Nebulized Dexmedetomidine for Postoperative Sore Throat: A Systematic Review and Meta-analysis

Postoperative sore throat (POST) is common following general anesthesia, and the effects of preoperative nebulized dexmedetomidine on reducing the incidence of POST is uncertain. We aimed to clarify the efficacy of preoperative nebulized dexmedetomidine compared to nebulized ketamine and placebo on the incidence of POST. A systematic review and meta-analysis was performed from the PubMed, EMBASE, Web of Science, CENTRAL, Google Scholar databases (inception to May 2024). Trials involving adult patients (> 18 years) undergoing surgery under general anesthesia with tracheal intubation, with one group receiving preoperative nebulized dexmedetomidine, and the other receiving either preoperative nebulized ketamine or normal saline placebo were included. The primary outcome was the incidence of POST at 2-, 12- and 24-h. Eight randomized controlled trials (n = 686) were included in the final analysis. Preoperative nebulized dexmedetomidine did not reduce the incidence of POST at 2-, 12- and 24-h compared to ketamine [OR(95% CI) 0.89(0.38-2.07), p = 0.79; 0.86(0.40-1.85), p = 0.70; 0.67(0.25-1.77), p = 0.42, respectively]. Preoperative nebulized dexmedetomidine significantly reduced the incidence of POST at 2-, 12- and 24-h compared to normal saline placebo [OR(95% CI) 0.16(0.04-0.60), p = 0.007; 0.13(0.02-0.80), p = 0.03; 0.07(0.01-0.35), p = 0.001, respectively]. Preoperative dexmedetomidine nebulization is superior to nebulization with normal saline placebo and comparable to nebulized ketamine in terms of the incidence of POST. The quality of evidence is, however, low.