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Vetter C, Biedermann C, Berger-Estilita J, Bütikofer A. Coma After Droperidol Administration: A Case Report. A A Pract 2024; 18:e01831. [PMID: 39137114 DOI: 10.1213/xaa.0000000000001831] [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: 08/15/2024]
Abstract
In Switzerland, approximately 32,000 patients are hospitalized annually due to adverse drug reactions (ADRs), representing 2.3% of all hospitalizations. During the perioperative period, the administration of a variety of drugs from different classes over a relatively short period of time increases the risk of ADR. Here, we describe the case of a 32-year-old woman who was administered droperidol to treat nausea in the recovery room after a myomectomy and who subsequently became comatose. Correctable metabolic, respiratory, and cerebrovascular disorders were ruled out. Six hours after the event, she was extubated without residual effects. We discuss potential ADR for droperidol.
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Affiliation(s)
- Christian Vetter
- From the Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Carlos Biedermann
- From the Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Joana Berger-Estilita
- Institute for Medical Education, University of Bern, Bern, Switzerland
- CINTESIS@RISE - Center for Health Technology and Services Research, Porto, Portugal
| | - Anne Bütikofer
- From the Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
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Frelich M, Sklienka P, Romanová T, Němcová S, Bílená M, Straková H, Lečbychová K, Jor O, Formánek M, Burša F. The effect of BIS-guided anaesthesia on the incidence of postoperative nausea and vomiting in children: a prospective randomized double-blind study. BMC Anesthesiol 2024; 24:228. [PMID: 38982400 PMCID: PMC11232140 DOI: 10.1186/s12871-024-02610-w] [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: 02/16/2024] [Accepted: 06/28/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a significant problem following paediatric surgery, and volatile anaesthetics are an important cause of this phenomenon. BIS-guided anaesthesia, by reducing the consumption of anaesthetics, leads to a decrease in PONV in adult patients. STUDY OBJECTIVE Evaluate the role of BIS-guided anaesthesia in reducing the incidence of paediatric PONV. DESIGN Prospective, randomized, double-blind study. SETTING A single center study in university hospital in Czech republic, from June 2021 to November 2022. PATIENTS A total of 163 children, aged 3-8 years with ASA I-II who underwent endoscopic adenoidectomy under general anaesthesia were included. INTERVENTIONS In the intervention group, the depth of anaesthesia was maintained to values between 40 and 60 of BIS. MAIN OUTCOME MEASURE The primary outcome was the incidence of postoperative nausea and vomiting during 24 h after surgery. RESULTS The use of BIS-guided anaesthesia led to a significant decrease in the incidence of nausea and vomiting compared to the control group [17% vs. 53%; RR (95%CI) 0.48 (0.27-0.86); p < 0.001and 16% vs. 34%; RR (95%CI) 0.33 (0.20-0.54); p = 0.01, respectively]. CONCLUSIONS BIS-guided anaesthesia decreases the incidence of postoperative nausea and vomiting in children undergoing adenoidectomy. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT04466579.
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Affiliation(s)
- Michal Frelich
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, University of Ostrava, Ostrava, Czech Republic
| | - Peter Sklienka
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, University of Ostrava, Ostrava, Czech Republic
| | - Tereza Romanová
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
| | - Simona Němcová
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
| | - Markéta Bílená
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
| | - Hana Straková
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
| | - Karolína Lečbychová
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
| | - Ondřej Jor
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, University of Ostrava, Ostrava, Czech Republic
| | - Martin Formánek
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, University of Ostrava, Ostrava, Czech Republic
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Ostrava, 17.listopadu 1790, Ostrava, Czech Republic
| | - Filip Burša
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic.
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, University of Ostrava, Ostrava, Czech Republic.
