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Samieirad S, Sharifian-Attar A, Eshghpour M, Mianbandi V, Shadkam E, Hosseini-Abrishami M, Hashemipour MS. Comparison of Ondansetron versus Clonidine efficacy for prevention of postoperative pain, nausea and vomiting after orthognathic surgeries: A triple blind randomized controlled trial. Med Oral Patol Oral Cir Bucal 2018; 23:e767-e776. [PMID: 30341261 PMCID: PMC6261005 DOI: 10.4317/medoral.22493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/30/2018] [Indexed: 12/18/2022] Open
Abstract
Background The aim of this randomized controlled triple blind trial was to compare the efficacy of clonidine with dexamethasone versus ondansetron with dexamethasone for postoperative pain, nausea and vomiting prevention in orthognathic surgery patients. Material and Methods In this clinical trial study, 30 consecutive patients with skeletal class III deformities were candidates for orthognathic surgery in Qaem hospital, Mashhad University of medical sciences, Mashhad, Iran from March to November 2017. These subjects were randomly assigned to two equal number groups, ondansetron or clonidine. Patients received either oral ondansetron 8mg or oral clonidine 150μg as premedication, 1 hour before the surgery (both dissolved in 20 cc of water). Also both groups received intravenous dexamethasone 8mg (1 hour preoperatively and every 4 hours intraoperatively). Results In this study, a total of 30 patients (14 males and 16 females) with a mean age of 23.9 ± 3.9 were investigated. The incidence of postoperative nausea in women was more than men (p=0.003), also the correlation between the incidence of PON and the surgery duration ≥ 3 hours was statistically significant (p = 0.050). The frequency of postoperative nausea (PON) in the ondansetron group was less than clonidine (53.3% vs 73.3% respectively). There was no postoperative vomiting (POV) in the ondansetron group, but 6.7% of cases in clonidine group suffered POV.
Post-operative nausea in ondansetron group occurred significantly later than clonidine (525.0±233.2 vs 100.0±34.0 min; p<0.001). On the other hand, the incidence time of post-operative severe pain or in other word the analgesia time in clonidine group was significantly more than ondansetron one (875/0±68/5 vs 614.3±159.1 min; p<0.001). Conclusions Ondansetron with dexamethasone premedication was more effective in controlling PONV after orthognathic surgery compared to clonidine with dexamethasone group. Key words:Postoperative nausea and vomiting, ondansetron, clonidine.
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Affiliation(s)
- S Samieirad
- Department of Oral Medicine, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran,
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Ohsfeldt RL, Li P, Schneider JE, Stojanovic I, Scheibling CM. Outcomes of Surgeries Performed in Physician Offices Compared With Ambulatory Surgery Centers and Hospital Outpatient Departments in Florida. Health Serv Insights 2017; 10:1178632917701025. [PMID: 28469457 PMCID: PMC5404902 DOI: 10.1177/1178632917701025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/16/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The proportion of outpatient surgeries performed in physician offices has been increasing over time, raising concern about the impact on outcomes. OBJECTIVE To use a private insurance claims database to compare 7-day and 30-day hospitalization rates following relatively complex outpatient surgical procedures across physician offices, freestanding ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPDs). METHODS A multivariable logistic regression model was used to compare the risk-adjusted probability of hospitalization among patients after any of the 88 study outpatient procedures at physician offices, ASCs, and HOPDs over 2008-2012 in Florida. RESULTS Risk-adjusted hospitalization rates were higher following procedures performed in physician offices compared with ASCs for all procedures grouped together, for most procedures grouped by type, and for many individual procedures. CONCLUSIONS Hospitalizations following surgery were more likely for procedures performed in physician offices compared with ASCs, which highlights the need for ongoing research on the safety and efficacy of office-based surgery.
