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Management of perioperative pain after TKA. Orthop Traumatol Surg Res 2023; 109:103443. [PMID: 36252926 DOI: 10.1016/j.otsr.2022.103443] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/05/2022] [Accepted: 04/15/2022] [Indexed: 11/05/2022]
Abstract
Postoperative pain is the prime obstacle to recovery of motion and return to activity after total knee arthroplasty (TKA). Combating pain is a key point in enhanced recovery after surgery (ERAS) protocols. Outcome depends on the efficacy of pain relief, making it a major issue. The pain originates locally in the knee and also remotely via neural pathways. Regression can be slow, over several months. Pain may sometimes be definitive, to a varying degree. Pain should be managed at each step of ERAS, from the preoperative period to the last follow-up consultation, and most especially during the perioperative phase. Pain needs to be anticipated and limited for as long as necessary. The impact of analgesics should be enhanced by means of potentiators. Some are administered by general route, sometimes preoperatively; others are applied locally, directly in the surgical site by local injection, or close to the nerves, to reduce painful stimuli. The two main principles of pain management are preventive analgesia and multimodal analgesia associating various molecules and routes.
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Harkouk H, Capmas P, Derridj N, Belbachir A, Nkam L, Aegerter P, Battaglia E, Tharel L, Fletcher D. Limited impact of a top-down approach to improve enhanced recovery programme in French university hospitals: a before-after retrospective survey. Perioper Med (Lond) 2021; 10:29. [PMID: 34482837 PMCID: PMC8419963 DOI: 10.1186/s13741-021-00200-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 06/08/2021] [Indexed: 11/28/2022] Open
Abstract
Background Enhanced recovery programme (ERP) after surgery needs development in Assistance Publique Hôpitaux de Paris (APHP). Methods A retrospective before-and-after study was performed in 2015 and 2017 on three surgical models (total knee arthroplasty (TKA), colectomy and hysterectomy) in 17 hospitals including 29 surgical departments. Data were collected in one control intervention (total hip arthroplasty (THA), gastrectomy and ovariectomy). In 2016, Massive Open Online Course on ERP and a day meeting information were developed by APHP. A national update on ERP was also organized by HAS and a regional professional partnership programme was started. Primary outcomes were length of stay (LOS) and complications after surgery. Data on ERP items were collected in the patients’ chart and in anaesthetist and surgeon interview. Seventy percent application rate reflects application of ERP procedure. Results 1321 patient’s files were analysed (812 in 2015 and 509 in 2017). The LOS (mean (SD)) is reduced by 1.6 day for TKA (2015, 8.7 (6.7) versus 7.1 (3.4) in 2017; p<0.001) but stable for colectomy and hysterectomy. Incidence of severe complications after surgery is unchanged in all types of surgical models. For TKA and hysterectomy respectively applied items of ERP (i.e. >70% application) increased respectively from 5 to 7 out of 17 and 16 in 2015 and 2017. For colectomy, they were stable at 6 out of 21 in 2015 and 2017. The mean application rates of ERP items stayed below 50% in all cases in 2017. The LOS was negatively correlated with ERP items’ application when data collected in 2015 and 2017 were analysed together. Conclusion ERP application did not significantly improved between 2015 and 2017 for three surgical models after an institutional information and diffusion of recommendations in 29 surgical departments of seventeen French University hospitals underlining the limit of a top-down approach.
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Affiliation(s)
- Hakim Harkouk
- Anaesthesia and Intensive Care Department, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.,Université Paris-Saclay, UVSQ, Inserm, LPPD, 92100, Boulogne, France
| | - Perrine Capmas
- Obstetric Gynecology Department, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France
| | - Nawal Derridj
- Clinical Research Unit, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France
| | - Anissa Belbachir
- Anaesthesia and Intensive Care Department, Cochin Hospital, APHP, Paris, France
| | - Lionelle Nkam
- Clinical Research Unit, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France
| | - Philippe Aegerter
- GIRCI-IDF, Cellule Méthodologie, Paris, France.,Université Paris-Saclay, UVSQ, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP - Centre de recherche en Epidémiologie et Santé des Populations U1018 INSERM UPS UVSQ, 94807, Villejuif, France
| | - Eva Battaglia
- Direction de la Politique et de la Transformation, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Laure Tharel
- Direction de la Politique et de la Transformation, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Dominique Fletcher
- Anaesthesia and Intensive Care Department, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France. .,Université Paris-Saclay, UVSQ, Inserm, LPPD, 92100, Boulogne, France.