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Deb B, Saini K, Arora S, Kumar S, Soni SL, Saini M. Olanzapine versus standard antiemetic prophylaxis for the prevention of post-discharge nausea and vomiting after propofol-based general anaesthesia: A randomised controlled trial. Indian J Anaesth 2024; 68:566-571. [PMID: 38903258 PMCID: PMC11186532 DOI: 10.4103/ija.ija_1162_23] [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: 12/03/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/22/2024] Open
Abstract
Background and Aims Post-discharge nausea and vomiting (PDNV) is a pertinent problem in patients undergoing ambulatory surgery. The objective of this study was to assess the efficacy of the novel drug olanzapine, which has proved its efficiency in patients undergoing highly emetogenic chemotherapy for PDNV prevention. Methods This randomised controlled trial recruited 106 adult patients (18-65 years) undergoing highly emetogenic daycare surgeries with propofol-based general anaesthesia (GA). Group O received preoperative oral olanzapine 10 mg, and Group C, acting as a control, received 8 mg of intravenous dexamethasone and 4 mg of ondansetron intraoperatively. The primary outcome was nausea (numeric rating scale >3) and/or vomiting 24 h after discharge. Secondary outcomes included nausea and vomiting in the post-anaesthesia care unit (PACU), severe nausea, vomiting and side effects. Normality was assessed using the Shapiro-Wilk test, and the independent samples t-test or the Mann-Whitney U test was used to compare continuous variables. Fisher's exact test was used to assess any non-random associations between the categorical variables. Results The incidence and severity of postoperative nausea and vomiting were similar in both groups within PACU (four patients experienced nausea and vomiting, three had severe symptoms in Group O, P = 0.057) and in the post-discharge period (three patients in Group O had nausea and vomiting compared to five patients in Group C, of which four were severe, P = 0.484). The side effects (sedation, dizziness, and light-headedness) were comparable between the two groups. Conclusion A single preoperative oral olanzapine can be an effective alternative to standard antiemetic prophylaxis involving dexamethasone and ondansetron for preventing PDNV in highly emetogenic daycare surgeries with propofol-based GA.
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Affiliation(s)
- Binayak Deb
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Kulbhushan Saini
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Suman Arora
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Sanjay Kumar
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Shiv L. Soni
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Manu Saini
- Department of Ophthalmology, PGIMER Chandigarh, India
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Karami A, Ramadani E, Banifatemi M, Asmarian N, Fattahi Saravi Z. Comparison of Nausea and Vomiting Incidence After Laparoscopic Cholecystectomy With Pretreatment With Haloperidol and Ondansetron: A Randomization Clinical Trial Study. Surg Laparosc Endosc Percutan Tech 2024; 34:118-123. [PMID: 38450649 DOI: 10.1097/sle.0000000000001269] [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: 07/24/2023] [Accepted: 11/20/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Nausea and vomiting after surgery are the most common complications. Therefore, we performed this study to compare the effect of ondansetron and haloperidol on nausea and vomiting after laparoscopic cholecystectomy. PATIENTS AND METHODS In this randomized clinical trial, 60 patients candidates for elective laparoscopic cholecystectomy were allocated to haloperidol (0.05 mg/kg, n = 30) and ondansetron (0.15 mg/kg, n = 30) groups. An Ocular Analog Scale was used to assess postoperative nausea and vomiting. Every 15 minutes in the recovery room, heart rate and blood pressure were measured up to 6 hours after surgery. In addition, patient satisfaction was assessed postoperatively. RESULTS Haloperidol and ondansetron have the same effect on postoperative nausea and vomiting in the recovery room and ward. It was found that the trend of Visual Analog Scale variable changes in the recovery room was similar in the haloperidol and ondansetron group ( P = 0.58); it was also true for the ward ( P = 0.79). Comparing the length of stay in a recovery room in the 2 groups was not statistically significant ( P = 0.19). In addition, the 2 groups did not differ in satisfaction postoperatively ( P = 0.82). CONCLUSION Haloperidol and ondansetron had an equal effect on reducing nausea and vomiting in the recovery room and ward after laparoscopic cholecystectomy. Patient satisfaction and length of stay in the recovery room did not differ between groups.
