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Au E, Zhao K, Belley-Côté E, Song Y, Al-Hazzani W, Sadeghirad B, Wang E, Young J, Kashani H, Kavosh M, Inami T, Beaver C, Kloppenburg S, Mazer D, Jacobsohn E, Um K, Spence J. The effect of perioperative benzodiazepine administration on postoperative nausea and vomiting: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth 2024; 132:469-482. [PMID: 38177006 DOI: 10.1016/j.bja.2023.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Despite recent systematic reviews suggesting their benefit for postoperative nausea, vomiting, or both (PONV) prevention, benzodiazepines have not been incorporated into guidelines for PONV prophylaxis because of concerns about possible adverse effects. We conducted an updated meta-analysis to inform future practice guidelines. METHODS We included randomised controlled trials (RCTs) of all languages comparing benzodiazepines with non-benzodiazepine comparators in adults undergoing inpatient surgery. Our outcomes were postoperative nausea, vomiting, or both. We assessed risk of bias for RCTs using the Cochrane Risk of Bias tool. We pooled data using a random-effects model and assessed the quality of evidence for each outcome using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS We screened 31 413 abstracts and 950 full texts. We included 119 RCTs; 104 were included in quantitative synthesis. Based on moderate certainty evidence, we found that perioperative benzodiazepine administration reduced the incidence of PONV (52 studies, n=5086, relative risk [RR]: 0.77, 95% confidence interval [CI] 0.66-0.89; number needed to treat [NNT] 16; moderate certainty), postoperative nausea (55 studies, n=5916, RR: 0.72, 95% CI 0.62-0.83; NNT 21; moderate certainty), and postoperative vomiting (52 studies, n=5909, RR: 0.74, 95% CI 0.60-0.91; NNT 55; moderate certainty). CONCLUSIONS Moderate quality evidence shows that perioperative benzodiazepine administration decreases the incidence of PONV. The results of this systematic review and meta-analysis will inform future clinical practice guidelines. SYSTEMATIC REVIEW PROTOCOL The protocol for this systematic review was pre-registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42022361088) and published in BMJ Open (PMID 31831540).
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Affiliation(s)
- Emily Au
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Karen Zhao
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Emilie Belley-Côté
- Department of Medicine (Cardiology and Critical Care), Perioperative Research Division, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Yuri Song
- Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Waleed Al-Hazzani
- Departments of Critical Care, Medicine (Gastroenterology), Health Research Methods, Evaluation, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Behnam Sadeghirad
- Departments of Anesthesia and Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada
| | - Eugene Wang
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jack Young
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - Hessam Kashani
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Morvarid Kavosh
- Department of Medicine, Coney Island Hospital, New York, NY, USA
| | - Toru Inami
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | | | | | - David Mazer
- Department of Anesthesia and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Eric Jacobsohn
- Department of Anesthesia and Perioperative Medicine and Medicine (Critical Care), University of Manitoba, Winnipeg, MB, Canada
| | - Kevin Um
- Department of Medicine (Cardiology), McMaster University, Hamilton, ON, Canada
| | - Jessica Spence
- Departments of Anesthesia and Critical Care and Health Research Methods, Evaluation, and Impact, Perioperative Research Division, Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
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Prakash K, Meshram T, Jain P. Midazolam versus dexamethasone-ondansetron in preventing post-operative nausea-vomiting in patients undergoing laparoscopic surgeries. Acta Anaesthesiol Scand 2021; 65:870-876. [PMID: 33683710 DOI: 10.1111/aas.13813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 01/13/2021] [Accepted: 02/08/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Midazolam reduces post-operative nausea and vomiting (PONV) when compared to a placebo or when used as an adjuvant to other antiemetics. The present study was designed to compare midazolam with a combination of dexamethasone-ondansetron in preventing PONV. METHODS One hundred and twenty patients undergoing laparoscopic surgeries having 2 or more risk factors for PONV (simplified Apfel score) were randomised into 2 groups of 60 each. Patients in group D received 8-mg dexamethasone and 4-mg ondansetron for PONV prophylaxis while those in group M received 2-mg midazolam towards the end of surgery. The proportion of patients (frequency) who had PONV, post-operative nausea (PON) and post-operative vomiting (POV) was noted over 24 hours over the following intervals: 0-2 hours, 2-24 hours and 0-24 hours. RESULTS The frequency of PONV at 24 hours in group D and group M was 30% and 33.3% respectively and was not significantly different (P = .70). There was no difference in the time to achieve post-anaesthesia discharge score of ≥9 between the two groups {5 minutes (5, 5) in group D; 5 minutes (1.25, 5) in group M, P = .48}. Ten patients in group D and 11 in group M required a rescue antiemetic over 24 hours (P = .81). The frequency of PON, POV and PONV as well as the median PONV score was similar at all time periods. CONCLUSION Midazolam does not result in significantly different frequency of PONV than a combination of dexamethasone-ondansetron.
