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Luo L, Yang L, Lou F, Zhang J. Transcutaneous Pericardium 6 Acupoint Electrical Stimulation Provides Comparable Antiemetic Effect to Granisetron When Combined With Dexamethasone in Patients Undergoing Breast Cancer Surgery. J Surg Res 2024; 303:81-88. [PMID: 39303649 DOI: 10.1016/j.jss.2024.08.016] [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: 01/10/2024] [Revised: 07/09/2024] [Accepted: 08/16/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Perioperative transcutaneous pericardium 6 (P6) electrical stimulation is effective for prevention of postoperative nausea and vomiting (PONV). The patients undergoing breast cancer surgery have a high PONV prevalence; however, the effectiveness of P6 stimulation in this surgical population has not been investigated. MATERIALS AND METHODS A total of 198 patients undergoing mastectomy under general anesthesia were enrolled. They were randomly assigned to the one of three treatments: P6 stimulation + dexamethasone (group PD, n = 66), granisetron + dexamethasone (group GD, n = 66), and dexamethasone alone (group DM, n = 66). The primary endpoint was the incidence of postoperative vomiting (POV) within postoperative 48h. The secondary endpoints included the use of rescue antiemetic, severity of POV, and the incidence of postoperative nausea and other adverse events. RESULTS The incidence of POV in group PD (9.1%) was similar to group GD (10.6%, P = 0.770), but significantly lower than that in the group DM (28.8%, P = 0.004) within postoperative 48 h. And, the incidence of postoperative nausea was similar between group PD and group GD but lower than that in group DM. The use of rescue antiemetics had no statistical differences among the three groups. The median (interquartile range) scores of POV severity were higher in group GD [6.0 (5.0, 7.0)] than in group DM [4.0 (3.0, 6.0), P = 0.012] within postoperative 48 h, but similar to group PD [5.5 (4.0, 6.3), P = 0.208]. CONCLUSIONS Combined with dexamethasone, P6 stimulation has similar effectiveness for PONV prophylaxis with 5- hydroxytryptamine 3 antagonist granisetron but lower cost of antiemetic use. Moreover, both groups had a lower incidence of PONV and higher satisfaction than dexamethasone alone in patients undergoing breast cancer surgery.
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Affiliation(s)
- Lu Luo
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Li Yang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Feifei Lou
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Bell J, Bindelglass A, Morrone J, Park S, Costa A, Bergese S. Postoperative Nausea and Vomiting in the Ambulatory Surgery Center: A Narrative Review. MEDICINES (BASEL, SWITZERLAND) 2024; 11:16. [PMID: 39189162 PMCID: PMC11348043 DOI: 10.3390/medicines11070016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/17/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024]
Abstract
Postoperative nausea and vomiting (PONV) is a common complication of ambulatory surgery, leading to numerous deleterious effects such as decreased patient satisfaction, prolonged recovery unit stays, and rarely, more serious complications such as aspiration pneumonia or wound dehiscence. In this paper, we present a narrative review of the literature regarding common risk factors for PONV including patient factors, surgical factors, and anesthetic factors. We then will review anesthetic techniques and antiemetic drugs demonstrated to mitigate the risk of PONV. Finally, we discuss the potential economic benefits of PONV prophylaxis in the perioperative ambulatory setting.
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Affiliation(s)
- Justin Bell
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.B.); (A.B.); (S.P.); (A.C.)
| | - Adam Bindelglass
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.B.); (A.B.); (S.P.); (A.C.)
| | - Jennifer Morrone
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Sherwin Park
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.B.); (A.B.); (S.P.); (A.C.)
| | - Ana Costa
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.B.); (A.B.); (S.P.); (A.C.)
| | - Sergio Bergese
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.B.); (A.B.); (S.P.); (A.C.)
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Liu J, Fang S, Cheng L, Wang L, Wang Y, Gao L, Liu Y. A web-based dynamic predictive model for postoperative nausea and vomiting in patient receiving gynecological laparoscopic surgery. J Obstet Gynaecol Res 2024; 50:1216-1228. [PMID: 38644529 DOI: 10.1111/jog.15956] [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: 12/24/2023] [Accepted: 04/10/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE The aim of this study was to develop a web-based dynamic prediction model for postoperative nausea and vomiting (PONV) in patients undergoing gynecologic laparoscopic surgery. METHODS The patients (N = 647) undergoing gynecologic laparoscopic surgery were included in this observational study. The candidate risk-factors related to PONV were included through literature search. Lasso regression was utilized to screen candidate risk-factors, and the variables with statistical significance were selected in multivariable logistic model building. The web-based dynamic Nomogram was used for model exhibition. Accuracy and validity of the experimental model (EM) were evaluated by generating receiver operating characteristic (ROC) curves and calibration curves. Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model. Decision curve analysis (DCA) was used to evaluate the clinical practicability of the risk prediction model. RESULTS Ultimately, a total of five predictors including patient-controlled analgesia (odds ratio [OR], 4.78; 95% confidence interval [CI], 1.98-12.44), motion sickness (OR, 4.80; 95% CI, 2.71-8.65), variation of blood pressure (OR, 4.30; 95% CI, 2.41-7.91), pregnancy vomiting history (OR, 2.21; 95% CI, 1.44-3.43), and pain response (OR, 1.64; 95% CI, 1.48-1.83) were selected in model building. Assessment of the model indicates the discriminating power of EM was adequate (ROC-areas under the curve, 93.0%; 95% CI, 90.7%-95.3%). EM showed better accuracy and goodness of fit based on the results of the calibration curve. The DCA curve of EM showed favorable clinical benefits. CONCLUSIONS This dynamic prediction model can determine the PONV risk in patients undergoing gynecologic laparoscopic surgery.