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Affiliation(s)
- Ali Karami
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Amaya S, Kalsotra S, Tobias JD, Olbrecht VA. Clinical experience with the use of inhaled isopropyl alcohol to treat nausea and vomiting: A narrative review. Saudi J Anaesth 2023; 17:383-390. [PMID: 37601520 PMCID: PMC10435785 DOI: 10.4103/sja.sja_151_23] [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: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 08/22/2023] Open
Abstract
Isopropyl alcohol (IA) is a colorless, flammable organic compound that has been used in the manufacturing process of a wide variety of industrial and household chemicals. Inhalation of its vapor has been noted to potentially have antiemetic effects, which may be useful in the treatment of postoperative nausea and vomiting (PONV). However, given the varied study protocols and endpoints assessing its efficacy as antiemetic, clinical trials have yielded mixed results. If effective, inhalation of IA may be a cost-effective, readily available, and inexpensive therapy that can be used for the treatment of PONV with a low risk of adverse effects. The following narrative review explores the available information regarding the mechanism of action of IA in treating PONV, presents clinical information including possible mechanism of action and clinical applications, and reviews the published literature on its efficacy to treat nausea and vomiting with a focus on its use postoperatively. While early studies suggested that inhaled IA may be successful for the short-term treatment of PONV compared with placebo, subsequent studies both in and out of the operating room (OR) have reported conflicting results. In general, studies in the perioperative setting have provided some evidence to support the use of inhaled IA in alleviating or reducing the severity of PONV in adults. In particular, inhaled IA may have a more rapid onset compared with traditional antiemetic agents, but the clinical effect has generally been found to be short-lived. The results outside of the OR and perioperative setting have been somewhat more favorable, generally showing that inhaled IA reduces nausea and vomiting of various etiologies in adults in the emergency department setting. Similarly, it has been shown to reduce the need for rescue antiemetic agents in this area and thus may be considered a cost-cutting strategy with no reported adverse effects. The available literature suggests that inhaled IA may be considered a potential therapy to achieve rapid relief of PONV and assist in the management of nausea and vomiting in adult patients outside of the perioperative setting. There remain insufficient data to determine how inhaled IA may impact PONV in children. Given the mixed results and the limitations of the current studies, additional data are needed to draw firm conclusions regarding the utility of inhaled IA.
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Affiliation(s)
- Sebastian Amaya
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Sidhant Kalsotra
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Joseph D. Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Vanessa A. Olbrecht
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio
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Bontea M, Bimbo-Szuhai E, Macovei IC, Maghiar PB, Sandor M, Botea M, Romanescu D, Beiusanu C, Cacuci A, Sachelarie L, Huniadi A. Anterior Approach to Hip Arthroplasty with Early Mobilization Key for Reduced Hospital Length of Stay. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1216. [PMID: 37512027 PMCID: PMC10384527 DOI: 10.3390/medicina59071216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/17/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: This study aimed to explore the preoperative factors related to early mobilization and length of stay (LOS) after total hip arthroplasty and the benefits of the anterior approach over the traditional lateral approach. Materials and Methods: Every patient benefits from information regarding details of the surgery approach, possible intra, and postoperative complications, post-operator medical care, and steps in the early mobilization protocol. The patient underwent a pre-anesthetic evaluation, was checked for preoperatory vital function, and was reevaluated for mobilization at 6, 12, 24, 36, 48, and 96 h after total hip arthroplasty using the anterior versus lateral approach. Results: The result of the statistical calculations indicates the independent negative risk factors for reaching the mobilization target: age with a coefficient of -0.046, p = 0.0154 and lateral approach with a relative risk of 0.3802 (95% CI: 0.15-0.90), p = 0.0298. Statistical data concerning the length of stay (LOS) showed significant differences in the total days spent in the hospital. The patients who were operated on using the lateral approach presented a higher body mass index than those with the anterior approach, but this difference did not reach the threshold of statistical significance. Conclusions: In our study, patient mobilization is crucial to reduce LOS.
