented cough and postoperative nausea and vomiting (PONV), whereas dexamethasone did not. Patient satisfaction was highest in the ketamine group (p < 0.001). Although an increase in systolic blood pressure (SBP) and heart rate (HR) was observed after ketamine nebulization, no serious systemic adverse effects occurred.

Conclusions:
Nebulization with 50 mg ketamine or 8 mg dexamethasone effectively prevents and reduces the incidence of POST and laryngeal morbidities, with ketamine demonstrating superior efficacy.

Keywords: Ketamine, Dexamethasone, Nebulizer, Sore throat.

Conference Title

https://nursingworld.mindauthors.com/

Conference Country

Singapore

Conference Date

March 9, 2026 - March 11, 2026

Conference Sponsor

the author