Comparison of Dynamic Measures in Intraoperative Goal-Directed Fluid Therapy of Patients with Morbid Obesity Undergoing Laparoscopic Sleeve Gastrectomy.

INTRODUCTION: Obesity increases the risk of morbidity and mortality during surgical procedures. Goal-directed fluid therapy (GDFT) is a new concept for perioperative fluid management that has been shown to improve patient prognosis. This study aimed to investigate the role of the Pleth Variability Index (PVI), systolic pressure variation (SPV), and pulse pressure variation (PPV) in maintaining tissue perfusion and renal function during GDFT management in patients undergoing laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: Two hundred ten patients were enrolled in our prospective randomized controlled clinical trial. Demographic data, hemodynamic parameters, biochemical parameters, the amount of crystalloid and colloid fluid administered intraoperatively, and the technique of goal-directed fluid management used were recorded. Patients were randomly divided into three groups: PVI (n = 70), PPV (n = 70), and SPV (n = 70), according to the technique of goal-directed fluid management. Postoperative nausea and vomiting, time of return of bowel movement, and hospital stay duration were recorded. RESULTS: There was no statistically significant difference between the number of crystalloids administered in all three groups. However, the amount of colloid administered was statistically significantly lower in the SPV group than in the PVI group, and there was no significant difference in the other groups. Statistically, there was no significant difference between the groups in plasma lactate, blood urea, and creatinine levels. CONCLUSION: In LSG, dynamic measurement techniques such as PVI, SPV, and PPV can be used in patients with morbid obesity without causing intraoperative and postoperative complications. PVI may be preferred over other invasive methods because it is noninvasive.

Effect of Patient State Index Monitoring on the Recovery Characteristics in Morbidly Obese Patients: Comparison of Inhalation Anesthesia and Total Intravenous Anesthesia.

PURPOSE: Obese patients have a significantly higher risk of adverse effects associated with general anesthesia. The purpose of this study was to evaluate the effects of Patient State Index (PSI) monitoring on recovery from anesthesia and the incidence of any postoperative complications among patients undergoing bariatric surgery with total intravenous anesthesia (TIVA) and inhalational anesthesia. DESIGN: This prospective, double-blind, and randomized controlled trial was conducted between February 2017 and August 2017 and included 120 morbidly obese patients (body mass index >40 kg/m2). METHODS: Patients were randomly divided into four groups; group P-PSI (n = 30): TIVA with PSI monitoring; group P (n = 30): TIVA without PSI monitoring; group D-PSI (n = 30): desflurane with PSI monitoring; and group D (n = 30): desflurane without PSI monitoring. The discharge time from the postanesthesia care unit (PACU), postoperative complications, and hemodynamic parameters were recorded and evaluated. FINDINGS: No significant differences were found in demographic data, duration of anesthesia, admittance to PACU, discharge from PACU, modified Aldrete scores, and perioperative mean blood pressure and heart rate. Nausea and vomiting scores were significantly lower in group P-PSI, group P, and group D-PSI compared with group D. CONCLUSIONS: Although TIVA and inhalational anesthesia can be safely used for obese patients, intraoperative PSI monitoring may decrease the discharge time from PACU and reduces incidence of postoperative nausea and vomiting caused by inhalation anesthetics.

Evaluation of the Effect of Erector Spinae Plane Block in Patients Undergoing Belt Lipectomy Surgery.

BACKGROUND: The interest in and demand for post-bariatric surgery have increased along with the increase in obesity surgery. Belt lipectomy, during which a circular correction is made in the center of the trunk, is the most commonly performed among these surgical techniques. Postoperative pain is an important problem due to the size of the surgical site and stretched closure. In this study, it was aimed to evaluate the intraoperative and postoperative narcotic analgesic consumption, postoperative analgesic requirement, postoperative visual analog scale (VAS) scores, postoperative nausea and vomiting (PONV), and the first mobilization time in patients with and without erector spinae plane block (ESPB). METHODS: The files of patients who had undergone belt lipectomy between 2016 and 2019 in our hospital were retrospectively reviewed. Patients who received ESPB were called group 1, and those who did not undergo ESPB were called group 2. Their demographic characteristics, intraoperative and postoperative narcotic and non-narcotic analgesic consumption, VAS scores, PONV, and the first mobilization times were recorded. RESULTS: The files of a total of 51 patients, including 23 patients in group 1 and 28 patients in group 2, were reviewed. It was determined that intraoperative and postoperative narcotic analgesic consumption (p < 0.005), PONV (p < 0.005), and the first mobilization time (p < 0.005) were significantly lower in group 1 compared with group 2. CONCLUSION: The use of the ESP block in belt lipectomy surgeries significantly reduces intraoperative and postoperative narcotic analgesic consumption and pain scores. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of the Reasons for the Cancellation of Elective Procedures at Level 3 University Hospital on the Day of Surgery.