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Affiliation(s)
- Jiang Liu
- School of Nursing, Shandong Second Medical University, Weifang, China
| | | | - Lin Cheng
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Liwei Wang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Yuwen Wang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Lunan Gao
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Yuxiu Liu
- School of Nursing, Shandong Second Medical University, Weifang, China
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Kim JH, Kim JS, Jeon YG, Bae J, Shin K, Hwang B. Effect of dexamethasone and ramosetron on the prevention of postoperative nausea and vomiting in low-risk patients: a randomized, double-blind, placebo-controlled, multicenter trial. BMC Anesthesiol 2023; 23:363. [PMID: 37936053 PMCID: PMC10629132 DOI: 10.1186/s12871-023-02334-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Several studies have investigated the effect of antiemetics on postoperative nausea and vomiting (PONV) in high-risk groups. However, few studies have investigated the effect of antiemetics in patients at low risk of developing PONV. METHODS In this prospective, randomized, double-blinded trial, 177 patients undergoing surgery under general anesthesia were randomly allocated to three groups. Patients allocated to group C (control group) received 2 mL of intravenous 0.9% saline, those allocated to group R (ramosetron group) received 0.3 mg of intravenous ramosetron, and those allocated to group DR (ramosetron plus dexamethasone group) received 5 mg of intravenous dexamethasone and 0.3 mg of intravenous ramosetron. RESULTS Finally, 174 patients completed the study, and the types of surgeries were orthopedic (n = 80), rhinologic (n = 47), urologic (n = 29), and others (n = 18). The incidence of PONV up to 48 h postoperatively was significantly lower in group DR than in group C. The incidence of PONV up to 0-1 h postoperatively was significantly lower in groups R and DR than in group C. The usage pattern of rescue antiemetics was consistent with the incidence of PONV. The percentage of patients requiring rescue analgesics 0-1 h postoperatively was significantly lower in groups R and DR than in group C. CONCLUSIONS The combination of dexamethasone and ramosetron demonstrated a superior effect in preventing PONV for 48 h after surgery under general anesthesia than saline in patients at low risk of developing PONV. Compared with saline injections, ramosetron injections yielded better outcomes for the incidence of PONV and the use of rescue antiemetics and rescue analgesics 0-1 h postoperatively. TRIAL REGISTRATION Clinical trial registration number: criskorea@korea.kr, KCT0006749.
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Affiliation(s)
- Jong-Ho Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University Medical Center, 77 Sakju-ro, Chuncheon, 24253, Republic of Korea
| | - Jin-Sun Kim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangwon, Republic of Korea
| | - Yeong-Gwan Jeon
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University Hospital, Wonju, Republic of Korea
| | - Jangho Bae
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, 24341, Gangwon-do, Republic of Korea
| | - Kiyoung Shin
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, 24341, Gangwon-do, Republic of Korea
| | - Byeongmun Hwang
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, 24341, Gangwon-do, Republic of Korea.
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Yan S, Xu M, Zou X, Xiong Z, Li H, Yang J, Cao W, Zhu Z, Liu C. Acupuncture combined with ondansetron for prevention of postoperative nausea and vomiting in high-risk patients undergoing laparoscopic gynaecological surgery: A randomised controlled trial. United European Gastroenterol J 2023. [PMID: 37318120 DOI: 10.1002/ueg2.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/17/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Consensus guidelines recommend the use of multiple antiemetics as prophylaxis in patients at high risk of postoperative nausea and vomiting (PONV), but the evidence regarding combining acupuncture and antiemetics as a multimodal approach was of very low quality. OBJECTIVE This study aimed to assess the effect of combinations of acupuncture with ondansetron versus ondansetron alone for PONV prophylaxis in women at a high risk. METHODS This parallel, randomised controlled trial was conducted in a tertiary hospital in China. Patients who had three or four PONV risk factors on the Apfel simplified risk score, undergoing elective laparoscopic gynaecological surgery for benign pathology, were recruited. Patients in the combination group received two sessions of acupuncture treatment and 8 mg intravenous ondansetron, whereas those in the ondansetron group received ondansetron alone. The primary outcome was the incidence of PONV within 24 h postoperatively. Secondary outcomes included the incidence of postoperative nausea, postoperative vomiting, adverse events etc. RESULTS: Between January and July 2021, a total of 212 women were recruited, 91 patients in the combination group and 93 patients in the ondansetron group were included in the modified intention-to-treat analysis. In the first 24 h postoperatively, 44.0% of the patients in the combination group and 60.2% of the patients in the ondansetron group experienced nausea, vomiting, or both (difference, -16.3% [95% CI, -30.5 to -2.0]; risk ratio, 0.73 [95% CI, 0.55-0.97]; p = 0.03). However, the results of the secondary outcomes showed that compared to ondansetron alone, acupuncture together with ondansetron was only effective in reducing nausea but did not have a significant impact on vomiting. The incidence of adverse events was similar between the groups. CONCLUSION Acupuncture combined with ondansetron as a multimodal prophylaxis approach is more effective than ondansetron alone in preventing postoperative nausea in high-risk patients.
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Affiliation(s)
- Shiyan Yan
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Mingjun Xu
- Department of Anaesthesiology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
| | - Xuan Zou
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiyi Xiong
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Hewen Li
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jingwen Yang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Wenchao Cao
- Department of Anaesthesiology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
| | - Ziqiong Zhu
- Department of Anaesthesiology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
| | - Cunzhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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Qin J, Ye X, Ye C, Huang X, Sun H, Zhao X, Tong Y, Mazomba M, Mo Y. The Effect of Transcutaneous Electrical Acupoint Stimulation on High-Risk Patients with PONV Undergoing Laparoscopic Gynecologic Surgery: A Randomized Controlled Trial. J Clin Med 2023; 12:jcm12031192. [PMID: 36769839 PMCID: PMC9917901 DOI: 10.3390/jcm12031192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is one of the most common complications after general anesthesia. The traditional comprehensive management of PONV usually uses one or two drugs, but this regimen fails to meet the requirements of the latest version of PONV guidelines. The purpose of this study was to evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on high-risk PONV patients who are undergoing laparoscopic gynecological surgery. METHODS In total, 162 high-risk PONV patients were randomly divided into an experimental group (n = 81) and a control group (n = 81). Both groups were injected with 4 mg of dexamethasone and 0.25 mg of palonosetron. In the experimental group, Nei-guan (PC6) and He-gu (LI4) were stimulated by a transcutaneous acupoint electrical stimulation instrument (HANS200E) 30 min before the surgery. The control group also received electrodes but no stimulation. Variance analysis and rank sum test were used to compare the differences between the two groups. RESULTS The results of the incidence of postoperative nausea, vomiting, NRS score, degree of abdominal distension, and time to first flatus in the experimental group were lower than those in the control group. Nursing satisfaction of the experimental group was higher than that of the control group. CONCLUSIONS The study demonstrates that TEAS combined with dexamethasone and palonosetron can effectively prevent PONV, reduce postoperative abdominal distension and postoperative pain, and shorten the first postoperative flatus time in high-risk patients with PONV. At the same time, it can improve nursing satisfaction.