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Affiliation(s)
- Robert L Ohsfeldt
- School of Public Health, Texas A&M University, College Station, TX, USA
| | - Pengxiang Li
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Gupta V, Parikh R, Nguyen L, Afshari A, Shack RB, Grotting JC, Higdon KK. Is Office-Based Surgery Safe? Comparing Outcomes of 183,914 Aesthetic Surgical Procedures Across Different Types of Accredited Facilities. Aesthet Surg J 2017; 37:226-235. [PMID: 27553613 DOI: 10.1093/asj/sjw138] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There has been a dramatic rise in office-based surgery. However, due to wide variations in regulatory standards, the safety of office-based aesthetic surgery has been questioned. OBJECTIVES This study compares complication rates of cosmetic surgery performed at office-based surgical suites (OBSS) to ambulatory surgery centers (ASCs) and hospitals. METHODS A prospective cohort of patients undergoing cosmetic surgery between 2008 and 2013 were identified from the CosmetAssure database (Birmingham, AL). Patients were grouped by type of accredited facility where the surgery was performed: OBSS, ASC, or hospital. The primary outcome was the incidence of major complication(s) requiring emergency room visit, hospital admission, or reoperation within 30 days postoperatively. Potential risk factors including age, gender, body mass index (BMI), smoking, diabetes, type of procedure, and combined procedures were reviewed. RESULTS Of the 129,007 patients (183,914 procedures) in the dataset, the majority underwent the procedure at ASCs (57.4%), followed by hospitals (26.7%) and OBSS (15.9%). Patients operated in OBSS were less likely to undergo combined procedures (30.3%) compared to ASCs (31.8%) and hospitals (35.3%, P < .01). Complication rates in OBSS, ASCs, and hospitals were 1.3%, 1.9%, and 2.4%, respectively. On multivariate analysis, there was a lower risk of developing a complication in an OBSS compared to an ASC (RR 0.67, 95% CI 0.59-0.77, P < .01) or a hospital (RR 0.59, 95% CI 0.52-0.68, P < .01). CONCLUSIONS Accredited OBSS appear to be a safe alternative to ASCs and hospitals for cosmetic procedures. Plastic surgeons should continue to triage their patients carefully based on other significant comorbidities that were not measured in this present study. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Varun Gupta
- Drs Gupta and Higdon are Assistant Professors, Drs Nguyen and Afshari are Research Fellows, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Nguyen is also a General Surgey Resident, Department of Surgery, Morristown Medical Center, Morristown, NJ, and Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Parikh is a plastic surgeon in private practice in Bellevue, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Rikesh Parikh
- Drs Gupta and Higdon are Assistant Professors, Drs Nguyen and Afshari are Research Fellows, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Nguyen is also a General Surgey Resident, Department of Surgery, Morristown Medical Center, Morristown, NJ, and Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Parikh is a plastic surgeon in private practice in Bellevue, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Lyly Nguyen
- Drs Gupta and Higdon are Assistant Professors, Drs Nguyen and Afshari are Research Fellows, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Nguyen is also a General Surgey Resident, Department of Surgery, Morristown Medical Center, Morristown, NJ, and Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Parikh is a plastic surgeon in private practice in Bellevue, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Ashkan Afshari
- Drs Gupta and Higdon are Assistant Professors, Drs Nguyen and Afshari are Research Fellows, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Nguyen is also a General Surgey Resident, Department of Surgery, Morristown Medical Center, Morristown, NJ, and Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Parikh is a plastic surgeon in private practice in Bellevue, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - R Bruce Shack
- Drs Gupta and Higdon are Assistant Professors, Drs Nguyen and Afshari are Research Fellows, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Nguyen is also a General Surgey Resident, Department of Surgery, Morristown Medical Center, Morristown, NJ, and Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Parikh is a plastic surgeon in private practice in Bellevue, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - James C Grotting
- Drs Gupta and Higdon are Assistant Professors, Drs Nguyen and Afshari are Research Fellows, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Nguyen is also a General Surgey Resident, Department of Surgery, Morristown Medical Center, Morristown, NJ, and Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Parikh is a plastic surgeon in private practice in Bellevue, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - K Kye Higdon
- Drs Gupta and Higdon are Assistant Professors, Drs Nguyen and Afshari are Research Fellows, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Nguyen is also a General Surgey Resident, Department of Surgery, Morristown Medical Center, Morristown, NJ, and Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Parikh is a plastic surgeon in private practice in Bellevue, WA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
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Butz DR, Gill KK, Randle J, Kampf N, Few JW. Facial Aesthetic Surgery: The Safe Use of Oral Sedation in an Office-Based Facility. Aesthet Surg J 2016; 36:127-31. [PMID: 26446058 DOI: 10.1093/asj/sjv200] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The desire for efficient and safe office-based facial plastic surgery procedures has continued to rise. Oral sedation is a safe and effective method to provide anesthesia for facial aesthetic surgery. OBJECTIVES This study reviewed private practice anesthesia-related outcomes using oral sedation combined with local anesthesia for office-based facial aesthetic surgery procedures. METHODS A retrospective chart review was performed on all patients who underwent office-based facial plastic surgery procedures from July 2008 to July 2014. Patient demographic data including age, gender, body mass index (BMI), past medical history, social history, surgical history, allergies, and medications were collected. Anesthesia-related data were also collected including: American Society of Anesthesia (ASA) class, type of procedure, medications administered, and major complications related to sedation were assessed. RESULTS There were 199 patients (23 males and 176 females) who underwent 283 facial aesthetic surgical procedures. Mean age was 49.8 years (range, 29 to 80 years). There were 195 patients in ASA class I and 4 patients were in ASA class II. Patients underwent 44 upper blepharoplasty procedures, 35 lower blepharoplasty procedures, 5 browlifts, 43 upper blepharoplasty-browpexy, 46 facelifts, 38 neck lifts/lower facelifts, 54 fat grafting, 3 tip rhinoplasties, and 15 minor revision cases. During the study period, there were no major complications and no sedation issues. CONCLUSIONS Facial aesthetic surgical procedures can be performed safely and comfortably in the office-based setting under oral sedation in appropriately selected patients. LEVEL OF EVIDENCE 4: Therapeutic.