PURPOSE: Unexpected cancellations of planned elective procedures are a global problem for hospitals, causing a waste of hospital resources and manpower, and reduces the efficiency of hospitals. In this study, we tried to identify the causes of cancellations of elective procedures, and to examine the relationship between the causes. DESIGN: A retrospective, descriptive single-center study. METHODS: Nine thousand five hundred sixty-six elective procedures scheduled between January 2015 and December 2015 were retrospectively examined. Reasons for cancellation, the associated surgical clinic, and the day and season of the canceled procedures were recorded. FINDINGS: Of the total 9,566 procedures, 496 (5.2%) were canceled. Of the cancellations, 31.3% were due to patient-related reasons, 29.2% because of inadequate anesthesia preparation, and 19% because of nonavailability of operating rooms. CONCLUSIONS: Cancellation of elective surgeries causes a waste of time and resources. Determining the reasons for cancellations to reduce cancellation rates is important for each hospital.

The Relationship Between the Preoperative Neutrophil-to-Lymphocyte Ratio and Postoperative Nausea and Vomiting in Patients Undergoing Septorhinoplasty Surgery.

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most common complications during the postoperative period. In the literature, there are many factors associated with PONV risk, but it is claimed that inflammation increases this risk. The neutrophil-to-lymphocyte ratio (NLR) is a cheap parameter to use in the diagnosis and follow-up of systemic inflammatory diseases. In this study, we aimed to investigate whether the preoperative NLR was a marker for PONV and to determine its relation with antiemetic use. METHODS: Eighty patients who were planned to undergo elective septorhinoplasty and were in ASA I-II were prospectively included in the study. The NLR value was calculated by dividing the number of neutrophils by the number of lymphocytes obtained from the preoperative complete blood count. The patients were divided into two groups of 40 patients: patients with an NLR < 2 (group 1) and patients with an NLR > 2 (group 2). Nausea and vomiting during the first 24 h in the recovery room and in the related clinic and antiemetic requirement were recorded. RESULTS: The rate of nausea-vomiting in the recovery room and in the postoperative 24-h period in group 1 was significantly lower than in group 2 (p < 0.05). The rate of use of antiemetics in the recovery room and in the postoperative 24-h period in group 1 was significantly lower than in group 2 (p < 0.05). CONCLUSION: NLR values above 2 calculated in the preoperative period may be an indicator of PONV risk. Antiemetic prophylaxis may be given according to this value. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Efficacy of Goal-Directed Fluid Therapy via Pleth Variability Index During Laparoscopic Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients.

BACKGROUND: There is no well-recognized guideline for intraoperative fluid management in bariatric surgery. Goal-directed fluid therapy (GDFT) is a new concept of perioperative fluid management which was shown to improve patients' prognoses. Dynamic indicators may better predict fluid response compared to static indicators. In this study, we aimed to assess effects of administering GDFT protocol via Pleth Variability Index (PVI) in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) surgery. METHODS: The study included 60 patients who underwent elective laparoscopic RYGB surgery. Subjects were randomized to two groups as being managed with either standard fluid regimen (control group) or PVI (PVI group) during intraoperative period. After induction of general anesthesia, control group received 500 ml crystalloid bolus followed by 4-8 ml/kg/h infusion. Fluid management of the control group was guided by central venous pressure and mean arterial pressure. PVI group received 500 ml crystalloid bolus followed by 2 ml/kg/h infusion. If PVI had been > 14%, 250 ml colloid was administered. Norepinephrine was given by infusion to keep mean arterial pressure > 65 mmHg, if needed. Perioperative lactate levels, hemodynamic parameters, and renal functions were recorded. RESULTS: In PVI group, volume of crystalloid and total fluid infusion during intraoperative period was significantly lower than the control group (p < 0.05). The groups did not significantly differ in terms of lactate or creatinine levels before or after the surgery (p > 0.05). CONCLUSIONS: There is no need to administer extra volume of fluid to obese patients undergoing laparoscopic bariatric surgery. Use of dynamic indicators like PVI helps to decrease intraoperative volume of infused fluids with no effects on either intraoperative or postoperative lactate levels in laparoscopic bariatric interventions.

