Anesthesia, Endotracheal
Conditions
Keywords
intubation, intensive care, cardiac surgery, sore throat
Brief summary
The aim of the study is to test the effectiveness of a solutions of beclomethasone repeatedly instilled through the supraglottic line of the endotracheal tube on post-extubation airway disturbances related to tracheal intubation. The primary endpoint will be the decrease of the incidence of sore-throat 15 minutes and 12 hours after extubation. Secondary endpoints will regard the effects on hoarseness and cough.
Detailed description
The study will be prospective, randomized, controlled. Patients will be premedicated with diazepam, 0.1 mg/Kg and scopolamine, 0.05 mg/Kg, i.m. one hour prior to their arrival in the operatory theatre. Anesthesia will be induced by fentanyl, 0.1 mg, and propofol, 1.5-2 mg/Kg. After obtaining muscle relaxation with cis-atracurium, 0.15 mg/Kg, a Taper Guard Evac Murphy Eye Oral Tracheal Tube (Mallinkrodt, Mirandola, Italy) with an internal diameter of 9 in men and 8 in women, will be positioned. These tubes have a line for suctioning above the cuff. The cuff pressure will be set to 20-30 cmH2O and checked every 6 hours with a proper inflating device. Patients will be connected to a mechanical ventilator and anesthesia will be maintained with sevoflurane 1-2.5% and remifentanil, 0.05-0.15 mcg/Kg/min. At the end of surgery, patients will be moved to the cardiac surgical intensive care, connected to a mechanical ventilator, and sedated with propofol and remifentanil until the conditions needed for weaning from the ventilator (control of bleeding, cardiovascular stability, thermal equilibrium) are achieved. Then, propofol infusion will be stopped and remifentanil dosage decreased to 0.02-0.05 mcg/Kg/min. After a successful t-tube trial of spontaneous breathing, tracheal tubes will be removed. Remifentanil infusion will be continued and dosage titrated on patient pain evaluated with a VAS scale; paracetamol 1 g will be given if need be.
Interventions
DRUGBeclomethasone
beclometasone, 0.8 mg of saline to a volume of 8 mL, three times through the line for suctioning above the cuff: a) after positioning the tube; b) at the arrival in the cardiac intensive care unit; c) just prior to start respiratory weaning
DRUGPlacebo
patients will receive 8 mL of saline without any drug
Sponsors
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Months to 90 Years
Healthy volunteers
No
Inclusion criteria
* intensive care postoperative admission * tracheal intubation for a total lapse of time between 10 and 18 hours
Exclusion criteria
* age \< 18, * hypersensitivity to FANS and/or corticosteroids, * a medical history positive for diseases affecting upper airways or trachea or causing cough, hoarseness, or voice disorders; * intubation after more than two attempts or with aids (i.e. stylets, Airtraq, Glidescope, Fibroscopy).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Decrease of the incidence of sore-throat. | Fifteen minutes after removing the tracheal tube | Presence and intensity of sore throat by asking the patients to quantify it on a 0-3 scale Sore Throat Scoring System\* 0 No sore throat 1. Minimal sore throat, less severe than with a cold 2. Moderate sore throat, similar to that noted with a cold 3. Severe sore throat, more severe than noted with a cold |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Decrease of the incidence of hoarseness | Fifteen minutes after removing the tracheal tube | Presence and degree of hoarseness by asking the patients to quantify it on a 0-3 scale (table 3). In addition patients will be asked to pronounce a prolonged e in order to assess the capacity to adduce vocal cords, an ENT evaluation will be requested. Hoarseness Scoring System\* 0 No evidence of hoarseness 1. Hoarseness that is noted by the patient only 2. Hoarseness that is easily noted |
Outcome results
None listed