A Narrative Review on Pain Management in Head and Neck Cancer: Integrating Multimodal Analgesia and Interventional Procedures.

Surgical interventions and radiotherapy for head and neck cancer frequently result in substantial instances of acute and chronic discomfort. Optimizing pain management techniques stands as a pivotal factor in enhancing the well-being and overall quality of life for patients. This comprehensive review discusses various pain conditions encountered after head and neck cancer and explores a multidimensional approach to pain management. The review highlights the significance of incorporating multimodal analgesia, physical therapy, psychological support, palliative care, and emerging techniques including nerve blocks to achieve efficacious pain control. Such an endeavor necessitates cooperation among head and neck surgeons, radiotherapists, and pain specialists.

A Comparative Study of the Effect of Labetalol and Remifentanil on Pain Control After Bariatric Surgery.

Background: Finding the optimal combination of anesthetics to maintain hemodynamic stability during surgery can be challenging. Traditionally, strong opioid analgesics such as fentanyl and its newer analogs have been used. However, the use of narcotics is associated with certain side effects. Objectives: This study compares the effects of labetalol and remifentanil in pain control after bariatric surgery in Hazrat Rasool Akram Hospital. Methods: This randomized, double-blind clinical trial was conducted on 48 laparoscopic bariatric surgery patients. The participants were randomly divided into two groups receiving remifentanil or labetalol. Postoperative pain was measured in the recovery unit using the numerical rating scale (NRS). This score was recorded upon entering recovery, and 30 minutes, 60 minutes, and 120 minutes after surgery for each patient. Also, the duration of anesthesia, the duration of the operation, the recovery time, the dose of the administered opioids, the volume of intravenous fluids, and the dose of administered propofol were recorded for each patient. Nausea and vomiting after the operation were also recorded as outcomes. Results: There were no significant differences between the two groups regarding the mean duration of surgery and anesthesia, dose of the administered anesthetics, recovery period, nausea and vomiting, and the dose of analgesics after the operation. The mean pain intensity during the given period and also the trend of pain intensity changes between the two groups demonstrated no statistically significant differences (P = 0.112). During the operation, 9 subjects (37.5%) in the labetalol group and 16 (66.7%) in the remifentanil group needed more analgesics (rescue drug); in this regard, a significant difference was observed between the two groups (P = 0.043). Conclusions: Based on the study's findings, there were no significant differences between labetalol and remifentanil in post and perioperative pain control. However, rescue drugs needed to maintain hemodynamic stability during laparoscopic surgery were significantly lower in patients who received labetalol than remifentanil. Postoperative complications were also comparable between labetalol and remifentanil.

Efficacy of Low-Frequency Electroacupuncture on Urinary Retention After Spinal Anesthesia.

PURPOSE: This study was designed to evaluate the efficacy of low-frequency electroacupuncture (EA) in the prevention of urinary retention after orthopedic surgery. DESIGN: A double-blind placebo-controlled clinical trial. METHODS: Eighty patients with spinal anesthesia were randomly allocated into the groups of EA (40 cases) and control (40 cases). In the first group, the EA was applied to four points of SP6, SP9, ST28, and CV2; 4 Hz, retaining for 20 minutes in the postanesthesia care unit (PACU). In the control group, no intervention was applied. The incidence of postoperative urinary retention, incomplete or difficult urination, and the first automatic micturition time since spinal anesthesia were compared between the two groups. FINDINGS: The incidence of urinary retention and incomplete urination in the EA group was significantly lower than that in the control group; the time to first urination was shorter in the intervention group than in the control group (P < .05). CONCLUSIONS: Electroacupuncture after spinal anesthesia improves bladder function and reduces the need for a urinary catheter and its possible complications.

The Effect of Softening of Endotracheal Tubes on the Decrement of Postoperative Hoarseness and Sore Throat.

