BRIEF COMMUNICATIONS Widespread Application of Topical Steroids to Decrease Sore Throat, Hoarseness, and Cough After Tracheal Intubation Chakib M. Ayoub, MD, Ashraf Ghobashy, MD, Marc E. Koch, MD, Laura McGrimley, BA, Valentine Pascale, PharmD, Sohail Qadir, MD, Elie M. Ferneini, MHS, and David G. Silverman, MD Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut T racheal intubation for general anesthesia often leads to trauma of the airway mucosa, resulting in postoperative sore throat (ST), cough (C), and hoarseness (H), with reported incidences of 21%-65% (1,2). Although typically not incapacitating, these se- quelae can be very uncomfortable and may be espe- cially annoying to patients returning home after am- bulatory procedures. The aforementioned effects are likely the conse- quences of local irritation and inflammation and hence may be amenable to locally administered steroids. However, relatively little research has been performed in this area. Topical application of 1% hydrocortisone near the endotracheal tube cuff was not beneficial (3), whereas one puff of a beclomethasone inhaler (50 pg) effectively reduced the incidence of ST from 55% to 10% (4). Neither of these studies evaluated the effect of the steroid on H and C. In light of the cost associated with pretreatment with inhalers, we sought to deter- mine whether we could obtain a reduction of C and H as well as ST with a wider distribution of topical gel. We hypothesized that coating the endotracheal tube from the cuff to the 15-cm mark with betamethasone, a water-soluble steroid that has been used topically for the treatment of inflammatory lesions of the oral mu- cosa, would reduce these sequelae. Methods With institutional review board approval, written, in- formed consent was obtained from 87 ASA physical status I-III patients scheduled for elective surgery un- der general endotracheal anesthesia with propofol and a nondepolarizing relaxant. Subjects were informed that we would be inquiring about ST, C, and H. Ex- clusion criteria included operations involving the head and neck, anticipated rapid-sequence induction or airway difficulty, and patients who were ~16 yr old or who were using steroids preoperatively. Patients were randomly assigned so that before in- tubation, the endotracheal tube was lubricated uni- formly by an unblind investigator from the cuff to the 15-cm mark with 3 mL of a water-soluble gel contain- ing chlorhexidine gluconate alone or with the addition of betamethasone 0.05% (equivalent to 3 mg of pred- nisone). After preoxygenation for 2-5 min, anesthesia was induced with propofol and a nondepolarizing relaxant. Tracheal intubation then was performed by residents in their second year of clinical training who were blinded to the nature of the gel. Male and female patients received 7.5- and 7.0-mm inner diameter tubes, respectively. Immediately after intubation, tra- cheal tube cuffs were filled with the minimal volume of room air required to prevent an audible leak. An orogastric tube was placed and remained in place until just before tracheal extubation. Anesthetic man- agement consisted of positive pressure ventilation and was otherwise at the discretion of the anesthesia care team. All patients received oxygen via a face mask postoperatively. A blind member of the research team assessed the patients 1 and 24 h postoperatively, using the question- naire shown in Table 1 [by providing direct questions, as suggested by Harding and McVey (5)]. Differences in severity between groups were compared using the Mann-Whitney U-test; differences in incidence were compared by using 2 analysis. A P value co.05 was considered statistically significant. We calculated that 40 patients were required in each group to detect a differ- ence with a power ~0.90 and CY = 0.05. A patient was eliminated from the study if more than two attempts at passage of the endotracheal tube were required. Accepted for publication May 8, 1998. Address correspondence and reprint requests to David G. Silverman, MD, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06520-8051. Results The duration of anesthesia was 118 ? 56 min in the placebo group and 110 + 50 min in the steroid group 714 Anesth Analg 1998;87:7146 01998 by the International Anesthesia Research Society 0003-2999/98/$5.00