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Kenter K, Bovid K, Baker EB, Carson E, Mercer D. AOA Critical Issues Symposium: Promoting Health Equity. J Bone Joint Surg Am 2024; 106:1529-1534. [PMID: 38574165 DOI: 10.2106/jbjs.23.01056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
ABSTRACT Promoting equitable health care is to ensure that everyone has access to high-quality medical services and appropriate treatment options. The definition of health equity often can be misinterpreted, and there are challenges in fully understanding the disparities and costs of health care and when measuring the outcomes of treatment. However, these topics play an important role in promoting health equity. The COVID-19 pandemic has made us more aware of profound health-care disparities and systemic racism, which, in turn, has prompted many academic medical centers and health-care systems to increase their efforts surrounding diversity, equity, and inclusion. Therefore, it is important to understand the problems that some patients have in accessing care, promote health care that is culturally competent, create policies and standard operating procedures (at the federal, state, regional, or institutional level), and be innovative to provide cost-effective care for the underserved population. All of these efforts can assist in promoting equitable care and thus result in a more just and healthier society.
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Affiliation(s)
- Keith Kenter
- Department of Orthopaedic Surgery, Western Michigan University Homer Styker M.D. School of Medicine, Kalamazoo, Michigan
| | - Karen Bovid
- Department of Orthopaedic Surgery, Western Michigan University Homer Styker M.D. School of Medicine, Kalamazoo, Michigan
| | - E Brooke Baker
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Eric Carson
- Harlem Hospital Center, New York, NY
- Hospital for Special Surgery, Weill Cornell Medical College, New York, NY
| | - Deana Mercer
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, New Mexico
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Cheng Y, Yuan YJ, Xue FS. Determining efficacy and safety of opioid-free anesthesia combined with a regional block for thyroid surgery. J Anesth 2024; 38:567-568. [PMID: 37897543 DOI: 10.1007/s00540-023-03277-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/14/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Yi Cheng
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Yu-Jing Yuan
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
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Chen Y, Niu D, Wang Y, Zhao T, Xin W, Qian Q, Fu P. Perioperative Dexamethasone Split Between 2 Doses Further Reduced Early Postoperative Nausea and Vomiting Than Single-Dose Dexamethasone: A Randomized Blinded Placebo-Controlled Trial. J Arthroplasty 2024:S0883-5403(24)00752-6. [PMID: 39053664 DOI: 10.1016/j.arth.2024.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND We investigated whether 2 doses of dexamethasone are more effective than a single dose in reducing early postoperative nausea and vomiting (PONV) during total knee arthroplasty (TKA). METHODS A total of 150 patients between June 2021 and June 2022 were randomized into 3 groups: 2 doses of normal saline (group A), a single dose of 10 mg dexamethasone before surgery and normal saline after surgery (group B), and 2 doses of 5 mg dexamethasone during the perioperative period (group C). Primary outcomes were incidences and severity of PONV within 24 hours after surgery, the number and consumption of patients requiring morphine and metoclopramine, and visual analog scale scores for nausea and vomiting at 2, 4, 6, and 24 hours after surgery. Blood glucose levels on days 1, 2, and 3 after operation and incidences of surgical site infection (SSI) as well as gastrointestinal bleeding (GIB) within 45 days after operation were compared. RESULTS Within 24 hours after operation, the number and consumption of patients requiring morphine and metoclopramide in groups B and C were significantly lower than those in group A. Incidences and severity of PONV in groups B and C were significantly lower than those in group A. And these differences between groups B and C were significant. At 2, 4, 6, and 24 hours after operation, there were significant differences in visual analog scale scores of PONV between groups A and B, A and C, as well as B and C. On postoperative days 1, 2, and 3, there were no significant differences in blood glucose levels among the groups, and there were no incidences of SSI or GIB in any group within 45 days after operation. CONCLUSION Dexamethasone significantly reduces PONV within 24 hours after TKA, does not result in significant changes in postoperative blood glucose levels, and does not increase the risk of SSI or GIB, particularly on group C. REGISTRATION NUMBER ChiCTR2400088512. REGISTRATION CENTER Chinese Clinical Trial Registry (ChiCTR). WEBSITE: www.chictr.org.cn.
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Affiliation(s)
- Yancheng Chen
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai, China
| | - Dawei Niu
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai, China
| | - Yinyin Wang
- Ambulatory Surgery Center, Naval Medical University Second Affiliated Hospital, Shanghai, China
| | - Tianlei Zhao
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai, China
| | - Wei Xin
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai, China
| | - Qirong Qian
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai, China
| | - Peiliang Fu
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai, China
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Wang DF, Xue FS, Lin DY. Letter to the Editor Regarding "The Impact of Aprepitant on Nausea and Vomiting Following Laparoscopic Sleeve Gastrectomy: A Blinded Randomized Controlled Trial". Obes Surg 2024:10.1007/s11695-024-07371-6. [PMID: 39028488 DOI: 10.1007/s11695-024-07371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/08/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Dan-Feng Wang
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134 Dongjie, Fuzhou, 350001, China.
| | - Dao-Yi Lin
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
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Yang Y, Liao B, Deng R, Ren L, Sun Y, Xiong S, Wu X. Comparison of anaesthesia strategies on postoperative nausea and vomiting in laparoscopic sleeve gastrectomy: a randomised controlled trial. BMC Anesthesiol 2024; 24:207. [PMID: 38872117 PMCID: PMC11170773 DOI: 10.1186/s12871-024-02577-8] [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: 02/03/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Intra-operative anaesthesia management should be optimised to reduce the occurrence of postoperative nausea and vomiting in high-risk patients; however, a single intervention may not effectively reduce postoperative nausea and vomiting in such patients. This study assessed the effect of an optimised anaesthetic protocol versus a conventional one on postoperative nausea and vomiting in patients who underwent laparoscopic sleeve gastrectomy. METHODS A single-centre randomised trial was conducted at Peking University Shenzhen Hospital from June 2021 to December 2022. Among 168 patients who underwent laparoscopic sleeve gastrectomy, 116 qualified, and 103 completed the study with available data. Patients were categorized into the conventional group (received sevoflurane and standard fluids) and the optimised group (underwent propofol-based anaesthesia and was administered goal-directed fluids). The primary endpoints were postoperative nausea and vomiting incidence and severity within 24 h. RESULTS Postoperative nausea and vomiting assessment at 0-3 h post-surgery revealed no significant differences between groups. However, at 3-24 h, the optimised anaesthetic protocol group showed lower postoperative nausea and vomiting incidence and severity than those of the conventional group (P = 0.005). In the conventional group, 20 (37.04%) patients experienced moderate-to-severe postoperative nausea and vomiting, compared to six (12.25%) patients in the optimised group (odds ratio = 0.237; 95% CI = 0.086, 0.656; P = 0.006). No significant differences were noted in antiemetic treatment, moderate-to-severe pain incidence, anaesthesia recovery, post-anaesthetic care unit stay, or postoperative duration between the groups. While the total intra-operative infusion volumes were comparable, the optimised group had a significantly higher colloidal infusion volume (500 mL vs. 0 mL, P = 0.014) than that of the conventional group. CONCLUSIONS The incidence and severity of postoperative nausea and vomiting 3-24 h postoperatively in patients who underwent laparoscopic sleeve gastrectomy were significantly lower with propofol-based total intravenous anaesthesia and goal-directed fluid therapy than with sevoflurane anaesthesia and traditional fluid management. Total intravenous anaesthesia is an effective multimodal antiemetic strategy for bariatric surgery. TRIAL REGISTRATION This trial was registered with the Chinese Clinical Trial Registry (ChiCTR-TRC- 2,100,046,534, registration date: 21 May 2021).
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Affiliation(s)
- Ying Yang
- Department of Anesthesiology, Peking University Shenzhen Hospital, No. 1200 Lianhua Street, Futian District, Shenzhen, Guangdong, 518036, China
| | - Bucheng Liao
- Department of Anesthesiology, Peking University Shenzhen Hospital, No. 1200 Lianhua Street, Futian District, Shenzhen, Guangdong, 518036, China
| | - Ruoxi Deng
- Department of Anesthesiology, Peking University Shenzhen Hospital, No. 1200 Lianhua Street, Futian District, Shenzhen, Guangdong, 518036, China
| | - Liwei Ren
- Hubei University of Medicine, Shiyan, Shenzhen, China
| | - Yongjie Sun
- Hubei University of Medicine, Shiyan, Shenzhen, China
| | - Shaowei Xiong
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xinhai Wu
- Department of Anesthesiology, Peking University Shenzhen Hospital, No. 1200 Lianhua Street, Futian District, Shenzhen, Guangdong, 518036, China.
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Chen J, Liu L, Xie Y, Yu G, Zhang X. Acupoint Stimulation for Pain Control in Enhanced Recovery After Surgery: Systematic Review and Meta-Analysis. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:493-506. [PMID: 38153965 DOI: 10.1089/jicm.2023.0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Introduction: Postoperative pain control is a challenge in enhanced recovery after surgery (ERAS). The current study reviewed the efficacy and safety of incorporating acupoint stimulation for postoperative pain control in ERAS. Methods: Ten databases for relevant randomized controlled trials (RCTs) published in English or Mandarin Chinese were searched from 1997 to 2022. The quality of each article was appraised using the Cochrane Collaboration Risk of Bias Criteria and the modified Jadad Scale. The primary outcome was pain control, measured using the visual analog scale 24 h after surgery. Results: Eleven trials met the eligibility criteria and were included in the study. Acupoint stimulation was found more effective than control treatments in terms of pain intensity (standardized mean difference [SMD] -0.94; 95% confidence interval [CI] -1.35 to -0.53), analgesic drug consumption (SMD -1.87; 95% CI -2.98 to -0.75), postoperative nausea (PON; SMD 0.31; 95% CI 0.13 to 0.73), postoperative vomiting (POV; SMD 0.57; 95% CI 0.11 to 2.92), and PON and POV (PONV; SMD 0.29; 95% CI 0.16 to 0.53). The Zusanli (ST36) and Neiguan (PC6) were the most-used acupoints in the included trials (8/11). The reported adverse reaction was only one case of bruising. Discussion: Acupoint stimulation improved pain control in patients undergoing ERAS more than control treatments. The findings provide an evidence-based premise for incorporating acupoint stimulation into ERAS strategies. More rigorous RCTs are needed in the future.
