Evaluation of The Efficacy of Preoperative Ketamine Nebulization on Postoperative Sore Throat due to Tracheal Intubation

Background: Post-intubation sore throat (PIST) is a common postoperative disorder that is characterized with dysphagia, hoarseness and odynophagia. It is associated with multiple risk factors including mechanical trauma, high endotracheal cuff pressure and difficult intubation process. PIST is associated with patient's discomfort, which necessitate proper preventive measurement to reduce its incidence. Objective: In this review we aimed to provide a comprehensive assessment of PIST, regarding its pathology, associated risk factors and treatment. Special focus is given to the role of nebulized ketamine in the treatment of PIST, due to its anti-inflammatory and analgesic effects. Methods: We used Google Scholar, Science Direct, PubMed, and other internet databases for PIST, Ketamine, Difficult intubation, NMDA receptor antagonist and Airway management. Additionally, the writers combed through relevant literature for references, however they only included researches covering the years from 1999 to 2024. Due of lack of translation-related sources, documents in languages other than English were excluded. Also, works in progress, unpublished publications, abstracts from conferences, and dissertations that did not form part of broader scientific investigations were excluded. Conclusions: We reported that difficult intubation is a major factor in the occurrence of PIST, emphasizing the need for accurate tools to predict difficult intubation and proper management. Additionally, our review demonstrated the ability of nebulized ketamine in reducing the incidence and severity of PIST due to its analgesic and anti-inflammatory actions based on its N-methyl-D-aspartate (NMDA) receptor antagonism. Ultimately, our review supports the recommendation for further high-quality studies to help establishing standardized protocol for the treatment of PIST.