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Affiliation(s)
- Mihaela Bontea
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Erika Bimbo-Szuhai
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
- Pelican Hospital, Corneliu Coposu Street 2, 410450 Oradea, Romania
| | - Iulia Codruta Macovei
- Pelican Hospital, Corneliu Coposu Street 2, 410450 Oradea, Romania
- Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Paula Bianca Maghiar
- Pelican Hospital, Corneliu Coposu Street 2, 410450 Oradea, Romania
- Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Mircea Sandor
- Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Mihai Botea
- Pelican Hospital, Corneliu Coposu Street 2, 410450 Oradea, Romania
- Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Dana Romanescu
- Pelican Hospital, Corneliu Coposu Street 2, 410450 Oradea, Romania
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Corina Beiusanu
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Adriana Cacuci
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
| | - Liliana Sachelarie
- Department of Prelinical Discipline, Apollonia University, 700511 Iasi, Romania
| | - Anca Huniadi
- Pelican Hospital, Corneliu Coposu Street 2, 410450 Oradea, Romania
- Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania
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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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Qasemi F, Aini T, Ali W, Dost W, Rasully MQ, Anwari M, Dost W, Zaheer R, Dost R, Talpur AS. The Effectiveness of Ondansetron and Dexamethasone in Preventing Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy. Cureus 2023; 15:e37419. [PMID: 37181978 PMCID: PMC10174678 DOI: 10.7759/cureus.37419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Background The current research compared the effectiveness of dexamethasone with ondansetron in terms of the frequency of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Methodology A comparative cross-sectional study was conducted in the Department of Surgery, Civil Hospital, Karachi, Pakistan, between June 2021 and March 2022. All patients aged between 18 and 70 years who were scheduled for elective laparoscopic cholecystectomy under general anesthesia were included in the study. All women who were on antiemetics or cortisone before surgery pregnant, and had hepatic, or renal malfunction were excluded. Group A included patients who were administered 8 mg of dexamethasone intravenously, and group B included patients who were prescribed 4 mg of ondansetron intravenously. Observation of patients was done for any symptoms such as vomiting, nausea, or the need for any antiemetic medication after the surgery. The number of episodes of vomiting and nausea was recorded in the proforma along with the duration of stay in the hospital. Results A total of 259 patients were examined during the study - 129 (49.8%) in the dexamethasone group (group A) and 130 (50.2%) in the ondansetron group (group B). The mean age of group A was 42.56 ± 11.9 years, with a mean weight of 61.4 ± 8.5 kg. The mean age of group B was 41.19 ± 10.8 years, with a mean weight of 62.56 ± 6.3 kg. Upon assessing the effectiveness of each drug in preventing nausea and vomiting, postoperatively, it was found that both drugs were equally effective in preventing nausea in the majority of the patients (73.85% vs. 65.89%; P = 0.162). However, ondansetron was significantly more effective in preventing vomiting in patients than dexamethasone (91.54% vs. 79.07%; P = 0.004). Conclusions This study concluded that the use of either dexamethasone or ondansetron effectively reduces the incidence of postoperative nausea and vomiting. However, ondansetron was significantly more effective in reducing the incidence of vomiting in patients after laparoscopic cholecystectomy than dexamethasone.
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Affiliation(s)
- Farzad Qasemi
- General Surgery, Dr. Ruth K. M. Pfau, Civil Hospital, Karachi, PAK
| | - Tahmina Aini
- General Surgery, Dr. Ruth K. M. Pfau, Civil Hospital, Karachi, PAK
| | - Wahida Ali
- General Surgery, Dr. Ruth K. M. Pfau, Civil Hospital, Karachi, PAK
| | - Wahidullah Dost
- General Surgery, Dr. Ruth K. M. Pfau, Civil Hospital, Karachi, PAK
- General Surgery, Jamhuriat Hospital, Kabul, AFG
| | | | - Maiwand Anwari
- General Surgery, Dr. Ruth K. M. Pfau, Civil Hospital, Karachi, PAK
| | - Wahida Dost
- General Surgery, Jinnah Postgraduate Medical Center, Karachi, PAK
| | - Rabia Zaheer
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Raisa Dost
- General Surgery, Dr. Ruth K. M. Pfau, Civil Hospital, Karachi, PAK
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Abdulhussain AS. Combination of dexamethasone and ondansetron in prophylaxis nausea and vomiting in gynecological operation. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY = JOURNAL DE LA THERAPEUTIQUE DES POPULATIONS ET DE LA PHARMACOLOGIE CLINIQUE 2022; 29:e150-e157. [PMID: 36464494 DOI: 10.47750/jptcp.2022.984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postoperative nausea and vomiting occur in about 20-30% of women; however, some reports have estimated the rate at 70% in at-risk individuals. Gynecological and obstetrical operations are among the most frequent types of surgeries to be associated with nausea and vomiting postoperatively. Ondansetron and dexamethasone have been compared in a variety of studies for postoperative prophylaxis. AIM OF THE STUDY This study was conducted in order to compare the efficacy and safety of dexamethasone and ondansetron, alone or in combination, for prevention of postoperative nausea and vomiting in a sample of Iraqi women undergoing gynecological surgeries. PATIENTS AND METHODS The study was conducted in Al-Diwaniyah Province, a region belonging to the Mid-Euphrates sector of Iraq, at the Child and Maternity Teaching Hospital. The study started in June 2021 and the work with the research was accomplished in September 2022. The study included a total of 100 women undergoing different gynecological surgeries such as ovarian cystectomy, oophorectomy, ectopic pregnancy, total abdominal hysterectomy, and myomectomy. All participants involved in the study were categorized randomly into four groups, namely, dexamethasone, ondansetron, combined, and placebo groups. RESULTS The rates of nausea in the different groups were analyzed. The rates of nausea in dexamethasone, ondansetron, and combined groups revealed a significant decrease compared with that of placebo group (P < 0.05), and the rate was significantly lower in combined group when compared with dexamethasone and ondansetron groups (P < 0.05). The rate of nausea in combined group was significantly lower than that of dexamethasone and ondansetron groups. The rate of vomiting in combined group was significantly lower than that of placebo group and less than that of the dexamethasone group (P < 0.05). CONCLUSION Based on our study and previous reports, both dexamethasone and ondansetron are efficient and safe in preventing nausea and vomiting in gynecological operations; however, combination of both provides the best results.
