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Matin M, Matin FB, Ksepka N, Wysocki K, Mickael ME, Wieczorek M, Horbańczuk JO, Jóźwik A, Atanasov AG. The Clinical Research on Ginger (Zingiber officinale): Insights from ClinicalTrials.gov analysis. PLANTA MEDICA 2024. [PMID: 38944033 DOI: 10.1055/a-2357-7064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Ginger (Zingiber officinale) has a rich history of traditional medicinal use and has attracted a global interest in its health benefits. This study aims to provide insights into the clinical research landscape on ginger, focusing on its pharmacological effects and studied health-related outcomes. The study design involves systematic analysis of data from clinical trials available on ClinicalTrials.gov and discussion of findings in the context of the existing scientific knowledge. A comprehensive analysis of clinical trials registered on ClinicalTrials.gov related to ginger was first conducted, and the scientific background related to specific ginger clinical research avenues was further evaluated through PubMed searches. A variety of trial designs were identified, including treatment, prevention, and supportive care objectives. A total of 188 studies were identified on ClinicalTrials.gov, of which 89 met the inclusion criteria. Among the 89 trials, treatment objectives were predominant (47.2%), and dietary supplements (40.4%) and drugs (27%) were the most prevalent intervention types. These trials covered various health outcomes, such as antiemetic activity, analgesic function, effects on health-related quality of life, blood pressure variation, energy expenditure, and reduction in xerostomia. This study analysis provides a comprehensive overview of the clinical trials landscape on ginger, focusing on its broad spectrum of potential health benefits. While individual trials show promising results, a significant gap in the available data with a low reporting rate of final results is identified, underscoring the need for further research to establish conclusive evidence of ginger's therapeutic potentials.
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Affiliation(s)
- Maima Matin
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Magdalenka, Poland
| | - Farhan Bin Matin
- Department of Pharmacy, East West University, Aftabnagar, Dhaka, Bangladesh
| | - Natalia Ksepka
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Magdalenka, Poland
| | - Kamil Wysocki
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Magdalenka, Poland
| | - Michel-Edwar Mickael
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Magdalenka, Poland
| | - Marek Wieczorek
- Department of Neurobiology, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Jarosław Olav Horbańczuk
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Magdalenka, Poland
| | - Artur Jóźwik
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Magdalenka, Poland
| | - Atanas G Atanasov
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Magdalenka, Poland
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
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Aijima R, Miura D, Takamori A, Kamohara A, Danjo A, Sakaguchi Y, Yamashita Y. Impact of general anesthesia on postoperative complications in orthognathic surgery: a retrospective comparison of total intravenous anesthesia versus volatile anesthesia. Sci Rep 2024; 14:16075. [PMID: 38992157 PMCID: PMC11239665 DOI: 10.1038/s41598-024-66926-w] [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: 12/01/2023] [Accepted: 07/05/2024] [Indexed: 07/13/2024] Open
Abstract
Orthognathic surgery has a high incidence of postoperative nausea (PON) and vomiting (POV), delaying mobility initiation and postoperative recovery. Bleeding is another risk associated with this surgical procedure. We aimed to compare total intravenous anesthesia (TIVA) and volatile anesthesia in patients undergoing orthognathic surgery in terms of postoperative nausea and vomiting (PONV) incidence and hemodynamic changes. This retrospective study included 82 patients who underwent bilateral sagittal split ramus osteotomies at Saga University Hospital between April 2016 and April 2021. We compared the effects of TIVA and volatile anesthesia on PONV onset after surgery, acute postoperative hemodynamic changes (blood pressure and heart rate), and factors contributing to PONV. PON was significantly lower in the TIVA group than in the volatile anesthesia group. The total dose of fentanyl contributed to the onset of POV, while the onset of PON was associated with low volumes of fluid infusion and urine in the TIVA and volatile anesthesia groups, respectively. Furthermore, post-extubation hemodynamic change was significantly smaller in the TIVA group than in the volatile anesthesia group. Therefore, TIVA could have a reduced risk of PONV and hemodynamic changes in patients undergoing orthognathic surgery. Employing TIVA could mitigate perioperative complications and enhance patient safety.
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MESH Headings
- Humans
- Female
- Male
- Retrospective Studies
- Adult
- Anesthesia, Intravenous/adverse effects
- Anesthesia, Intravenous/methods
- Anesthesia, General/adverse effects
- Anesthesia, General/methods
- Postoperative Nausea and Vomiting/epidemiology
- Postoperative Nausea and Vomiting/etiology
- Orthognathic Surgical Procedures/adverse effects
- Orthognathic Surgical Procedures/methods
- Postoperative Complications/etiology
- Postoperative Complications/epidemiology
- Postoperative Complications/prevention & control
- Orthognathic Surgery/methods
- Young Adult
- Anesthesia, Inhalation/adverse effects
- Anesthesia, Inhalation/methods
- Hemodynamics/drug effects
- Anesthetics, Intravenous/administration & dosage
- Anesthetics, Intravenous/adverse effects
- Osteotomy, Sagittal Split Ramus/adverse effects
- Osteotomy, Sagittal Split Ramus/methods
- Fentanyl/administration & dosage
- Fentanyl/adverse effects
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Affiliation(s)
- Reona Aijima
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Daisuke Miura
- Department of Anesthesiology, Saga Medical Center Koseikan, 400, Nakabaru, Kasemachi, Saga, Japan
| | - Ayako Takamori
- Clinical Research Center, Saga University Hospital, 5-1-1 Nabeshima, Saga, Japan
| | - Asana Kamohara
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Atsushi Danjo
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Yoshiro Sakaguchi
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Japan
| | - Yoshio Yamashita
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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Qiu N, Wang L, Chu R. Which 5-HT3 antagonist prevents nausea and vomiting in cesarean section more effectively: a network meta-analysis. Minerva Anestesiol 2024; 90:672-681. [PMID: 39021143 DOI: 10.23736/s0375-9393.24.17919-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Selective 5-hydroxytryptamine 3 receptor (5-HT3) antagonists are commonly used to prevent nausea and vomiting (NV) after cesarean section, but the comparative efficacy of different 5-HT3 antagonists remains unclear. This network meta-analysis aimed to determine which 5-HT3 antagonists might be the preferred choice for preventing NV in parturient scheduled for elective cesarean delivery under spinal anesthesia. EVIDENCE ACQUISITION PubMed, EMBASE, Cochrane library, and Web of Science were searched for relevant randomized controlled trials (RCTs) published before August 24, 2023. Random network meta-analysis was performed using Stata 14.0 to estimate the efficacy of different 5-HT3 antagonists in preventing intra- and post-operative NV. EVIDENCE SYNTHESIS Twenty-eight studies involving seven dosing regimens of three 5-HT3 antagonists were included. Pooled results showed that ondansetron 12 mg was superior to other six dosing regimens in the prevention of postoperative NV (PONV), PON, and POV, with the ranking probability of 80.2%, 95.8%, and 87.7%, respectively, followed by granisetron two mg. Ondansetron 4 mg might be the first choice for preventing intraoperative NV (IONV) (92.8%), with the least use of postoperative rescue antiemetics (90.6%). Granisetron 3 mg and tropisetron 2 mg might be the best options for preventing ION and IOV, respectively. CONCLUSIONS Based on available data, ondansetron 12 mg may have the best efficacy in preventing PONV, PON, and POV. Additionally, more studies are warranted to compare the safety of ondansetron 12 mg versus granisetron two mg.