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Affiliation(s)
- Jiu Chen
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Li Liu
- Department of Library, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Yirui Xie
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The Department of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Guoyou Yu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Xiaochen Zhang
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
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Wang XD, Meng QW, Xue FS. Comparing prophylactic efficacy of different interventions on postoperative nausea and vomiting: Methodology is critical-Re: Zhang Y, et al. Transcutaneous electrical acupoint stimulation versus dexamethasone for prophylaxis of postoperative nausea and vomiting in breast surgery: A non-inferiority randomized controlled trial. Surgery 2024; 175:1622-1623. [PMID: 38030523 DOI: 10.1016/j.surg.2023.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Xiao-Dong Wang
- Department of Anesthesiology, Wei-Hai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Wei-Hai City, Shandong Province, People's Republic of China
| | - Qing-Wei Meng
- Department of Anesthesiology, Wei-Hai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Wei-Hai City, Shandong Province, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, People's Republic of China.
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Li XT, Su K, Xue FS. Letter to the Editor Regarding "Electropress Needle Stimulation for the Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Sleeve Gastrectomy: a Prospective, Randomized Controlled Trial". Obes Surg 2024; 34:1024-1025. [PMID: 38280156 DOI: 10.1007/s11695-023-06977-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/13/2023] [Accepted: 12/06/2023] [Indexed: 01/29/2024]
Affiliation(s)
- Xin-Tao Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Kai Su
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
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Yaşlı SO, Canpolat DG, Dogruel F, Demirbaş AE. Is Postoperative Pain Associated With Nausea and Vomiting Following Orthognathic Surgery? J Oral Maxillofac Surg 2024; 82:279-287. [PMID: 38182117 DOI: 10.1016/j.joms.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/19/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a common adverse side-effect following orthognathic surgery, with pain potentially contributing as a risk factor. PURPOSE The study's purpose was to measure the association between postoperative pain and PONV. STUDY DESIGN, SETTING, SAMPLE This prospective cohort study involved patients who underwent bimaxillary surgery at Erciyes University, Oral and Maxillofacial Surgery Hospital. Patients with a history of routine antiemetic use, pregnancy, breastfeeding, morbid obesity, cardiac dysrhythmia, mental retardation, or psychiatric illness were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The predictor variable was postoperative pain, which was measured using a 100-mm visual analogue scale (VAS). VAS scores were documented at the 30-minute postoperative mark (referred to as VAS1), and the mean of hourly VAS scores over the initial three postoperative hours (denoted as VAS2). MAIN OUTCOME VARIABLE(S) The primary outcome was the occurrence of PONV, defined as active vomiting, retching, or nausea leading to vomiting. The secondary outcome was the timing of PONV, categorized as early (within 6 hours), late (6-24 hours), and delayed (beyond 24 hours postoperatively). COVARIATES The study's covariates were age, sex, body mass index, Apfel risk scores, surgery duration, history of PONV or motion sickness, and smoking status. ANALYSES Descriptive statistics and χ2 tests were used for data analysis, with statistical significance set at P value < .05. RESULTS The sample was composed of 86 subjects with a median age of 20 years (range: 18-30 years), of which 37.2% were male. The frequency of PONV was 50%. Postoperative pain, as measured by VAS scores, was significantly higher in the PONV group compared to the non-PONV group. The median VAS1 score was 60.0 (PONV group, range 40-90) versus 50.0 (non-PONV, range 0-90) (P = .041); for VAS2, it was 60.0 (PONV, range 40-80) compared to 40.0 (non-PONV, range 30-60) (P < .001). CONCLUSIONS AND RELEVANCE The frequency of PONV observed in patients undergoing bimaxillary surgery is substantial, necessitating the identification and management of risk factors to enhance perioperative care and patient outcomes. By improving PONV management and addressing postoperative pain, health-care providers can enhance the perioperative experience and patient outcomes in bimaxillary surgery.
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Affiliation(s)
- Seher Orbay Yaşlı
- Assistant Professor in Anesthesiology, Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Melikgazi, Kayseri, Turkey.
| | - Dilek Günay Canpolat
- Associate Professor in Anesthesiology, Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Melikgazi, Kayseri, Turkey
| | - Fatma Dogruel
- Assistant Professor in Internal Medicine, Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Melikgazi, Kayseri, Turkey
| | - Ahmet Emin Demirbaş
- Associate Professor, Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Melikgazi, Kayseri, Turkey
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Su K, Xue FS, Cheng Y. Comment on Matsumoto et al. Remimazolam's Effects on Postoperative Nausea and Vomiting Are Similar to Those of Propofol after Laparoscopic Gynecological Surgery: A Randomized Controlled Trial. J. Clin. Med.2023, 12, 5402. J Clin Med 2024; 13:923. [PMID: 38398238 PMCID: PMC10889553 DOI: 10.3390/jcm13040923] [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: 10/28/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
The recent article published in this journal by Matsumoto et al. [...].
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Affiliation(s)
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing 100050, China
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Yokoyama T, Tamura T, Nishida K, Ito R, Nishiwaki K. Anxiety evaluated by the Hospital Anxiety and Depression Scale as a predictor of postoperative nausea and vomiting: a pilot study. NAGOYA JOURNAL OF MEDICAL SCIENCE 2024; 86:72-81. [PMID: 38505720 PMCID: PMC10945218 DOI: 10.18999/nagjms.86.1.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/13/2023] [Indexed: 03/21/2024]
Abstract
The incidence of postoperative nausea and vomiting (PONV) remains high, and improving the accuracy of PONV prediction remains challenging. The primary aim of this study is to examine the impact of anxiety scores evaluated using the Hospital Anxiety and Depression Scale (HADS) on the PONV prediction model. We hypothesized that anxiety and depression, quantified using the HADS, could improve the accuracy of the PONV predictive model. This pilot study evaluated 100 patients. The HADS was conducted by a self-evaluation method before thoracoscopic surgery for lung tumors, and the anesthesia method was standardized. The criterion was whether the nurse in charge of the patient who complained of PONV assessed that drug administration was necessary. As the main analysis, the odds ratio of the HADS score for predicting PONV was evaluated using multivariable logistic regression models. Further, the receiver operating characteristic (ROC) curves of the model with the HADS score added to the variables of without-anxiety predictors and the model with the variables of without-anxiety predictors only were compared. The anxiety score was significantly higher in the PONV group than in the no PONV group (P = 0.021). For predictive accuracy, the model that included age, sex, smoking history, history of PONV, and anxiety score had a higher area under the ROC curve than did the model excluding the anxiety score (P = 0.021). In conclusion, the findings indicate that the HADS is worth investigating as a predictor of PONV.
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Affiliation(s)
- Tatsuro Yokoyama
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Anesthesiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takahiro Tamura
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuki Nishida
- Department of Advanced Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryohei Ito
- Department of Anesthesiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kimitoshi Nishiwaki
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Xue B, Xue FS, Li XY. Letter to the Editor: Effect of preoperative carbohydrate drink and postoperative chewing gum on postoperative nausea and vomiting in patients undergoing day care laparoscopic cholecystectomy: A randomized controlled trial. World J Surg 2024; 48:493-494. [PMID: 38310309 DOI: 10.1002/wjs.12028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Affiliation(s)
- Bai Xue
- Department of Anesthesiology, Sengkang General Hospital, Singapore, Singapore
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xin-Yue Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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13
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Su K, Xue FS, Cheng Y. Determining the Role of Preoperative Oral Amisulpride as Part of a Multimodal Antiemetic Prophylaxis Regime in Patients Undergoing Craniotomy. J Neurosurg Anesthesiol 2024:00008506-990000000-00092. [PMID: 38214517 DOI: 10.1097/ana.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Kai Su
- Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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Lee DJ, Douglas JE, Chang J, Wilensky J, Jackson C, Lee JYK, Grady MS, Yoshor D, Kohanski MA, Palmer JN, Atkins JH, Adappa ND. The use of aprepitant for the prevention of postoperative nausea and vomiting in endoscopic transsphenoidal pituitary surgery. Int Forum Allergy Rhinol 2023; 13:2180-2186. [PMID: 37302141 DOI: 10.1002/alr.23208] [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: 03/17/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) are adverse effects after surgery, which may increase the risk of complications. Aprepitant is a neurokinin-1 receptor blocker and has been shown to reduce chemotherapy-related nausea and vomiting and PONV. However, its role in endoscopic skull base surgery remains unclear. The purpose of this study was to evaluate the effect of aprepitant in reducing PONV in endoscopic transsphenoidal (TSA) pituitary surgery. METHODS A retrospective chart review between July 2021 and January 2023 of 127 consecutive patients who underwent TSA was performed at a tertiary academic institution. Patients were divided into 2 groups based on preoperative aprepitant use. Two groups were matched based on known risk factors of PONV (age, sex, nonsmoking, and history of PONV). The primary outcome was the incidence of PONV. Secondary outcome measures included the number of anti-emetic use, length of stay, and postoperative cererebrospinal fluid (CSF) leak. RESULTS After matching, 48 patients were included in each group. The aprepitant group demonstrated a significantly lower incidence of vomiting than the non-aprepitant group (2.1% vs 22.9%, p = 0.002). The number of nausea episodes and anti-emetic use decreased with aprepitant use (p < 0.05). There was no difference in the incidence of nausea, length of stay, or postoperative CSF leak. Multivariate analysis demonstrated that aprepitant decreased the incidence of postoperative vomiting with odds ratio of 0.107. CONCLUSION Aprepitant may serve as a useful preoperative treatment to reduce PONV in patients undergoing TSA. Further studies are needed to evaluate its impact in other arenas of endoscopic skull base surgery.
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Affiliation(s)
- Daniel J Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer E Douglas
- Department of Otorhinolaryngology-Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeremy Chang
- Department of Otorhinolaryngology-Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jadyn Wilensky
- Department of Otorhinolaryngology-Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina Jackson
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Y K Lee
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Sean Grady
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Yoshor
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James N Palmer
- Department of Otorhinolaryngology-Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua H Atkins
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head & Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Meyer TA, Hutson LR, Morris PM, McAllister RK. A Postoperative Nausea and Vomiting Update: Current information on New Drugs, Old Drugs, Rescue/Treatment, Combination Therapies and Nontraditional Modalities. Adv Anesth 2023; 41:17-38. [PMID: 38251617 DOI: 10.1016/j.aan.2023.05.002] [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] [Indexed: 01/23/2024]
Abstract
This article's objective is to present the latest evidence and information on the management of postoperative nausea and vomiting (PONV). PONV continues to affect 30% of the surgical population causing patient dissatisfaction, extending length of stay, and increasing overall costs. This review includes the introduction of 2 new intravenous formulations of antiemetics (amisulpride, aprepitant), updates on nontraditional therapies, suggestions for combination prophylaxis, emerging data on rescue treatment, and considerations for special populations and settings. Both of the new antiemetics provide promising options for pharmacologic interventions for PONV with favorable safety profiles.