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Affiliation(s)
- Jiazhu Qin
- Anesthesia Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xiaoxiao Ye
- Anesthesia Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Changzhou Ye
- Anesthesia Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xuliang Huang
- Anesthesia Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Huanhuan Sun
- Anesthesia Department, Taizhou Hospital of Zhejiang Province, Taizhou 318000, China
| | - Xinyu Zhao
- Anesthesia Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yao Tong
- Anesthesia Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Manala Mazomba
- Institute of International Education, Wenzhou Medical University, Ouhai District, Wenzhou 325000, China
| | - Yunchang Mo
- Anesthesia Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- Correspondence: ; Tel.: +86-577-88069790
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Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, Goldberg JE, Feingold DL, Lightner AL, Paquette IM. Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2023; 66:15-40. [PMID: 36515513 PMCID: PMC9746347 DOI: 10.1097/dcr.0000000000002650] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jennifer L. Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Traci L. Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Timothy E. Miller
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Emily Steinhagen
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - Benjamin D. Shogan
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Joel E. Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel L. Feingold
- Department of Surgery, Section of Colorectal Surgery, Rutgers University, New Brunswick, New Jersey
| | - Amy L. Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic
| | - Ian M. Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, Goldberg JE, Feingold DL, Lightner AL, Paquette IM. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Endosc 2023; 37:5-30. [PMID: 36515747 PMCID: PMC9839829 DOI: 10.1007/s00464-022-09758-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/15/2022]
Abstract
The American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) are dedicated to ensuring high-quality innovative patient care for surgical patients by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus as well as minimally invasive surgery. The ASCRS and SAGES society members involved in the creation of these guidelines were chosen because they have demonstrated expertise in the specialty of colon and rectal surgery and enhanced recovery. This consensus document was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus and develop clinical practice guidelines based on the best available evidence. While not proscriptive, these guidelines provide information on which decisions can be made and do not dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, healthcare workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. These guidelines should not be deemed inclusive of all proper methods of care nor exclusive of methods of care reasonably directed toward obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient. This clinical practice guideline represents a collaborative effort between the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and was approved by both societies.
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Affiliation(s)
- Jennifer L Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Traci L Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Timothy E Miller
- Duke University Medical Center Library, Duke University School of Medicine, Durham, NC, USA
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Emily Steinhagen
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Benjamin D Shogan
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Joel E Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel L Feingold
- Section of Colorectal Surgery, Rutgers University, New Brunswick, NJ, USA
| | - Amy L Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, USA
| | - Ian M Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine Surgery (Colon and Rectal), 222 Piedmont #7000, Cincinnati, OH, 45219, USA.
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Ji JY, Kim NS, Seo YH, Jung HS, Chun HR, Park JS, Choi JS, Ahn JM, Kim WJ. Comparing the effects of continuous infusion of esmolol and ramosetron alone and in combination on nausea and vomiting after laparoscopic cholecystectomy: A prospective, randomized, double-blind study. Medicine (Baltimore) 2022; 101:e30105. [PMID: 36107614 PMCID: PMC9439737 DOI: 10.1097/md.0000000000030105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a common complication of laparoscopic cholecystectomy. Although PONV is usually mild, severe thing can delay recovery and prolong hospitalization. We aimed to investigate the effects of ramosetron and esmolol, alone and in combination, on PONV, and pain. METHODS We enrolled 165 patients in their 20s to 50s who had an American Society of Anesthesiology physical status score of 1 or 2 and were scheduled to undergo laparoscopic cholecystectomy. They were randomly allocated into 3 groups: groups R, E, and E+R. Patients in group R received 0.3 mg of ramosetron following surgery. Those in group E were intravenously administered a bolus of esmolol (1.0 mg/kg) before endotracheal intubation. They were continuously infused with esmolol during the surgery to maintain their heart rate at 60 to 100 beats per minute and mean blood pressure at 60 to 100 mm Hg, followed by a bolus of esmolol (1.0 mg/kg) following surgery. Patients in group E+R were intravenously administered a bolus of esmolol (1.0 mg/kg) before endotracheal intubation, infused esmolol during surgery, and administered 0.3 mg of ramosetron and a bolus of esmolol (1.0 mg/kg) following surgery. We monitored the PONV stages (none, nausea, retching, and vomiting) and symptom severity in 3 postoperative stages (0-30 minutes, 30 minutes to 6 hours, and 6-24 hours), the latter by using the visual analog scale (VAS). We conducted an analysis of variance to compare VAS scores between groups. RESULTS Patients in groups E (mean ± standard deviation VAS score, 3.62 ± 1.00) and E+R (3.66 ± 0.71) exhibited less pain (P < .05) until 30 minutes following surgery compared to group R (5.72 ± 1.41). More patients in group E (28/50, 56%) experienced nausea compared to those in groups R (15/50, 30%) and E+R (8/50, 16%) until 30 minutes after surgery (P < .05). However, there were no differences in the severity of retching and vomiting between the groups in any of the phases (P > .05). CONCLUSION Despite reducing pain after laparoscopic cholecystectomy, esmolol did not prevent PONV, whether used alone or in combination with ramosetron.
