Comparative Analysis of Nebulized Versus Intravenous Fentanyl for Pain Control After Tonsillectomy: A Double-Blind, Randomized, Controlled Trial.

OBJECTIVES: Effective posttonsillectomy analgesia is crucial for patient comfort and recovery. Fentanyl, notable for its potency, rapid action, and lipophilicity, has been successfully used in various procedures through multiple administration routes. However, the use of its nebulized form for posttonsillectomy pain has not been extensively explored. This study sought to compare the analgesic efficacy, onset time, and complications between nebulized and intravenous fentanyl in posttonsillectomy patients. METHODS AND METHODS: In this randomized controlled trial, adult patients who underwent tonsillectomy were assigned to either an intravenous fentanyl group (1 mcg/kg) or a nebulized fentanyl group (4 mcg/kg). In both groups, fentanyl was administered when pain scores exceeded three. Pain levels were monitored every 5 minutes until they fell below four. The study also recorded the duration until the next analgesia request and noted complications (such as respiratory depression, bradycardia, chest tightness, drowsiness, nausea, pruritus, sweating, and flushing) within 24 hours. Patient exclusions were based on predetermined criteria. RESULTS: From an initial cohort of 59 patients, 22 in the intravenous group and 27 in the nebulizer group were eligible for analysis after applying the exclusion criteria. The nebulizer group exhibited a significantly prolonged period before the next analgesia request, with a median of 683.5 minutes (interquartile range 260-1440), in contrast to the 326.7 minutes (145.0-504.7) observed in the intravenous group (P = .009). The time to achieve a pain score less than 4 and the incidence of side effects did not differ significantly between the groups. CONCLUSION: Nebulized fentanyl provided a longer duration of analgesia than intravenous fentanyl in posttonsillectomy pain management, with similar onset times and side effect profiles. These findings underscore the potential of nebulized fentanyl as an effective alternative for pain control in posttonsillectomy patients.

Comparison of efficacy of meperidine and fentanyl in terms of pain management and quality of life in patients with cervical cancer receiving intracavitary brachytherapy: a double-blind, randomized controlled trial.

OBJECTIVE: The aim of this study was to compare the effectiveness of two sedative regimens, a benzodiazepine with either meperidine or fentanyl, in relieving pain in patients with cervical cancer undergoing intracavitary brachytherapy in terms of pain score and quality of life. METHODS: Forty unselected outpatients undergoing brachytherapy (160 fractions) were enrolled with informed consent and randomized to receive a benzodiazepine with either meperidine or fentanyl. The perceived pain score according to a standard 10-item numeric rating scale was collected every 15 min during the procedure, and the perceived quality of life was determined at the end of each procedure using the EuroQol five-dimension questionnaire. The patients and medical staff members directly involved with the procedure were blinded to the medication used. RESULTS: The patients' pain levels were mild in both analgesic groups. Meperidine appeared to be slightly more effective than fentanyl, although the differences in the average pain score and quality of life were not statistically significant. CONCLUSION: Both meperidine and fentanyl in combination with benzodiazepine were effective in relieving pain and discomfort in patients undergoing brachytherapy. TRIAL REGISTRATION: NCT02684942, ClinicalTrials.gov.

Comparison of Spraying and Nebulized Lidocaine in Patients Undergoing Esophago-Gastro-Duodenoscopy: A Randomized Trial.

OBJECTIVE: Esophago-gastro-duodenoscopy (EGD) was performed under the topical anesthesia of the pharynx. However spraying lidocaine was found to be an annoying maneuver to patients, while nebulized lidocaine appeared to efficiently suppress gags and cough reflexes in airway anesthesia. This study aimed to compare the effectiveness of spraying and nebulized lidocaine for patients undergoing EGD. MATERIAL AND METHOD: A total of 110 patients undergoing elective EGD, with a history of neither lidocaine intolerance nor irritable airways due to smoking, chronic obstructive pulmonary disease (COPD), upper respiratory infection, asthma, cardiac and pulmonary diseases and allergy to lidocaine were included. All patients were randomized into two groups: A- where 5 puffs (10 mg/puff) of spraying lidocaine were administered four times at 5-minute intervals, up to a total dose of 200 mg, and B-where 250 mg of nebulized lidocaine was administered via a nebulization kit with an oxygen face mask of 7 LPM for 15 minutes prior to the commencement of EGD. The procedure was performed by the same board-certified endoscopist The co-researcher who was blinded to the lidocaine administration technique assessed the ease of esophageal instrumentation as either difficult, poor; fair or excellent. Both the endoscopist and the patients expressed their satisfaction by using the numerical rating scale. RESULTS: The endoscopist expressed her satisfaction with instrumentation, which showed significant difference between group A and group B as 84.8 ± 8.3 and 79.2 ± 11.2, respectively. The co-researcher also found that group A patients responded to the ease of esophageal instrumentation better than those in group B. However nebulized lidocaine had significant advantages over spraying lidocaine, with better acceptance in patients undergoing EGD. CONCLUSION: The endoscopist expressed her approval of spraying lidocaine for taking less time to start the procedure, ease for instrumentation, less gag reflex during the procedure, less presence of hypersecretion, and smooth operation. However participants favored nebulized lidocaine administration.