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Affiliation(s)
- Tricia A Meyer
- Texas A&M University-School of Medicine, Temple, TX, USA.
| | - Larry R Hutson
- Texas A&M University-School of Medicine, Temple, TX, USA; Baylor College of Medicine - Temple, TX, USA; Department of Anesthesiology, Baylor Scott & White Medical Center-Temple, 2401 South 31st Street, Temple, TX 76508, USA
| | - Phillip M Morris
- Texas A&M University-School of Medicine, Temple, TX, USA; Department of Anesthesiology, Baylor Scott & White Medical Center-Temple, 2401 South 31st Street, Temple, TX 76508, USA
| | - Russell K McAllister
- Texas A&M University-School of Medicine, Temple, TX, USA; Baylor College of Medicine - Temple, TX, USA; Department of Anesthesiology, Baylor Scott & White Medical Center-Temple, 2401 South 31st Street, Temple, TX 76508, USA.
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16
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Zhong H, Liu Y, Liu P, Wang Z, Lian X, Xu Z, Xu R, Su S, Lyu G, Xu Z. Risk estimation for postoperative nausea and vomiting: development and validation of a nomogram based on point-of-care gastric ultrasound. BMC Anesthesiol 2023; 23:393. [PMID: 38036983 PMCID: PMC10688051 DOI: 10.1186/s12871-023-02345-0] [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: 06/21/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND We aimed to develop a nomogram that can be combined with point-of-care gastric ultrasound and utilised to predict postoperative nausea and vomiting (PONV) in adult patients after emergency surgery. METHODS Imaging and clinical data of 236 adult patients undergoing emergency surgery in a university hospital between April 2022 and February 2023 were prospectively collected. Patients were divided into a training cohort (n = 177) and a verification cohort (n = 59) in a ratio of 3:1, according to a random number table. After univariate analysis and multivariate logistic regression analysis of the training cohort, independent risk factors for PONV were screened to develop the nomogram model. The receiver operating characteristic curve, calibration curve, decision curve analysis (DCA) and clinical impact curve (CIC) were used to evaluate the prediction efficiency, accuracy, and clinical practicability of the model. RESULTS Univariate analysis and multivariate logistic regression analysis showed that female sex, history of PONV, history of migraine and gastric cross-sectional area were independent risk factors for PONV. These four independent risk factors were utilised to construct the nomogram model, which achieved significant concordance indices of 0.832 (95% confidence interval [CI], 0.771-0.893) and 0.827 (95% CI, 0.722-0.932) for predicting PONV in the training and validation cohorts, respectively. The nomogram also had well-fitted calibration curves. DCA and CIC indicated that the nomogram had great clinical practicability. CONCLUSIONS This study demonstrated the prediction efficacy, differentiation, and clinical practicability of a nomogram for predicting PONV. This nomogram may serve as an intuitive and visual guide for rapid risk assessment in patients with PONV before emergency surgery.
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Affiliation(s)
- Huohu Zhong
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yingchao Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Piaopiao Liu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zecheng Wang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xihua Lian
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Zhirong Xu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Ruopu Xu
- Department of Emergency, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Shanshan Su
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
| | - Guorong Lyu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology of Education Ministry, Quanzhou Medical College, Quanzhou, China.
| | - Zhenhong Xu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
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17
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Thawkar VN, Taksande K. Advances in Anesthesia for Shoulder Surgery: A Comprehensive Review of Dexmedetomidine-Enhanced Interscalene Brachial Plexus Block. Cureus 2023; 15:e48827. [PMID: 38106768 PMCID: PMC10722345 DOI: 10.7759/cureus.48827] [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: 09/11/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Surgical procedures on the shoulder pose distinctive challenges in managing pain during the perioperative period, underscoring the importance of exploring innovative anesthesia techniques. This comprehensive review article delves into integrating dexmedetomidine, an alpha-2 adrenergic agonist, within interscalene brachial plexus blocks for shoulder surgery. The review initiates by underscoring the pivotal role of effective anesthesia in shoulder surgery and elucidates the rationale behind investigating dexmedetomidine as an adjunct. It meticulously examines the anatomy and physiology of the brachial plexus, emphasizing its critical significance in shoulder surgery. Furthermore, the article expounds on dexmedetomidine's mechanisms of action and pharmacokinetics, encompassing its safety profile and potential side effects. The conventional interscalene brachial plexus block techniques, along with their limitations and challenges, are discussed, laying the foundation for the integration of dexmedetomidine. The review subsequently delves into exploring the role of dexmedetomidine in regional anesthesia, covering previous studies, mechanisms of action, and the potential advantages of incorporating it into nerve blocks. The review's core concentrates on the practical application of dexmedetomidine-enhanced interscalene brachial plexus blocks. This includes discussions on administration techniques, dosage guidelines, and compelling evidence supporting its utilization. Clinical scenarios where this approach proves most advantageous are thoroughly explored, comparing its effectiveness with traditional techniques in terms of pain control and patient outcomes. A comprehensive examination of relevant clinical trials and case studies highlights the evidence supporting its efficacy. The review also underscores safety considerations associated with dexmedetomidine. It proposes strategies for mitigating risks to ensure patient safety. Insights into future directions and research are provided, encompassing ongoing studies, areas necessitating further investigation, and potential refinements in technique. Finally, the article summarizes key findings, emphasizing the practicality of dexmedetomidine-enhanced interscalene brachial plexus blocks in shoulder surgery and its far-reaching implications for clinical practice and patient care.
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Affiliation(s)
- Varun N Thawkar
- Anesthesiology, Acharya Vinoba Bhave Rural Hospital, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Karuna Taksande
- Anesthesiology, Acharya Vinoba Bhave Rural Hospital, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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18
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Messerer B, Stijic M, Sandner-Kiesling A, Brillinger JM, Helm J, Scheer J, Strohmeier CS, Avian A. Is PONV still a problem in pediatric surgery: a prospective study of what children tell us. Front Pediatr 2023; 11:1241304. [PMID: 37964809 PMCID: PMC10642485 DOI: 10.3389/fped.2023.1241304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Background Postoperative nausea and vomiting (PONV) is an unpleasant complication after surgery that commonly co-occurs with pain. Considering the high prevalence among pediatric patients, it is important to explore the main risk factors leading to PONV in order to optimize treatment strategies. The objectives of this study are as follows: (1) to determine the prevalence of PONV on the day of surgery by conducting interviews with pediatric patients, (2) to assess PONV prevalence in the recovery room and on the ward by analyzing nursing records, and (3) to collect information on PONV risk factors on the day of surgery and the following postoperative days. We wanted to investigate real-life scenarios rather than relying on artificially designed studies. Methods A prospective analysis [according to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines] of PONV on the day of surgery and the following postoperative days was conducted by evaluating demographic and procedural parameters, as well as conducting interviews with the children under study. A total of 626 children and adolescents, ranging in age from 4 to 18 years, were interviewed on the ward following their surgery. The interviews were conducted using a questionnaire, as children aged 4 and above can participate in an outcome-based survey. Results On the day of surgery, several multivariable independent predictors were identified for PONV. The type of surgery was found to be a significant factor (p = 0.040) with the highest odds ratio (OR) in patients with procedural investigations [OR 5.9, 95% confidence interval (CI): 1.8-19.2], followed by abdominal surgery (OR 3.1, 95% CI: 0.9-11.1) when inguinal surgery was used as the reference category. In addition, the study identified several predictors, including the amount of fentanyl administered during anesthesia (µg/kg body weight) (OR 1.4, 95% CI: 1.1-1.8), intraoperative use of piritramide (OR 2.6, 95% CI: 1.5-4.4) and diclofenac (OR 2.0, 95% CI: 1. 3-3.1), opioid administration in the recovery room (OR 3.0, 95% CI: 1.9-4.7), and piritramide use on the ward (OR 4.5, 95% CI: 1.7-11.6). Conclusions The main risk factors for PONV include the intraoperative administration of opioids during the recovery room stay and at the ward, the intraoperative use of non-opioids (diclofenac), and the specific type of surgical procedure. Real-life data demonstrated that in clinical praxis, there is a gap between the adherence to established guidelines and the use of antiemetic prophylaxis in surgeries that are generally not associated with a high PONV prevalence. Further efforts are needed to improve the existing procedures and thus improve the overall outcome.
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Affiliation(s)
- Brigitte Messerer
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Marko Stijic
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
- University Clinic for Neurology, Clinical Department for Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Andreas Sandner-Kiesling
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Johanna M. Brillinger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Jasmin Helm
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Jacqueline Scheer
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Christof Stefan Strohmeier
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
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19
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Theodosopoulou P, Staikou C, Fassoulaki A. Preoperative versus intraoperative antiemetic strategies in patients undergoing laparoscopic cholecystectomy: A randomised double-blind study. Eur J Anaesthesiol 2023; 40:769-776. [PMID: 37466110 DOI: 10.1097/eja.0000000000001888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Previous studies have determined ondansetron's efficacy in preventing and treating postoperative nausea and vomiting (PONV). However, evidence regarding the timing of drug administration in relation to the surgical procedure remains vague. OBJECTIVE To compare the preoperative and intraoperative administration of ondansetron on the incidence of PONV. DESIGN Single-centred, randomised, double-blind trial. Patients were recruited between November 2018 and April 2021. Follow-up for PONV and retching was up to 24 h. SETTING Aretaieio University Hospital, Greece. PATIENTS A total of 121 patients undergoing elective laparoscopic cholecystectomy gave written consent. INTERVENTIONS Patients were randomly allocated to the preoperative or the intraoperative group. The preoperative group received 4 mg of ondansetron dissolved in 100 ml of 0.9% saline 1 hour before induction of anaesthesia and 100 ml of 0.9% saline 30 min before end of surgery. The intraoperative group received 100 ml of 0.9% saline 1 h before induction of anaesthesia and 4 mg of ondansetron dissolved in 100 ml of 0.9% saline 30 min before end of surgery. MAIN OUTCOME MEASURES The primary outcome was the incidence of nausea and/or vomiting combined at 24 h. RESULTS No difference was found between the two groups regarding either the incidence of nausea and vomiting at 24 h (1.7% for the preoperative group versus 5.3% for the intraoperative group, P = 0.31) or the incidence of nausea, vomiting and retching combined (5.3% for the preoperative group versus 10.5% for the intraoperative group, P = 0.30). There was no difference between the groups in the pain intensity at rest or with coughing in the post anaesthesia care unit, at 4, 8 and 24 h postoperatively ( P = 0.961, 0.929, 0.748 and 0.883 at rest, and 0.974, 0.220, 0.235 and 0.317 with coughing, respectively). CONCLUSION Under the current study design, we found no difference in the incidence of PONV between the administration of ondansetron 1 h before induction of anaesthesia and the intraoperative administration of ondansetron 30 min before the end of surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT03023306.
