Comparison of the effect of intravenous and intra-cuff magnesium on post-extubation tracheal morbidity.

Post extubation tracheal morbidity is a common complication after tracheal intubation . Its incidence ranges from 14-90% (2)(1) following endotracheal intubation and 5.8-34% after laryngeal mask insertion . Laryngotracheal morbidities following ETT extubation are associated with several negative outcomes including patient dissatisfaction, increased length of hospital stay, increased hospital cost and reduced bed turnover. Several studies have identified various means of reducing the occurrence of these morbidities . Amongst these findings are improvements in laryngoscopes and endotracheal tube properties(5), intra-cuff and intravenous lidocaine, topical airway and intravenous steroids, gargled NSAID’s nebulised and intravenous Ketamine. Magnesium which has anti-nociceptive and anti-inflammatory properties and can therefore play a role in reducing post extubation laryngotracheal morbidity. It is therefore not surprising to see the use of intravenous magnesium sulphate in preventing post extubation laryngotracheal morbidities in literature. Literature however does not show intra-cuff magnesium being proposed as a preventive measure for post extubation laryngotracheal morbidities.Objectives: 1. To determine and compare the incidence and severity of post-extubation laryngotracheal morbidity (sore throat, cough and hoarseness of voice) between patients who will have their ETT cuff filled with air, patients who will have their ETT cuffs filled with 2g Magnesium Sulphate and patients who will have their ETT cuffs filled with air and in addition receive 2g intravenous magnesium sulphate at induction. 2.To determine and compare the hemodynamic changes (Heart rate and Blood Pressure) during tracheal extubation between patients who will have their ETT cuff filled with air, patients who will have their ETT cuffs filled with 2g Magnesium Sulphate and patients who will have their ETT cuffs filled with air and in addition receiving 2g if intravenous magnesium sulphate.