Intra-operative Anesthetic
nausea, Pain, blood loss, vomiting, Wong-Baker, pain, Nausea, retching
BLOOD LOSS, BLOOD, SECONDARY, COMPLICATIONS
Following pre-medication with midazolam 1-2 mg IV, anesthesia was induced with lidocaine 1 mg/kg IV, propofol 1-2 mg/kg IV, fentanyl 1 mcg/kg IV, and rocuronium 0.6 mg/kg IV.The surgeon then administered standard topical intranasal anesthesia with lidocaine and epi-soaked pledgets on the inner nasal mucosa. Less than 10 cc of 1% lidocaine with epi 1:200 000 was used to ensure hemostasis. Access to the pituitary gland was obtained transnasally with an endoscope Following induction of anesthesia, the local injection study block drug/placebo was administered, and the patients were maintained on a balanced anesthetic technique using intravenous agents, inhaled gas, and a neuro-muscular relaxant. Desflurane in OPost-operatively, a morphine PCA (1mg IV every 6 min lock-out time) to a max of 10 mg IV morphine sulfate per hour, without a basal rate, was administered. For pain ranked at > 4/10, rescue pain medicine of morphine 1 mg IV was administered by the PACU recovery room nurses every 5-10 min until the pain was < 4/10 or acceptable to the patient. Blood pressure was maintained with a systolic BP < 140 mmHg using (labetalol, esmolol, and nicardipine). Following intraoperative treatment of nausea with ondansetron and dexamethasone/hydrocortisone, the following escalating rescue algorithm was used for PONV:1) Additional ondansetron 4 mg IV for 1 dose, then2) Prochlorperazine 5-10 mg IV, then3) Scopolamine patch 1.5 mg topical [The primary outcome of the study was to compare the total amount of morphine (in mg) used postoperatively (for 6 hours) in the 2 study groups from T0-T6 time from PACU entry (T0) to 6 hours post PACU entry (T6). Study data were collected for 5 data time points: T0 (PACU entry), T1, T2, T4, and T6 (1,2,4,6 hours after PACU entry, respectively). Pain scores (P0-P6) were collected using the Wong-Baker FACES Pain Rating Scale at times T0-T6 in the scale (0-10/10), with 10/10 being the worst imaginable pain. Nausea score N0-N6 was collected using the Baxter retching faces (BARF) nausea scale (0-10/10), with 10/10 being the worst nausea imaginable with or without vomiting. Other secondary data collected included Tr (total time in PACU from admission to “eligibility” for PACU discharge using the UCSF Modified Aldrete Score), Th (total time from surgery start to eligibility for home discharge), and Tn (time from surgery start to last dose of narcotics). Modified UCSF Aldrete PACU score in PACU assesses individual scores for vital signs, activity, mental status, pain, nausea, blood loss, and intake/output. At one-week post-op, patients were contacted by phone and asked about potential study complications.A research assistant collected all study data and was blinded to the assigned treatment group.