Background: Hoarseness, cough, and sore throat are the most prevalent complications after removing patients' endotracheal tube and general anesthesia. Various methods have been proposed to reduce these complications after intubation. Objectives: The present study aimed to assess the effect of softening the endotracheal tube with normal warm saline on reducing post-intubation complications such as sore throat and hoarseness. Methods: This double-blind, randomized controlled trial was performed on patients undergoing general anesthesia at Rasoul Akram and Firoozgar hospitals in Tehran, Iran. In the present study, 58 patients were randomly divided into 2 groups of 29 patients. All patients underwent the same premedication with fentanyl and lidocaine. Anesthesia was induced with propofol and atracurium. Three to 5 minutes after atracurium injection, the laryngoscopy test was performed. Randomly, some patients were intubated with a thermally softened endotracheal tube, and some were intubated with a normal tube. At the end of the operation, when the spontaneous breathing was adequate, and the patients could carry out oral instructions, the endotracheal tube was removed immediately after suctioning. All patients were evaluated for sore throat and hoarseness before discharge from recovery and 24 hours after surgery. The obtained data were analyzed using SPSS software package version 25. Results: The mean incidence of sore throat in recovery in the intervention group (20.7%) decreased compared to the control group (75.8%). Moreover, the mean incidence of hoarseness in the intervention group (17.2%) decreased in comparison to the control group (41.4%, P < 0.029). Based on the data of our study, we observed that 24 hours after surgery, the mean incidence of sore throat among the patients of the intervention group was significantly lower compared to the control group, where patients in the intervention group did not feel any sore throat (P < 0.002). We also observed that 24 hours after surgery, the amount of hoarseness in the intervention group (3.4%) also decreased compared to the control group (24.1%, P < 0.022). Conclusions: Based on the results, it can be concluded that thermal softening of the endotracheal tubes with normal warm saline before intubation could be significantly effective in decrement of sore throat and hoarseness during recovery and 24 hours after surgery.

The Effect of Phenylephrine Nasal Drops on Surgical Bleeding in Children Underwent Cleft Palate Surgery: A Randomized Clinical Trial.

Background: Cleft lip and palate are birth defects due to a lack of proper formation of the lip or mouth. Controlling bleeding during cleft lip and palate surgeries is very important. Objectives: This study aimed to evaluate the effect of phenylephrine nasal drops on bleeding during and after cleft palate repair surgery in children. Methods: This controlled, randomized, double-blind, clinical trial was performed on 36 children aged 6 months to 2 years with cleft palate who were candidates for repair surgery. Patients were randomly divided into 2 groups of 18 patients. In the intervention group, 0.25% phenylephrine drops were poured into the nostrils, and the same amount of normal saline was poured in the control group. Changes in systolic and diastolic blood pressures, heart rate, bleeding during surgery based on the gauzes used, the volume of blood in the suction canister, and the amount of blood in the field, as well as the surgical field quality and surgeon satisfaction, were evaluated using analysis. Results: No statistically significant difference was observed between the 2 groups in terms of age, sex, weight, heart rate, and systolic and diastolic blood pressures. The mean volume of bleeding based on the total weight of gauzes used and suctioned blood during surgery showed a statistically significant difference between the intervention and control groups (P = 0.0016). The surgeon satisfaction in terms of the surgical field quality using a 5-point Likert scale showed a significant difference between the 2 groups (P = 0.0068), as well as more satisfaction in the intervention group according to the Boezaart scale (P = 0.0043). Conclusions: It seems that the use of nasal phenylephrine drops in pediatric cleft palate surgeries can significantly reduce bleeding and increase the quality of the operation field. Therefore, nasal phenylephrine drops can be used to control bleeding in this type of surgery.

Comparison of Ultrasound-Guided Supra-scapular Plus Axillary Nerve Block with Interscalene Block for Postoperative Pain Management in Arthroscopic Shoulder Surgery; A Double-Blinded Randomized Open-Label Clinical Trial.