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Incidence of akathisia after postoperative nausea and vomiting prophylaxis with droperidol and ondansetron in outpatient surgery. Eur J Anaesthesiol 2018; 35:966-971. [DOI: 10.1097/eja.0000000000000821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hain E, Maggiori L, Mongin C, Prost A la Denise J, Panis Y. Risk factors for prolonged postoperative ileus after laparoscopic sphincter-saving total mesorectal excision for rectal cancer: an analysis of 428 consecutive patients. Surg Endosc 2017; 32:337-344. [PMID: 28656338 DOI: 10.1007/s00464-017-5681-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prolonged postoperative ileus (PPOI) is a common complication after colorectal resection but data regarding PPOI risk factors after laparoscopic rectal cancer surgery is lacking. This study aimed to identify risk factors for PPOI after laparoscopic sphincter-saving total mesorectal excision (TME) for cancer. METHODS All patients who underwent a laparoscopic sphincter-saving TME for cancer from 2005 to 2014 were identified from our prospective database. PPOI was defined as abdominal distension, nausea, and/or vomiting, requiring a nasogastric tube insertion, during the postoperative period. RESULTS Among 428 consecutive patients, 65 patients (15%) presented with POI. In multivariate analysis, male gender (Odds Ratio (OR) 2.3 [1.1-4.5]; p = 0.026, age >70 years (OR: 2.0 [1.1-4.0]; p = 0.037)], conversion to open approach (OR 4.9 [1.5-15.4]; p = 0.007), and intra-abdominal surgical site infection (OR 3.8 [1.9-7.5]; p < 0.001) were identified as independent risk factor for PPOI. PPOI risk was 5% in patients without any risk factor but raised to 11, 28, and 54% in patients with 1, 2, or ≥3 risk factors, respectively (p < 0.001). CONCLUSION PPOI is observed in 15% of the patients after laparoscopic sphincter-saving surgery for rectal cancer. We identified four independent factors for PPOI in multivariate analysis: male, gender, age >70, conversion to open approach, and intra-abdominal surgical site infection, leading to the construction of a simple and pragmatic predictive score. This score might help the surgeon to assess patient at risk of PPOI.
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Affiliation(s)
- Elisabeth Hain
- Department of Colorectal Surgery, Beaujon Hospital, Pôle des Maladies de l'Appareil Digestif - Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Léon Maggiori
- Department of Colorectal Surgery, Beaujon Hospital, Pôle des Maladies de l'Appareil Digestif - Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Cécile Mongin
- Department of Colorectal Surgery, Beaujon Hospital, Pôle des Maladies de l'Appareil Digestif - Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Justine Prost A la Denise
- Department of Colorectal Surgery, Beaujon Hospital, Pôle des Maladies de l'Appareil Digestif - Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, Pôle des Maladies de l'Appareil Digestif - Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), 100 Boulevard du Général Leclerc, 92110, Clichy, France.
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Chauvin C, Schalber-Geyer A, Lefebvre F, Bopp C, Carrenard G, Marcoux L, Mayer J, Schwaab C, Joshi G, Diemunsch P. Early postoperative oral fluid intake in paediatric day case surgery influences the need for opioids and postoperative vomiting: a controlled randomized trial † †This Article is accompanied by Editorial Aew450. Br J Anaesth 2017; 118:407-414. [DOI: 10.1093/bja/aew463] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 02/06/2023] Open
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Sansonnens J, Taffé P, Burnand B. Higher occurrence of nausea and vomiting after total hip arthroplasty using general versus spinal anesthesia: an observational study. BMC Anesthesiol 2016; 16:44. [PMID: 27459997 PMCID: PMC4962505 DOI: 10.1186/s12871-016-0207-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 07/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Under the assumption that postoperative nausea and vomiting (PONV) may occur after total hip arthroplasty (THA) regardless of the anesthetic technique used, it is not clear whether general (GA) or spinal (SA) anesthesia has higher causal effect on this occurrence. Conflicting results have been reported. METHODS In this observational study, we selected all elective THA interventions performed in adults between 1999 and 2008 in a Swiss orthopedic clinic under general or spinal anesthesia. To assess the effect of anesthesia type on the occurrence of PONV, we used the propensity score and matching methods, which allowed us to emulate the design and results of an RCT. RESULTS Among 3922 procedures, 1984 (51 %) patients underwent GA, of which 4.1 % experienced PONV, and 1938 underwent SA, of which 3.5 % experienced PONV. We found that the average treatment effect on the treated, i.e. the effect of anesthesia type for a sample of individuals that actually received spinal anesthesia compared to individuals who received GA, was ATET = 2.00 % [95 % CI, 0.78-3.19 %], which translated into an OR = 1.97 [95 % CI 1.35; 2.87]. CONCLUSION This suggests that the type of anesthesia is not neutral regarding PONV, general anesthesia being more strongly associated with PONV than spinal anesthesia in orthopedic surgery.