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Affiliation(s)
- Alaq Saeed Abdulhussain
- Obstetrics and Gynecology Department, College of Medicine, University of Al-Qadisiyah, Al Diwaniyah, Iraq;
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Yayla A, Eskici İlgin V, Kılınç T, Karaman Özlü Z, Ejder Apay S. Nausea and Vomiting After Laparoscopic Cholecystectomy: Analysis of Predictive Factors. J Perianesth Nurs 2022; 37:834-841. [PMID: 35382962 DOI: 10.1016/j.jopan.2022.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/02/2022] [Accepted: 01/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to identify the factors predictive of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy. DESIGN This is a descriptive, cross-sectional study. METHODS In total, 172 patients completed the study. "The Questionnaire Form," "Visual Analog Scale," "Nausea Scale," and "Anxiety Specific to Surgery Questionnaire" created by the researchers were used for data collection. FINDINGS At the second postoperative hour, 55.8% of the patients had nausea, 20.3% had vomiting and 75% had severe pain. The severity of nausea, vomiting, and pain decreased with time. Age, gender, smoking, motion sickness, postoperative pain, opioid use, preoperative fasting time, time of first postoperative fluid intake and preoperative anxiety score were found to be among the factors predictive of PONV (P < .05). CONCLUSIONS High rates of postoperative nausea and vomiting were recorded. The factors predictive of PONV can be evaluated in the preoperative period, and PONV can be controlled with early interventions and treatment of patients in the risk group.
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Affiliation(s)
- Ayşegül Yayla
- Department of Surgical Nursing, Faculty of Nursing, Atatürk University, Erzurum, Turkey.
| | - Vesile Eskici İlgin
- Department of Surgical Nursing, Faculty of Nursing, Atatürk University, Erzurum, Turkey
| | - Tülay Kılınç
- Department of Surgical Nursing, Faculty of Nursing, Atatürk University, Erzurum, Turkey
| | - Zeynep Karaman Özlü
- Department of Surgical Nursing, Faculty of Nursing, Anesthesiology Clinical Research Office, Atatürk University, Erzurum, Turkey
| | - Serap Ejder Apay
- Atatürk University Health Science Faculty, Department of Midwifery, Erzurum, Turkey
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11
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Formenti P, Piuri G, Bisatti R, Pinciroli R, Umbrello M. Role of acupuncture in critically ill patients: A systematic review. J Tradit Complement Med 2022; 13:62-71. [PMID: 36685071 PMCID: PMC9845654 DOI: 10.1016/j.jtcme.2022.10.005] [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: 07/25/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/07/2022] Open
Abstract
Acupuncture is part of a complex medical approach used in China for about 2000 years, known as Traditional Chinese Medicine, whose central assumption is that health occurs when the patterned energy flow throughout the body is balanced. Within this paradigm, acute illness occurs when a major state of imbalance or disruption arises, and the use of acupuncture may help in correcting these imbalances. While the Chinese hospital system often offers the integration of traditional and western medicine, in Europe and the United States this combined approach is infrequently practiced. However, several investigations have consistently shown the effectiveness of acupuncture for different aspects of critical illness. The aim of this systematic review is to increase the clinician's awareness of the current evidence regarding the use of acupuncture for the management of critically ill patients, both alone or as a complement to western medicine. The effects of acupuncture on critical illness, with a particular focus on respiratory function, pain and delirium treatment and prevention, circulatory function, nutritional support, and recovery after acute illness are explored and summarized, and evidence is provided that acupuncture is an acceptable and feasible option for the management of several aspects of critical illness. In addition, we suggest a practical selection of potentially useful acupuncture points in the critical care setting, with indications for simple localization and the correct puncture method.