The Montreal Cognitive Assessment as a Screening Tool for Preoperative Cognitive Impairment in Geriatric Patients.

OBJECTIVE: Study the prevalence of cognitive impairment using the Montreal Cognitive Assessment (MoCA), its relationship to physiologic age-related change, and the preoperative drugs used in geriatric patients. MATERIAL AND METHOD: At the preoperative visit, the co-researchers invited 322 general/vascular patients (190 male, 132 female) and 260 urological patients (220 male, 40 female) who met the inclusion criteria and were scheduled for elective surgery to join the study. They went for the MoCA interview, and their preoperative drugs used were recorded in a medication reconciliation file. A cut-off score 24 or above was considered normal. RESULTS: Ninety-two general/vascular and 126 urological patients had taken drugs before admission, but those did not show any correlation with the MoCA score. There were 231 and 91 general/vascular patients and 175 and 85 urological patients with formal education of less than six years and equal/more than six years respectively. The 286 and 36 general/vascular patients and 212 and 48 urological patients posted scores of less than 24 and equal/more than 24 respectively. Gender and education correlated positively and significantly with the score; however age proved negatively significant. CONCLUSION: The prevalence of cognitive impairment featured highly in preoperative geriatric patients. The gender age, and education but not preoperative drugs used affected cognitive function.

A stress survey in anesthesia personnel in Thailand.

OBJECTIVE: To find out stressful events related to anesthesia and psychological responses in anesthesia personnel. MATERIAL AND METHOD: Three hundred fifty three nurses and 286 doctors from all over the country who currently working in operating theatres participated in this study. Research tools comprised of interactive online anesthesia-related and psychological stress tests. Data were analyzed as mean and standard deviations. Comparisons of all associated factors between groups were performed by the Kolmogorov-Smirnov Two-Sample test and t-test independent. Correlations between groups were determined by Spearman's rho and Pearson's. Statistical significance was defined as p-value less than 0.05 with a 95% confidence interval. RESULTS: Nurses expressed greater worries with impairment of cognitive and immune functions, particularly on night shifts. They had intense responsibility, compounded by lack of experiences and knowledge. Doctors were under stress during the day. This depended on their ages, experiences, morbidity rumors, working hours, and day off after operation, which manifested themselves as disturbances of the autonomic nervous system and emotions. CONCLUSION: Nurse anesthetists expressed their worries, particularly on night shifts. Their psychological distresses were observed as impairment of cognitive and immune functions. Doctors were under professional stress during the day, which came across as disturbances of the autonomic nervous systems and emotions.

Comparison of the clinical use of macintosh and miller laryngoscopes for orotracheal intubation by second-month nurse students in anesthesiology.

Aim. The aim of this study is to compare the clinical feasibility of Macintosh and Miller laryngoscopes for tracheal intubation in non-experienced users in anesthetized patients. Patients and Methods. 119 patients were randomized into the Macintosh group (59) and the Miller group (60). The primary outcome variable was successful tracheal intubation. The secondary outcome variables were number of insertion attempt, intubation time needed, total time to intubation, hemodynamic change and complications. Results. All patients were successfully intubated using the Macintosh, whereas 13 patients (21.6%) were failed with the Miller (P < .001). The Macintosh significantly reduced the mean total time to intubation (P < .001). There were significant differences in the mean blood pressure at 2 minutes after laryngoscope insertion, immediately, and 2 minutes after tracheal intubation and in the mean heart rate at the laryngoscope insertion, immediately, and at 2 minutes after tracheal intubation between the two groups. Overall complications in both were not significantly different. Conclusion. Orotracheal intubation using the Macintosh is an effective and safe technique in non-experienced hands with significantly increased success rate as well as decreased mean total time to intubation as compare to the Miller. However, these intubations only apply to selected patients deemed to have normal airways.