RESUMEN
OBJECTIVE: Antagonism of the central nervous system inhibitor neurotransmitter gamma-Aminobutyric acid (GABA) or serotonergic system activation is an important factor in the pathogenesis of intrathecal morphine-induced pruritus. This study tested the hypothesis that preoperative use of ondansetron, gabapentin or mirtazapine can prevent morphine-induced pruritus. METHODS: We randomly allocated 80 patients of American Society of Anesthesiology (ASA) classification I and II physical status who were to undergo unilateral inguinal hernia or pilonidal sinus operations under spinal anesthesia into 4 equal groups. The first 3 groups received oral doses of 30 mg mirtazapine, 8 mg ondansetron, and 1200 mg gabapentin at 2 hours, 10 minutes, and 1 hour before surgery, respectively, and the fourth group was given a placebo. All patients received intrathecal injection of 15 mg of 0.5% hyperbaric bupivacaine and 0.2 mg morphine. Pruritus was evaluated at 0, 3, 6, 9, 12, and 24 hours after intrathecal morphine administration, and details of presence, onset time, duration, localization, and severity of pruritus were recorded. RESULTS: Incidence of pruritus was significantly more frequent in the placebo group compared to ondansetron, gabapentin, and mirtazapine groups (70%, 55%, 35%, and 35%, respectively). In general, onset of pruritus was between 2 and 6 hours after intrathecal morphine injection; however, onset in the gabapentin group (mean±SD: 4.75±2.7 hours; p=0.019) was delayed compared to other groups. It was observed that pruritus persisted relatively longer in the ondansetron and placebo groups (mean±SD: 6±3.08; 5.82±2.96 hours, respectively; p=0.047). No statistical determination was made regarding location of pruritus. Severity of pruritus was greater in the placebo group (p=0.0001). Necessity for antipruritic treatment was not statistically significantly different between groups. CONCLUSION: Incidence and severity of intrathecal morphine-induced pruritus decreased with use of each of all 3 drugs compared to placebo.
RESUMEN
OBJECTIVES: To compare the insertion time, ease of device insertion, ease of gastric tube insertion, airway leakage pressure, and complications between the laryngeal mask airway (LMA) ProSeal (P-LMA) and I-gel (I-gel) groups. METHODS: Eighty patients with age range 18-65 years who underwent elective surgery were included in the study. The study took place in the operation rooms of Haydarpasa Numune Hospital, Istanbul, Turkey from November 2013 to April 2014. Patients were equally randomized into 2 groups; the I-gel group, and the P-LMA group. In both groups, the same specialist inserted the supraglottic airway devices. The insertion time of the devices, difficulty during insertion, difficulty during gastric tube insertion, coverage of airway pressure, and complications were recorded. RESULTS: The mean insertion time in the I-gel group was significantly lower than that of the P-LMA group (I-gel: 8±3; P-LMA: 13±5 s). The insertion success rate was higher in the I-gel group (100%, first attempt) than in the P-LMA group (82.5%, first attempt). The gastric tube placement success rate was higher in the I-gel group (92.5%, first attempt) than in the P-LMA group (72.5%, first attempt). The airway leakage pressures were similar. CONCLUSION: Insertion was easier, insertion time was lower, and nasogastric tube insertion success was higher with the I-gel application, and is, therefore, the preferred LMA.