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Affiliation(s)
- Jae Young Ji
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
| | - Nan Seol Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
- *Correspondence: Nan Seol Kim, Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Soonchunhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, Korea (e-mail: )
| | - Yong Han Seo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
| | - Ho Soon Jung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
| | - Hea Rim Chun
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
| | - Jin Soo Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
| | - Jeong Soo Choi
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
| | - Jae Min Ahn
- Department of Neurosurgery, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
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Use of Apfel Simplified Risk Score to Guide Postoperative Nausea and Vomiting Prophylaxis in Adult Patients Undergoing Same-day Surgery. J Perianesth Nurs 2022; 37:445-451. [DOI: 10.1016/j.jopan.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 12/20/2022]
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Hussain M, Kumar K, Kumar R, Kumari B, Kumar A. Comparison of palonosetron versus palonosetron and dexamethasone for prevention of postoperative nausea and vomiting after middle ear surgeries: A randomized controlled study. Anesth Essays Res 2022; 16:17-21. [PMID: 36249139 PMCID: PMC9558669 DOI: 10.4103/aer.aer_131_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/13/2022] [Accepted: 04/01/2022] [Indexed: 11/04/2022] Open
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Dexamethasone for the treatment of established postoperative nausea and vomiting: A randomised dose finding trial. Eur J Anaesthesiol 2021; 39:549-557. [PMID: 34799501 DOI: 10.1097/eja.0000000000001636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dexamethasone is widely used for the prevention of postoperative nausea and vomiting (PONV) but little is known about its efficacy for the treatment of established PONV. OBJECTIVE To test the antiemetic efficacy of intravenous dexamethasone for the treatment of established PONV in adults undergoing surgery under general anaesthesia and to determine whether there is dose-responsiveness. DESIGN The DexPonv trial is a multicentre, placebo-controlled, randomised, double-blind, dose-finding study. Inclusion of patients was between September 2012 and November 2017. Follow-up for PONV symptoms was for 24 h. Thirty days postoperatively, patients were contacted by study nurses for any information on postoperative bleeding and infection. SETTING Four public hospitals in Switzerland. PATIENTS A total of 803 adults scheduled for elective surgery without any antiemetic prophylaxis signed the consent form; 714 were included. Among those, 319 had PONV and 281 patients were eventually randomised (intention to treat population and safety set). The per protocol set consisted of 260 patients. INTERVENTIONS Patients with PONV symptoms (including retching) were randomised to a single intravenous dose of dexamethasone 3, 6 or 12 mg or matching placebo. MAIN OUTCOME MEASURES The primary endpoint was the absence of further nausea or vomiting (including retching), within 24 h after administration of the study drug. RESULTS Dexamethasone was ineffective during the first 24 h, whatever the dosage, compared to placebo, even when the model was adjusted for known risk factors (P = 0.170). There were no differences in the time to treatment failure or the quality of sleep during the first night. There was a positive correlation between the dose of dexamethasone and blood glucose concentrations (P < 0.001), but not with bleeding risk, wound infections or other adverse effects. CONCLUSION This randomised trial failed to show antiemetic efficacy of any of the tested intravenous regimens of dexamethasone for the treatment of established PONV in adults undergoing surgery under general anaesthesia. TRIAL REGISTRATION clinicaltrials.gov (NCT01975727).
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Effect of Adding Midazolam to Dual Prophylaxis for Preventing Postoperative Nausea and Vomiting. J Clin Med 2021; 10:jcm10214857. [PMID: 34768378 PMCID: PMC8585003 DOI: 10.3390/jcm10214857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
Multimodal prophylaxis for postoperative nausea and vomiting (PONV) has been recommended, even in low-risk patients. Midazolam is known to have antiemetic properties. We researched the effects of adding midazolam to the dual prophylaxis of ondansetron and dexamethasone on PONV after gynecologic laparoscopy. In this prospective, randomized, double-blinded trial, 144 patients undergoing gynecological laparoscopic surgery under sevoflurane anesthesia were randomized to receive either normal saline (control group, n = 72) or midazolam 0.05 mg/kg (midazolam group, n = 72) intravenously at pre-induction. All patients were administered dexamethasone 4 mg at induction and ondansetron 4 mg at the completion of the laparoscopy, intravenously. The primary outcome was the incidence of complete response, which implied the absence of PONV without rescue antiemetic requirement until 24 h post-surgery. The complete response during the 24 h following laparoscopy was similar between the two groups: 41 patients (59%) in the control group and 48 patients (72%) in the midazolam group (p = 0.11). The incidence of nausea, severe nausea, retching/vomiting, and administration of rescue antiemetic was comparable between the two groups. The addition of 0.05 mg/kg midazolam at pre-induction to the dual prophylaxis had no additive preventive effect on PONV after gynecologic laparoscopy.
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Gupta AK, Mena S, Jin Z, Gan TJ, Bergese S. Postoperative pain: a review of emerging therapeutic options. Expert Rev Neurother 2021; 21:1085-1100. [PMID: 34461794 DOI: 10.1080/14737175.2021.1974840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Postoperative pain is often managed by opioid medications, even though they carry a risk of adverse effects such as vomiting, constipation, sedation, respiratory depression and physical dependence. Furthermore, opioid use in the healthcare setting has likely contributed to the epidemic. However, the mismanagement of postoperative pain can result in delayed recovery time, impaired physical function, increased risk of morbidity and mortality, chronic pain, and higher healthcare costs. AREAS COVERED This review explores emerging therapeutic options and strategies in the management of acute postoperative pain and focuses on opioid-sparing, multimodal analgesia. This includes regional anesthetic techniques, non opioid pharmacotherapy, novel opioids and non-pharmacologic therapy. We have also discussed examples of novel analgesics and formulations which have potential benefits in reducing postoperative pain and opioid use after surgery. EXPERT OPINION The development of novel regional anesthesia techniques allows for opioid minimization in increasing number of surgical procedures. This synergizes with the availability of novel non-opioid analgesic adjucts. In addition, several novel opioid drugs have been developed which may be pathway selective and associated with less adverse effect than conventional opioids.