BACKGROUND: Post-arthroscopic shoulder surgery pain is severe enough to interfere with initial recovery and rehabilitation. OBJECTIVES: We aimed to evaluate the analgesic effects of postoperative ultrasound-guided suprascapular plus axillary nerve blocks superficial subepidermal axon bundles (SSAB) with interscalene block (ISB) in arthroscopic shoulder surgery. METHODS: In this single-blind randomized, open-label clinical trial, 80 candidates of elective arthroscopic shoulder surgery were randomly allocated to receive either SSAB or ISB at a postoperative care unit. The severity of resting and changing position pain was measured using visual analogue scale (VAS) score at 4h, 8h, 12h, 16h, and 24h, postoperatively. Timing of first opioid request, 24h dose requirement, patients' satisfaction rate, and side effects were also recorded. All registered data were analyzed using SPSS software version 23 for Windows (SPSS, Chicago, IL). RESULTS: Resting and changing position pain scores were comparable between SSAB and ISB groups in the most time intervals. At 12h, moving and resting pain was significantly lower in ISB than SSAB group, while moving pain was more severe in ISB group at 24h assessment. Patient satisfaction scores were comparable between the two groups except for 12h assessment. Time to first analgesic requirement and total dose of 24h opioid requirement were not significantly different between the two groups. CONCLUSIONS: Suprascapular plus axillary nerve block could be an effective and safe alternative for interscalene block for pain management after arthroscopic shoulder surgery.

Desmopressin nasal spray reduces blood loss and improves the quality of the surgical field during functional endoscopic sinus surgery.

BACKGROUND AND AIMS: Making a dry surgical field during functional endoscopic sinus surgery (FESS) is a challenge for anesthetists. This study was conducted to evaluate the pre-emptive hemostatic effects of a single dose of an intranasal spray of desmopressin (DDAVP) in sinus surgery. MATERIAL AND METHODS: Sixty consecutive patient's as first-time candidates for FESS due to chronic sinusitis were enrolled. They were randomly allocated to receive either a nasal spray of DDAVP 20 µg or sterile water before induction of anesthesia. Management of anesthesia was achieved with propofol and remifentanil infusions. Blood loss, quality of the surgical field, and surgeon's satisfaction were compared between the two groups. RESULTS: Blood loss in the DDAVP group was 147 ± 43 mL and in the placebo group 212 ± 64 mL (mean ± SD, P < 0.01). The quality of the surgical field in the DDAVP group was better than the placebo group. (median score, 1 (1-2) vs. 2 (1-3), P = 0.017). Surgeons were more satisfied with the surgical field in the DDAVP group than in the control group (median score, 4 (2.8-5) vs. 3 (2-3), P = 0.04). CONCLUSION: Premedication with nasal spray DDAVP 20 µg effectively reduces bleeding and improves the surgical field during FESS.

Anesthesia for laryngotracheal reconstruction in a child with single ventricle.

The number of children with congenital heart requiring anesthetic care is increasing. We describe the anesthetic management of a child with single ventricle candidate for laryngotracheal reconstruction. The patient suffered from severe subglottic stenosis due to prolonged intubation following Glenn shunt procedure. Anesthetic considerations in the care of patients with single ventricle for non-cardiac surgeries are reviewed. Particular concerns in the airway management of children with severe subglottic stenosis and during the tracheal surgery are also reviewed.

Regional vitamin C in Bier block reduces the incidence of CRPS-1 following distal radius fracture surgery.

BACKGROUND: Systemic vitamin C supplementation after wrist fracture has been suggested to reduce the incidence of complex regional pain syndrome (CRPS). This study aimed to evaluate the effect of regional vitamin C in Bier block in the early phase of fracture on CRPS occurrence following surgery for distal radius fractures. METHODS: Seventy-four patients with isolated extra-articular distal radius fracture with the plan of fixation under Bier block were enrolled. Patients were assigned randomly into two groups: receiving either 500 mg vitamin C or sterile water as a Bier block adjuvant. Both groups received 500 mg of oral vitamin C for six weeks. The patients were evaluated for CRPS signs and symptoms at 2, 4, 6, and 12 weeks post-surgery. RESULTS: The overall incidence of CRPS 12 weeks after surgery in the vitamin C group was significantly less than the controls (22.9% vs 45.5%, p = 0.04). Logistic regression analysis showed that the only significant contribution in predicting the incidence of CRPS came from the intervention variable (OR 0.26, CI95% 0.08-0.85; P = 0.027). CONCLUSIONS: The findings suggest that adding vitamin C 500 mg to the local anesthetic in Bier block significantly reduces the incidence of CRPS following distal radius fractures.