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Affiliation(s)
- Ningning Qiu
- Department of Anesthesiology, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, Shandong, China
| | - Li Wang
- Department of Anesthesiology, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, Shandong, China
| | - Ruichao Chu
- Department of Anesthesiology, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, Shandong, China -
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Ha NY, Park MJ, Ko SJ, Park JW, Kim J. Effect of herbal medicine on postoperative nausea and vomiting after laparoscopic surgery: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e38334. [PMID: 38847692 PMCID: PMC11155545 DOI: 10.1097/md.0000000000038334] [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] [Received: 02/01/2024] [Accepted: 05/02/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Traditionally, herbal medicines have been used to alleviate nausea and vomiting; however, a comprehensive clinical evaluation for postoperative nausea and vomiting (PONV), especially after laparoscopic surgery, remains limited. This review aimed to evaluate the efficacy and safety of herbal medicine as an alternative therapy to prevent and manage nausea and vomiting after laparoscopic surgery compared with untreated, placebo, and Western medicine groups. METHODS We searched 11 databases, including EMBASE, PubMed, and the Cochrane Library, to collect randomized controlled trials (RCTs) of herbal medicines on PONV after laparoscopic surgery on July 7, 2022. Two independent reviewers screened and selected eligible studies, extracted clinical data, and evaluated the quality of evidence using the Cochrane risk-of-bias tool. The primary outcome was the incidence of PONV, whereas the secondary outcomes included the frequency and intensity of PONV, symptom improvement time, antiemetic requirement frequency, and incidence of adverse events. Review Manager Version 5.3. was used for the meta-analysis. RESULTS We identified 19 RCTs with 2726 participants comparing herbal medicine with no treatment, placebo, and Western medicine. The findings showed that compared with no treatment, herbal medicine demonstrated significant effects on vomiting incidence (risk ratio [RR] = 0.43, 95% confidence interval [CI] 0.32-0.57, P < .00001). Compared with placebo, herbal medicine revealed a significant effect on the severity of nausea 12 hours after laparoscopic surgery (standardized mean difference = -2.04, 95% CI -3.67 to -0.41, P = .01). Herbal medicines showed similar effects with Western medicine on the incidence of postoperative nausea (RR = 0.94, 95% CI 0.63-1.42, P = .77) and vomiting (RR = 0.68, 95% CI 0.25-1.84, P = .45). Furthermore, comparing the experimental group containing herbal medicine and control group excluding herbal medicine, adverse events were considerably lower in the group with herbal medicine (RR = 0.45, 95% CI 0.27-0.72, P = .001). CONCLUSION Herbal medicine is an effective and safe treatment for nausea and vomiting secondary to laparoscopic surgery. However, the number of studies was small and their quality was not high; thus, more well-designed RCTs are warranted in the future.
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Affiliation(s)
- Na-Yeon Ha
- Division of Digestive Diseases, Department of Korean Internal Medicine, Kyung Hee University Korean Medicine Hospital, Seoul, Republic of Korea
- Department of Digestive Diseases, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Mu-Jin Park
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Seok-Jae Ko
- Department of Digestive Diseases, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jae-Woo Park
- Department of Digestive Diseases, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jinsung Kim
- Division of Digestive Diseases, Department of Korean Internal Medicine, Kyung Hee University Korean Medicine Hospital, Seoul, Republic of Korea
- Department of Digestive Diseases, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
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Laconi G, Coppens S, Roofthooft E, Van De Velde M. High dose glucocorticoids for treatment of postoperative pain: A systematic review of the literature and meta-analysis. J Clin Anesth 2024; 93:111352. [PMID: 38091865 DOI: 10.1016/j.jclinane.2023.111352] [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: 04/27/2023] [Revised: 10/30/2023] [Accepted: 11/22/2023] [Indexed: 01/14/2024]
Abstract
STUDY OBJECTIVE Glucocorticoids as a component of multimodal analgesia have been studied for many years and their post-operative analgesic effects appear to be dose-dependent. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the evidence of peri-operative high dose corticosteroid therapy in comparison to placebo (placebo drug) or control group (no treatment) for improving the quality of post-operative analgesia as indicated by a reduction of 10 mm in 100 mm Visual Analogue Scale (VAS) or reduction of 1 point in a 0-10 point VAS scale, or a reduction of 1 point in an 11-point Numerical Rating Scale (NRS) score, or reduction of rescue opioid analgesia, in patients undergoing all types of surgery. DESIGN Systematic review of RCTs with meta-analysis. SETTING Acute postoperative pain treatment in non-obese adult population. INTERVENTIONS Perioperative administration of high dose of Dexamethasone (≥ 0,2 mg/Kg or ≥ 15 mg), or a corresponding dose of a systemic glucocorticoid. MEASUREMENTS Primary outcomes were postoperative pain measured in 0-100 mm VAS score at 24 h after surgery upon rest and movement. Secondary outcomes were postoperative pain 0-100 mm VAS score 48 h after surgery, postoperative rescue analgesic requirement, postoperative nausea and vomiting (PONV), relevant adverse events. MAIN RESULTS 47 RCT's were included (3943 patients). The Mean Difference (MD) of 100 mm VAS scores for pain at rest 24 h after surgery was -6.18 mm 95% CI [-8.53, -3.83], at motion -8.86 mm 95% CI [-11.82, -5.89]. Opioid analgesic requirements evaluated in Oral Morphine Equivalents (OME) was -10.00 mg 95% CI [-13.65, -6.34]. PONV events Odds Ratio of 0.29 95%CI [0.24, 0.36]. Major adverse events OR was 0.88 95% CI [0.65, 1.19]. Minor adverse events OR 1.29 95% CI [0.86, 1.92]. CONCLUSION High doses of glucocorticoids are one of the many possible tools available in multimodal postoperative analgesia, possibly reducing opioids consumption and recurrence of PONV but with no relevant effects in terms of reduction of postoperative VAS score. Available data show a safe therapeutic profile, without increase adverse events. PROTOCOL REGISTRATION CRD42020137119.