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Affiliation(s)
- Abhishek K Gupta
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States
| | - Shayla Mena
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States
| | - Sergio Bergese
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States.,Department of Neurological Surgery, Stony Brook University Health Science Center, Stony Brook, United States
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Jin Z, Kowa CY, Gan S, Lin J, Gan TJ. Efficacy of palonosetron-dexamethasone combination compared to palonosetron alone for prophylaxis against postoperative nausea and vomiting. Curr Med Res Opin 2021; 37:711-718. [PMID: 33617380 DOI: 10.1080/03007995.2021.1893677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Postoperative nausea and vomiting (PONV) is a common complication following surgery, and may be one of the most distressing parts of the surgical journey. With combination pharmacological therapy recommended for PONV prophylaxis, this systematic review and meta-analysis evaluates whether perioperative palonosetron and dexamethasone is more efficacious than palonosetron administered alone. METHODS We searched CENTRAL; EMBASE; CINAHL; Google Scholar; Web of Science citation index; the US clinical trials register; UK clinical trials register; Australia and New Zealand Clinical trials register; and conference abstracts for major anaesthesia conferences in the last three years.We included randomized controlled trials that compared adult patients undergoing surgery who received palonosetron and dexamethasone, against those who received palonosetron. RESULTS A total of 12 studies (1152 patients) were included. Medium-grade evidence showed that the palonosetron and dexamethasone combination significantly reduced 24-hour rescue anti-emetic requirement (RR: 0.59, 95% confidence interval (CI): 0.41-0.86). There was however no significant difference in the 6-hour (RR: 0.82, 95% CI: 0.61-1.09) and 24-hour PONV incidences (RR: 0.60, 95% CI: 0.33-1.10). Similarly, PONV incidences after 24 h did not differ between groups (RR:0.82, 95% CI: 0.59-1.14). Headache and dizziness were the most common side-effects reported. CONCLUSIONS Combination prophylaxis with palonosetron and dexamethasone reduces post-operative anti-emetic requirement, although is not associated with a significant difference in PONV. There was considerable heterogeneity in the studies, and trial sequential analysis indicates that further studies are needed to strengthen the clinical evidence.
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Affiliation(s)
- Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Chao-Ying Kowa
- Paediatric Critical Care Unit, The Royal London Hospital, London, United Kingdom
| | - Sophie Gan
- Thomas Jefferson School of Nursing, Philadelphia, PA, USA
| | - Jun Lin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
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Jin Z, Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS, Kovac AL, Meyer TA, Urman RD, Apfel CC, Ayad S, Beagley L, Candiotti K, Englesakis M, Hedrick TL, Kranke P, Lee S, Lipman D, Minkowitz HS, Morton J, Philip BK. In Response. Anesth Analg 2021; 132:e31-e33. [PMID: 33449569 DOI: 10.1213/ane.0000000000005280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Zhaosheng Jin
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, New York,
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, New York,
| | - Kumar G Belani
- M Health Fairview, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota
| | - Sergio Bergese
- Stony Brook Renaissance School of Medicine, Stony Brook, New York
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Pierre Diemunsch
- University Hospitals of Hautepierre and CMCO, Strasbourg, France
| | - Ashraf S Habib
- Duke University School of Medicine, Durham, North Carolina
| | | | - Tricia A Meyer
- Baylor Scott & White Health-Temple Medical Center, Texas A&M College of Medicine
| | - Richard D Urman
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christian C Apfel
- University of California San Francisco Medical Center, San Francisco, California
| | - Sabry Ayad
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Outcomes Research, Anesthesiology Institute, Cleveland Clinic
| | - Linda Beagley
- Department of Nursing Education, Swedish Hospital Part of NorthShore, Chicago, Illinois
| | - Keith Candiotti
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miller School of Medicine
| | - Marina Englesakis
- Health Sciences Library, University Health Network, University of Toronto, Ontario, Canada
| | - Traci L Hedrick
- University of Virginia Health System, Charlottesville, Virginia
| | - Peter Kranke
- Department of Anaesthesia, University Hospital of Wuerzburg, Germany
| | - Samuel Lee
- University of Colorado Hospital, Aurora, Colorado
| | | | - Harold S Minkowitz
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Morton
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Beverly K Philip
- Harvard Medical School, Brigham and Women's Hospital, Department of Anesthesiology and Perioperative and Pain Medicine, Boston, Massachusetts
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Jin Z, Gan TJ, Bergese SD. Prevention and Treatment of Postoperative Nausea and Vomiting (PONV): A Review of Current Recommendations and Emerging Therapies. Ther Clin Risk Manag 2020; 16:1305-1317. [PMID: 33408475 PMCID: PMC7780848 DOI: 10.2147/tcrm.s256234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/05/2020] [Indexed: 12/16/2022] Open
Abstract
Postoperative nausea and vomiting is one of the most frequent adverse events after surgery and anesthesia. It is distressing for the patient and can lead to other postoperative complications. Management of PONV involves a framework of risk assessment, multimodal risk reduction, and prophylactic measures, as well as prompt rescue treatment. There has been a significant paradigm shift in the approach towards PONV prevention. There have also been several emerging therapeutic options for PONV prophylaxis and treatment. In this review, we will discuss the up-to-date PONV management guidelines and highlight novel therapeutic options which have emerged in the last few years.