The effect of body mass index on perioperative thermoregulation.

PURPOSE: We evaluated the effects of body mass index (BMI) on thermoregulation in obese patients scheduled to undergo laparoscopic abdominal surgery. METHODS: Sixty patients scheduled to undergo laparoscopic abdominal surgery with no pre-medication were included in the study. The patients were classified into 4 groups according to BMI <24.9, 25-39.9, 40-49.9, and >50. Anesthesia was provided with routine techniques. Tympanic and peripheral temperatures were recorded every 5 minutes starting with the induction of anesthesia. The mean skin temperature (MST), mean body temperature (MBT), vasoconstriction time, and vasoconstriction threshold that triggers core warming were calculated with the following formulas: MST = 0.3 (Tchest + Tarm) + 0.2 (Tthigh + Tcalf). MBT was calculated using the equation 0.64Tcore+0.36Tskin, and vasoconstriction was determined by calculating Tforearm-Tfinger. RESULTS: There was no significant difference between the groups in terms of age, gender, duration of operation, and room temperature. Compared to those with BMI <24.9, the tympanic temperature was significantly higher in those with BMI =25-39.9 in the 10th, 15th, 20th, and 50th minutes. In addition, BMI =40-49.9 in the 5th, 10th, 15th, 20th, 25th, 30th, 40th, 45th, 50th, and 55th minutes and BMI >50 in the 5th, 10th, 15th, 20th, 25th, 30th, 50th, and 55th minutes were less than those with BMI <24.9 (P<0.05). There was no significant difference in terms of MST and MBT. Vasoconstriction occurred later, and that vasoconstriction threshold was significantly higher in patients with higher BMIs. CONCLUSION: Under anesthesia, the core temperature was protected more easily in obese patients as compared to nonobese patients. Therefore, obesity decreases the negative effects of anesthesia on thermoregulation.

The effect of sugammadex on steroid hormones: A randomized clinical study.

STUDY OBJECTIVE: Sugammadex is an alternative drug to traditional decurarization by cholinesterase inhibitors. It has been examined the effect of sugammadex on steroid hormones in this study. DESIGN: Randomized clinical trial. SETTING: The study was conducted in a University Teaching Hospital from January 2013 to May 2014. PATIENTS: Fifty male patients between 18 and 45years of age with an American Society of Anesthesiology (ASA) class I or II undergoing elective lower extremity surgery were included in this study. INTERVENTIONS: Patients were categorized into two groups (neostigmin group, Group N; and sugammadex group, Group S). In addition to standard monitorization, train-of-four (TOF) was also used to monitorize the level of neuromuscular blockade. Standard induction and maintenance of anesthesia were performed. At the termination of surgery, neuromuscular blockade was antagonized using 0.05mg/kg of neostigmine and 0.01mg/kg of atropin when spontaneous recovery of neuromuscular blockade occurred with the reappearance of T2 in Group N and using 4mg/kg sugammadex in Group S. MEASUREMENTS: The primary outcome in this study was to determine serum aldosterone, cortisol, progesterone, and free testosterone levels. Three blood samples were obtained in each patient just before and 15minutes and 4hours after antagonism, MAIN RESULTS: No significant differences were found in demographic characteristics between the groups. While there were no differences in serum progesterone levels, patients in neostigmin group had significantly higher cortisol levels at 15minutes as compared to baseline. Also, patients in sugammadex group had significantly higher serum aldosterone and testosterone levels 15minutes after antagonism as compared to those in the neostigmine group. CONCLUSIONS: Our findings suggest that sugammadex is not associated with adverse effects on steroid hormones progesterone and cortisol, while it may lead to a temporary increase in aldosterone and testosterone.

Effect of gabapentin pretreatment on myoclonus after etomidate: a randomized, double-blind, placebo-controlled study.