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Affiliation(s)
- Giulia Laconi
- Anesthesia and Intensive Care Unit, AOU Sant'Anna, Ferrara, Italy.
| | - Steve Coppens
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | - Eva Roofthooft
- Department of Anesthesia, GZA Hospitals, Antwerp, Belgium and Department of Cardiovascular sciences, KULeuven, Leuven, Belgium
| | - Marc Van De Velde
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
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Liu F, Duan M, Fu H, Wang T. The efficacy and safety of perioperative glucocorticoid for total knee arthroplasty: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:144. [PMID: 38622510 PMCID: PMC11017604 DOI: 10.1186/s12871-024-02530-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 04/08/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND An increasing number of individuals undergo total knee arthroplasty (TKA), which can result in pain, limited motor function and adverse complications such as infection, nausea and vomiting. Glucocorticoids have been shown anti-inflammatory and antiemetic effects, but can also elevate blood glucose levels and increase the risk of wound infection. Thus, it is essential to investigate the efficacy and safety of glucocorticoid usage in TKA. METHOD A comprehensive systematic search of PubMed, Medline, EMBASE, Cochrane databases, to identify relevant randomized controlled trials (RCTs) of glucocorticoid application in TKA. The primary outcomes assessed were the postoperative pain assessment. Secondary outcomes included the range of motion in knee joint, levels of inflammatory cytokines, adverse complications, and the length of hospital stay. RESULTS Thirty-six randomized controlled trials were included in the final analysis. The glucocorticoid group exhibited significant reduction in the resting VAS scores on postoperative days 1, 2 (POD1, 2)and postoperative 3 months (POM3), as well as decreased morphine consumption on POD1 and increased range of motion (ROM) in knee joint on POD1, 3. Additionally, the glucocorticoid group exhibited decreased levels of postoperative inflammatory cytokines and the incidence of PONV along with a shorter length of hospital stay. The blood glucose concentration was significantly increased in the glucocorticoid group on POD1 compared with the control group. While the blood glucose on POD2 and occurrence of postoperative adverse complications were similar between two groups including wound infection and venous thrombosis. The periarticular injection analgesia (PIA) group demonstrated lower VAS scores on POD2 comparing to the systemic administration (SA) group according to two studies. However, there was no significant difference of the resting VAS on POD1 and POD2 between PIA and SA group across all studies. CONCLUSION Perioperative glucocorticoids treatment in TKA significantly reduced short-term pain score and opioid-use which was probably not patient relevant. The application of glucocorticoids in TKA implied a beneficial trend in analgesic, anti-inflammatory, and antiemetic effects, as well as improved range of motion and shortened hospital stay. While it will not increase the risk of continued high glucose, postoperative wound infection and venous thrombosis.
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Affiliation(s)
- Fangyan Liu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Mei Duan
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Huiqun Fu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.
- National Clinical Research Center for Geriatric Diseases, Beijing, China.
- Beijing Institute for Brain Disorders, Beijing, China.
- Center for Sleep and Consciousness Disorders, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.
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Zhao K, Gao Y, Zhang J, Wang S, Chen J, Guo F, Wang S. Penehyclidine for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Gynecological Laparoscopic Surgery Under Combined Intravenous and Inhalation Anesthesia: A Randomized, Double-Blind, Placebo-Controlled Trial. Drug Des Devel Ther 2024; 18:685-697. [PMID: 38445065 PMCID: PMC10913797 DOI: 10.2147/dddt.s453327] [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] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/13/2024] [Indexed: 03/07/2024] Open
Abstract
Purpose We designed this study to investigate the effect of intravenous use of penehyclidine on postoperative nausea and vomiting (PONV) after gynecological laparoscopic surgery. Patients and Methods Ninety-two Women Patients (Aged ≥ 18) Scheduled for Elective Gynecologic Laparoscopy Were Enrolled in the Current Study. Patients Were Equally Randomized Assigned Into Penehyclidine group (PHC group: received a bolus of penehyclidine 10 μg/kg during the induction of anesthesia, then followed by a continuous infusion of 10 μg/kg penehyclidine at a fixed rate of 2.0 mL/h in postoperative intravenous analgesia pump over 48h, 0.5 mg upper limit respectively) or Control group (received 0.9% saline in replace of penehyclidine at the same time points). The primary outcome measure was the incidence of postoperative nausea and vomiting in the postanesthesia care unit and ward area. Quality of Recovery-15 (QoR-15) scores and general comfort questionnaire (GCQ) scores were assessed on postoperative day (POD) 1, 2. Results Patients between two groups had comparable baseline characteristics. Compared with the Control group, the incidence and severity of PONV, postoperative nausea (PON), and postoperative vomiting (POV) were significantly lower in the PHC group at 2h (PONV: P = 0.002, P = 0.004, respectively; PON: P = 0.018, P = 0.038, respectively; POV: P = 0.011, P = 0.072, respectively), 24h (PONV: P = 0.003, P = 0.001, respectively; PON: P = 0.010, P = 0.032, respectively; POV: P = 0.006, P = 0.044, respectively), and 48h (PONV: P = 0.003, P = 0.002, respectively; PON: P = 0.007, P = 0.019, respectively; POV: P = 0.002, P = 0.013, respectively) after surgery. The QoR-15 and GCQ scores of the PHC group were significantly higher than those of the Control group at POD 1, 2 (P < 0.001; P < 0.001, respectively). Conclusion Our findings suggest that perioperative intravenous application of penehyclidine can effectively prevent postoperative nausea and vomiting in gynecological laparoscopic surgery patients and improve postoperative recovery.