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Affiliation(s)
- Julien Sansonnens
- IUMSP-Institute of Social and Preventive Medicine, Lausanne University Hospital, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Patrick Taffé
- IUMSP-Institute of Social and Preventive Medicine, Lausanne University Hospital, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Bernard Burnand
- IUMSP-Institute of Social and Preventive Medicine, Lausanne University Hospital, Route de la Corniche 10, CH-1010, Lausanne, Switzerland.
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Wiesmann T, Kranke P, Eberhart L. Postoperative nausea and vomiting – a narrative review of pathophysiology, pharmacotherapy and clinical management strategies. Expert Opin Pharmacother 2015; 16:1069-77. [DOI: 10.1517/14656566.2015.1033398] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Droperidol transiently prolongs the QT interval in children undergoing single ventricle palliation. Pediatr Cardiol 2015; 36:196-204. [PMID: 25087057 DOI: 10.1007/s00246-014-0985-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 07/22/2014] [Indexed: 01/27/2023]
Abstract
Historically, droperidol was commonly used for postoperative sedation of critically ill children. A FDA black box warning regarding its arrhythmogenic potential greatly reduced its use. We hypothesized that administration of neuroleptic dose droperidol during volatile anesthesia would transiently prolong the corrected QT interval (QTc) in patients undergoing single ventricle palliation. As part of a prospective study in children undergoing stage 2 or 3 single ventricle palliation, we recorded electrocardiograms preoperatively, after induction of volatile anesthesia, immediately after completion of 30 min intravenous infusion of 75 mcg/kg droperidol, and shortly after arrival in the cardiac intensive care unit. Mean absolute QT intervals and heart rate data were analyzed in a blinded fashion and the longest QT interval was determined. QT intervals were corrected for heart rate (QTc) with the Bazett and Friderici formulae. Any perioperative arrhythmias were recorded. Complete data were available for 62 patients. Volatile anesthesia was associated with significant prolongation of the QTc interval. Administration of droperidol after cardiopulmonary bypass was associated with further significant QTc prolongation. All QTc changes were transient and the postoperative QTc, while still prolonged relative to baseline, was significantly shorter than the QTc immediately postdroperidol. No episodes of Torsades de Pointes (TdP) or ventricular arrhythmias were observed. The administration of a neuroleptic dose of droperidol during volatile anesthesia in patients undergoing single ventricle palliation was associated with a significant prolongation of QTc, which was transient and did not result in TdP or other ventricular arrhythmias in our study population.
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Ferary M, Biet A, Strunski V, Page C. Impact of the mode of hospitalisation on the postoperative complication rate after dissection tonsillectomy in children. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:345-349. [PMID: 24993782 DOI: 10.1016/j.anorl.2013.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/27/2013] [Accepted: 11/05/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To compare postoperative complication rates after dissection tonsillectomy in patients operated by outpatient surgery and patients operated by inpatient surgery. POPULATION AND METHODS A prospective, single-centre, observational study was conducted over a period of 1 year. Dissection tonsillectomy was performed in 103 patients (mean age: 4 years) between September 2011 and September 2012. The following parameters were studied: bleeding or inflammatory complication rate, readmissions, unscheduled visits, factors contraindicating outpatient surgery, reasons for failure of outpatient surgery and influence of Postoperative Nausea and Vomiting scores. RESULTS Two patient groups were composed: 54 patients were managed by outpatient surgery (Group O) and 49 patients were managed by inpatient surgery (Group I). The two main factors contraindicating outpatient surgery were age less than 3 years (40%) and preoperative suspicion of sleep apnoea-hypopnoea syndrome (26%). Seven patients of Group O had to stay in hospital (outpatient failure rate of 13%). Postoperative complications were observed in 13% of patients of Group O versus 12.2% of patients of Group I with no statistically significant difference between the two groups. One patient in each group had to be readmitted; no statistically significant difference was observed between the two groups (P=0.41). PONV scores were very high (2) in all cases. CONCLUSION Outpatient tonsillectomy in well-selected patients is not associated with a higher postoperative complication rate than inpatient tonsillectomy. With systematic appropriate prophylaxis, Postoperative Nausea and Vomiting scores had no influence on the postoperative course.