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Affiliation(s)
- Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY 11794-8480, USA
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY 11794-8480, USA
| | - Sergio D Bergese
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY 11794-8480, USA.,Department of Neurological Surgery, Stony Brook University Health Science Center, Stony Brook, NY 11794-8480, USA
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A history of severe nausea and vomiting during pregnancy predicts a higher incidence of postoperative nausea and vomiting after breast cancer surgery without breast reconstruction. Breast Cancer 2020; 28:506-512. [PMID: 33242108 DOI: 10.1007/s12282-020-01190-0] [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: 08/11/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) occur in up to 30 percent of patients after breast cancer surgery despite routine administration of antiemetic prophylaxis. A history of nausea and vomiting during pregnancy (NVP) has been reported as a risk factor of intraoperative nausea and vomiting in caesarean delivery. Nevertheless, whether a history of severe nausea and vomiting during pregnancy (SNVP) is associated with a higher occurrence of PONV remains unclear. METHODS In this study, 121 sequential female patients who were scheduled to undergo breast cancer surgery were assigned to study group (30 cases, with SNVP) or control group (91 cases, with mild NVP (MNVP)). The incidence of PONV and the need for rescue antiemetic were recorded in post-anesthesia care unit (PACU), at 6 h, 12 h, 24 h, and 36 h after operation. Moreover, postoperative pain, level of satisfaction, and the relationship of ER/PR status in breast cancer tissue with SNVP and PONV were also investigated. RESULTS Data from 115 patients were analyzed. The incidence of PONV in the SNVP group was significantly higher than that in the MNVP group at 6 h (P < 0.005), 12 h (P < 0.05), and 24 h after the operation (P < 0.05). The incidence of PONV in the MNVP group was approximately 30% lower than in the SNVP group. Besides, more severe PONV, a larger number of demands for rescue antiemetic, fewer patient satisfaction scores, and more dizziness were observed in the SNVP group. Yet, no relationship was found between ER/PR status of breast cancer tissue and SNVP or PONV. CONCLUSIONS Compared to patients with MNVP, those with a history of SNVP experienced a higher incidence of PONV and severe PONV, presented with a larger number of requirements for postoperative antiemetic and a lower level of satisfaction.
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19
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Uribe AA, Bergese SD. What is the ideal combination antiemetic regimen? Best Pract Res Clin Anaesthesiol 2020; 34:701-712. [PMID: 33288120 DOI: 10.1016/j.bpa.2020.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/16/2020] [Accepted: 10/29/2020] [Indexed: 01/29/2023]
Abstract
Postoperative nausea and vomiting (PONV) and post-discharge nausea and vomiting (PDNV) are frequent unpleasant complaints that patients and clinicians report after surgery. PONV and PDNV have been associated with postoperative complications and hospital discharge delays. Despite the extensive evidence describing the use of several regimens in different surgical populations, the ideal regimen has not been established. Several antiemetic drugs have been evaluated in more than 1000 clinical controlled trials for management of this complex emetogenic pathway, including the 5-hydroxytryptamine (5-HT3) receptor antagonists, dopamine receptor antagonists, neurokinin-type receptor antagonists, antihistaminics, anticholinergics, and corticosteroids, with the 5-HT3 receptor antagonists being the most commonly used for PONV prophylaxis. Because of the complex emetogenic pathway and multifactorial etiology of PONV, a multimodal approach using two or more drugs that act at different neuro-receptor sites is suggested in patients with one or more risk factors to successfully address PONV and reduce its incidence. Nevertheless, the most studied regimens in randomized clinical trials (RCTs) are the combination of serotonin 5-HT3 receptor antagonists with dexamethasone or dopamine receptor antagonists (droperidol). Therefore, the safest and more effective combination regimen appears to be the use of serotonin 5-HT3 receptor antagonist antiemetic drugs with dexamethasone.
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Affiliation(s)
- Alberto A Uribe
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Sergio D Bergese
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
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20
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Besir A, Tugcugil E. Comparison of different end-tidal carbon dioxide levels in preventing postoperative nausea and vomiting in gynaecological patients undergoing laparoscopic surgery. J OBSTET GYNAECOL 2020; 41:755-762. [PMID: 33045886 DOI: 10.1080/01443615.2020.1789961] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to compare different end-tidal carbon dioxide (EtCO2) levels to prevent postoperative nausea and vomiting (PONV) caused by increased intracranial pressure due to pneumoperitoneum and Trendelenburg position in gynaecological laparoscopic surgery. A total of 60 female patients aged 25-50 years who would undergo laparoscopic gynaecological surgery under general anaesthesia were randomised into two groups: group A (EtCO2: 26 - 35 mmHg, n = 30) and group B (EtCO2: 36 - 45 mmHg, n = 30). In both groups, ONSD and EtCO2 of the patients were measured at baseline after anaesthesia induction (Tb), at 5 min after pneumoperitoneum (TPP5), and at 10 min intervals after Trendelenburg position (TPP10, TPP20, TPP30). At 5 (TD5) and 10 min (TD10) after deflation, ONSD measurements were repeated. The incidence and severity of PONV of the patients, and antiemetic drugs used in both groups were assessed in the postoperative period. In the intraoperative follow-up periods, TPP5 and subsequent EtCO2 values, as well as TPP10 and subsequent ONSD values, were significantly higher in group B and the incidence of nausea, the PONV scores and the incidence of rescue antiemetic use significantly lower in group A than in group B (p<.001 for all). This result indicates that low EtCO2 levels have beneficial effects on ICP and PONV in laparoscopic gynaecological operations.Impact statementWhat is already known on this subject? Laparoscopic gynaecologic surgery has been a more preferred technique. The incidence of postoperative nausea and vomiting (PONV) after laparoscopic gynaecologic surgery is remarkably high. In the prevention of PONV after gynaecologic laparoscopic surgery, single and multiple drug therapies and methods have been used.What the results of this study add? Postoperative nausea and vomiting caused by intracranial pressure (ICP) increase due to carbon dioxide pneumoperitoneum and Trendelenburg position in gynaecologic laparoscopic surgeries were decreased in the early postoperative period by low end-tidal carbon dioxide levels in the intraoperative period. It was shown that low end-tidal carbon dioxide levels have beneficial effects on ICP and PONV in laparoscopic gynaecologic operations.What the implications are of these findings for clinical practice and/or further research? This result indicates that low end-tidal carbon dioxide levels have beneficial effects on ICP and PONV in laparoscopic gynaecologic operations.