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Affiliation(s)
- Kai Zhao
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, People’s Republic of China
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, People’s Republic of China
| | - Yali Gao
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, People’s Republic of China
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, People’s Republic of China
| | - Jianping Zhang
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, People’s Republic of China
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, People’s Republic of China
| | - Shan Wang
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, People’s Republic of China
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, People’s Republic of China
| | - Jiaqi Chen
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, People’s Republic of China
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, People’s Republic of China
| | - Fenglin Guo
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, People’s Republic of China
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, People’s Republic of China
| | - Sheng Wang
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, People’s Republic of China
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, People’s Republic of China
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Asif M, Kosar N, Sajid H, Qureshi S, Gilani MA, Ayub K, Arshad M, Imran M, Hamid MHS, Bayach I, Sheikh NS, Mahmood T. Exploring the Sensing Potential of g-C 3N 4 versus Li/g-C 3N 4 Nanoflakes toward Hazardous Organic Volatiles: A DFT Simulation Study. ACS OMEGA 2024; 9:3541-3553. [PMID: 38284053 PMCID: PMC10810007 DOI: 10.1021/acsomega.3c07350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024]
Abstract
Ab initio calculations were performed to determine the sensing behavior of g-C3N4 and Li metal-doped g-C3N4 (Li/g-C3N4) quantum dots toward toxic compounds acetamide (AA), benzamide (BA), and their thio-analogues, namely, thioacetamide (TAA) and thiobenzamide (TAA). For optimization and interaction energies, the ωB97XD/6-31G(d,p) level of theory was used. Interaction energies (Eint) illustrate the high thermodynamic stabilities of the designed complexes due to the presence of the noncovalent interactions. The presence of electrostatic forces in some complexes is also observed. The observed trend of Eint in g-C3N4 complexes was BA > TAA > AA > TBA, while in Li/g-C3N4, the trend was BA > AA > TBA > TAA. The electronic properties were studied by frontier molecular orbital (FMO) and natural bond orbital analyses. According to FMO, lithium metal doping greatly enhanced the conductivity of the complexes by generating new HOMOs near the Fermi level. A significant amount of charge transfer was also observed in complexes, reflecting the increase in charge conductivity. NCI and QTAIM analyses evidenced the presence of significant noncovalent dispersion and electrostatic forces in Li/g-C3N4 and respective complexes. Charge decomposition analysis gave an idea of the transfer of charge density between quantum dots and analytes. Finally, TD-DFT explained the optical behavior of the reported complexes. The findings of this study suggested that both bare g-C3N4 and Li/g-C3N4 can effectively be used as atmospheric sensors having excellent adsorbing properties toward toxic analytes.
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Affiliation(s)
- Misbah Asif
- Department
of Chemistry, COMSATS University Islamabad,
Abbottabad Campus, Abbottabad 22060, Pakistan
| | - Naveen Kosar
- Department
of Chemistry, University of Management and
Technology (UMT), C-11, Johar Town, Lahore 54782, Pakistan
| | - Hasnain Sajid
- School
of Science and Technology, Nottingham Trent
University, Clifton Lane, Nottingham NG11 8NS, U.K.
| | - Sana Qureshi
- Department
of Chemistry, COMSATS University Islamabad,
Abbottabad Campus, Abbottabad 22060, Pakistan
| | - Mazhar Amjad Gilani
- Department
of Chemistry, COMSATS University Islamabad,
Lahore Campus, Lahore 54000, Pakistan
| | - Khurshid Ayub
- Department
of Chemistry, COMSATS University Islamabad,
Abbottabad Campus, Abbottabad 22060, Pakistan
| | - Muhammad Arshad
- Institute
of Chemistry, The Islamia University of
Bahawalpur, Baghdad-ul-Jadeed Campus, Bahawalpur 63100, Pakistan
| | - Muhammad Imran
- Department
of Chemistry, Faculty of Science, King Khalid
University, P.O. Box 9004, Abha 61413, Saudi Arabia
| | - Malai Haniti S.
A. Hamid
- Chemical
Sciences, Faculty of Science, Universiti
Brunei Darussalam, Jalan Tungku
Link, Gadong BE1410, Brunei Darussalam
| | - Imene Bayach
- Department
of Chemistry, College of Science, King Faisal
University, Al-Ahsa 31982, Saudi Arabia
| | - Nadeem S. Sheikh
- Chemical
Sciences, Faculty of Science, Universiti
Brunei Darussalam, Jalan Tungku
Link, Gadong BE1410, Brunei Darussalam
| | - Tariq Mahmood
- Department
of Chemistry, COMSATS University Islamabad,
Abbottabad Campus, Abbottabad 22060, Pakistan
- Department
of Chemistry, College of Science, University
of Bahrain, P.O. Box 32038, Sakhir 1054, Bahrain
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Stewart CM, Bassiri-Tehrani B, Jones HE, Nahai F. Evidence of Hematoma Prevention After Facelift. Aesthet Surg J 2024; 44:134-143. [PMID: 37540899 DOI: 10.1093/asj/sjad247] [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: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/06/2023] Open
Abstract
Hematoma is a common complication after facelift procedures. Multiple factors have been shown to increase the risk of hematoma formation, such as male gender, anticoagulant medication use, perioperative hypertension, increased intrathoracic pressure, and operative technique. The purpose of this manuscript is to provide an overview of existing literature to provide surgeons with evidence-based recommendations on how to minimize hematoma risk during facelift surgery. A literature search for hematoma and facelift surgery was performed that identified 478 unique manuscripts. Abstracts were reviewed, excluding articles not describing facelift surgery, those written before 1970, studies with a sample size of fewer than 5 patients, non-English studies, and those that did not provide postoperative hematoma rates. Forty-five articles were included in this text, with their recommendations. Measures such as the prophylactic management of pain, nausea, and hypertension, the use of fibrin glue tissue sealants, the use of local anesthesia rather than general anesthesia, and strict blood pressure control of at least <140 mmHg were found to significantly reduce hematoma formation. Quilting sutures has shown benefit in some high-risk patients. Measures such as drains, compression dressings, perioperative use of selective serotonin reuptake inhibitors, and perioperative steroids had no significant effect on hematoma formation. In addition to appropriate patient selection and careful intraoperative hemostasis, many adjunct measures have been shown to reduce postoperative hematoma formation in facelift procedures. LEVEL OF EVIDENCE: 3
