Postintubation Sequels: Influence of Fluticasone and Technique of Intra-Operative Muscle Relaxation

Postintubation sequels (PIS) are a cause of serious concern in the postoperative period.

The aim of this study is to find the influence of preoperative inhaled steroid and technique of muscle relaxation on PIS.

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 were randomized into four groups as follows: intermittent muscle relaxation with preanesthetic inhalation of either distilled water puffs (Group I_D) or fluticasone puffs (Group I_F); continuous infusion of muscle relaxant with preanesthetic inhalation of either distilled water puffs (Group C_D) or fluticasone puffs (Group C_F). 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.

Qualitative parameters were compared using the Chi-square test and quantitative parameters using repeated measure ANOVA followed by Tukey's test.

Group C_F had significantly less incidence of sore throat and hoarseness compared to groups I_D and I_F. The severity of sore throat was more in groups I_D and I_F than in groups C_F and C_D (P < 0.002). The severity of hoarseness was least in group C_F (23.3%) and highest in group I_F (90%). None of the patients had a cough in group C_F. The incidence and severity of dysphagia were significantly less in group C_F as compared to other groups (P < 0.005 and P < 0.008, respectively).

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.