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Affiliation(s)
- Ahmet Besir
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ersagun Tugcugil
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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21
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Zhu Y, Yang S, Zhang R, Fan P, Yao G, Li J, Xie Z, Gan X. Using Clinical-Based Discharge Criteria to Discharge Patients After Ophthalmic Ambulatory Surgery Under General Anesthesia: An Observational Study. J Perianesth Nurs 2020; 35:586-591.e1. [PMID: 32855052 DOI: 10.1016/j.jopan.2020.04.012] [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: 01/10/2020] [Revised: 04/11/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To verify the feasibility of the clinical-based discharge (CBD) criteria and identify the reasons of long postanesthesia care unit length of stay (PACU-LOS) for ophthalmic ambulatory surgical patients under general anesthesia. DESIGN A prospectively observational study conducted at a tertiary eye center in China. METHODS Medical records were collected from patients admitted for strabismus ambulatory surgery under general anesthesia from September 2018 to March 2019. The patients were discharged home once met the CBD criteria based on a combination of the modified Aldrete's scoring system and Chung's Post-Anesthetic Discharge Scoring System. Postoperative complications were recorded in the PACU and within 24 hours after discharge. Multivariate logistic regression was applied to identify the factors relating to late discharges. FINDINGS All patients (N = 400) were safely and successfully same-day discharged home as none of the patients informed severe emergency events or unanticipated readmission. Nine displayed discharge delays mainly because of mild postoperative nausea and vomiting (PONV) although met the discharge criteria. About 85.5% of patients were discharged within a PACU-LOS of 150 minutes, 379 (94.8%) were within 180 minutes, and the cutoff time in PACU-LOS was 150 minutes. Multivariable analysis indicated that sevoflurane anesthesia and the presence of PONV were related to late discharges (PACU-LOS of greater than 150 minutes, all P < .05). CONCLUSIONS The CBD criteria can efficiently and safely guide the ophthalmic ambulatory surgical patients to discharge home on the same-surgery day, whereas sevoflurane anesthesia and the presence of PONV are associated with a relatively long PACU-LOS.
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Affiliation(s)
- Yanling Zhu
- State Key Laboratory of Ophthalmology, Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shiying Yang
- State Key Laboratory of Ophthalmology, Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Rui Zhang
- State Key Laboratory of Ophthalmology, Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Peiting Fan
- State Key Laboratory of Ophthalmology, Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Guanjing Yao
- State Key Laboratory of Ophthalmology, Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jinfei Li
- State Key Laboratory of Ophthalmology, Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhubin Xie
- State Key Laboratory of Ophthalmology, Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoliang Gan
- State Key Laboratory of Ophthalmology, Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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Alvarez L, Imbaquingo G, Rivadeneira MF, Reascos L. Validation of the translation and cross-cultural adaptation into Spanish of the Postoperative Nausea and Vomiting Intensity Scale. ACTA ACUST UNITED AC 2020; 67:538-544. [PMID: 32819752 DOI: 10.1016/j.redar.2020.05.016] [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: 11/01/2019] [Revised: 02/28/2020] [Accepted: 05/18/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Postoperative nausea and vomiting (PONV) is a common problem in patients undergoing surgical procedures, generating patient dissatisfaction and increasing hospital costs. The Postoperative Nausea and Vomiting Intensity Scale identifies clinically significant cases; however, it has not been validated in Spanish. OBJECTIVE To carry out a cross-cultural adaptation of the PONV Intensity Scale into Spanish and validate it for use in the postoperative period of patients undergoing elective non-cardiac and non-intracranial surgery. MATERIALS AND METHODS Cross-sectional validation study of a diagnostic test. The NVPO Intensity Scale was culturally adapted to Spanish and administered to 393 adult hospitalized patients at 6 postoperative hours. The data were compared with the Apfel Scale and nausea measured on a visual analogue scale (VAS). Internal consistency and inter-observer concordance were calculated. RESULTS 59.8% of patients presented NVPO, of which 14.5% were clinically significant. An acceptable internal consistency was obtained for the NVPO Intensity Scale (Cronbach's alpha 0.7) and a high inter-observer correlation (Kappa 0.9, 95% CI 0.86-0.92), statistically significant, for the overall scale. The correlation with VAS was high (Rho Spearman 0.9). The mean VAS and Apfel scale score was significantly higher in patients with clinically significant PONV. CONCLUSIONS The PONV Intensity Scale adapted to Spanish is a valid and reliable instrument for monitoring and evaluating postoperative nausea and vomiting.
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Affiliation(s)
- L Alvarez
- Anestesiología, Reanimación y Terapia del Dolor, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - G Imbaquingo
- Anestesiología, Reanimación y Terapia del Dolor, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - M F Rivadeneira
- Epidemiología, Facultad de Medicina, Instituto de Salud Pública, Pontificia Universidad Católica del Ecuador, Quito, Ecuador.
| | - L Reascos
- Servicio de Anestesiología, Hospital de Especialidades FF. AA. N° 1, Quito, Ecuador
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Li J, Ye H, Shen W, Chen Q, Lin Y, Gan X. Retrospective analysis of risk factors of postoperative nausea and vomiting in patients undergoing ambulatory strabismus surgery via general anaesthesia. Indian J Anaesth 2020; 64:375-382. [PMID: 32724245 PMCID: PMC7286407 DOI: 10.4103/ija.ija_16_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/28/2020] [Accepted: 02/22/2020] [Indexed: 12/30/2022] Open
Abstract
Background and Aims Postoperative nausea and vomiting (PONV), one of the common complications following strabismus surgery, would delay the ambulatory discharge time. The aim of this retrospective study was to determine the risk factors of PONV in patients undergoing ambulatory strabismus surgery under general anaesthesia, with the treatments of dexamethasone and 5-HT3 antagonist combination. Methods We reviewed 721 consecutive patients (12-60 years old) undergoing ambulatory strabismus surgery under general anaesthesia at an academic eye centre between December 2016 and January 2019. Patients received prophylactic treatment of dexamethasone and 5-HT3 antagonist combination during anaesthesia induction, and PONV was evaluated during the early recovery period before discharge. Results The dexamethasone and 5-HT3 antagonist combination effectively reduced the incidence of PONV (3.05%, 22/721), and the patients who experienced PONV had statistically prolonged phase II recovery time as compared those who did not (P = 0.006). The sum of the extraocular muscles manipulated and the use of nalbuphine (vs flurbiprofen axetil) were the independent risk factors for PONV (P < 0.05). Conclusion The sum of the extraocular muscles manipulated and the use of nalbuphine are potentially modifiable risk factors for PONV after strabismus surgery with the treatments of dexamethasone and 5-HT3 antagonist combination.