The Effect of Preoperative Oral Versus Parenteral Dextrose Supplementation on Pain, Nausea, and Quality of Recovery After Laparoscopic Cholecystectomy.

PURPOSE: Earlier studies suggest that carbohydrate loading is effective in reducing preoperative nausea. This study was conducted to investigate the effect of preoperative oral versus parenteral carbohydrate loading on the postoperative pain, nausea, and quality of recovery (QoR). DESIGN: Three-arm randomized, single-blind clinical trial. METHODS: In this study, 95 adult patients scheduled for elective laparoscopic cholecystectomy were randomly assigned into three groups of preoperative intravenous dextrose 10% infusion, oral carbohydrate (OCH)-rich drink, and control. The pain and nausea severity scores were measured during recovery, 6 hours, and 24 hours thereafter. The 40-item QoR score was evaluated the day after surgery. FINDINGS: In recovery, nausea severity was comparable among three groups, whereas pain score in the OCH group was significantly less than the controls (P = .009). Pain score in patients who received intravenous dextrose was mediocre and not statistically different from two other groups. Six and 24 hours after surgery, nausea and pain scores in OCH and dextrose infusion groups were significantly lower than the control group (P < .05). The 40-item QoR score was significantly higher in intervention groups than control participants (P < .05). Blood glucose levels were comparable in three groups before and after surgery. CONCLUSIONS: Preoperative carbohydrate loading significantly improves the QoR after laparoscopic cholecystectomy without significant effect on blood glucose levels. Oral route more effectively controls nausea and pain than parenteral dextrose administration.

The effects of ondansetron versus dexamethasone on electrocardiographic markers of ventricular repolarization in children undergoing cochlear implant.

INTRODUCTION: Congenital hearing loss is associated with cardiac rhythm disturbances namely long Q-T syndrome. This study was designed to investigate the effect of anti-emetic doses of ondansetron and dexamethasone on ECG recordings in children undergoing cochlear implant surgery. METHODS: Sixty-three pediatric patients scheduled for elective cochlear implantation were enrolled in the study. Two patients were excluded as their baseline ECG showed long QT syndrome. Anesthesia was induced with fentanyl, propofol and atracurium and maintained with propofol. Dexamethasone 0.1 mg.kg-1or ondansetron 0.2 mg.kg-1was randomly administered for the participants approximately 30 min before the end of surgery. ECG recording was performed 15 min after induction of anesthesia and 15 min after dexamethasone/ondansetron administration. RR interval, QRS duration, QT interval, and Tp-e interval were measured by a blinded cardiologist. RESULTS: Ondansetron resulted in no significant changes in RR, JTc and QTc intervals; while prolongedTp-e interval. Multivariable logistic regression analysis showed that use of ondansetron was an independent predictor of QTc prolongation after adjustment for age, gender and baseline QTc (OR = 17.94, CI 95% 1.97-168.70, p = 0.011). The incidence of postoperative retching/vomiting in ondansetron group was significantly lower than dexamethasone group. (3.2% vs. 26.7%, p = 0.011). CONCLUSION: The risk of arrhythmias with the use of ondansetron in otherwise healthy candidates of cochlear implant is very low. However, the drug may induce significant changes in ECG parameters. The clinical significance of these changes in patients with cardiac conduction abnormalities should be investigated in further studies.

Effects of Liberal Versus Restrictive Fluid Therapy on Renal Function Indices in Laparoscopic Bariatric Surgery.