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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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11
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Sforza M, Sidhu M, Okhiria R, Okhiria T, Saghir R, Saghir N, Husein R, Poojary M, Seifalian A. Using Ginger Oil to Treat Nausea and Vomiting Following Breast Augmentation Surgery. PLASTIC AND AESTHETIC NURSING 2023; 43:225-230. [PMID: 37774171 DOI: 10.1097/psn.0000000000000534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
We conducted a double-blind, randomized, placebo-controlled, single-center study involving 30 women undergoing breast augmentation surgery with silicone breast implants. All patients had an A cup breast size and a similar body mass index. We placed the same type of implant in a subpectoral dual plane in each patient. We randomly allocated the study participants to receive either three drops of ginger oil (110 mg Zingiber officinale) or three drops of a placebo control oil placed on their laryngeal mask before insertion. We used a postoperative nausea and vomiting (PONV) and a visual analog scale (VAS) scores as outcome measures and compared the scale results with the dose of morphine used by the patient. The results of the multivariate analysis of variance showed that the ginger oil had a significant effect on PONV/VAS scores, V = 0.87, F(3, 16) = 34.78, p < .001. The results of the univariate analysis of variance showed that using the ginger oil provided significant treatment effects on PONV, F(1, 18) = 73.05, p < .001. These results are also reflected in the descriptive statistics. The mean PONV score for the experimental group and the control group was 1.70 ± 0.48 and 4.20 ± 0.79, respectively. The mean VAS score for the experimental group and the control group was 5.0 ± 1.63 and 5.9 ± 2.33, respectively. The results of our study showed that ginger oil has an important role in preventing PONV and reducing the use of postoperative opioids in women who have undergone breast augmentation surgery.
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Affiliation(s)
- Marcos Sforza
- Marcos Sforza, MD, is a Plastic Surgeon, responsible for the Elective Internship in Plastic Surgery at The Dolan Park Hospital, UK, and a fellow of the Royal College of Surgeons of England
- Manu Sidhu, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Renee Okhiria, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Terrell Okhiria, MD, is a Foundation Doctor at Peterborough City Hospital, Peterborough, UK
- Reyan Saghir, MD, is a Core Surgical Trainee Doctor at Pinderfields Hospital, Wakefield, UK
- Norman Saghir, MD, MBChB, BSc (Hons), PGCert HR, is a Registrar in Plastic Surgery, University Hospital North Durham, UK
- Rodwan Husein, MD, MBChB, is an Anesthesia Trainee at the Royal Free London National Health Service Foundation Trust, London, UK
- Manoj Poojary, MD, is an Anesthetist at The Dolan Park Hospital, UK
- Amelia Seifalian, MD, is a Physician at Watford General Hospital and Imperial College, London, UK
| | - Manu Sidhu
- Marcos Sforza, MD, is a Plastic Surgeon, responsible for the Elective Internship in Plastic Surgery at The Dolan Park Hospital, UK, and a fellow of the Royal College of Surgeons of England
- Manu Sidhu, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Renee Okhiria, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Terrell Okhiria, MD, is a Foundation Doctor at Peterborough City Hospital, Peterborough, UK
- Reyan Saghir, MD, is a Core Surgical Trainee Doctor at Pinderfields Hospital, Wakefield, UK
- Norman Saghir, MD, MBChB, BSc (Hons), PGCert HR, is a Registrar in Plastic Surgery, University Hospital North Durham, UK
- Rodwan Husein, MD, MBChB, is an Anesthesia Trainee at the Royal Free London National Health Service Foundation Trust, London, UK
- Manoj Poojary, MD, is an Anesthetist at The Dolan Park Hospital, UK
- Amelia Seifalian, MD, is a Physician at Watford General Hospital and Imperial College, London, UK
| | - Renee Okhiria
- Marcos Sforza, MD, is a Plastic Surgeon, responsible for the Elective Internship in Plastic Surgery at The Dolan Park Hospital, UK, and a fellow of the Royal College of Surgeons of England
- Manu Sidhu, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Renee Okhiria, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Terrell Okhiria, MD, is a Foundation Doctor at Peterborough City Hospital, Peterborough, UK
- Reyan Saghir, MD, is a Core Surgical Trainee Doctor at Pinderfields Hospital, Wakefield, UK
- Norman Saghir, MD, MBChB, BSc (Hons), PGCert HR, is a Registrar in Plastic Surgery, University Hospital North Durham, UK
- Rodwan Husein, MD, MBChB, is an Anesthesia Trainee at the Royal Free London National Health Service Foundation Trust, London, UK
- Manoj Poojary, MD, is an Anesthetist at The Dolan Park Hospital, UK
- Amelia Seifalian, MD, is a Physician at Watford General Hospital and Imperial College, London, UK
| | - Terrell Okhiria
- Marcos Sforza, MD, is a Plastic Surgeon, responsible for the Elective Internship in Plastic Surgery at The Dolan Park Hospital, UK, and a fellow of the Royal College of Surgeons of England
- Manu Sidhu, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Renee Okhiria, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Terrell Okhiria, MD, is a Foundation Doctor at Peterborough City Hospital, Peterborough, UK
- Reyan Saghir, MD, is a Core Surgical Trainee Doctor at Pinderfields Hospital, Wakefield, UK
- Norman Saghir, MD, MBChB, BSc (Hons), PGCert HR, is a Registrar in Plastic Surgery, University Hospital North Durham, UK
- Rodwan Husein, MD, MBChB, is an Anesthesia Trainee at the Royal Free London National Health Service Foundation Trust, London, UK
- Manoj Poojary, MD, is an Anesthetist at The Dolan Park Hospital, UK
- Amelia Seifalian, MD, is a Physician at Watford General Hospital and Imperial College, London, UK
| | - Reyan Saghir
- Marcos Sforza, MD, is a Plastic Surgeon, responsible for the Elective Internship in Plastic Surgery at The Dolan Park Hospital, UK, and a fellow of the Royal College of Surgeons of England
- Manu Sidhu, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Renee Okhiria, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Terrell Okhiria, MD, is a Foundation Doctor at Peterborough City Hospital, Peterborough, UK
- Reyan Saghir, MD, is a Core Surgical Trainee Doctor at Pinderfields Hospital, Wakefield, UK