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Affiliation(s)
- Kelika Prakash
- Department of Anaesthesiology and Critical Care Institute of Liver and Biliary Sciences New Delhi India
| | - Tanvi Meshram
- Department of Anaesthesiology and Critical Care Institute of Liver and Biliary Sciences New Delhi India
| | - Priyanka Jain
- Department of Epidemiology Institute of Liver and Biliary Sciences New Delhi India
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Dinges E, Heier J, Delgado C, Bollag L. Multimodal general anesthesia approach for Ex Utero Intrapartum Therapy (EXIT) procedures: two case reports. Int J Obstet Anesth 2018; 38:142-145. [PMID: 30243809 DOI: 10.1016/j.ijoa.2018.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 08/03/2018] [Accepted: 08/26/2018] [Indexed: 02/04/2023]
Abstract
High-dose volatile anesthesia is the most common method of achieving uterine relaxation for Ex Utero Intrapartum Therapy (EXIT) procedures. Other methods employ nitroglycerin for additional uterine relaxation with or without remifentanil for additional fetal analgesia. We report a combination approach including one minimum alveolar concentration of volatile anesthetic plus nitroglycerin and remifentanil infusions, to provide timely uterine relaxation under general anesthesia for both mother and fetus, during two EXIT procedures.
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Affiliation(s)
- E Dinges
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
| | - J Heier
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - C Delgado
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - L Bollag
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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Abstract
BACKGROUND Drugs can prevent postoperative nausea and vomiting, but their relative efficacies and side effects have not been compared within one systematic review. OBJECTIVES The objective of this review was to assess the prevention of postoperative nausea and vomiting by drugs and the development of any side effects. SEARCH METHODS We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2004), MEDLINE (January 1966 to May 2004), EMBASE (January 1985 to May 2004), CINAHL (1982 to May 2004), AMED (1985 to May 2004), SIGLE (to May 2004), ISI WOS (to May 2004), LILAC (to May 2004) and INGENTA bibliographies. SELECTION CRITERIA We included randomized controlled trials that compared a drug with placebo or another drug, or compared doses or timing of administration, that reported postoperative nausea or vomiting as an outcome. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted outcome data. MAIN RESULTS We included 737 studies involving 103,237 people. Compared to placebo, eight drugs prevented postoperative nausea and vomiting: droperidol, metoclopramide, ondansetron, tropisetron, dolasetron, dexamethasone, cyclizine and granisetron. Publication bias makes evidence for differences among these drugs unreliable. The relative risks (RR) versus placebo varied between 0.60 and 0.80, depending upon the drug and outcome. Evidence for side effects was sparse: droperidol was sedative (RR 1.32) and headache was more common after ondansetron (RR 1.16). AUTHORS' CONCLUSIONS Either nausea or vomiting is reported to affect, at most, 80 out of 100 people after surgery. If all 100 of these people are given one of the listed drugs, about 28 would benefit and 72 would not. Nausea and vomiting are usually less common and, therefore, drugs are less useful. For 100 people, of whom 30 would vomit or feel sick after surgery if given placebo, 10 people would benefit from a drug and 90 would not. Between one to five patients out of every 100 people may experience a mild side effect, such as sedation or headache, when given an antiemetic drug. Collaborative research should focus on determining whether antiemetic drugs cause more severe, probably rare, side effects. Further comparison of the antiemetic effect of one drug versus another is not a research priority.