BACKGROUND: Earlier studies have suggested the liberal administration of fluids in favor of reducing the risk of rhabdomyolysis in obese patients, but the results are conflicting. OBJECTIVES: The present study aimed at comparing the effects of liberal and restrictive fluid therapy on renal indices in laparoscopic gastric bypass surgery. METHODS: In a double-blinded randomized clinical trial, 72 candidates of bariatric surgery were randomly assigned into two groups of restrictive and liberal fluid therapy. Indices, including BUN, creatinine, creatine kinase, GFR, and urine output were measured before and 24 hours after the surgery. The clinical trial was registered at IRCT.ir under code IRCT20170109031852N3. RESULTS: There was no significant difference in BUN, creatinine, creatinine kinase, and GFR indices between the two groups of liberal and restrictive fluid therapy both before and 24 hours after surgery (P > 0.05). Intragroup comparisons before and after surgery revealed that BUN decreased in both groups after the surgery (P < 0.05). Also, creatinine and GFR values improved in patients who received a liberal fluid regimen, whereas these indices remained statistically unchanged in the restrictive group before and 24 hours after the surgery (P > 0.05). CONCLUSIONS: Two methods of liberal and restrictive fluid therapy have comparable effects on traditional renal functional indices in laparoscopic bariatric surgery. The clinical significance of observed differences in outcomes should be investigated in further studies. The use of early biomarkers of acute kidney injury is warranted.

Safe Use of Flammable Endotracheal Tubes During Anesthesia for Laryngeal Laser Surgery-Report of 1024 Cases and a Brief Literature Review.

INTRODUCTION: One of the major concerns in laryngeal laser surgery is the risk of airway fire. The introduction ofwrapped tubes and metal tubes has reduced the fire hazards. However, these tubes are expensive and do not provide convenient access to the surgical field. There are few laboratory studies addressing the resistance of polyvinylchloride tubes against ignition in the given circumstances. Nevertheless, its safety should be approved in clinical practices. MATERIALS AND METHODS: This retrospective studyevaluated the airway management on 1024 patients undergoing laryngeal laser surgery. The data collection included the information about the type of endotracheal tube (ETT), mode of ventilation, and airway hazards (e.g., tube ignition). RESULTS: Polyvinylchloride tubes and conventional positive pressure ventilation was applied for most of the patients (84.1%). The tube cuff was pierced with laser beam in 22 cases (2.5%). However, there was no case of ETT ignition or airway fire. CONCLUSION: Polyvinylchloride tubes can be safely used in this subset of surgeries pending meticulous attention to the safety recommendations.

The injection rate of intravenous midazolam significantly influences the occurrence of paradoxical reaction in pediatric patients.

BACKGROUND: Paradoxical reactions to benzodiazepines including restlessness, anxiety and sometimes violent behavior sometimes occur. Most of the known predicting factors of disinhibitory reactions such as age, gender, genetic or the psychological background are not modifiable. This study was conducted to evaluate the effect of rate of midazolam administration, as a controllable factor, on the occurrence of paradoxical reaction to midazolam (PRM) in pediatric patients. MATERIALS AND METHODS: In a randomized, double-blind clinical trial 98 American Society of Anesthesiologists physical status I, II, aged from 6 months to 6 years, and undergoing elective surgery, were enrolled in the study. Patients were randomly allocated to receive midazolam 0.1 mg/kg as a 0.1% solution at an injection rate of 0.2 ml/s or 1 ml/s. The occurrence of PRM was compared between the two groups with Chi-square test. RESULTS: The occurrence of PRM in the rapid injection group was significantly higher than the slow injection group (20.4% vs. 4.1%, P < 0.05, relative risk CI: 95% 6.03 (1.24-29.4)). CONCLUSION: Slow intravenous administration of midazolam significantly reduces the occurrence of paradoxical reactions and should be respected in premedication of pediatric patients.

Does changes in the electrical resistance of an acupuncture meridian predict pain intensity following orthopedic surgery?