- Norman Saghir, MD, MBChB, BSc (Hons), PGCert HR, is a Registrar in Plastic Surgery, University Hospital North Durham, UK
- Rodwan Husein, MD, MBChB, is an Anesthesia Trainee at the Royal Free London National Health Service Foundation Trust, London, UK
- Manoj Poojary, MD, is an Anesthetist at The Dolan Park Hospital, UK
- Amelia Seifalian, MD, is a Physician at Watford General Hospital and Imperial College, London, UK
| | - Norman Saghir
- Marcos Sforza, MD, is a Plastic Surgeon, responsible for the Elective Internship in Plastic Surgery at The Dolan Park Hospital, UK, and a fellow of the Royal College of Surgeons of England
- Manu Sidhu, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Renee Okhiria, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Terrell Okhiria, MD, is a Foundation Doctor at Peterborough City Hospital, Peterborough, UK
- Reyan Saghir, MD, is a Core Surgical Trainee Doctor at Pinderfields Hospital, Wakefield, UK
- Norman Saghir, MD, MBChB, BSc (Hons), PGCert HR, is a Registrar in Plastic Surgery, University Hospital North Durham, UK
- Rodwan Husein, MD, MBChB, is an Anesthesia Trainee at the Royal Free London National Health Service Foundation Trust, London, UK
- Manoj Poojary, MD, is an Anesthetist at The Dolan Park Hospital, UK
- Amelia Seifalian, MD, is a Physician at Watford General Hospital and Imperial College, London, UK
| | - Rodwan Husein
- Marcos Sforza, MD, is a Plastic Surgeon, responsible for the Elective Internship in Plastic Surgery at The Dolan Park Hospital, UK, and a fellow of the Royal College of Surgeons of England
- Manu Sidhu, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Renee Okhiria, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Terrell Okhiria, MD, is a Foundation Doctor at Peterborough City Hospital, Peterborough, UK
- Reyan Saghir, MD, is a Core Surgical Trainee Doctor at Pinderfields Hospital, Wakefield, UK
- Norman Saghir, MD, MBChB, BSc (Hons), PGCert HR, is a Registrar in Plastic Surgery, University Hospital North Durham, UK
- Rodwan Husein, MD, MBChB, is an Anesthesia Trainee at the Royal Free London National Health Service Foundation Trust, London, UK
- Manoj Poojary, MD, is an Anesthetist at The Dolan Park Hospital, UK
- Amelia Seifalian, MD, is a Physician at Watford General Hospital and Imperial College, London, UK
| | - Manoj Poojary
- Marcos Sforza, MD, is a Plastic Surgeon, responsible for the Elective Internship in Plastic Surgery at The Dolan Park Hospital, UK, and a fellow of the Royal College of Surgeons of England
- Manu Sidhu, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Renee Okhiria, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Terrell Okhiria, MD, is a Foundation Doctor at Peterborough City Hospital, Peterborough, UK
- Reyan Saghir, MD, is a Core Surgical Trainee Doctor at Pinderfields Hospital, Wakefield, UK
- Norman Saghir, MD, MBChB, BSc (Hons), PGCert HR, is a Registrar in Plastic Surgery, University Hospital North Durham, UK
- Rodwan Husein, MD, MBChB, is an Anesthesia Trainee at the Royal Free London National Health Service Foundation Trust, London, UK
- Manoj Poojary, MD, is an Anesthetist at The Dolan Park Hospital, UK
- Amelia Seifalian, MD, is a Physician at Watford General Hospital and Imperial College, London, UK
| | - Amelia Seifalian
- Marcos Sforza, MD, is a Plastic Surgeon, responsible for the Elective Internship in Plastic Surgery at The Dolan Park Hospital, UK, and a fellow of the Royal College of Surgeons of England
- Manu Sidhu, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Renee Okhiria, MD, is a Foundation Doctor at Addenbrookes Hospital, Cambridge, UK
- Terrell Okhiria, MD, is a Foundation Doctor at Peterborough City Hospital, Peterborough, UK
- Reyan Saghir, MD, is a Core Surgical Trainee Doctor at Pinderfields Hospital, Wakefield, UK
- Norman Saghir, MD, MBChB, BSc (Hons), PGCert HR, is a Registrar in Plastic Surgery, University Hospital North Durham, UK
- Rodwan Husein, MD, MBChB, is an Anesthesia Trainee at the Royal Free London National Health Service Foundation Trust, London, UK
- Manoj Poojary, MD, is an Anesthetist at The Dolan Park Hospital, UK
- Amelia Seifalian, MD, is a Physician at Watford General Hospital and Imperial College, London, UK
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12
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Lee SY, Tamale JR. Isopropyl alcohol inhalation for the treatment of nausea in adult emergency department patients: a systematic review and meta-analysis. Emerg Med J 2023; 40:660-665. [PMID: 37076258 DOI: 10.1136/emermed-2022-212871] [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: 09/26/2022] [Accepted: 03/29/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Nausea and vomiting is a common ED chief complaint. However, randomised trials comparing antiemetic agents to placebo have not demonstrated superiority. This systematic review investigates the efficacy of inhaled isopropyl alcohol (IPA) compared with usual care or placebo in adults presenting to the ED with nausea and vomiting. METHODS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, other relevant trial registries, journals, and conference proceedings up to September 2022. Randomised controlled trials using IPA to treat adult ED patients with nausea and vomiting were included. The primary outcome was change in severity of nausea, measured by a validated scale. A secondary outcome was vomiting during the ED stay. We used a random-effects model for the meta-analysis, and assessed certainty of evidence using the Grades of Recommendation, Assessment, Development and Evaluation system. RESULTS Two trials comparing inhaled IPA to saline placebo and including a total of 195 patients were pooled for meta-analysis of the primary outcome. A third study comparing a group receiving inhaled IPA and oral ondansetron to another group receiving inhaled saline placebo and oral ondansetron did not qualify for the original registered protocol, but was included in a secondary analysis. All studies were judged to be at low or unclear risk of bias. The pooled mean difference for the primary analysis was a reduction in reported nausea of 2.18 on a 0-10 scale (95% confidence interval (CI) 1.60 to 2.76), favouring IPA over placebo, where the minimum clinically significant difference was defined as 1.5. The evidence level was graded as moderate, due to imprecision from low patient numbers. Only the study included in the secondary analysis assessed the secondary outcome of vomiting, and did not find a difference between intervention and control. CONCLUSION This review suggests that IPA likely has a modest effect in reducing nausea in adult ED patients, compared with placebo. Larger multicentre trials are needed, as the evidence is limited by few trials and patients. PROSPERO REGISTRATION NUMBER CRD42022299815.