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Affiliation(s)
- Polyxeni Theodosopoulou
- From the Department of Anaesthesia, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece (PT, CS, AF)
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20
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Kim JH, Cheon BR, Kim MG, Hwang SM, Lim SY, Lee JJ, Kwon YS. Postoperative Nausea and Vomiting Prediction: Machine Learning Insights from a Comprehensive Analysis of Perioperative Data. Bioengineering (Basel) 2023; 10:1152. [PMID: 37892882 PMCID: PMC10604280 DOI: 10.3390/bioengineering10101152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Postoperative nausea and vomiting (PONV) are common complications after surgery. This study aimed to present the utilization of machine learning for predicting PONV and provide insights based on a large amount of data. This retrospective study included data on perioperative features of patients, such as patient characteristics and perioperative factors, from two hospitals. Logistic regression algorithms, random forest, light-gradient boosting machines, and multilayer perceptrons were used as machine learning algorithms to develop the models. The dataset of this study included 106,860 adult patients, with an overall incidence rate of 14.4% for PONV. The area under the receiver operating characteristic curve (AUROC) of the models was 0.60-0.67. In the prediction models that included only the known risk and mitigating factors of PONV, the AUROC of the models was 0.54-0.69. Some features were found to be associated with patient-controlled analgesia, with opioids being the most important feature in almost all models. In conclusion, machine learning provides valuable insights into PONV prediction, the selection of significant features for prediction, and feature engineering.
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Affiliation(s)
- Jong-Ho Kim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea; (J.-H.K.); (B.-R.C.); (M.-G.K.); (S.-M.H.); (S.-Y.L.); (J.-J.L.)
- Institute of New Frontier Research Team, Hallym University College of Medicine, Chuncheon-si 24252, Republic of Korea
| | - Bo-Reum Cheon
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea; (J.-H.K.); (B.-R.C.); (M.-G.K.); (S.-M.H.); (S.-Y.L.); (J.-J.L.)
| | - Min-Guan Kim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea; (J.-H.K.); (B.-R.C.); (M.-G.K.); (S.-M.H.); (S.-Y.L.); (J.-J.L.)
| | - Sung-Mi Hwang
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea; (J.-H.K.); (B.-R.C.); (M.-G.K.); (S.-M.H.); (S.-Y.L.); (J.-J.L.)
| | - So-Young Lim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea; (J.-H.K.); (B.-R.C.); (M.-G.K.); (S.-M.H.); (S.-Y.L.); (J.-J.L.)
| | - Jae-Jun Lee
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea; (J.-H.K.); (B.-R.C.); (M.-G.K.); (S.-M.H.); (S.-Y.L.); (J.-J.L.)
- Institute of New Frontier Research Team, Hallym University College of Medicine, Chuncheon-si 24252, Republic of Korea
| | - Young-Suk Kwon
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea; (J.-H.K.); (B.-R.C.); (M.-G.K.); (S.-M.H.); (S.-Y.L.); (J.-J.L.)
- Institute of New Frontier Research Team, Hallym University College of Medicine, Chuncheon-si 24252, Republic of Korea
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21
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Deljou A, Kanaparthi A, Soleimani J, Sprung J, Schroeder DR, Weingarten TN, Chalupka AN. Gravid status is not associated with postoperative nausea and vomiting: a matched case-control study. J Anesth 2023; 37:681-686. [PMID: 37368075 DOI: 10.1007/s00540-023-03220-5] [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: 01/23/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a common and unpleasant complication of general anesthesia. There are well-known risk factors that predispose a patient to develop PONV. While studies exist that explore PONV incidence in gravid and non-gravid women separately, limited studies exist to compare the two cohorts to identify if pregnancy is associated with increased risk for PONV or differences in PONV prophylaxis and treatment. METHODS This is a retrospective case-control cohort study, with 1:2 matching based on age, year of surgery, and surgical procedure. Electronic medical records were abstracted for demographic information, predisposing risk factors, prophylactic antiemetics, PONV documentation, rescue antiemetics, PACU stay, and length of hospitalization. Analyses of risk factors for PONV were performed using logistic and multinomial logistic regression analyses. RESULTS 237 gravid women who underwent non-obstetric procedures with general anesthesia were identified and matched with 474 non-gravid women. PONV complicated the course of 51 (21.5%) gravid and 72 (15.2%) non-gravid women. The number of prophylactic antiemetics was fewer among gravid (median 2 [1, 2]) than non-gravid (3 [2, 3]) women (P < 0.001). No association was found between gravid status and risk for PONV (adjusted odds ratio 1.35 [95%CI 0.84, 2.17], P = 0.222). Gravid women had longer hospital lengths of stay (P < 0.001), despite having shorter surgical duration (P = 0.015). CONCLUSIONS The risk for PONV is similar between gravid and similarly aged women. However, anesthesiologists administer fewer prophylactic antiemetics to gravid women during non-obstetric surgery.
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Affiliation(s)
- A Deljou
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN, 55905, USA.
| | - A Kanaparthi
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN, 55905, USA
| | - J Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN, 55905, USA
| | - J Sprung
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN, 55905, USA
| | - D R Schroeder
- Department of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - T N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN, 55905, USA
| | - A N Chalupka
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN, 55905, USA
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Zhao W, Li J, Wang N, Wang Z, Zhang M, Zhang H, Liu M, He J, Yu D. Effect of dexmedetomidine on postoperative nausea and vomiting in patients under general anaesthesia: an updated meta-analysis of randomised controlled trials. BMJ Open 2023; 13:e067102. [PMID: 37527891 PMCID: PMC10394554 DOI: 10.1136/bmjopen-2022-067102] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES To explore the effect of dexmedetomidine (DEX) on postoperative nausea and vomiting (PONV) in adult patients after general anaesthesia. DESIGN Systematic review and meta-analysis. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials (RCTs) comparing the efficacy of DEX with placebo or a single drug on PONV in adult patients after general anaesthesia. DATA SOURCES We searched the PubMed, the Web of Science, the Cochrane Library and Embase (1 January 2000 to 30 June 2022) to select the relevant RCTs. DATA ANALYSIS All the relevant data were analysed by using RevMan V.5.4. Heterogeneity was tested for each outcome, and random-effect or fixed-effect models was selected according to the level of heterogeneity. The primary outcome was the incidence of PONV. The secondary outcomes were the incidence of bradycardia, perioperative opioid consumption, extubation time and the length of hospitalisation. RESULTS A total of 18 trials involving 2018 patients were included in this meta-analysis. Notably, 15 updated studies were not involved in the previous meta-analysis. The incidence of PONV in DEX group was lower than that in the control group (OR=0.49, 95% CI: 0.36 to 0.67) and the perioperative opioid consumption in DEX group was also decreased significantly (standard mean difference (SMD)=-1.04, 95% CI: -1.53 to -0.54). Moreover, the length of hospitalisation (SMD=-2.29, 95% CI: -4.31 to -0.28) and the extubation time (SMD=-0.75, 95% CI: -1.26 to -0.25) in DEX group were shorter. Whereas, more number of patients receiving DEX might increase the occurrence of bradycardia (OR=1.60, 95% CI: 1.13 to 2.27). CONCLUSIONS DEX could decrease the occurrence of PONV in adult patients under general anaesthesia and promote the recovery after surgery. However, DEX might increase the occurrence of bradycardia. PROSPERO REGISTRATION NUMBER CRD 42022341548.
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Affiliation(s)
- Weihong Zhao
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Na Wang
- Department of Rheumatology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Zhibin Wang
- Department of Anesthesiology, The Fifth People's Hospital of Hengshui, Hengshui, Hebei Province, China
| | - Meng Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Meinv Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Jinhua He
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Dongdong Yu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
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23
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Mac Curtain BM, O'Mahony A, Temperley HC, Ng ZQ. Enhanced recovery after surgery protocols and emergency surgery: a systematic review and meta-analysis of randomized controlled trials. ANZ J Surg 2023; 93:1780-1786. [PMID: 37282791 DOI: 10.1111/ans.18550] [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: 04/12/2023] [Revised: 05/12/2023] [Accepted: 05/21/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND This systematic review and meta-analysis seeks to assess the modified protocols used and patient outcomes when enhanced recovery after surgery (ERAS) protocols are utilized in an emergency setting. METHODS PubMed, MEDLINE, EMBASE and Cochrane Central Registry of Controlled Trials were comprehensively searched until 13 March 2023. The Cochrane Risk of Bias Assessment Tool was used to assess for bias, along with funnel plot asymmetry. We present log risk ratios for dichotomous variables and raw mean differences for continuous variables. RESULTS Seven randomized trials were included, comprising 573 patients. Results of the primary outcomes when comparing ERAS to standard care are as follows; withdrawal of nasogastric tube (raw mean difference -1.87 CI: -2.386 to -1.359), time to first liquid diet (raw mean difference -2.56 CI: -3.435 to -1.669), time to first solid diet (raw mean difference -2.35 CI: -2.933 to -1.76), time to first flatus (raw mean difference -2.73 CI: -5.726 to 0.257), time to first stool passed (raw mean difference -1.83 CI: -2.307 to -1.349), time to removal of drains (raw mean difference -3.23 CI: -3.609 to -2.852), time to removal of urinary catheter (raw mean difference -1.57 CI: -3.472 to 0.334), mean pain score (raw mean difference -1.79 CI: -2.222 to -1.351) and length of hospital stay (raw mean difference -3.16 CI: -3.688 to -2.63). CONCLUSIONS The adoption of ERAS protocols in an emergency surgery setting was observed to enhance patient recovery, while not indicating any statistically significant increase in adverse outcomes.