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Affiliation(s)
- John Carlisle
- Torbay Hospital, South Devon Healthcare NHS Foundation TrustDepartment of AnaestheticsLawes BridgeTorquayDevonUKTQ2 7AA
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Veiga-Gil L, Pueyo J, López-Olaondo L. Postoperative nausea and vomiting: physiopathology, risk factors, prophylaxis and treatment. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2017; 64:223-232. [PMID: 28041609 DOI: 10.1016/j.redar.2016.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/09/2016] [Accepted: 10/10/2016] [Indexed: 06/06/2023]
Abstract
Recognising the importance of the prevention and early treatment of postoperative nausea and vomiting (PONV) is essential to avoid postoperative complications, improve patient satisfaction and enable the development of major outpatient surgery and fast-track surgery. The topic of PONV might seem to have become stagnant, but we are moving forward. New concepts and problems like post-discharge nausea and vomiting, new risk factors and new drugs are appearing. However, there continue to be mistaken notions about PONV, such as the association between PONV and post-anaesthesia care unit stays, or assuming that it is a risk factore characteristic of the patient, anaesthesia or surgery when it is not. Perhaps, now is the moment to tackle PONV in a different manner, implementing guidelines and going for more aggressive prophylaxis in some groups of patients. We present an extensive review of this topic.
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Affiliation(s)
- L Veiga-Gil
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | - J Pueyo
- Departamento de Anestesiología y Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - L López-Olaondo
- Departamento de Anestesiología y Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Navarra, España
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Jung JS, Park JS, Kim SO, Lim DG, Park SS, Kwak KH, Cho JD, Jeon YH. Prophylactic antiemetic effect of midazolam after middle ear surgery. Otolaryngol Head Neck Surg 2016; 137:753-6. [DOI: 10.1016/j.otohns.2007.07.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 07/18/2007] [Indexed: 10/22/2022]
Abstract
Objective To investigate the prophylactic antiemetic effect of midazolam after middle ear surgery. Study Design A prospective, randomized, double-blind, placebo-controlled study. Subjects and Methods Ninety women patients undergoing middle ear surgery with general anesthesia received intravenously either midazolam 0.075 mg/kg or normal saline (n = 45 each) after induction of anesthesia. The incidence and severity of postoperative nausea and vomiting, rescue antiemetics, pain intensity, and side effects such as headache, dizziness, and drowsiness were assessed during the first 24 hours after anesthesia. Results Midazolam groups showed total incidence and severity of nausea and vomiting. Patients who required rescue antiemetics were significantly lower than in saline group ( P < 0.05), but there were no significant differences in pain intensity and side effects such as headache, dizziness, and drowsiness between groups. Conclusions Midazolam 0.075 mg/kg is effective for reducing nausea and vomiting after middle ear surgery.
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Affiliation(s)
- Jae Sik Jung
- Departments of Anesthesiology and Otolaryngology, Kyungpook National University Hospital
| | - Jun Sik Park
- Departments of Anesthesiology and Otolaryngology, Kyungpook National University Hospital
| | - Si Oh Kim
- Departments of Anesthesiology and Otolaryngology, Kyungpook National University Hospital
| | - Dong Gun Lim
- Departments of Anesthesiology and Otolaryngology, Kyungpook National University Hospital
| | - Sung Sik Park
- Departments of Anesthesiology and Otolaryngology, Kyungpook National University Hospital
| | - Kyung Hwa Kwak
- Departments of Anesthesiology and Otolaryngology, Kyungpook National University Hospital
| | - Jin Duck Cho
- Departments of Anesthesiology and Otolaryngology, Kyungpook National University Hospital
| | - Young Hoon Jeon
- Departments of Anesthesiology and Otolaryngology, Kyungpook National University Hospital
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Grant MC, Kim J, Page AJ, Hobson D, Wick E, Wu CL. The Effect of Intravenous Midazolam on Postoperative Nausea and Vomiting. Anesth Analg 2016; 122:656-663. [DOI: 10.1213/ane.0000000000000941] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Comparative study of the antiemetic efficacy of ondansetron, propofol and midazolam in the early postoperative period: Retraction. Eur J Anaesthesiol 2013; 30:582. [PMID: 23903560 DOI: 10.1097/eja.0b013e328363c92e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Kim WJ, Kang H, Shin HY, Baek CW, Jung YH, Woo YC, Kim JY, Koo GH. Ramosetron, midazolam, and combination of ramosetron and midazolam for prevention of postoperative nausea and vomiting: A prospective, randomized, double-blind study. J Int Med Res 2013; 41:1203-13. [DOI: 10.1177/0300060513485864] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To compare the efficacy of ramosetron, midazolam, and the combination of ramosetron and midazolam in the prevention of postoperative nausea and vomiting (PONV) in female patients undergoing thyroidectomy. Methods Patients were randomized to receive 0.3 mg ramosetron (Group R), 75 µg/kg midazolam (Group M) or 0.3 mg ramosetron combined with 75 µg/kg midazolam (Group RM) before the induction of anaesthesia. PONV, use of rescue antiemetics, pain severity and fentanyl consumption were assessed for 24 h after thyroidectomy. Results A total of 100 patients were enrolled; 94 patients completed the study. The severity of nausea was statistically significantly reduced at 0–2 h in Group RM compared with Groups R and M, and at 2–6 h in Group RM compared with Group M. The incidence of retching and vomiting was significantly lower at 0–2 h, 2–6 h, 6–12 h in Group RM than in Group M, and lower in Group R than Group M at 6–12 h. The requirement for rescue antiemetics was significantly lower at 0–2 h in group RM than in group M. Conclusion The combination therapy of ramosetron and midazolam provided superior antiemetic efficacy compared with midazolam single therapy, but did not show any significant additional benefits compared with ramosetron single therapy.
