الفهرس 
PREFACEOnly 14 pages are availabe for public view
 |  | from | 83 |  |  |
| | | from | 83 | | |
Abstract
One of the major responsibilities of the anesthesiologist is to provide adequate ventilation to the patient. The most vital element in providing adequate ventilation is the airway. Through a secured airway, the anesthesiologist can maintain adequate gas exchange, whereas, failure to maintain a patent airway for more than few minutes can result in brain damage and hence death. Management of the airway has come a long way since the development of endotracheal intubation by MacEwan in 1880 to present day use of modern and sophisticated devices.
Endotracheal intubation is still the gold standard in airway care and provides the highest level of protection against vomitus and regurgitation, and from upper airway and maxillofacial hemorrhage.
The endotracheal intubation has been associated with a wide range of complications, including dental injury which is the most common cause of malpractice claims against anesthesiologists. Acute airway injury due to instrumentation with a metal laryngoscope blade and insertion of a stiff tracheal tube often traumatize delicate airway tissues, leading to mucosal trauma. This can lead to complications ranging from sore throat and hoarseness of voice to tracheal stenosis as well as esophageal perforation, tracheal perforation, vocal cord hematoma.
Post operative sore throat (POST) is a common complication of general anesthesia. The incidence is highest after tracheal intubation. POST contributes to postoperative morbidity and for patient dissatisfaction and can delay return to routine activities. POST had been rated by patients as eighth most common adverse effect in the postoperative period. It can be associated with cough and hoarseness of voice.
Various non-pharmacological and pharmacological trials have been used for attenuating POST, cough and hoarseness of voice with variable success.
Among the non-pharmacological methods: smaller sized endotracheal tubes, lubricating the endotracheal tube with water soluble jelly, careful airway instrumentation, intubation after full relaxation, gentle pharyngeal suctioning, minimizing intra cuff pressure.
Among the pharmacological methods: gargling with ketamine, sodium azulene sulfonate, cinchocaine jelly, licorice and aspirin gargle. Also, the use of topical and systemic lidocaine.
Local application of betamethasone gel to the ETT is proposed in this study for its anti-inflammatory to reduce the incidence and severity of POST, cough and hoarseness of voice. Betamethasone has mainly an anti-inflammatory effect by reducing the levels of pro-inflammatory cytokines (NF-_B, TNF_ and IL-1), while it stimulates the expression of the anti-inflammatory cytokine (IL-10).