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Affiliation(s)
- Paolo Formenti
- SC Anestesia e Rianimazione, Ospedale San Paolo – Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | | | | | - Riccardo Pinciroli
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Michele Umbrello
- SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, Milan, Italy,Corresponding author. SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, 20151, Milano, Italy.
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12
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Ji JY, Kim NS, Seo YH, Jung HS, Chun HR, Park JS, Choi JS, Ahn JM, Kim WJ. Comparing the effects of continuous infusion of esmolol and ramosetron alone and in combination on nausea and vomiting after laparoscopic cholecystectomy: A prospective, randomized, double-blind study. Medicine (Baltimore) 2022; 101:e30105. [PMID: 36107614 PMCID: PMC9439737 DOI: 10.1097/md.0000000000030105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a common complication of laparoscopic cholecystectomy. Although PONV is usually mild, severe thing can delay recovery and prolong hospitalization. We aimed to investigate the effects of ramosetron and esmolol, alone and in combination, on PONV, and pain. METHODS We enrolled 165 patients in their 20s to 50s who had an American Society of Anesthesiology physical status score of 1 or 2 and were scheduled to undergo laparoscopic cholecystectomy. They were randomly allocated into 3 groups: groups R, E, and E+R. Patients in group R received 0.3 mg of ramosetron following surgery. Those in group E were intravenously administered a bolus of esmolol (1.0 mg/kg) before endotracheal intubation. They were continuously infused with esmolol during the surgery to maintain their heart rate at 60 to 100 beats per minute and mean blood pressure at 60 to 100 mm Hg, followed by a bolus of esmolol (1.0 mg/kg) following surgery. Patients in group E+R were intravenously administered a bolus of esmolol (1.0 mg/kg) before endotracheal intubation, infused esmolol during surgery, and administered 0.3 mg of ramosetron and a bolus of esmolol (1.0 mg/kg) following surgery. We monitored the PONV stages (none, nausea, retching, and vomiting) and symptom severity in 3 postoperative stages (0-30 minutes, 30 minutes to 6 hours, and 6-24 hours), the latter by using the visual analog scale (VAS). We conducted an analysis of variance to compare VAS scores between groups. RESULTS Patients in groups E (mean ± standard deviation VAS score, 3.62 ± 1.00) and E+R (3.66 ± 0.71) exhibited less pain (P < .05) until 30 minutes following surgery compared to group R (5.72 ± 1.41). More patients in group E (28/50, 56%) experienced nausea compared to those in groups R (15/50, 30%) and E+R (8/50, 16%) until 30 minutes after surgery (P < .05). However, there were no differences in the severity of retching and vomiting between the groups in any of the phases (P > .05). CONCLUSION Despite reducing pain after laparoscopic cholecystectomy, esmolol did not prevent PONV, whether used alone or in combination with ramosetron.