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Affiliation(s)
- Stefanie Y Lee
- Department of Radiology, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - John R Tamale
- Department of Family Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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13
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Ha NY, Park MJ, Kim J. Chinese herbal medicine as adjuvant treatment for postoperative nausea and vomiting in patients undergoing laparoscopic surgery: a protocol for systematic review and meta-analysis. BMJ Open 2023; 13:e072499. [PMID: 37380209 PMCID: PMC10410898 DOI: 10.1136/bmjopen-2023-072499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/16/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION Postoperative nausea and vomiting (PONV) is a distressing symptom that patients often complain of even after less invasive surgery such as laparoscopic surgery (LS). If PONV is not well managed, patient recovery and postoperative quality of life are adversely affected. Although various drugs have been administered to prevent PONV, their effectiveness is limited, and adverse effects are numerous. Although herbal medicines have been widely used to manage various gastrointestinal symptoms, including nausea and vomiting, scientific evidence of their effects is lacking. This protocol is intended for a systematic review to analyse the efficacy and safety of Chinese herbal medicines for PONV after LS through a meta-analysis. METHODS AND ANALYSIS Randomised controlled trials, reported until June 2022, will be retrieved from electronic databases such as Medline, EMBASE and Cochrane Library. We will compare the effects of herbal medicine in patients presenting with PONV after LS with those of Western medicine, placebo and no treatment. If sufficient studies are identified, we will evaluate the combined effects of herbal and Western medicine. The incidence of nausea and vomiting will be considered the primary outcome. Secondary outcomes will include the intensity of complaints, quality of life and incidence of adverse events. Two independent reviewers will collect data based on the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, evaluate the quality of each study using the Cochrane risk-of-bias tool and synthesise the results via meta-analysis, if possible. ETHICS AND DISSEMINATION Ethical approval is not required for this review. The results of this study will be disseminated to peer-reviewed journals and posters. PROSPERO REGISTRATION NUMBER CRD42022345749.
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Affiliation(s)
- Na-Yeon Ha
- Division of Digestive Diseases, Department of Internal Korean Medicine, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
| | - Mu-Jin Park
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Korea (the Republic of)
| | - Jinsung Kim
- Department of Gastroenterology, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul, Korea (the Republic of)
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14
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Xue Q, Xing Q, Dong L, Guo M, Zhang X, Wei X, Jia B, Wang Y, Chen H, Hu X, Liu H, Zhang Y, Wong GTC, Huang C. ST36 acupoint injection with anisodamine for postoperative nausea and vomiting in female patients after bariatric surgery: a prospective, randomized controlled trial. Surg Endosc 2023:10.1007/s00464-023-10037-6. [PMID: 37095234 PMCID: PMC10338617 DOI: 10.1007/s00464-023-10037-6] [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: 09/04/2022] [Accepted: 03/12/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND The use of multimodal pharmacological prophylactic regimes has decreased postoperative nausea and vomiting (PONV) in general but it still occurs in over 60% of female patients after bariatric surgery. This study aimed to evaluate the efficacy of ST36 acupoint injection with anisodamine in prevention of PONV among female patients after bariatric surgery. METHODS Ninety patients undergoing laparoscopic sleeve gastrectomy were randomly allocated to anisodamine or control group at the ratio of 2:1. Anisodamine or normal saline was injected into Zusanli (ST36) bilaterally after induction of general anesthesia. The incidence and severity of PONV were assessed during the first 3 postoperative days and at 3 months. The quality of early recovery of anesthesia, gastrointestinal function, sleep quality, anxiety, depression, and complications were also evaluated. RESULTS Baseline and perioperative characteristics were comparable between two groups. In the anisodamine group, 25 patients (42.4%) experienced vomiting within postoperative 24 h compared with 21 (72.4%) in the control group (relative risk 0.59; 95% confidence interval 0.40-0.85). Time to first rescue antiemetic was 6.5 h in anisodamine group, and 1.7 h in the control group (P = 0.011). Less rescue antiemetic was required during the first 24 h in the anisodamine group (P = 0.024). There were no differences in either postoperative nausea or other recovery characteristics. CONCLUSIONS The addition of ST36 acupoint injection with anisodamine significantly reduced postoperative vomiting without affecting nausea in female patients with obesity undergoing laparoscopic sleeve gastrectomy.
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Affiliation(s)
- Qi Xue
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei City, Anhui Province, China
- Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Qijing Xing
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei City, Anhui Province, China
- Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Ling Dong
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
- Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Min Guo
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
- Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Xiaoyan Zhang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
- Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Xinchun Wei
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
- Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Benli Jia
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
- Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Yong Wang
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
- Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Hong Chen
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
- Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Xianwen Hu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei City, Anhui Province, China
- Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Ye Zhang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China.
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei City, Anhui Province, China.
- Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei City, Anhui Province, China.
| | - Gordon Tin Chun Wong
- Department of Anaesthesiology, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
| | - Chunxia Huang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China.
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei City, Anhui Province, China.
- Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei City, Anhui Province, China.