BACKGROUND: Several methods for assessment of severity of pain have been proposed but all of them are subjective. OBJECTIVES: This study evaluated the association concerning changes in electrical resistance (ER) between two acupuncture points and severity of postoperative pain in order to define an objective measurement of pain. PATIENTS AND METHODS: In a cross-sectional study, 50 patients undergoing lower extremity orthopedic surgery with postoperative moderate to severe pain (VAS > 4,) were consecutively enrolled. In the recovery room, the patients' pain scores were assessed and in patients with VAS > 4, the electrical resistance between Li4 and Li11 acupuncture points as well as pain scores was measured prior and following analgesic administration. RESULTS: Following meperidine use, the mean VAS significantly decreased and the ER between the two acupoints was significantly increased. However, Pearson correlation analysis did not reveal any association between the trends of pain intensity and ER (P > 0.05). The ER change in patients operated under epidural anesthesia was significantly less than those who experienced general or spinal anesthesia. CONCLUSIONS: There is a coincidence of pain relief and change in the ER of acupuncture meridians without significant association. The diagnostic value of ER for pain, stress response or any other physiologic outcome needs to be investigated in clinical trials with a well-defined control group, with more accurate instruments and probably in different acupuncture meridians.

Intraoperative haloperidol does not improve quality of recovery and postoperative analgesia.

INTRODUCTION: Haloperidol has an established role in nausea and vomiting prophylaxis and possible effects on multiple aspects of postoperative recovery including pain and sedation. The purpose of this study was to evaluate the effects of low-dose intraoperative intravenous haloperidol on quality of recovery (QoR) and pain control after general anesthesia and surgery. METHODS: Ninety eight American Society of Anesthesiologists (ASA) physical status I-II patients undergoing elective general, gynecologic or orthopedic surgery under general anesthesia were enrolled. Participants were randomly allocated to receive either haloperidol 2 mg or sterile water intravenously after induction of anesthesia. All patients were given elastometric morphine patient-controlled analgesia (PCA) pump for pain control after the surgery. Post-operative QoR was evaluated within 20 min in the recovery room and 6 h post-operatively. Pain intensity and demand for additional analgesic was measured in the 6(th) post-operative hour. RESULTS: The QoR score in two measurements was not statistically different between the two groups. Haloperidol significantly reduced the nausea in the recovery. The visual analog scale pain score showed that the severity of pain in the haloperidol group was more than the placebo group (4.7 ± 2.4 vs. 3.8 ± 2.5, P = 0.05). CONCLUSION: Intraoperative small-dose IV haloperidol is effective against post-operative nausea and vomiting with no significant effect on overall QoR. It may also attenuate the analgesic effects of morphine PCA.

Effect of clonidine premedication on blood loss in spine surgery.

BACKGROUND: Blood loss in spine surgery is an important issue, even though it has been understudied compared with hip and knee arthroplasty. OBJECTIVES: In this study, we evaluated the effect of oral clonidine as premedication on blood loss in lumbar spine fusion surgery under anesthesia with propofol and remifentanil. PATIENTS AND METHODS: In this double-blind, randomized clinical trial, 30 patients who were undergoing lumbar spine posterior fusion surgery due to traumatic fracture were allocated randomly into 2 groups. The study group (clonidine group) received a 200-µg oral clonidine tablet 60-90 minutes before anesthesia, and the control group received placebo at the same time. Induction and maintenance of anesthesia and the mean target arterial pressure for controlled hypotension with remifentanil were the same in the 2 groups. We compared the amount of intraoperative blood loss, dose of remifentanil/hour administered, need for nitroglycerine to reach the mean target arterial pressure when remifentanil was insufficient, duration of operation, and surgeon's satisfaction of a bloodless field between groups. RESULTS: There was no statistically significant difference between groups in age (P = 0.115), sex (P = 0.439), weight (P = 0.899), operation time (P = 0.2), or American Society of Anesthesiologists physical status score (P = 0.390). Intraoperative blood loss and remifentanil dose administered per hour in the clonidine group were significantly less than in the control group (P = 0.002 and P = 0.001, respectively), but there was no significant difference in surgeon's satisfaction between groups (P = 0.169). CONCLUSIONS: As an oral premedication, clonidine can reduce surgical blood loss in lumbar spine posterior fusion surgery, even at the same levels of mean arterial pressure (MAP) with the control group. Its use can be studied in more complicated spine surgeries, such as scoliosis and spinal deformity surgeries.

