Outcome measures
sore throat, nausea, POV, vomiting or retching, pain, cough, vomiting and/or retching, cyanosis, coughing or bucking, PONV, retching, postoperative nausea (PON), vomiting (POV, nausea, vomiting
SORE THROAT, LARYNGOSPASM, BRONCHOSPASM, COMPLICATIONS
Early recovery times (from delivery of 100% oxygen to first eye opening and response to verbal commands, to extubation and orientation to time and place) were recorded by a blinded anesthesiologist who did not perform anesthesia. A simple verbal order to “open your eyes,” “squeeze my hand,” “open your mouth,” or “stick out your tongue” was given every 15 seconds during emergence. The number of bucking episodes before extubation and the number of cough and sore throat episodes at one, three, and five minutes after extubation, as well as at two and 24 hours postoperatively were recorded. The quality of tracheal extubation was evaluated on a five-rating scale (1 = no cough or buck; 2 = very smooth, minimal coughing; 3 = moderate coughing; 4 = large degree of coughing or bucking; and 5 = poor extubation, very uncomfortable) (An anesthesiologist who was blinded to the study protocol noted complications during emergence in operating room (OR): laryngospasm, bronchospasm, cessation of breathing (number of episodes and duration in seconds), cyanosis, SpOA modified Aldrete score (0-10 points) was used to determine OR and post-anesthesia care unit discharge readiness (≥9 points). Postoperatively, patients were allowed to drink after three hours, if tolerated. All patients stayed in hospital for at least 24 hours. The incidence of postoperative nausea (PON), vomiting (POV), and the use of rescue antiemetic were assessed at two and 24 hours after surgery. Patients were considered to have had PONV if they experienced at least one episode of nausea, vomiting, or retching, or any combination of these during the initial 24 postoperative hours. POV was defined as at least one episode of vomiting or retching that occurred within 24 postoperative hours. PONV was defined as early (within the first two hours) or late (2-24 postoperative hours). Severity of pain was evaluated with a 100-mm visual analog scale (VAS) at the same time points (0 = no pain to 100 = maximum pain). The same blinded anesthesiologist collected postoperative data. Rescue antiemetic (metoclopramide 0.4 mg/kg IV) was given to patients who experienced two or more episodes of vomiting and/or retching within 30 min, any nausea lasting more than 15 min, or nausea VAS score 50 mm or greater, or when they requested treatment. The pain VAS score and the total amount of postoperative opioids were recorded at two and 24 h after surgery. Diclofenac 75 mg intramuscular injection (IM) was given immediately at the arrival to the recovery room. For severe pain (VAS>40 mm), meperidine up to 100 mg IV was used and repeated four hours later if needed.