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Affiliation(s)
- Won Joong Kim
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Hyun Kang
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Hwa Yong Shin
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Chong Wha Baek
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Yong Hun Jung
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Young Cheol Woo
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Jin Yun Kim
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Gil Hoi Koo
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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Jang JS, Lee JH, Lee JJ, Park WJ, Hwang SM, Lee SK, Lim SY. Postoperative nausea and vomiting after myringoplasty under continuous sedation using midazolam with or without remifentanil. Yonsei Med J 2012; 53:1010-3. [PMID: 22869486 PMCID: PMC3423846 DOI: 10.3349/ymj.2012.53.5.1010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This prospective study evaluated the effects of continuous sedation using midazolam, with or without remifentanil, on postoperative nausea and vomiting (PONV) in patients undergoing myringoplasty. MATERIALS AND METHODS Sixty patients undergoing myringoplasty were sedated with midazolam in the presence of remifentanil (group MR), or after saline injection instead of remifentanil (group M). RESULTS Three patients (10%) in group M complained of nausea; two vomited. Four patients (13%) in group MR complained of nausea and vomited within 24 h after surgery. Rescue drugs were given to the six patients who vomited. No significant difference was detected between the two groups regarding the incidence or severity of nausea, incidence of vomiting, or need for rescue drugs. CONCLUSION Midazolam-based continuous sedation can reduce PONV after myringoplasty. Compared with midazolam alone, midazolam with remifentanil produced no difference in the incidence or severity of nausea, incidence of vomiting, or need for rescue drugs.
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Affiliation(s)
- Ji Su Jang
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hallym University, Chuncheon, Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Hallym University, Chuncheon, Korea
| | - Jae Jun Lee
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hallym University, Chuncheon, Korea
| | - Won Jae Park
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hallym University, Chuncheon, Korea
| | - Sung Mi Hwang
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hallym University, Chuncheon, Korea
| | - Soo Kyung Lee
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hallym University, Chuncheon, Korea
| | - So Young Lim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hallym University, Chuncheon, Korea
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Kim S, Seo J, Jeon Y. Antiemetic effects of midazolam added to fentanyl-ropivacaine patient-controlled epidural analgesia after subtotal gastrectomy: A prospective, randomized, double-blind, controlled trial. Curr Ther Res Clin Exp 2010; 71:298-308. [PMID: 24688151 DOI: 10.1016/j.curtheres.2010.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Nausea and vomiting are frequent adverse effects of patient-controlled epidural analgesia (PCEA) with opioids. OBJECTIVE This study was designed to assess the antiemetic effect of midazolam added to fentanyl-ropivacaine PCEA. METHODS In a prospective, randomized, double-blind, controlled trial, smoking patients with gastric cancer undergoing elective subtotal gastrectomy were evenly allocated to 1 of 2 treatment groups to manage postoperative pain: 0.2% ropivacaine mixed with fentanyl 4 μg/mL and midazolam 0.2 mg/mL (test group) or 0.2% ropivacaine mixed with fentanyl 4 μg/mL (control group). The PCEA infusion was set to deliver 4 μL/h of the study solution, with a bolus of 2 mL per demand and a 15-minute lockout time. The incidence of postoperative nausea and vomiting (PONV), pain intensity, sedation score, usage of rescue analgesia and rescue antiemetic, respiratory depression, urinary retention, and pruritus were recorded at 2, 6, 12, 24, 48, and 72 hours after surgery. Total infused volume of PCEA at 72 hours after surgery was measured. RESULTS A total of 60 patients were approached and randomized to treatment. No patients were excluded by exclusion criteria and all enrolled patients completed this study. Incidence of nausea (7% vs 33%; P = 0.02) in the test group was significantly lower than in the control group. The overall frequency of PONV in the test group was significantly less than that of the control group (7% vs 40%; P = 0.006). In addition, the mean (SD) infused volume of PCEA in the test group was significantly lower than that in the control group (392.3 [68.9] vs 351.2 [49.8] mL; P = 0.01). However, there were no significant differences in pain intensity, usage of rescue antiemetics and rescue analgesics, and mild pruritus between groups. No patient reported moderate or severe sedation, respiratory depression, or hypoxemia. In addition, there were no severe adverse events. CONCLUSIONS Midazolam added to fentanyl-ropivacaine PCEA was associated with a significant reduction in the incidence of PONV compared with fentanyl-ropivacaine alone, and a significant decrease in the amount of PCEA administered without a significant increase in adverse events in these patients who underwent subtotal gastrectomy.