The effect of intravenous tranexamic acid on blood loss and surgical field quality during endoscopic sinus surgery: a placebo-controlled clinical trial.

STUDY OBJECTIVES: To evaluate the effects of intravenous (IV) tranexamic acid on blood loss and surgical field quality during functional endoscopic sinus surgery (FESS). DESIGN: Randomized, double-blinded, controlled trial. SETTING: Operating room and postoperative recovery area of a university-affiliated hospital. PATIENTS: 84 consecutive, adult, ASA physical status 1 and 2 patients undergoing FESS. INTERVENTIONS: Patients were randomized to receive either IV tranexamic acid 10 mg/kg (TA group) or sterile water 0.1 mL/kg (placebo group) as a bolus dose immediately after induction of anesthesia. MEASUREMENTS: Amount of blood loss and bleeding and satisfaction scores were obtained from the surgeon. MAIN RESULTS: Blood loss in the TA group was 184 ± 64 mL and in the placebo group, 312 ± 75 mL on average (P < 0.01). The median (range) bleeding score in the TA group was significantly lower than the placebo group [2 (1-3) vs 2.5 (2-4); P < 0.0001]. The surgeon was more satisfied with the surgical field in the TA group than the placebo group [median score: 4 (3-5) vs 3 (1-5), P < 0.001]. CONCLUSION: Intravenous tranexamic acid effectively reduces bleeding and improves the surgical field during FESS.

The effect of oral clonidine premedication on blood loss and the quality of the surgical field during endoscopic sinus surgery: a placebo-controlled clinical trial.

Bleeding during functional endoscopic sinus surgery (FESS) remains a challenge for both surgeons and anesthesiologists despite several modalities available for improving the surgical field. This study was conducted to evaluate the effect of oral clonidine premedication on blood loss and the quality of the surgical field in FESS. In a placebo-controlled clinical trial, a total of 84 American Society of Anesthesiologists (ASA) physical status I-II patients undergoing endoscopic sinus surgery for chronic sinusitis were randomly allocated to receive either oral clonidine 0.2 mg or identical-looking placebo tablets 90 min before arrival at the operating room. Blood loss in the clonidine group was 214 ± 67 ml on average and that in the placebo group was 276 ± 78 ml (mean ± SD, p < 0.01). The median (range) bleeding score in the clonidine group was significantly lower than that in the placebo group (2 (1-3) vs. 2.5 (2-4), p < 0.0001). Accordingly, the surgeon was more satisfied with the surgical field in the clonidine group than with that in the placebo group (median score, 4 (3-5) vs. 3 (1-5), p < 0.001). In conclusion, premedication with oral clonidine 0.2 mg can effectively reduce bleeding during FESS.

Strepsils® tablets reduce sore throat and hoarseness after tracheal intubation.

BACKGROUND: Amyl-m-cresol (Strepsils®) has been successfully used in the prophylaxis and treatment of oral inflammations, but its effects on postintubation sore throat and hoarseness are unknown. We conducted this study to evaluate the effects of Strepsils in reducing postintubation sore throat and hoarseness. METHODS: One hundred fifty patients, ASA physical status I to II, scheduled to undergo general anesthesia and elective orthopedic or gynecologic surgery were enrolled. Participants were randomly allocated to receive either Strepsils or identical-looking placebo tablets immediately before arrival to the operating room. The incidence and severity of postoperative sore throat and hoarseness were evaluated immediately and 24 hours after surgery. RESULTS: The incidence of early postoperative sore throat was 13.7% and 33.3% and hoarseness was 12.3% and 26.4% in the Strepsils and placebo groups, respectively (P < 0.05). One day after surgery, the incidence of sore throat decreased to 6.8% and 18.1% in the Strepsils and control groups, respectively. The incidence of hoarseness 1 day after the operation decreased to 8.2% in the Strepsils group and 19.4% in the placebo group, but the difference remained statistically significant (P < 0.05). CONCLUSION: Perioperative use of Strepsils tablets reduces postoperative sore throat and hoarseness of voice.