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Affiliation(s)
- Benjamin M Mac Curtain
- Department of Surgery, St. John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Aaron O'Mahony
- Department of Surgery, St. John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Hugo C Temperley
- Department of Surgery, St. John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Zi Qin Ng
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
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Aghazarian GS, Lind R, Motola D, Perry M, Singletary N, Lastrapes L, Ghanem M, Jawad MA, Teixeira AF. Impact of Emend on Perioperative Bariatric Surgery Antiemetic Utilization, Patient Satisfaction, and Costs. Surg Laparosc Endosc Percutan Tech 2023; 33:265-269. [PMID: 36821697 DOI: 10.1097/sle.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/25/2022] [Indexed: 02/25/2023]
Abstract
PURPOSE Postoperative nausea and vomiting (PONV) is one of the most common adverse effects of anesthesia and surgery, resulting in patient discomfort and dissatisfaction. Latest research has demonstrated the efficacy of NK-1 receptor antagonists in PONV management and its use in chemotherapy nausea prophylaxis. The authors of this article would like to provide evidence to support the use fosaprepitant, as monotherapy, in postoperative care, replacing a polypharmacological standard of care regimen. METHODS This was a retrospective chart review of 400 patients who received standard of care antiemetic regimen or received fosaprepitant (No-Fosaprepitant vs. Fosaprepitant groups, respectively). The primary outcome of this study is to evaluate the impact of fosaprepitant (administered intravenously) on perioperative antiemetic use, treatment cost, and patient satisfaction. RESULTS Total PONV medication cost decreased with the replacement of standard of care regimen for fosaprepitant, from 46.47±20.54 United States Dollars in the no-Fosaprepitant group to 25.69±14.84 United States Dollars in the Fosaprepitant group. There was a significant reduction in antiemetic doses between groups; 0.37±0.745 versus 7.61±5.202 for ondansetron ( P =0.001), 92±1.279 versus 2.21±2.399 for promethazine ( P =0.001), 0.25±0.685 versus 1.41±0.577 for scopolamine patch ( P =0.001), and 0.05±0.218 versus 1.14±0.398 for dexamethasone ( P =0.001). Patient satisfaction, measured by a questionnaire, was a 11.6% higher in the Fosaprepitant group. CONCLUSION Fosaprepitant is a relevant alternative in preventing and treating PONV in patients who underwent bariatric/metabolic surgical procedures.
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Affiliation(s)
| | - Romulo Lind
- Department of Bariatric Surgery, 89 W Copeland Dr, 1st Floor
| | - David Motola
- Department of Bariatric Surgery, 89 W Copeland Dr, 1st Floor
| | - Melanie Perry
- Department of Pharmacy, Orlando Regional Medical Center, Orlando Health, 1414 Kuhl Ave., Orlando, FL
| | - Norman Singletary
- Department of Pharmacy, Orlando Regional Medical Center, Orlando Health, 1414 Kuhl Ave., Orlando, FL
| | - Linda Lastrapes
- Department of Bariatric Surgery, 89 W Copeland Dr, 1st Floor
| | - Muhammad Ghanem
- Department of Bariatric Surgery, 89 W Copeland Dr, 1st Floor
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Wesmiller SW, Bender CM, Grayson SC, Harpel CK, Alsbrook K, Diego E, McAuliffe PF, Steiman JG, Sereika SM. Postdischarge Nausea and Vomiting and Co-occurring Symptoms in Women Following Breast Cancer Surgery. J Perianesth Nurs 2023; 38:478-482. [PMID: 36635124 PMCID: PMC10200720 DOI: 10.1016/j.jopan.2022.08.014] [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: 08/22/2021] [Revised: 08/19/2022] [Accepted: 08/28/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose of this study was to investigate the influence of potential co-occurring symptoms, including fatigue, sleep disturbance, anxiety, depressive symptoms, and pain, on the incidence of postdischarge nausea (PDN) measured two days following discharge to home after surgery for breast cancer. DESIGN This study used a prospective, cross-sectional, observational design. METHODS The sample was 334 women aged 27 to 88 years of age. Demographic data were collected from the patient and the medical record before surgery. Symptom data were collected 48 hours following surgery using the Patient Reported Outcome Measurement System (PROMIS) and numerical nausea and pain scales. FINDINGS Eighty-five (25.4%) of study participants reported some nausea two days after discharge. Study participants who experienced PDN frequently described that it occurred after they left the hospital to drive home following their surgery. Unadjusted odds ratios showed the presence of co-occurring symptoms of anxiety, fatigue, sleep disturbance, and pain were all significantly associated with the presence of nausea 48 hours following surgery. Other significant factors associated with (PDN) were history of motion sickness, history of pregnancy-induced nausea, use of opioids, and type of surgery. CONCLUSIONS Same-day surgery nurses providing postoperative education for women following surgery for breast cancer should explain to patients that nausea may occur after they are discharged, especially those with known motion sickness. In addition, patients should be informed that other symptoms, especially fatigue, sleep disturbance, and anxiety, may co-occur.
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Affiliation(s)
| | - Catherine M Bender
- University of Pittsburgh School of Nursing, Pittsburgh, PA; UPMC-Hillman Cancer Center, Pittsburgh, PA
| | | | | | - Karen Alsbrook
- University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Emilia Diego
- Magee-Womens Hospital of UPMC, Magee-Women Surgical Associates, Pittsburgh, PA
| | | | - Jennifer G Steiman
- Magee-Womens Hospital of UPMC, Magee-Women Surgical Associates, Pittsburgh, PA
| | - Susan M Sereika
- University of Pittsburgh School of Nursing, Pittsburgh, PA; University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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Moraitis A, Myrberg T, Hultin M, Nyström H, Walldén J. Palonosetron as prophylaxis for post-discharge nausea and vomiting: a prospective, randomised, double-blind, placebo-controlled trial in ambulatory surgery. Br J Anaesth 2023:S0007-0912(23)00227-1. [PMID: 37246062 DOI: 10.1016/j.bja.2023.04.034] [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: 11/29/2022] [Revised: 03/31/2023] [Accepted: 04/27/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Approximately 25% of ambulatory surgery patients experience post-discharge nausea and vomiting (PDNV). We aimed to investigate whether palonosetron, a long-acting anti-emetic, decreases the incidence of PDNV in high-risk patients. METHODS In this prospective, randomised, double-blind, placebo-controlled trial, 170 male and female patients undergoing ambulatory surgery under general anaesthesia, with a high predicted risk for PDNV, were randomised to receive either palonosetron 75 μg i.v. (n=84) or normal saline (n=86) before discharge. During the first 3 postoperative days (PODs), we measured outcomes using a patient questionnaire. The primary outcome was the incidence of a complete response (no nausea, vomiting, or use of rescue medication) until POD 2. Secondary outcomes included the incidence of PDNV each day until POD 3. RESULTS The incidence of a complete response until POD 2 was 48% (n=32) in the palonosetron group and 36% (n=25) in the placebo group (odds ratio 1.69 [95% confidence interval: 0.85-3.37]; P=0.131). No significant difference in the incidence of PDNV was observed between the two groups on the day of surgery (47% vs 56%; P=0.31). Significant differences in the incidence of PDNV were found on POD 1 (18% vs 34%; P=0.033) and POD 2 (9% vs 27%; P=0.007). No differences were observed on POD 3 (15% vs 13%; P=0.700). CONCLUSIONS Compared with placebo, palonosetron did not reduce the overall incidence of PDNV up to POD 2. The lower incidence of PDNV on POD 1 and POD 2 in the palonosetron group requires further investigation. CLINICAL TRIAL REGISTRATION EudraCT 2015-003956-32.
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Affiliation(s)
- Antonio Moraitis
- Department of Surgical and Perioperative Sciences (Sundsvall), Faculty of Medicine, Umeå University, Umeå, Sweden.
| | - Tomi Myrberg
- Department of Surgical and Perioperative Sciences (Sunderbyn), Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences (Umeå), Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Helena Nyström
- Department of Surgical and Perioperative Sciences (Umeå), Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Jakob Walldén
- Department of Surgical and Perioperative Sciences (Sundsvall), Faculty of Medicine, Umeå University, Umeå, Sweden
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Ursavaş FE, Baksi A, Sarıca E. Postoperative Nausea and Vomiting After Orthopaedic Surgery: Prevalence and Associated Factors. Orthop Nurs 2023; 42:179-187. [PMID: 37262378 DOI: 10.1097/nor.0000000000000945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Postoperative nausea and vomiting (PONV) is a common complication after surgery and can lead to additional complications and delayed discharge. This descriptive, cross-sectional study assessed the prevalence of PONV and its associated factors in patients undergoing orthopaedic surgery. The study was conducted between November 2020 and July 2021 with 149 patients in a public hospital in the Central Anatolia region of Turkey. In the first 48 hours after surgery, 40.9% of the patients had nausea and 17.4% had vomiting. Gender, age, medical diagnosis, surgical procedure, operative time, postoperative opioid use, and anxiety were identified as significant risk factors for PONV after orthopaedic surgery (p < .05). These factors should be considered during postoperative follow-up, and patients who are older, female, and have prolonged operative time or anxiety should be monitored more closely for PONV.