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Affiliation(s)
- Sioh Kim
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jeongwon Seo
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Younghoon Jeon
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
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Huh BK, Jung S, White W, Jeon Y. Anti-Emetic Effect of Midazolam Added to Morphine Patient-Controlled Analgesia After Total Abdominal Hysterectomy. Anaesth Intensive Care 2010; 38:481-5. [DOI: 10.1177/0310057x1003800311] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nausea and vomiting are frequent adverse effects of patient-controlled analgesia with opioids. This study was designed to compare the effect of midazolam to that of ondansetron for prevention of nausea and vomiting during morphine patient-controlled analgesia. In a randomised, double-blind, prospective trial, 90 patients were allocated to one of three groups of 30 each, to receive one of three patient-controlled analgesia regimens to manage postoperative pain: a combination of midazolam and morphine (group M), a mixture of ondansetron and morphine (group O) or morphine alone (group C). Patients were assessed for the incidence of nausea and vomiting, the degree of sedation (awake, mild, moderate, deep) and other side-effects during the first 24 hours after the operation. The frequency of nausea and vomiting was significantly lower in groups M (27%) and O (37%) compared with group C (70%) (P <0.05). The incidence of mild sedation in group M was significantly higher than that in groups O or C (P <0.05). We conclude that midazolam is as effective as ondansetron in preventing opioid-induced nausea and vomiting following total abdominal hysterectomy and has acceptable side-effects.
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Affiliation(s)
- B. K. Huh
- Department of Anesthesiology, Kyungpook National University Hospital, Daegu, Repulic of Korea
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - S. Jung
- Department of Anesthesiology, Kyungpook National University Hospital, Daegu, Repulic of Korea
| | - W. White
- Department of Anesthesiology, Kyungpook National University Hospital, Daegu, Repulic of Korea
- Consultant, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Y. Jeon
- Department of Anesthesiology, Kyungpook National University Hospital, Daegu, Repulic of Korea
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Dalal PG, Taylor D, Somerville N, Seth N. Adverse events and behavioral reactions related to ketamine based anesthesia for anorectal manometry in children. Paediatr Anaesth 2008; 18:260-7. [PMID: 18230071 DOI: 10.1111/j.1460-9592.2008.02410.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric patients undergoing anorectal manometry require ketamine anesthesia as other anesthetic agents affect the anorectal sphincter tone. The aim of this prospective observational audit was to evaluate our practice and report the occurrence of adverse events and behavioral reactions related to the use of ketamine, propofol, and midazolam combinations. METHODS Eighty-two consecutive pediatric patients (mean age 8.06 +/- 3.43 years) undergoing anorectal manometry were audited over a 1-year period. After a routine ketamine anesthetic some children were administered midazolam 0.1 mg.kg(-1), at the discretion of the attending anesthetist. Children requiring anal stretch following manometry studies also received propofol 3-5 mg.kg(-1). Intra- and postoperative adverse events, times to spontaneous awakening and discharge from the PACU were noted. Postoperative behavioral reactions were noted in the PACU and at follow-up interviews on the first postoperative day and after a period of 1 month. RESULTS Following completion of the audit, all patients fell into one of the four groups depending on the anesthetic agents they received: K (ketamine only, n = 16), KM (ketamine and midazolam, n = 10), KP (ketamine and propofol, n = 27), and KPM (ketamine, propofol, and midazolam, n = 29). There was no difference in the occurrence of behavioral reactions between the four groups at the three stages of follow-up. Overall, five patients reported 'new onset' nightmares that had resolved completely at the 3-month follow-up. The time to spontaneous awakening was shorter for K group (17.8 min +/- 20.2) vs KPM group (61.7 min +/- 24.4; P < 0.001). The times to discharge in minutes was also shorter in the K group (54.5 min, IQR 30-75 vs 90 min IQR 78-120; P < 0.001). Administration of propofol appeared to have an antiemetic effect [odds ratio (OR) 0.1, 95% confidence intervals (CI) 0.02-0.58, P < 0.009] in the recovery unit. CONCLUSIONS Our study findings suggest that, besides significantly prolonging time to spontaneous awakening and PACU discharge, neither the use of midazolam, propofol, or combinations is beneficial in preventing the occurrence of behavioral reactions following ketamine anesthesia. Behavioral reactions were common but did not appear to be long-term. Drug combinations with ketamine may have other benefits such as antiemesis.