AIM: To evaluate the effects of three different doses of gabapentin pretreatment on the incidence and severity of myoclonic movements linked to etomidate injection. METHOD: One hundered patients, between 18 and 60 years of age and risk category American Society of Anesthesiologists I-II, with planned elective surgery under general anesthetic were included in the study. The patients were randomly divided into four groups and 2h before the operation were given oral capsules of placebo (Group P, n=25), 400mg gabapentin (Group G400, n=25), 800mg gabapentin (Group G800, n=25) or 1200mg gabapentin (Group G1200, n=25). Side effects before the operation were recorded. After preoxygenation for anesthesia induction 0.3mgkg(-1) etomidate was administered for 10s. A single anesthetist with no knowledge of the study medication evaluated sedation and myoclonic movements on a scale between 0 and 3. Two minutes after induction, 2µgkg(-1) fentanyl and 0.8mgkg(-1) rocuronium were administered for tracheal intubation. RESULTS: Demographic data were similar. Incidence and severity of myoclonus in Group G1200 and Group G800 were significantly lower than in Group P; sedation incidence and level were appreciably higher compared to Group P and Group G400. While there was no difference in the incidence of myoclonus between Group P and Group G400, the severity of myoclonus in Group G400 was lower than in the placebo group. In the two-hour period before induction other than sedation none of the side effects related to gabapentin were observed in any patient. CONCLUSION: Pretreatment with 800mg and 1200mg gabapentin 2h before the operation increased the level of sedation and reduced the incidence and severity of myoclonic movements due to etomidate.

Lumbar Disc Surgery with Epidural Anesthesia: Review of 700 Cases.

AIM: Lumbar disc surgery can be performed under general anesthesia or regional anesthesia methods. There are long-standing discussions between neurosurgeons, orthopedic surgeons and anesthesiologists concerning the use of epidural anesthesia in lumbar surgery. The results of this study's 700 lumbar disc surgery cases operated with epidural anesthesia in our clinic between September 2006 and December 2011 will contribute to these discussions. MATERIAL AND METHODS: This study included 700 patients underwent lumbar disc surgery with epidural anesthesia, which consisted of 388 males (55%) and 312 females (45%). Forty-two of these cases had recurrence disc herniation and only 11 of 42 cases were operated in our department. RESULTS: Eleven of 700 cases had dural injury and were repaired intraoperatively by primary sutures and tissue sealants. Infection of the incision site developed in six patients, who healed with appropriate antibiotic treatment with no problems. In addition to those 700 cases, 22 patients received general anesthesia in which we started with epidural anesthesia. Microdiscectomies were performed in 578 of 700 cases, and open surgery in 122 cases. CONCLUSION: This study showed that epidural anesthesia seems more advantageous for some patients since it does not have some of the risks that general anesthesia bears.

[Effect of gabapentin pretreatment on myoclonus after etomidate: a randomized, double-blind, placebo-controlled study]. / Efeito do pré-tratamento com gabapentina sobre a mioclonia após etomidato: um estudo randômico, duplo-cego e controlado por placebo.

AIM: To evaluate the effects of three different doses of gabapentin pretreatment on the incidence and severity of myoclonic movements linked to etomidate injection. METHOD: One hundered patients, between 18 and 60 years of age and risk category American Society of Anesthesiologists I-II, with planned elective surgery under general anesthetic were included in the study. The patients were randomly divided into four groups and 2h before the operation were given oral capsules of placebo (Group P, n=25), 400mg gabapentin (Group G400, n=25), 800mg gabapentin (Group G800, n=25) or 1200mg gabapentin (Group G1200, n=25). Side effects before the operation were recorded. After preoxygenation for anesthesia induction 0.3mgkg(-1) etomidate was administered for 10s. A single anesthetist with no knowledge of the study medication evaluated sedation and myoclonic movements on a scale between 0 and 3. Two minutes after induction, 2µgkg(-1) fentanyl and 0.8mgkg(-1) rocuronium were administered for tracheal intubation. RESULTS: Demographic data were similar. Incidence and severity of myoclonus in Group G1200 and Group G800 were significantly lower than in Group P; sedation incidence and level were appreciably higher compared to Group P and Group G400. While there was no difference in the incidence of myoclonus between Group P and Group G400, the severity of myoclonus in Group G400 was lower than in the placebo group. In the two-hour period before induction other than sedation none of the side effects related to gabapentin were observed in any patient. CONCLUSION: Pretreatment with 800mg and 1200mg gabapentin 2h before the operation increased the level of sedation and reduced the incidence and severity of myoclonic movements due to etomidate.

Management of anesthesia in unspecified extra-adrenal pheochromocytoma patient who used beta-blocker.