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Affiliation(s)
- Daniel R Butz
- Dr Butz is a Resident and Next Generation Editor of Aesthetic Surgery Journal and Dr Few is a Clinical Professor of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Chicago, Illinois; and Cosmetic Medicine Section Editor of Aesthetic Surgery Journal. Dr Gill is a plastic surgeon in private practice in Naples, Florida. Ms Randle and Ms Kampf are research assistants at a private plastic surgery practice in Chicago, Illinois
| | - Kiranjeet K Gill
- Dr Butz is a Resident and Next Generation Editor of Aesthetic Surgery Journal and Dr Few is a Clinical Professor of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Chicago, Illinois; and Cosmetic Medicine Section Editor of Aesthetic Surgery Journal. Dr Gill is a plastic surgeon in private practice in Naples, Florida. Ms Randle and Ms Kampf are research assistants at a private plastic surgery practice in Chicago, Illinois
| | - Jasmine Randle
- Dr Butz is a Resident and Next Generation Editor of Aesthetic Surgery Journal and Dr Few is a Clinical Professor of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Chicago, Illinois; and Cosmetic Medicine Section Editor of Aesthetic Surgery Journal. Dr Gill is a plastic surgeon in private practice in Naples, Florida. Ms Randle and Ms Kampf are research assistants at a private plastic surgery practice in Chicago, Illinois
| | - Natalie Kampf
- Dr Butz is a Resident and Next Generation Editor of Aesthetic Surgery Journal and Dr Few is a Clinical Professor of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Chicago, Illinois; and Cosmetic Medicine Section Editor of Aesthetic Surgery Journal. Dr Gill is a plastic surgeon in private practice in Naples, Florida. Ms Randle and Ms Kampf are research assistants at a private plastic surgery practice in Chicago, Illinois
| | - Julius W Few
- Dr Butz is a Resident and Next Generation Editor of Aesthetic Surgery Journal and Dr Few is a Clinical Professor of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Chicago, Illinois; and Cosmetic Medicine Section Editor of Aesthetic Surgery Journal. Dr Gill is a plastic surgeon in private practice in Naples, Florida. Ms Randle and Ms Kampf are research assistants at a private plastic surgery practice in Chicago, Illinois
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Wu HH, Yin JB, Zhang T, Cui YY, Dong YL, Chen GZ, Wang W. Inhibiting spinal neuron-astrocytic activation correlates with synergistic analgesia of dexmedetomidine and ropivacaine. PLoS One 2014; 9:e92374. [PMID: 24658263 PMCID: PMC3962412 DOI: 10.1371/journal.pone.0092374] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 02/21/2014] [Indexed: 02/07/2023] Open
Abstract
Background This study aims to identify that intrathecal (i.t.) injection of dexmedetomidine (Dex) and ropivacaine (Ropi) induces synergistic analgesia on chronic inflammatory pain and is accompanied with corresponding “neuron-astrocytic” alterations. Methods Male, adult Sprague-Dawley rats were randomly divided into sham, control and i.t. medication groups. The analgesia profiles of i.t. Dex, Ropi, and their combination detected by Hargreaves heat test were investigated on the subcutaneous (s.c.) injection of complete Freund adjuvant (CFA) induced chronic pain in rat and their synergistic analgesia was confirmed by using isobolographic analysis. During consecutive daily administration, pain behavior was daily recorded, and immunohistochemical staining was applied to investigate the number of Fos-immunoreactive (Fos-ir) neurons on hour 2 and day 1, 3 and 7, and the expression of glial fibrillary acidic protein (GFAP) within the spinal dorsal horn (SDH) on day 1, 3, 5 and 7 after s.c. injection of CFA, respectively, and then Western blot to examine spinal GFAP and β-actin levels on day 3 and 7. Results i.t. Dex or Ropi displayed a short-term analgesia in a dose-dependent manner, and consecutive daily administrations of their combination showed synergistic analgesia and remarkably down-regulated neuronal and astrocytic activations indicated by decreases in the number of Fos-ir neurons and the GFAP expression within the SDH, respectively. Conclusion i.t. co-delivery of Dex and Ropi shows synergistic analgesia on the chronic inflammatory pain, in which spinal “neuron-astrocytic activation” mechanism may play an important role.
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Affiliation(s)
- Huang-Hui Wu
- Department of Anesthesiology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, PR China
| | - Jun-Bin Yin
- Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi’an, PR China
| | - Ting Zhang
- Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi’an, PR China
| | - Yuan-Yuan Cui
- Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi’an, PR China
| | - Yu-Lin Dong
- Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi’an, PR China
| | - Guo-Zhong Chen
- Department of Anesthesiology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, PR China
- * E-mail: (GZC); (WW)
| | - Wen Wang
- Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi’an, PR China
- * E-mail: (GZC); (WW)
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