Preoperative Ketamine Gargle for Prevention of Postoperative Sore Throat After Tracheal Intubation in Adults: A Meta-Analysis.

Objective: This meta-analysis aims to evaluate the impact of preoperative ketamine gargle on postoperative throat pain in patients undergoing general anesthesia with endotracheal intubation (ETI). Methods: A comprehensive search was conducted in databases including PubMed, Cochrane Library, Web of Science, ScienceDirect, Scopus, ClinicalTrials.gov, and others. Data analysis was performed using RevMan 5.4 and Stata Statistical Software 18 (StataCorp., Texas., United States of America). Odds ratio with 95% confidence interval (CI) and mean difference were calculated for outcomes: incidence of postoperative 0, 2, 4, 8, and 24 h sore throat and anesthesia time. The overall certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, with trial sequential analysis (TSA) performed to establish implications for further research. Main outcome: A total of ten RCTs involving 593 patients were included in the analysis. The results demonstrated a significant reduction in the incidence of postoperative sore throat at 0, 2, 4, 8, and 24 h after the operation (0 h: OR: 0.14; 95% CI: 0.04-0.47; p=0.002; I (2) = 67%; 2 h: OR: 0.30; 95% CI: 0.17-0.52; p < 0.0001; I (2) = 31%; 4 h: OR: 0.32; 95% CI: 0.20-0.52; p < 0.00001; I (2) = 0%; 8 h: OR: 0.40; 95% CI: 0.23-0.70; p=0.001; I (2) = 29%; 24 h: OR: 0.36; 95% CI: 0.25-0.51; p < 0.00001; I (2) = 0%) in patients who received ketamine gargle compared to those who received a placebo. In addition, our meta-analysis indicated that ketamine gargle did not result in a reduction in anesthesia time (min) (MD: -1.16; 95% CI: -6.44-4.11; p=0.67). Conclusion: Our meta-analysis demonstrated the efficacy of prophylactic ketamine gargle in reducing the incidence of POST across all studied time intervals in patients requiring tracheal intubation of general anesthesia compared to placebo.