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Affiliation(s)
- Priti G Dalal
- Department of Anesthesia, Penn State Milton Hershey Medical Center College of Medicine, Hershey, PA 17033, USA.
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Jung JS, Jeon YH. Effect of Midazolam upon the Prevention of Nausea and Vomiting after Middle Ear Surgery. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.52.5.550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jae Sik Jung
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young Hun Jeon
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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15
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Ha JH, Kwak KH, Seo JW, Lee SH, Park SS, Baek WE. Effectiveness of Ondansetron and Midazolam in the Prevention of PONV after Thyroidectomy. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.3.344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jae Hyun Ha
- Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Deagu, Korea
| | - Kyung Hwa Kwak
- Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Deagu, Korea
| | - Jeong Won Seo
- Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Deagu, Korea
| | - Su Hyun Lee
- Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Deagu, Korea
| | - Sung Sik Park
- Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Deagu, Korea
| | - Woon Ei Baek
- Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Deagu, Korea
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Abstract
BACKGROUND Drugs can prevent postoperative nausea and vomiting, but their relative efficacies and side effects have not been compared within one systematic review. OBJECTIVES The objective of this review was to assess the prevention of postoperative nausea and vomiting by drugs and the development of any side effects. SEARCH STRATEGY We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2004), MEDLINE (January 1966 to May 2004), EMBASE (January 1985 to May 2004), CINAHL (1982 to May 2004), AMED (1985 to May 2004), SIGLE (to May 2004), ISI WOS (to May 2004), LILAC (to May 2004) and INGENTA bibliographies. SELECTION CRITERIA We included randomized controlled trials that compared a drug with placebo or another drug, or compared doses or timing of administration, that reported postoperative nausea or vomiting as an outcome. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted outcome data. MAIN RESULTS We included 737 studies involving 103,237 people. Compared to placebo, eight drugs prevented postoperative nausea and vomiting: droperidol, metoclopramide, ondansetron, tropisetron, dolasetron, dexamethasone, cyclizine and granisetron. Publication bias makes evidence for differences among these drugs unreliable. The relative risks (RR) versus placebo varied between 0.60 and 0.80, depending upon the drug and outcome. Evidence for side effects was sparse: droperidol was sedative (RR 1.32) and headache was more common after ondansetron (RR 1.16). AUTHORS' CONCLUSIONS Either nausea or vomiting is reported to affect, at most, 80 out of 100 people after surgery. If all 100 of these people are given one of the listed drugs, about 28 would benefit and 72 would not. Nausea and vomiting are usually less common and, therefore, drugs are less useful. For 100 people, of whom 30 would vomit or feel sick after surgery if given placebo, 10 people would benefit from a drug and 90 would not. Between one to five patients out of every 100 people may experience a mild side effect, such as sedation or headache, when given an antiemetic drug. Collaborative research should focus on determining whether antiemetic drugs cause more severe, probably rare, side effects. Further comparison of the antiemetic effect of one drug versus another is not a research priority.
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Affiliation(s)
- J B Carlisle
- NHS, Department of Anaesthetics, Torbay Hospital, Lawes Bridge, Torquay, Devon, UK EX6 7LU.
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Toprak V, Keles GT, Kaygisiz Z, Tok D. Subcutaneous emphysema following severe vomiting after emerging from general anesthesia. Acta Anaesthesiol Scand 2004; 48:917-8. [PMID: 15242441 DOI: 10.1111/j.0001-5172.2004.00456.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Postoperative nausea and vomiting-related subcutaneous emphysema is an unexpected complication, especially after uneventful surgery and anesthesia. Here we report and discuss two cases of subcutaneous emphysema following severe retching and vomiting which resolved spontaneously after several days.
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Affiliation(s)
- V Toprak
- Department of Anesthesiology and Reanimation, Celal Bayar University, School of Medicine, Manisa, Turkey.
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