The Effect of Pharyngeal Packing on Postoperative Gastric Volume in Patients Undergoing Nasal Surgery

Study Overview
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Brief Summary
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Pharyngeal packing is a frequently used application to reduce the incidence and severity of postoperative nausea and vomiting (PONV) in patients who undergo nasal surgery. This study aims to research the effects of PP on gastric antral cross-sectional area (ACSA) and hence gastric volume as assessed by ultrasound, therewithal PONV and sore throat were evaluated as secondary outcomes in rhino logic surgeries (Septorhinoplasty, Septoplasty, Functional endoscopic sinus surgery).

Detailed Description
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Postoperative nausea and vomiting (PONV) after nasal surgery (Septorhinoplasty, Septoplasty, Functional endoscopic sinus surgery) is a very common complication (34-60%). Therefore, pharangeal packing was performed to prevent blood ingestion so as to decrease the incidence of PONV and the risk of aspiration. Also, gastric blood is known to be a powerful emetic. Actually, there is not any evidence in the literature reporting the quantitative values of gastric volumes due to blood ingestion. The aim of this study is to research the effect of pharyngeal packing on the perioperative gastric antral cross-sectional area (ACSA) so the gastric volumes. Measurements were performed by ultrasound with convex probe in right lateral decubitus position, in order to evaluate the effectiveness of pharyngeal packing in patients undergoing nasal surgery, and to show its effects on PONV and sore throat.

Official Title
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Investigation of the Effect of Pharyngeal Packing on Postoperative Gastric Volume in Patients Undergoing Nasal Surgery

Conditions
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Anesthesia, Nasal Surgery, Pharyngeal Packing, Gastric Volume, Postoperative Nausea

Intervention / Treatment
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* Device: Pharyngeal packing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: undergoing elective nasal or paranasal sinus surgery following overnight fasting 18-70 years of age accepting to join the study American Society of Anesthesiologist (ASA) classification system I-III Body mass Index (BMI) < 30 kg/m2 Exclusion Criteria: ASA classification higher than III Age younger than 18 years BMI>30 kg/m2 Preoperative vomiting or antiemetic medication therapy Intubation needing more than two laryngoscopy attempts Not agreeing to participate in the study Coagulation disorders Diseases or conditions affecting gastric volume or motility

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Group Control<br>Without pharyngeal pack insertion | |
| Experimental: Group Pharyngeal packing (Group PP)<br>Pharyngeal pack insertion after endotracheal intubation | Device: Pharyngeal packing<br>* Placing gauze-like material in the nasal cavity to absorb blood or other fluids right after tracheal intubation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The crosssectional area (ACSA) (Postoperative) (mm2) (Postoperative) | measurements are done with USG and calculated with this formula CSA = (AP (anterior-posterior) diameter × CC (cranio-caudal) diameter× 3.14) / 4. | 10 minutes before extubation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative presence and severity of PONV | The severity of PONV was assessed according to the four points score: None (0 point), nausea (1 point), nausea with maximum of two vomiting episodes (2 points), more than two vomiting episodes (3 points). When PONV with ≥ 2 points metaclopropamid 10 mg was done, and in order to repetition granisetron 3 mg was added. | at the first, second and 24th hours in PACU and at the ward | 
| The severity of sore throat | No pain (0 point), mild pain (1 point), moderate pain (2 points) and severe pain (3 points). Patients with severe sore throat were given paracetamol. | at the first, second and 24th hours in PACU and at the ward | 
| Blood volume in the suction system | weighing sponge, pad, compress and blood volume in the aspirator | in the perioperative period |