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Affiliation(s)
- M Ferary
- Service d'ORL et de chirurgie de la face et du cou, centre hospitalier Nord, place Victor-Pauchet, 80054 Amiens cedex, France
| | - A Biet
- Service d'ORL et de chirurgie de la face et du cou, centre hospitalier Nord, place Victor-Pauchet, 80054 Amiens cedex, France
| | - V Strunski
- Service d'ORL et de chirurgie de la face et du cou, centre hospitalier Nord, place Victor-Pauchet, 80054 Amiens cedex, France
| | - C Page
- Service d'ORL et de chirurgie de la face et du cou, centre hospitalier Nord, place Victor-Pauchet, 80054 Amiens cedex, France.
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Effet d’une dose unique intramusculaire de déxaméthasone sur la douleur après circoncision. Étude randomisée contrôlée. ACTA ACUST UNITED AC 2013; 32:98-103. [DOI: 10.1016/j.annfar.2012.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 12/21/2012] [Indexed: 11/22/2022]
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Sédation et analgésie en structure d’urgence. Quelles sédation et analgésie chez le patient en ventilation spontanée en structure d’urgence ? ACTA ACUST UNITED AC 2012; 31:295-312. [DOI: 10.1016/j.annfar.2012.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med 2012; 38:384-94. [PMID: 22310869 PMCID: PMC3286505 DOI: 10.1007/s00134-011-2459-y] [Citation(s) in RCA: 304] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 12/20/2011] [Indexed: 12/11/2022]
Abstract
Purpose Acute gastrointestinal (GI) dysfunction and failure have been increasingly recognized in critically ill patients. The variety of definitions proposed in the past has led to confusion and difficulty in comparing one study to another. An international working group convened to standardize the definitions for acute GI failure and GI symptoms and to review the therapeutic options. Methods The Working Group on Abdominal Problems (WGAP) of the European Society of Intensive Care Medicine (ESICM) developed the definitions for GI dysfunction in intensive care patients on the basis of the available evidence and current understanding of the pathophysiology. Results Definitions for acute gastrointestinal injury (AGI) with its four grades of severity, as well as for feeding intolerance syndrome and GI symptoms (e.g. vomiting, diarrhoea, paralysis, high gastric residual volumes) are proposed. AGI is a malfunctioning of the GI tract in intensive care patients due to their acute illness. AGI grade I = increased risk of developing GI dysfunction or failure (a self-limiting condition); AGI grade II = GI dysfunction (a condition that requires interventions); AGI grade III = GI failure (GI function cannot be restored with interventions); AGI grade IV = dramatically manifesting GI failure (a condition that is immediately life-threatening). Current evidence and expert opinions regarding treatment of acute GI dysfunction are provided. Conclusions State-of-the-art definitions for GI dysfunction with gradation as well as management recommendations are proposed on the basis of current medical evidence and expert opinion. The WGAP recommends using these definitions for clinical and research purposes. Electronic supplementary material The online version of this article (doi:10.1007/s00134-011-2459-y) contains supplementary material, which is available to authorized users.
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Binhas M, Diemunsch P, Hawajri N, Maison P, Brucker R, Marty J, Mercier F, Keita H. [Prophylactic anti-emetic strategy: prevention among obstetrician-gynaecologists anaesthesia]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2011; 30:809-813. [PMID: 21981852 DOI: 10.1016/j.annfar.2011.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Accepted: 05/27/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES A prophylactic anti-emetic strategy should depend on the number of nausea and vomiting risk factors. This study was undertaken to evaluate the practices of postoperative nausea and vomiting (PONV) prevention practices among obstetrician-gynaecologists, anaesthetists. STUDY DESIGN A prospective, self-administered questionnaire survey was emailed to all Club d'Anesthésie Réanimation Obstétricale (Caro) members (French Obstetric and Gynaecology Anaesthetists' Association). METHODS The questionnaire had closed-ended questions to evaluate each Caro member's prophylactic anti-emetic practices. Questions concerned demographic datas, prophylactic anti-emetic drugs administered to the patients with or without well known risk factors for developing PONV, the existence of protocol to prevent PONV in their own department of anaesthesiology and their awareness of the existence of French Society of Anaesthesia and Intensive Care (Sfar) PONV prevention guidelines 2007. RESULTS Of 115 questionnaires, 66 respondents (57%) returned the questionnaires. Most of the respondents (74%) worked in a university hospital. Forty-two percent practiced exclusively in obstetric-gynaecology department. Fifty-six percent were anaesthetists for more than 20 years. Eighty-five percent of the physicians were well-informed about the SFAR's PONV prevention guidelines. Thirty seven percent of respondents assessed Apfel score systematically for all their patients. The percentages, which didn't calculate the probability of PONV with Apfel score or calculated only in cases of PONV history or travel sickness were 18% and 45% respectively. In cases of two or more risk factors, 63% used droperidol, dexamethasone and ondansetron in double or triple combinations. CONCLUSIONS Although most surveyed practitioners were well informed about the new guidelines concerning PONV prevention, 27% not follow these guidelines regarding the administration of anti-emetic drugs. The calculation of Apfel score in the preoperative period must be also strengthened.