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Affiliation(s)
- Figen Erol Ursavaş
- Figen Erol Ursavaş, PhD, MSc, BSN, Associate Professor, Department of Surgical Nursing, Faculty of Health Science, Çankırı Karatekin University, Çankırı, Turkey
- Altun Baksi, PhD, MSc, BSN, Associate Professor, Department of Surgical Nursing, Faculty of Health Sciences, Suleyman Demirel University, Isparta, Turkey
- Emine Sarıca, MSc, BSN, Çankırı Public Hospital, Çankırı, Turkey
| | - Altun Baksi
- Figen Erol Ursavaş, PhD, MSc, BSN, Associate Professor, Department of Surgical Nursing, Faculty of Health Science, Çankırı Karatekin University, Çankırı, Turkey
- Altun Baksi, PhD, MSc, BSN, Associate Professor, Department of Surgical Nursing, Faculty of Health Sciences, Suleyman Demirel University, Isparta, Turkey
- Emine Sarıca, MSc, BSN, Çankırı Public Hospital, Çankırı, Turkey
| | - Emine Sarıca
- Figen Erol Ursavaş, PhD, MSc, BSN, Associate Professor, Department of Surgical Nursing, Faculty of Health Science, Çankırı Karatekin University, Çankırı, Turkey
- Altun Baksi, PhD, MSc, BSN, Associate Professor, Department of Surgical Nursing, Faculty of Health Sciences, Suleyman Demirel University, Isparta, Turkey
- Emine Sarıca, MSc, BSN, Çankırı Public Hospital, Çankırı, Turkey
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Abstract
Appropriate perioperative pain control is essential to aid in patients' recovery after surgery; however, acute postsurgical pain remains poorly treated and there continues to be an overreliance on opiates. Perioperative pain control starts in the operating room, and opiate-free anesthesia (OFA), where no opiates are used intraoperatively, has been proposed as a feasible strategy to further minimize opiates in the perioperative period. In this article, we address the potential benefits and shortcomings of OFA, while exploring tools available to accomplish multimodal anesthesia and ideally OFA, and the evidence behind the techniques proposed.
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Effect of Preoperative Oral Carbohydrate on Patients Undergoing Gynecological Laparoscopic Surgery With Different Fasting Times: A Randomized Control Study. J Perianesth Nurs 2022; 37:858-864. [PMID: 35811226 DOI: 10.1016/j.jopan.2022.01.009] [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: 07/18/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to investigate the effect of preoperative oral carbohydrates (POC) on patients undergoing gynecological laparoscopic surgery with different fasting times. DESIGN A randomized control study. METHODS Two hundred patients were randomly divided into F group (first operation without carbohydrates intake), S group (second operation without carbohydrates intake), Fpo group (first operation with POC intake), and Spo group (second operation with POC intake). The visual analog scale (VAS) of thirst and hunger, perioperative buffer excess (BE), electrolyte and glucose levels, as well as insulin resistance (IR) were compared. Time to first flatus, hospital stay, and eating time were also recorded. FINDINGS POC reduces the aggravation of thirst and hunger discomfort during the perioperative period. Abnormal perioperative BE and lactate levels were found in patients of F and S groups, while those in the Fpo and Spo groups almost returned to normal. Patients in all groups had preoperative hypokalemia, and those in the Fpo and Spo groups recovered quickly to normal intraoperatively. IR in patients in the Fpo and Spo groups retured to preoperative levels after surgery while, those in the F and S groups persisted until 48 hour postoperatively. No significant differences in postoperative nausea and vomiting, time to first flatus, time of first eating, and postoperative hospital stay were found among the four groups. CONCLUSION POC accelerates postoperative recovery in patients undergoing gynecological laparoscopy with different fasting times.
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Gan TJ, Jin Z, Meyer TA. Rescue Treatment of Postoperative Nausea and Vomiting: A Systematic Review of Current Clinical Evidence. Anesth Analg 2022; 135:986-1000. [PMID: 36048730 DOI: 10.1213/ane.0000000000006126] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although prophylactic antiemetics are commonly used perioperatively, an estimated 30% of surgical patients still suffer from postoperative nausea and vomiting (PONV). Very few prospective trials have studied rescue treatment of PONV after failure of prophylaxis, providing limited evidence to support clinical management. In patients who have failed PONV prophylaxis, administering a rescue antiemetic from the same drug class has been reported to be ineffective. For many antiemetics currently used in PONV rescue, significant uncertainty remains around the effective dose range, speed of onset, duration of effect, safety, and overall risk-benefit ratio. As prompt, effective PONV rescue after failure of prophylaxis is important to optimize postoperative recovery and resource utilization, we conduct this systematic review to summarize the current evidence available on the topic.
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Affiliation(s)
- Tong J Gan
- From the Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, New York
| | - Zhaosheng Jin
- From the Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, New York
| | - Tricia A Meyer
- Department of Anesthesiology, Texas A&M College of Medicine, Temple, Texas
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Bayramov N, Mammadova S. A review of the current ERAS guidelines for liver resection, liver transplantation and pancreatoduodenectomy. Ann Med Surg (Lond) 2022; 82:104596. [PMID: 36268404 PMCID: PMC9577502 DOI: 10.1016/j.amsu.2022.104596] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/04/2022] [Indexed: 11/25/2022] Open
Abstract
In perioperative care after liver resection, transplantation and pancreatoduodenectomy, ERAS (Enhanced Recovery After Surgery) recommendations are based on the reducing invasiveness of procedures and the severity of the surgical stress, which results in decreasing complications and enhanced recovery. Recommendations for all three operations can be classified into five groups: recommended for all patients, recommended for special patient groups, rejected for all patients, controversial recommendations, specific recommendations for all three operations. Preoperative counselling and psychological support, nutritional support, smoking and alcohol cessation, pre- and intraoperative antibiotic prophylaxis, thrombosis prevention, limiting of preoperative hunger and thirst to 4 and 6 h, preoperative intaking carbohydrate rich drink, alcohol-based antiseptics for skin preparation, a goal-directed infusion therapy, providing normothermia, early removal of the drainage tube, glycemic control, dual antiemetic therapy, multimodal analgesia strategies, early oral feeding and activation, audit recommend for all patients. Postoperative antibiotic prophylaxis, enteral and parenteral nutrition, short-acting anxiolytics are recommended for individual patients. It is recommended to avoid Mercedes type incision, use of long-acting anxiolytics and postoperative nasogastric tube. The benefits of preoperative physical exercise, immunonutrition and probiotics are controversial. There are no specific recommendations for thoracic epidural anesthesia, preventing delayed gastric emptying and intestinal paresis in liver surgery.
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Affiliation(s)
- N. Bayramov
- Department of General Surgery and Transplantology, Azerbaijan Medical University, Baku, Azerbaijan
| | - Sh. Mammadova
- Department of General Surgery and Transplantology, Azerbaijan Medical University, Baku, Azerbaijan
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32
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Yang H, Gu X, Xu M, Yang G, Rao Y, Gao L, Gong G, He S. Preventing nausea and vomiting after gynecological laparoscopic surgery by patient-controlled intravenous analgesia with a naloxone admixture: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e29584. [PMID: 35866767 PMCID: PMC9302326 DOI: 10.1097/md.0000000000029584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Opioid-induced nausea and vomiting are common side effects of patient-controlled intravenous analgesia (PCIA). This study aimed to explore the inhibitory effect of a naloxone admixture on the incidence of sufentanil-induced postoperative nausea and vomiting (PONV). METHODS A total of 132 Uyghur American Society of Anesthesiologists I and II patients scheduled to undergo elective gynecological laparoscopic surgery were recruited; among these, 120 patients were enrolled and randomly allocated into 4 groups: patients receiving PCIA but no naloxone were included in the control group (group A); patients receiving PCIA with a low-dose naloxone admixture at 0.2 μg·kg-1·h-1 were included in group B; patients receiving PCIA with naloxone admixture at 0.4 μg·kg-1·h-1 were included in group C; patients receiving PCIA with naloxone admixture at 0.6 μg·kg-1·h-1 were included in group D. All patients were administered sufentanil at 0.04 kg-1·h-1, butorphanol at 2 kg-1·h-1, and dexmedetomidine at 0.08 kg-1·h-1 using a PCIA device within 2 days of surgery. The occurrence of nausea and vomiting, visual analogue scores for pain intensity, mean arterial pressure, heart rate, oxygen saturation, pruritus, lethargy, respiratory depression, etc, was recorded at 2, 8, 12, 24, and 48 hours postoperatively. RESULTS There was a significant difference in the PONV scores between the groups at 8, 12, and 24 hours after surgery (P < 0.01). At 8 and 12 hours, the score of group C/D was significantly lower than that of group A/B (P < 0.01). At 24 hours after surgery, the PONV score of group B/C/D was significantly lower than that of group A (P < 0.01). No significant difference was observed in the general data and visual analogue scores for postoperative pain between the 4 groups. CONCLUSION Naloxone admixture administered at 0.4 to 0.6 μg·kg-1·h-1 can exert an effective inhibitory effect on the incidence and intensity of PONV in gynecological laparoscopic surgery.
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Affiliation(s)
- Haihong Yang
- Department of Anesthesiology, The General Hospital of Western Theater Command, Sichuan, China
- Department of Anesthesiology, No. 950 Hospital of PLA, Yecheng, China
| | - Xuedong Gu
- Department of Anesthesiology, The General Hospital of Western Theater Command, Sichuan, China
| | - Meiling Xu
- Department of Geriatrics, The General Hospital of Western Theater Command, Sichuan, China
| | - Guan Yang
- Department of Anesthesiology, The General Hospital of Western Theater Command, Sichuan, China
| | - Yunju Rao
- School of Clinical Medicine, Southwest Medical University, Sichuan, China
| | - Liang Gao
- Military Prevention and Treatment Center for Mountain Sickness, No. 950 Hospital of PLA, Yecheng, China
| | - Gu Gong
- Department of Anesthesiology, The General Hospital of Western Theater Command, Sichuan, China
| | - Siyi He
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, Sichuan, China
- * Correspondence: Siyi He, Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, Rongdu Avenue No. 270, Jinniu District, Chengdu City, Sichuan Province 610083, China (e-mail: )
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Echeverria-Villalobos M, Fiorda-Diaz J, Uribe A, Bergese SD. Postoperative Nausea and Vomiting in Female Patients Undergoing Breast and Gynecological Surgery: A Narrative Review of Risk Factors and Prophylaxis. Front Med (Lausanne) 2022; 9:909982. [PMID: 35847822 PMCID: PMC9283686 DOI: 10.3389/fmed.2022.909982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022] Open
Abstract
Postoperative nausea and vomiting (PONV) have been widely studied as a multifactorial entity, being of female gender the strongest risk factor. Reported PONV incidence in female surgical populations is extremely variable among randomized clinical trials. In this narrative review, we intend to summarize the incidence, independent predictors, pharmacological and non-pharmacological interventions for PONV reported in recently published clinical trials carried out in female patients undergoing breast and gynecologic surgery, as well as the implications of the anesthetic agents on the incidence of PONV. A literature search of manuscripts describing PONV management in female surgical populations (breast surgery and gynecologic surgery) was carried out in PubMed, MEDLINE, and Embase databases. Postoperative nausea and vomiting incidence were highly variable in patients receiving placebo or no prophylaxis among RCTs whereas consistent results were observed in patients receiving 1 or 2 prophylactic interventions for PONV. Despite efforts made, a considerable number of female patients still experienced significant PONV. It is critical for the anesthesia provider to be aware that the coexistence of independent risk factors such as the level of sex hormones (pre- and postmenopausal), preoperative anxiety or depression, pharmacogenomic pleomorphisms, and ethnicity further enhances the probability of experiencing PONV in female patients. Future RCTs should closely assess the overall risk of PONV in female patients considering patient- and surgery-related factors, and the level of compliance with current guidelines for prevention and management of PONV.