An operation was planned for a female patient aged 59 for intra-abdominal mass. The patient was using nebivolol for hypertension. Blood pressure (BP) of the patient was raised to 200/130 mmHg during anesthesia induction. BP was gradually reduced by remifentanil infusion. Following the manipulation of the mass, BP began to increase (225/160 mmHg), thus nitroglycerin and followed nitroprusside infusion was started. Propofol (200 + 200 mg) and furosemide (20 mg) were administered intravenously. BP suddenly dropped (90/60 mmHg) following the removal of the mass, nitroglycerine, and nitroprusside infusions were stopped; remifentanil dose was decreased and fluid was quickly infused. The patient was uneventually recovered. Vanilmandelic acid level was higher in the patient and pheochromocytoma was considered.

Evaluation of maternal mortality cases in the province of Elazig, Turkey, 2007-2013: a retrospective study.

The aim of this study was to determine the causes and factors influencing maternal mortality. All maternal deaths occurring between January 2007 and November 2013 in the Elazig Province of Turkey were retrospectively investigated. The maternal age, obstetric history, cause of death, encountered delay model of each case, as well as the overall number of annual live births in the Province were determined. The information of cases was obtained from Directorate of Public Health and hospital records.  Families or family doctors were also interviewed to obtain details about the circumstances surrounding each death. There were a total of 64,423 live births in the Province of Elazig between 2007- 2013. The number and ratio of maternal deaths due to direct and indirect causes were 12 and 18.6, respectively. The direct causes of maternal death were hypertensive diseases of pregnancy (n=5, 41.7%), obstetric hemorrhages (n=3, 25%) and pulmonary embolism (n=1, 8.3%). The indirect causes of death were cardiac diseases (n=2, 16.7%) and malignancy (n=1, 8.3%). When classified according to the "Three Delays Model", 2 cases were in the first delay model and 3 cases in the third delay model; the second delay model led to no maternal deaths. Hypertensive diseases of pregnancy are the leading cause of maternal mortality in our province. The preventable causes of maternal mortality and factors contributing to death must be identified to reduce the incidence.

Comparison of patient-controlled analgesia versus continuous infusion of tramadol in post-cesarean section pain management.

AIM: To evaluate and compare analgesic efficacy, drug consumption and patient satisfaction with the i.v. patient-controlled and continuous infusion modes of administration of tramadol. METHODS: A total of 40 pregnant women in American Society of Anesthesiologists physical status classification system risk classes I-II scheduled for cesarean section were randomized into two groups to receive treatment in single-blind fashion. Patients in both groups received tramadol as an i.v. infusion 15 min before the end of surgery under general anesthesia for cesarean section. In the post-anesthesia care unit, the 20 patients allocated to group I were given i.v. tramadol in patient-controlled anesthesia (PCA), while the 20 other patients assigned to group II received it as a continuous infusion. Pain visual analog scores (VAS), mean arterial pressure (MAP), heart rate, total tramadol consumption, sedation scores, side-effects (nausea/vomiting) and patient satisfaction were evaluated seven times in the course of the first postoperative 24 h. The Mann-Whitney U-test and Friedman's anova were used for the statistical treatment of data. RESULTS: VAS, sedation scores and nausea/vomiting scores were similar in both groups (P > 0.05). The 24-h tramadol consumption was significantly lower in group I (420.15 ± 66.58 mg) than in group II (494.00 ± 29.45 mg), while patient satisfaction was significantly higher in group I (P < 0.05). CONCLUSION: While tramadol administration by either of the methods used may ensure efficient early postoperative anesthesia in cesarean section patients, i.v. PCA may be preferred because of the lower drug consumption and higher patient satisfaction associated with it.

The effects of anesthetic technique and ambient temperature on thermoregulation in lower extremity surgery.