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Affiliation(s)
- M Binhas
- Service d'anesthésie-réanimation chirurgicale, CHU Henri-Mondor, AP-HP, université Paris-XII, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
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Possibilities and limitations in the pharmacological management of postoperative nausea and vomiting. Eur J Anaesthesiol 2011; 28:758-65. [DOI: 10.1097/eja.0b013e32834a4e1e] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chhor V, Karachi C, Bonnet AM, Puybasset L, Lescot T. Anesthésie et maladie de Parkinson. ACTA ACUST UNITED AC 2011; 30:559-68. [DOI: 10.1016/j.annfar.2011.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
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Risk scores for predicting postoperative nausea and vomiting are clinically useful tools and should be used in every patient: pro--'don't throw the baby out with the bathwater'. Eur J Anaesthesiol 2011; 28:160-3. [PMID: 21206276 DOI: 10.1097/eja.0b013e328342fd86] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gómez-Arnau JI, Aguilar JL, Bovaira P, Bustos F, De Andrés J, de la Pinta JC, García-Fernández J, López-Alvarez S, López-Olaondo L, Neira F, Planas A, Pueyo J, Vila P, Torres LM. [Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment]. ACTA ACUST UNITED AC 2010; 57:508-24. [PMID: 21033457 DOI: 10.1016/s0034-9356(10)70711-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Española de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.
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Affiliation(s)
- J I Gómez-Arnau
- Servicio de Anestesia y Cuidados Criticos, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid.
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Frost F, Dailler F, Duflo F. Méta-analyse : ondansétron en prophylaxie des nausées et vomissements postopératoires chez l’adulte et l’enfant après craniotomie. ACTA ACUST UNITED AC 2010; 29:19-24. [DOI: 10.1016/j.annfar.2009.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 09/07/2009] [Indexed: 11/26/2022]
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[Management of transdermal therapeutics in perioperative care]. ACTA ACUST UNITED AC 2009; 28:311-20. [PMID: 19304449 DOI: 10.1016/j.annfar.2009.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Accepted: 01/14/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To provide guidance on perioperative management of most frequently encountered transdermal therapeutics in anaesthesiology: nicotine, fentanyl, nitroglycerin, scopolamine and estradiol. DATA SOURCES A review of the last decade literature was carried out on the Pubmed database using the following keywords (transcutaneous or percutaneous or transdermal or transdermic or skin or dermal) and (drug delivery systems or therapeutic systems or drug administration) grouped under the Mesh terms cutaneous administration, perioperative care, surgery, pharmacokinetics, nicotine, fentanyl, nitroglycerin, scopolamine, estradiol. STUDY SELECTION Original articles, general articles reviews, guidelines, letters to the editor and case reports have been selected. DATA EXTRACTION Articles were analyzed for each transdermal treatment in terms of pharmacokinetics as well as anaesthetics and surgical interactions. DATA SYNTHESIS Transdermal nicotine must be removed before anaesthesia of patients with coronary disease or with high risk of inhalation and in case of reconstructive surgery. Transdermal fentanyl must be maintained during the perioperative period and associated with preventive treatments of hyperalgesia. Transdermal administration of fentanyl by iontophoresis is a promising system for postoperative analgesia. Transdermal nitroglycerin must be maintained before scheduled surgery of a coronary patient. Transdermal scopolamine must be removed the day before surgery because of its side effects. It could have an interest in the prevention of postoperative nausea and vomiting, but its therapeutic method remain to be defined. Transdermal estradiol can be maintained during the perioperative period. CONCLUSION The management of transdermal therapeutics in peri operative care can be adapted for each treatment and for each patient by knowing pharmacokinetics as well as anaesthetics and surgical interactions. In emergency situations, the actions to be taken do not generally differ, but one must be aware that the effects of trandermal treatments do not disappear immediately when removed, due to their pharmacokinetics properties.
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