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Affiliation(s)
- Marco Echeverria-Villalobos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- *Correspondence: Marco Echeverria-Villalobos
| | - Juan Fiorda-Diaz
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Alberto Uribe
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Sergio D. Bergese
- Department of Anesthesiology, Health Sciences Center, School of Medicine, Stony Brook University, New York, NY, United States
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Beiranvand S, Alvani M, Sorori MM. The Effect of Ginger on Postoperative Nausea and Vomiting Among Patients Undergoing Upper and Lower Limb Surgery: A Randomized Controlled Trial. J Perianesth Nurs 2022; 37:365-368. [PMID: 35304019 DOI: 10.1016/j.jopan.2021.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/08/2021] [Accepted: 05/15/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Postoperative nausea and vomiting is one of the most common side effects associated with anesthesia. The aim of this study is to determine the effect of ginger on severity and incidence of nausea and vomiting after lower and upper limb surgery. DESIGN This was a triple-blinded clinical trial. METHODS Sixty eligible patients were randomly assigned to the intervention and control groups. The intervention group received four 250 mg ginger capsules and the control group received four placebo capsules 2 hours before surgery. Incidence and severity of nausea and vomiting immediately after the surgery and 2, 4, 6, and 8 hours after the surgery were evaluated. FINDINGS The results of this study showed that the use of ginger capsules significantly reduces the incidence and severity of postoperative nausea and vomiting at different hours after surgery compared to placebo, P < .05, irrespective of the gender and the age of the patients. CONCLUSIONS Use of ginger is effective in decreasing postoperative nausea and vomiting. However, further studies in comorbid patients are required to verify these outcomes.
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Affiliation(s)
- Siavash Beiranvand
- Department of Anesthesiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Mojtaba Alvani
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohamad Masud Sorori
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
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Effectiveness of Music Intervention on Postoperative Nausea and Vomiting: A Systematic Review and Meta-analysis. J Perianesth Nurs 2022; 37:717-727. [DOI: 10.1016/j.jopan.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/20/2022]
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Azaïs H, Simonet T, Foulon A, Fauvet R, Louis-Sylvestre C, Texier C, Bourdel N, Villefranque V, Salaün JP, Canlorbe G. Perioperative parameters to consider for enhanced recovery in surgery (ERS) in gynecology (excluding breast surgery). J Gynecol Obstet Hum Reprod 2022; 51:102372. [PMID: 35395432 DOI: 10.1016/j.jogoh.2022.102372] [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: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Abstract
The current review explores the Enhanced Rehabilitation in Surgery (ERS) approach in the specific context of gynecological surgery. Implementation of an ERS protocol in gynecological surgery reduces postoperative complications and length of stay without increasing morbidity. An ERS approach is based on maintaining an adequate diet and hydration before the operation, according to the recommended time frame, to reduce the phenomenon of insulin resistance, and to optimize patient comfort. On the other hand, the use of anxiolytic treatment as premedication is not recommended. Systematic preoperative digestive preparation, a source of patient discomfort, is not associated with an improvement in the postoperative functional outcome or with a reduction in the rate of complications. A minimally invasive surgical approach is preferrable in the context of ERS. Prevention of surgical site infection includes measures such as optimized antibiotic prophylaxis, skin disinfection with alcoholic chlorhexidine, reduction in the use of drainage of the surgical site, and prevention of hypothermia. Early removal of the bladder catheter is associated with a reduction in the risk of urinary tract infection and a reduction in the length of hospital stay. Prevention of postoperative ileus is based on early refeeding, and prevention of postoperative nausea-vomiting in a multimodal strategy to be initiated during the intraoperative period. Intraoperative hydration should be aimed at achieving euvolemia. Pain control is based on a multimodal strategy to spare morphine use and may include locoregional analgesia. Medicines should be administered orally during the postoperative period to hasten the resumption of the patient's autonomy. The prevention of thromboembolic risk is based on a strategy combining drug prophylaxis, when indicated, and mechanical restraint, as well as early mobilization. However, the eclectic nature of the implementation of these measures as reported in the literature renders their interpretation difficult. Furthermore, beyond the application of one of these measures in isolation, the best benefit on the postoperative outcome is achieved by a combination of measures which then constitutes a global strategy allowing the objectives of the ERS to be met.
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Affiliation(s)
- Henri Azaïs
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, service de chirurgie cancérologique gynécologique et du sein, F-75015, Paris, France..
| | - Thérèse Simonet
- CHU Caen, Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen, F-14033, France
| | - Arthur Foulon
- Centre de Gynécologie-Obstétrique, Université Picardie Jules Verne, CHU Amiens Picardie, 1 rue du Professeur Christian Cabrol, F-80054, Amiens, France
| | - Raffaele Fauvet
- Obstetrics and Gynecology Department, Caen Normandy University Hospital, 1 avenue de la côte de Nacre, F-14000, Caen, France; Université Caen Normandie, Esplanade de la Paix, CS 14032, F-14032, Caen, France; INSERM ANTICIPE Unit, Centre François Baclesse, 3 Ave du Général Harris, BP 5026, F-14076, Caen, France
| | | | - Célia Texier
- Department of Gynecological Surgery, CHU of Clermont Ferrand, 1 Place Lucie Aubrac, F-63 003, Clermont, Ferrand, France
| | - Nicolas Bourdel
- Department of Gynecological Surgery, CHU of Clermont Ferrand, 1 Place Lucie Aubrac, F-63 003, Clermont, Ferrand, France
| | - Vincent Villefranque
- Maternity Department, Simone Veil Hospital, 14 rue de Saint Prix, F-95600, Eaubonne, France
| | - Jean-Philippe Salaün
- CHU Caen, Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen, F-14033, France
| | - Geoffroy Canlorbe
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, F-75013, Paris, France.; Sorbonne université, biologie et thérapeutique du cancer, centre de recherche Saint-Antoine (CRSA), Paris, France
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Gloor Y, Czarnetzki C, Curtin F, Gil-Wey B, Tramèr MR, Desmeules JA. Genetic Susceptibility Toward Nausea and Vomiting in Surgical Patients. Front Genet 2022; 12:816908. [PMID: 35173765 PMCID: PMC8842269 DOI: 10.3389/fgene.2021.816908] [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: 11/17/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Postoperative nausea and vomiting (PONV) are frequently occurring adverse effects following surgical procedures. Despite predictive risk scores and a pallet of prophylactic antiemetic treatments, it is still estimated to affect around 30% of the patients, reducing their well-being and increasing the burden of post-operative care. The aim of the current study was to characterize selected genetic risk factors of PONV to improve the identification of at risk patients. We genotyped 601 patients followed during the first 24 h after surgery for PONV symptoms in the absence of any antiemetic prophylaxis. These patients were recruited in the frame of a randomized, placebo controlled clinical study aiming to test the efficacy of dexamethasone as a treatment of established PONV. We examined the impact of selected single nucleotide polymorphisms (SNPs) located around 13 different genes and the predicted activity of 6 liver drug metabolizing enzymes from the cytochromes P450 family (CYP) on the occurrence and recurrence of PONV. Our genetic study confirms the importance of genetic variations in the type 3B serotonin receptor in the occurrence of PONV. Our modelling shows that integration of rs3782025 genotype in preoperative risk assessments may help improve the targeting of antiemetic prophylaxis towards patients at risk of PONV.
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Affiliation(s)
- Yvonne Gloor
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Christoph Czarnetzki
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.,Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Emergency Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - François Curtin
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.,Personalized Health Programs, Swiss Federal Institute of Technology Zurich (ETHZ), Zurich, Switzerland
| | - Béatrice Gil-Wey
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Martin R Tramèr
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Jules A Desmeules
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
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Lin Y, Tiansheng S, Zhicheng Z, Xiaobin C, Fang L. Effects of Ramosetron on Nausea and Vomiting Following Spinal Surgery: A Meta-Analysis. CURRENT THERAPEUTIC RESEARCH 2022; 96:100666. [PMID: 35464291 PMCID: PMC9019236 DOI: 10.1016/j.curtheres.2022.100666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spinal surgery is associated with severe pain within the first few days after surgery. Opioids are commonly used to control postoperative pain, but these can lead to postoperative nausea and vomiting (PONV). Therefore, use of more effective and better-tolerated agents would be beneficial for these patients. Serotonin receptor antagonists, such as ramosetron, have been used to reduce PONV in patients receiving anesthesia. OBJECTIVE We conducted a meta-analysis of published randomized controlled trials (RCTs) to compare the efficacy and tolerance of ramosetron to prevent PONV after spinal surgery. METHODS Medline, Embase, Cochrane Library, and Science Citation Index databases were systematically searched for relevant RCT articles published between January 1979 and November 2020. Full text articles restricted to English language that described RCTs comparing the use of ramosetron with other serotonin antagonists to treat PONV following spinal surgery in adult patients were considered for meta-analysis. Two reviewers independently performed study selection, quality assessment, and data extraction of all articles. Differences were resolved by a third reviewer. RESULTS The search identified 88 potentially relevant articles, of which only 3 met our selection criteria. Study drugs were administered at the end of spinal surgery in all 3 included articles. The meta-analysis revealed that ramosetron (0.3 mg) reduced the pain score (mean difference = -0.66; 95% CI -1.02 to -0.30), lowered the risk of PONV (risk ratio = 0.86; 95% CI, 0.76-0.97), and postoperative vomiting (risk ratio = 0.32; 95% CI, 0.17-0.60), and limited the use of rescue antiemetics (risk ratio = 0.66; 95% CI, 0.45-0.96) after spinal surgery. However, there were no significant differences in the incidence of postoperative nausea, the use of rescue pain medications, the number of rescue analgesics required, and the risk of discontinuation of patient-controlled analgesia between ramosetron and palonosetron (0.075 mg) or ondansetron (4 mg). There were no statistically significant differences in the risk of adverse events among the 3 medications. CONCLUSIONS This meta-analysis of 3 RCTs showed that ramosetron reduced the risk of PONV and POV, limited the use of rescue antiemetics, reduced the postoperative pain score, and did not increase the risk of discontinuing patient-controlled analgesia compared with palonosetron or ondansetron after spinal surgery in 3 RCTs. Therefore, this meta-analysis indicates that ramosetron is an effective and well tolerated antiemetic that can be used to prevent PONV following spinal surgery in adult patients. PROSPERO identifier: CRD42020223596 (Curr Ther Res Clin Exp. 2022; 83:XXX-XXX)© 2022 Elsevier HS Journals, Inc.