PURPOSE: The purpose of our study was to determine the effects of anesthetic technique and ambient temperature on thermoregulation for patients undergoing lower extremity surgery. METHODS: Our study included 90 male patients aged 18-60 years in American Society of Anesthesiologists Physical Status groups I or II who were scheduled for lower extremity surgery. Patients were randomly divided into three groups according to anesthetic technique: general anesthesia (GA), epidural anesthesia (EA), and femoral-sciatic block (FS). These groups were divided into subgroups according to room temperature: the temperature for group I was 20-22 °C and that for group II was 23-25 °C. Therefore, we labeled the groups as follows: GA I, GA II, EA I, EA II, FS I, and FS II. Probes for measuring tympanic membrane and peripheral temperature were placed in and on the patients, and mean skin temperature (MST) and mean body temperature (MBT) were assessed. Postoperative shivering scores were recorded. RESULTS: During anesthesia, tympanic temperature and MBT decreased whereas MST increased for all patients. There was no significant difference between tympanic temperatures in either the room temperature or anesthetic method groups. MST was lower in group GA I than in group GA II after 5, 10, 15, 20, 60 and 90 min whereas MBT was significantly lower at the basal level (p < 0.05). MST after 5 min was significantly lower in group GA I than in group FS I (p < 0.05). Shivering score was significantly higher in group GA I (p < 0.05). CONCLUSIONS: There were no significant differences in thermoregulation among anesthetic techniques. Room temperature affected thermoregulation in Group GA.

Administration of general anaesthesia to a paediatric patient with osteopetrosis.

Osteopetrosis is a rare clinical syndrome characterised by the failure of bone resorption and remodelling, which causes multiple anatomical and physiological impairments. Pathological fractures can occur, in addition to, haemathological and metabolic impairments. Our patient was a 9-year-old girl diagnosed with osteopetrosis in the neonatal period. She had severe anaemia, thrombocytopaenia, hypocalcaemia, as well as growth and development delays. In this case report, the administration of general anaesthesia to the patient for a biopsy of the scalp and skull and a partial maxillectomy is presented.

TURP syndrome and severe hyponatremia under general anaesthesia.

Transurethral resection of prostate (TURP) syndrome is a complication characterised by symptoms changing from an asymptomatic hyponatremic state to convulsions, coma and death due to absorption of irrigation fluid during TURP. The syndrome appears to be related to the amount of fluid that enters the circulation via the blood vessels in the resection area. The first step in the course of action for therapy is to control bleeding and suspend the operation. In the case presented, we aimed to emphasise the importance of an early diagnosis and treatment of TURP syndrome in a patient that developed hyponatremia (90 mmol/l) while under general anaesthesia during a TURP procedure. In addition, multiple cystoscopic applications in the same session may facilitate development of the TURP syndrome.

Dental avulsion due to direct laryngoscopy during the induction of general anaesthesia and avulsed teeth in nasopharynx.

General anaesthesia was induced to a 32-year-old female patient. During direct laryngoscopy, the four upper front incisors were avulsed and fell into the patient's oral cavity without fracture. After endotracheal intubation, her oral cavity was searched laryngoscopically but the teeth were not found. Radiological findings of her chest and abdomen obtained by the C-armed x-ray device and endoscopic findings of the oesophagus were normal. Her head and neck imaging revealed a radiopaque lesion in the nasopharyngeal area. Later, the nasopharyngeal area was examined endoscopically and the teeth were removed following adenoidectomy. We emphasise that preoperative evaluation is essential for dental injuries, and patients with a risk of dental injury must be detected before surgery. The localisation of the broken teeth must be identified and removed, and one must keep in mind that the dental fragments can travel to the nasopharynx.

Preliminary findings for preemptive analgesia with inhaled morphine: efficacy in septoplasty and septorhinoplasty cases.

OBJECTIVE: The aim of this study was to assess the efficacy of inhaled morphine for preemptive analgesia in patients who undergo septoplasty or septorhinoplasty. STUDY PLAN AND METHODS: Eighty ASA I-II patients scheduled for septoplasty or septorhinoplasty were recruited and randomly divided into 2 groups that received different treatments 10 minutes prior to induction. The preemptive analgesia group (Group P, n = 40) received 65 mug kg(-1) morphine sulphate (a 3-mL volume) via an oral nebulizer, and the control group (Group C, n = 40) received 3 mL 0.9% sodium chloride (physiological saline) via the same type of nebulizer. Blood pressure, oxygen saturation, heart rate, time to first requirement for analgesia, and occurrence of nausea/vomiting were recorded. RESULTS: There were no significant differences between Groups P and C with respect to age, body weight, sex distribution, or duration of surgery. There was also no significant difference between the group frequencies of postoperative nausea/vomiting. The time to first requirement for analgesia was significantly longer in Group P than Group C. CONCLUSION: The results of this preliminary study suggest that a single dose of inhaled morphine administered preemptively prior to septoplasty or septorhinoplasty provides effective postoperative analgesia. EBM RATING: B-3b.