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Affiliation(s)
- Jinfei Li
- State Key Laboratory of Ophthalmology, Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Huijin Ye
- State Key Laboratory of Ophthalmology, Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Weihua Shen
- State Key Laboratory of Ophthalmology, Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Qianru Chen
- State Key Laboratory of Ophthalmology, Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Yiquan Lin
- State Key Laboratory of Ophthalmology, Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Xiaoliang Gan
- State Key Laboratory of Ophthalmology, Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
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Peng C, Lei JX. Compatible stability of methylprednisolone sodium succinate and tropisetron in 0.9% sodium chloride injection. Eur J Hosp Pharm 2020; 27:e58-e62. [PMID: 32296507 DOI: 10.1136/ejhpharm-2018-001693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/06/2018] [Accepted: 11/12/2018] [Indexed: 11/04/2022] Open
Abstract
Background A combination of methylprednisolone sodium succinate and tropisetron hydrochloride is commonly used to treat the nausea and vomiting associated with antineoplastic therapy. The objective of this study was to investigate the stability of tropisetron hydrochloride and methylprednisolone sodium succinate in 0.9% sodium chloride injection for up to 48 hours. Methods Commercial solutions of methylprednisolone sodium succinate and tropisetron hydrochloride were obtained and further diluted with 0.9% sodium chloride injection to final concentrations of either 0.4 or 0.8 mg/mL (methylprednisolone sodium succinate) and 0.05 mg/mL (tropisetron). The admixtures were assessed for periods of up to 48 hours after storage at 4°C with protection from light and at 25°C without protection from light. Physical compatibility was determined visually, and the chemical compatibility was measured with high-performance liquid chromatography (HPLC) and by measurement of pH values. Results HPLC analysis demonstrated that methylprednisolone sodium succinate and tropisetron hydrochloride in the various solutions were maintained at 97% of the initial concentrations or higher during the testing period. There were no changes observed by physical precipitation or pH in any of the prepared solutions. Conclusions Tropisetron hydrochloride injection and methylprednisolone sodium succinate injection in 0.9% sodium chloride injection are stable for up to 48 hours at 4°C and 25°C.
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Affiliation(s)
- Chen Peng
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Jie-Xin Lei
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
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Hannon JD, Warner LL, Stewart TM, Kor TM, Blackmon SH, Brown MJ, Subramanian A. Antinausea Protocol Reduces Hospital Length of Stay for Laparoscopic Nissen Fundoplication. J Cardiothorac Vasc Anesth 2020; 34:1853-1857. [PMID: 32234276 DOI: 10.1053/j.jvca.2020.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The perioperative course of patients undergoing laparoscopic Nissen fundoplication (LNF) was reviewed to determine whether the use of a new treatment protocol consisting of total intravenous anesthesia (TIVA) plus triple antiemetic therapy was associated with shorter hospital length of stay (HLOS). DESIGN Retrospective cohort. SETTING Single academic center. PARTICIPANTS The study comprised 448 patients. Fifty-four patients undergoing LNF who received TIVA were compared with 394 who received standard inhalational anesthesia (non-TIVA) between January 2010 and June 2017. INTERVENTIONS Patients who received TIVA were compared with those who received non-TIVA. MEASUREMENTS AND MAIN RESULTS In multivariate analysis, TIVA was significantly associated with reduced HLOS (odds ratio 2.91, 95% confidence interval 1.47-5.78) and a 7.8% reduction in cost of care (p < 0.01). Female sex, length of surgery, and older age all were negatively associated with length of stay. The association between the use of TIVA and reduced HLOS and institutional cost was compared using univariate and multivariate analyses. CONCLUSIONS The use of TIVA in patients undergoing uncomplicated LNF shortens HLOS and is associated with reduced cost of care. This study illustrates that communication among surgeons and anesthesiologists results in improved patient care.
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Affiliation(s)
- James D Hannon
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| | - Lindsay L Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Thomas M Stewart
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Todd M Kor
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | | | - Michael J Brown
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Arun Subramanian
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019. World J Surg 2020; 44:2056-2084. [DOI: 10.1007/s00268-020-05462-w] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Yamamoto K, Yamatodani A. Involvement of leukotriene pathway in the development of sevoflurane-induced pica in rats. Can J Physiol Pharmacol 2019; 97:436-439. [PMID: 30730768 DOI: 10.1139/cjpp-2018-0494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We previously reported that sevoflurane-induced pica, kaolin ingestion behavior, in rats has the potential to reflect postoperative nausea and vomiting (PONV) in humans. It is well-known that corticosteroids, which inhibit both prostaglandin and leukotriene syntheses due to phospholipase A2 inhibition, are effective for reducing PONV; however, the precise mechanisms remain unclear. We investigated the involvement of the prostaglandin or leukotriene pathway in the development of sevoflurane-induced pica. We found that sevoflurane-induced pica was effectively inhibited by pretreatment with a leukotriene receptor antagonist (montelukast) or an inhibitor of 5-lipoxygenase (zileuton), rather than an inhibitor of cyclooxygenase (flurbiprofen). Furthermore, we observed that sevoflurane significantly increased urinary leukotriene excretion and 5-lipoxygenase mRNA expression in the spleen, but not hypothalamus. These results suggest that the production of leukotriene may lead to the development of sevoflurane-induced pica in rats, and that inhibition of the leukotriene pathway could be potentially useful for the treatment of PONV.
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Affiliation(s)
- Kouichi Yamamoto
- a Department of Medical Science and Technology, Division of Health Sciences, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan
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