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Affiliation(s)
- Yiyun Lin
- Correspondence to: Lin Yiyun, MD, Department of Orthopedic Surgery, Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Nanmengcang 5#, Beijing, China, 100700, Tell: + 86 010 84008002; fax: + 86 010 84008002
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Digestion-Specific Acupuncture Effect on Feeding Intolerance in Critically Ill Post-Operative Oral and Hypopharyngeal Cancer Patients: A Single-Blind Randomized Control Trial. Nutrients 2021; 13:nu13062110. [PMID: 34205461 PMCID: PMC8234819 DOI: 10.3390/nu13062110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
Malnourishment is prevalent in patients suffering from head and neck cancer. The postoperative period is crucial in terms of nutritional support, especially after composite resection and reconstruction surgery. These patients present with a number of risk factors that aggravate feeding intolerance, including postoperative status, prolonged immobility, decreased head elevation, mechanical ventilation, and applied sedative agents. Routine management protocols for feeding intolerance include prokinetic drug use and post-pyloric tube insertion, which could be both limited and accompanied by detrimental adverse events. This single-blind clinical trial aimed to investigate the effects of acupuncture in postoperative feeding intolerance in critically ill oral and hypopharyngeal cancer patients. Twenty-eight patients were randomized into two groups: Intervention group and Control group. Interventions were administered daily over three consecutive postoperative days. The primary outcome revealed that the intervention group reached 70% and 80% of target energy expenditure (EE) significantly earlier than the control group (4.00 ± 1.22 versus 6.69 ± 3.50 days, p = 0.012), accompanied by higher total calorie intake within the first postoperative week (10263.62 ± 1086.11 kcals versus 8384.69 ± 2120.05 kcals, p = 0.004). Furthermore, the intervention group also needed less of the prokinetic drug (Metoclopramide, 20.77 ± 48.73 mg versus 68.46 ± 66.56 mg, p = 0.010). In conclusion, digestion-specific acupuncture facilitated reduced postoperative feeding intolerance in oral and hypopharyngeal cancer patients.
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Nakai A, Nakada T, Okamoto S, Takahashi Y, Sakakura N, Nakada J, Kuroda H. Risk factors for postoperative nausea and vomiting after thoracoscopic pulmonary wedge resection: pitfalls of an increased fentanyl dose. J Thorac Dis 2021; 13:3489-3496. [PMID: 34277044 PMCID: PMC8264675 DOI: 10.21037/jtd-21-296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/09/2021] [Indexed: 01/08/2023]
Abstract
Background Thoracoscopic pulmonary wedge resection (TPWR) is a surgical procedure that can maintain lung function and is less physically invasive to a patient. However, the risk factors for postoperative nausea and vomiting (PONV) following TPWR remain unknown. We aimed to evaluate multiple risk factors of PONV after TPWR and the impact of PONV on postoperative outcomes. Methods We retrospectively reviewed consecutive patients who underwent TPWR for malignant pulmonary tumors at our institution between October 2017 and March 2020. We assessed the differences in the clinical and perioperative parameters between the PONV and non-PONV groups. Results We reviewed 160 patients, of whom 27 (16.9%) had PONV. Sixteen (59.3%) patients with PONV required postoperative antiemetics. Failed mobilization was associated with PONV requiring postoperative antiemetics (P=0.048). In the multivariate analysis, increased fentanyl dose was an independent risk factor for PONV (P=0.022). Using the receiver operating characteristic curve, the optimal cut-off value for PONV was 3.58 µg/kg/hr (area under the curve =0.665; sensitivity =85.2%; specificity =53.4%; 95% confidence interval: 0.562–0.768; P=0.007). For example, in a case of a 50-kg patient who underwent a 70-min operation (our median operative time), the total dose of fentanyl within 208 µg was the cut-off value for preventing PONV. Conclusions An increased dose of fentanyl/kg/h was the strongest risk factor for PONV during TPWR. The optimal cut-off value for PONV was 3.58 µg/kg/hr. It is important to avoid the inadvertent administration of intraoperative fentanyl.
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Affiliation(s)
- Aiko Nakai
- Department of Anesthesiology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Takeo Nakada
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Sakura Okamoto
- Department of Anesthesiology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Yusuke Takahashi
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Junya Nakada
- Department of Anesthesiology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
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Zhong W, Shahbaz O, Teskey G, Beever A, Kachour N, Venketaraman V, Darmani NA. Mechanisms of Nausea and Vomiting: Current Knowledge and Recent Advances in Intracellular Emetic Signaling Systems. Int J Mol Sci 2021; 22:5797. [PMID: 34071460 PMCID: PMC8198651 DOI: 10.3390/ijms22115797] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023] Open
Abstract
Nausea and vomiting are common gastrointestinal complaints that can be triggered by diverse emetic stimuli through central and/or peripheral nervous systems. Both nausea and vomiting are considered as defense mechanisms when threatening toxins/drugs/bacteria/viruses/fungi enter the body either via the enteral (e.g., the gastrointestinal tract) or parenteral routes, including the blood, skin, and respiratory systems. While vomiting is the act of forceful removal of gastrointestinal contents, nausea is believed to be a subjective sensation that is more difficult to study in nonhuman species. In this review, the authors discuss the anatomical structures, neurotransmitters/mediators, and corresponding receptors, as well as intracellular emetic signaling pathways involved in the processes of nausea and vomiting in diverse animal models as well as humans. While blockade of emetic receptors in the prevention of vomiting is fairly well understood, the potential of new classes of antiemetics altering postreceptor signal transduction mechanisms is currently evolving, which is also reviewed. Finally, future directions within the field will be discussed in terms of important questions that remain to be resolved and advances in technology that may help provide potential answers.
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Affiliation(s)
- Weixia Zhong
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766, USA; (W.Z.); (G.T.); (V.V.)
| | - Omar Shahbaz
- School of Medicine, Universidad Iberoamericana, Av. Francia 129, Santo Domingo 10203, Dominican Republic;
| | - Garrett Teskey
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766, USA; (W.Z.); (G.T.); (V.V.)
| | - Abrianna Beever
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA; (A.B.); (N.K.)
| | - Nala Kachour
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA; (A.B.); (N.K.)
| | - Vishwanath Venketaraman
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766, USA; (W.Z.); (G.T.); (V.V.)
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA; (A.B.); (N.K.)
| | - Nissar A. Darmani
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766, USA; (W.Z.); (G.T.); (V.V.)
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Eryilmaz F, Farooque U. A Clinical Research on the Impact of Dexamethasone Versus Dexamethasone-Metoclopramide Combination in Reducing Postoperative Vomiting and Nausea After Cranial Surgery. Cureus 2021; 13:e15139. [PMID: 34159037 PMCID: PMC8212905 DOI: 10.7759/cureus.15139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction This brief study shows the consumption of two medications that are related to those patients who have gone through the complicated procedure of craniotomy. The basic aim of these drugs is to subside the after-effects of the procedure like postoperative nausea and vomiting in patients. Hereby, the study outlines the functional efficiency of dexamethasone along with the metoclopramide and dexamethasone alone. Materials and methods Randomly two groups were listed of 120 patients that have undergone elective craniotomy with ASA I-II. These groups were called out as group A and group B. Group A was under the medication of combination of dexamethasone and metoclopramide 8 mg and 10 mg, respectively, induced separately while group B was induced with 8 mg of dexamethasone along with 2 ml of normal saline. These drugs were induced right before anesthesia. The procedure from here on gets the same for both groups. After the surgical approach, a verbal evaluation was taken from the members of each group to collect specific data accordingly within the first 24 hours. As the method is double-blinded thus the patients were unaware of the ongoing research study. In any case of a mishap, rescue antiemetic drugs were also considered for the patients who would have experienced uncontrolled nausea and vomiting in the timeframe. Results The results show that only 16.7% of the patients from group A showed signs of nausea and only 5% showed vomiting while 31.7% of the patients from group B showed signs of nausea and 11.7% showed vomiting. It clearly showed that the patients tend to have either no sign of nausea and vomiting or showed little controllable nausea and vomiting when induced with dexamethasone and metoclopramide compared to those who were induced with the dexamethasone alone. Conclusions Postoperative nausea and vomiting are studied in terms of those who had undergone craniotomy. This study shows the prophylaxis of adverse effects of postoperative nausea and vomiting between the two groups under the influence of altered drugs. Thus, the results were noticeably in the favor of the combination treatment of dexamethasone and metoclopramide.
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Affiliation(s)
- Fahri Eryilmaz
- Neurological Surgery, Hittite University Corum Erol Olcok Training and Research Hospital, Corum, TUR
| | - Umar Farooque
- Neurology, Dow University of Health Sciences, Karachi, PAK
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Sex and gender differences in anesthesia: Relevant also for perioperative safety? Best Pract Res Clin Anaesthesiol 2020; 35:141-153. [PMID: 33742574 DOI: 10.1016/j.bpa.2020.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022]
Abstract
Sex (a biological determination) and gender (a social construct) are not interchangeable terms and both impact perioperative management and patient safety. Sex and gender differences in clinical phenotypes of chronic illnesses and risk factors for perioperative morbidity and mortality are relevant for preoperative evaluation and optimization. Sex-related differences in physiology, as well as in pharmacokinetics and pharmacodynamics of anesthetic drugs may influence the anesthesia plan, the management of pain, postoperative recovery, adverse effects, patient satisfaction, and outcomes. Further studies are needed to characterize outcome differences between men and women in non-cardiac, cardiac, and transplantation surgery in order to individualize perioperative management and improve patient safety. Transgender patients represent a vulnerable population who need special perioperative care. Gender balance increases team performance and may improve perioperative outcomes.
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