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Affiliation(s)
- Jae Young Ji
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
| | - Nan Seol Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
- *Correspondence: Nan Seol Kim, Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Soonchunhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, Korea (e-mail: )
| | - Yong Han Seo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
| | - Ho Soon Jung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
| | - Hea Rim Chun
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
| | - Jin Soo Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
| | - Jeong Soo Choi
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
| | - Jae Min Ahn
- Department of Neurosurgery, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Chungcheongnam-do, Korea
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13
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Pejčić N, Mitić R, Sadana N, Veličković I. INTERFASCIAL PLANE BLOCKS IN OBSTETRIC AND GYNECOLOGIC SURGERY. Acta Clin Croat 2022; 61:145-150. [PMID: 36824640 PMCID: PMC9942458 DOI: 10.20471/acc.2022.61.s2.19] [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: 02/12/2023] Open
Abstract
Introduction Interfascial plane blocks (IPB) are truncal blocks with local anesthetic injected into space between two muscle layers. IPBs are easy to learn, simple to perform, provide satisfactory analgesia up to 24 hours, having a minimal risk of complications. Methods We present a retrospective analysis of the patients who had IPB as a part of postoperative pain management plan following either CD or hysterectomy in Leskovac General Hospital, Serbia during the period April 2017 - February 2022. Results We had 131 patients who had IPB perioperatively. Bilateral QLB type 1 was performed in 53 patients after CD and in 68 patients after hysterectomy. Bilateral ESPB T10-11 was done following one CD case and in 9 patients before hysterectomy. Patients had both acetaminophen and nonsteroidal anti-inflammatory drug for postoperative pain control. Decreased usage of fentanyl and sevoflurane was noticed in the cases where IPB was performed preoperatively. Almost all patients had well-controlled pain, and were very satisfied with pain score of 0-4/10 at numeric rating scale during 24 hours after surgery, with no opioid use. There were no complications regarding block performance. Conclusion QLB and ESPB have great potential to improve and facilitate postoperative pain management in obstetric and gynecologic surgery.
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Affiliation(s)
- Nada Pejčić
- Anesthesiologist, Department of Anesthesiology and Reanimatology,Leskovac General Hospital, Leskovac, Serbia
| | - Radomir Mitić
- Department of Anesthesiology and Reanimatology, Leskovac General Hospital, Leskovac, Serbia
| | - Neeti Sadana
- Director of Obstetric Anesthesia,Memorial Regional Hospital, Envision Physician Services, Hollywood, FL, USA,Director of Obstetric Anesthesia,SUNY Downstate Medical Center, Brooklyn, NY, USA Implementation of eras protocol for cesarean section
| | - Ivan Veličković
- Director of Obstetric Anesthesia,SUNY Downstate Medical Center, Brooklyn, NY, USA Implementation of eras protocol for cesarean section
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Kowa CY, Jin Z, Gan TJ. Framework, component, and implementation of enhanced recovery pathways. J Anesth 2022; 36:648-660. [PMID: 35789291 PMCID: PMC9255474 DOI: 10.1007/s00540-022-03088-x] [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: 06/30/2021] [Accepted: 06/15/2022] [Indexed: 12/01/2022]
Abstract
The introduction of enhanced recovery pathways (ERPs) has led to a considerable paradigm shift towards evidence-based, multidisciplinary perioperative care. Such pathways are now widely implemented in a variety of surgical specialties, with largely positive results. In this narrative review, we summarize the principles, components and implementation of ERPs, focusing on recent developments in the field. We also discuss ‘special cases’ in ERPs, including: surgery in frail patients; emergency procedures; and patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2/COVID-19).
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Affiliation(s)
- Chao-Ying Kowa
- Department of Anaesthesia, Whittington Hospital, Magdala Ave, London, N19 5NF, UK
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA.
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Modernizing Total Hip Arthroplasty Perioperative Pathways: The Implementation of ERAS-Outpatient Protocol. J Clin Med 2022; 11:jcm11123293. [PMID: 35743363 PMCID: PMC9224899 DOI: 10.3390/jcm11123293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 12/28/2022] Open
Abstract
Pressure to reduce healthcare costs, limited hospital availability along with improvements in surgical technique and perioperative care motivated many centers to focus on outpatient pathway implementation. However, in many short-stay protocols, the focus has shifted away from aiming to reduce complications and improved rehabilitation, to using length of stay as the main factor of success. To improve patient outcomes and maintain safety, the best way to implement a successful outpatient program would be to combine it with the principles of enhanced recovery after surgery (ERAS), and to improve patient recovery to a level where the patient is able to leave the hospital sooner. This article delivers a case for modernizing total hip arthroplasty perioperative pathways by implementing ERAS-outpatient protocols.
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Letter to the Editor: "Same-day discharge to home is feasible and safe in up to seventy five percent of unselected total hip and knee arthroplasty". INTERNATIONAL ORTHOPAEDICS 2022; 46:1669-1670. [PMID: 35511276 DOI: 10.1007/s00264-022-05430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 10/18/2022]
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