Comparison of Morphine and Fentanyl IV-PCA in Gastrectomy Patient

BACKGROUND: Morphine and fentanyl have potent analgesic effects and these agents are widely used for intravenous patient controlled analgesia (IV-PCA); however, these drugs have some side effects. The purpose of this study was to compare the postoperative analgesic effects and side effects of morphine and fentanyl, employing IV-PCA after gastrectomy. METHODS: Fifty patients undergoing gastrectomy were randomized to receive either morphine (M goup, n = 25) or fentanyl (F group, n = 25) via an IV-PCA pump for 48 hours after the end of surgery. The loading dose was administered when a patient first complained of pain, followed by a bolus dose of 2 mg morphine for the M group and 20microg fentanyl for the F group, with a lockout interval of 10 minutes between doses. The VAS pain score, PCA opioid consumption, rescue analgesic requirement, and side effects were assessed at 2, 6, 12, 24 and 48 hours after the end of surgery. RESULTS: No significant differences were observed between the two groups in terms of the VAS pain score, satisfaction score and total and hourly dose for 48 hours. The side effects were similar in both groups except that pruritus and urinary retention were significantly lower in the F group of patients. CONCLUSIONS: We conclude that both morphine and fentanyl have good analgesic effects with few side effects in gastrectomy patients, but the fentanyl group of patients experienced less pruritus and urinary retention than the morphine group of patients.

Damage to an Endotracheal Tube during Lefort I Osteotomy: A case report / 대한마취과학회지

In maxillofacial surgery endotracheal tube provides patent airway and prevents patient from aspirating the blood. But serious complications such as tube obstruction or injury have been reported. In this case, endotracheal tube injury by surgical saw during Lefort I osteotomy occurred. We could not exchange the defective tube for a good one using laryngoscope or fiberoptic bronchoscope due to edema and blood in nostril and oral cavity. We didn't have any tube exchanger available too. Therefore, to provide patent and safe airway, we packed gauze around the lacerated part of tube, provided positive end expiratory pressure ventilation and increased oxygen flow. After anesthesia, the damaged tube was safely removed and there were no respiratory complications.