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15
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Ke HH, Liou JY, Teng WN, Hsu PK, Tsou MY, Chang WK, Ting CK. Opioid-sparing anesthesia with dexmedetomidine provides stable hemodynamic and short hospital stay in non-intubated video-assisted thoracoscopic surgery: a propensity score matching cohort study. BMC Anesthesiol 2023; 23:110. [PMID: 37013487 PMCID: PMC10069055 DOI: 10.1186/s12871-023-02032-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/01/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVES Dexmedetomidine is an alpha-2 agonist with anti-anxiety, sedative, and analgesic effects and causes a lesser degree of respiratory depression. We hypothesized that the use of dexmedetomidine in non-intubated video-assisted thoracic surgery (VATS) may reduce opioid-related complications such as postoperative nausea and vomiting (PONV), dyspnea, constipation, dizziness, skin itching, and cause minimal respiratory depression, and stable hemodynamic status. METHODS Patients who underwent non-intubated VATS lung wedge resection with propofol combined with dexmedetomidine (group D) or alfentanil (group O) between December 2016 and May 2022 were enrolled in this retrospective propensity score matching cohort study. Intraoperative vital signs, arterial blood gas data, perioperative results and treatment outcomes were analyzed. Of 100 patients included in the study (group D, 50 and group O, 50 patients), group D had a significantly lower degree of decrement in the heart rate and the blood pressure than group O. Intraoperative one-lung arterial blood gas revealed lower pH and significant ETCO2. The common opioid-related side effects, including PONV, dyspnea, constipation, dizziness, and skin itching, all of which occurred more frequently in group O than in group D. Patients in group O had significantly longer postoperative hospital stay and total hospital stay than group D, which might be due to opioid-related side effects postoperatively. CONCLUSIONS The application of dexmedetomidine in non-intubated VATS resulted in a significant reduction in perioperative opioid-related complications and maintenance with acceptable hemodynamic performance. These clinical outcomes found in our retrospective study may enhance patient satisfaction and shorten the hospital stay.
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Affiliation(s)
- Hui-Hsuan Ke
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jing-Yang Liou
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Nung Teng
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Kuei Hsu
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Surgery, Division of Thoracic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mei-Yung Tsou
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Kuei Chang
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Kun Ting
- Department of Anesthesiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.
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16
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Cai Q, Liu G, Liu Z, Gao M, Huang L, He F, Liu S, Lin Y, Wei H, Dou Z, Liu D, Hu Y, Gong X. Efficacy of quadratus lumborum block on postoperative pain and side effects in patients who underwent urological surgery: A meta-analysis. Pain Pract 2023; 23:70-82. [PMID: 35726437 DOI: 10.1111/papr.13140] [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: 12/05/2021] [Revised: 04/13/2022] [Accepted: 05/31/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Ultrasound-guided quadratus lumborum block (QLB) is considered a novel nerve block for postoperative pain control. However, its efficacy after urological surgery remains unclear. OBJECTIVES The purpose of the current meta-analysis was to evaluate the effects of the QLB block versus control (placebo or no injection) on postoperative pain and other adverse outcomes after urological surgery, providing extensive evidence of whether quadratus lumborum block is suitable for pain management after urological surgery. STUDY DESIGN Systematic review with meta-analysis of randomized clinical trials. METHODS We searched PubMed, Cochrane Library, Embase, Web of Science, and ClinicalTrials.gov to collect studies investigating the effects of QLB on analgesia after urological surgery. The primary outcomes included visual analog scale (VAS) at rest and during movement, 24-h postoperative morphine consumption, and the incidence of postoperative nausea and vomiting (PONV). RESULTS Overall, 13 randomized controlled trials (RCTs) were reviewed, including 751 patients who underwent urological surgery. The QLB group exhibited a lower VAS score postoperatively at rest or on movement at 0, 6, 12, and 24 h, with less 24-h postoperative morphine consumption and lower incidence of PONV. LIMITATIONS Although the result is stable, heterogeneity exists in the current research. CONCLUSIONS QLB exhibited a favorable effect of postoperative analgesia with reduced postoperative complications at rest or during movement after urological surgery. However, it is still a novel technology at a primary stage, which needs further research to develop.
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Affiliation(s)
- Qiang Cai
- Department of Orthopedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China.,Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | | | | | - Meiling Gao
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Linsheng Huang
- Department of Hepatobiliary Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Fuhai He
- Guangxi Medical University, Nanning, China
| | | | - Yunhua Lin
- Guangxi Medical University, Nanning, China
| | - Huixia Wei
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Zhiqian Dou
- Department of Obstetrics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Dexi Liu
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yang Hu
- Department of Orthopedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Xingrui Gong
- Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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17
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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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18
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Park JM. Comparison of the effects of sevoflurane and desflurane on the severity score of postoperative pain and discomfort after thyroidectomy: A prospective, double-blinded, randomized controlled study. Medicine (Baltimore) 2022; 101:e31393. [PMID: 36316835 PMCID: PMC9622572 DOI: 10.1097/md.0000000000031393] [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: 11/06/2022] Open
Abstract
BACKGROUND Thyroidectomy is performed under general anesthesia using inhaled anesthetics such as sevoflurane or desflurane in many cases. The objective of this study was to investigate whether the incidence of postoperative pain and discomfort after thyroidectomy differed with the type of inhaled anesthetic. METHODS Eighty-one female patients who underwent thyroidectomy were randomly assigned to the Sevo group (n = 42) or the Des group (n = 39). On the day of surgery and on the first, third, and seventh days after surgery, one registered nurse in charge of the entire questionnaire survey conducted the questionnaire assessment through face-to-face interviews or phone calls with the patients. The questionnaire evaluated the severity scores for seven items (sore throat, wound pain, nausea and vomiting, dizziness, occipital headache, posterior neck pain, and shoulder pain) regarding postoperative pain and discomfort experienced by patients and assessed which of these seven items caused the greatest discomfort to the patient on each day. RESULTS Except for the severity score for dizziness on the day of surgery, the severity scores of postoperative pain and discomfort experienced by patients on the day of surgery and on the first, third, and seventh days after surgery showed no statistically significant differences between the two groups. In addition, on the day of surgery and on the first, third, and seventh days after surgery, patients reported that sore throat caused the greatest discomfort. CONCLUSION In patients undergoing thyroidectomy under general anesthesia using sevoflurane or desflurane, except for dizziness on the day of surgery, no other manifestation of postoperative pain and discomfort was influenced by the type of inhaled anesthetic. Moreover, after thyroidectomy, postoperative sore throat caused the greatest discomfort to patients from the day of surgery to the seventh day after surgery.
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Affiliation(s)
- Jun-Mo Park
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
- *Correspondence: Jun-Mo Park, Department of Anesthesiology and Pain Medicine, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Bukgu, Daegu 41404, South Korea (e-mail: )
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19
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Jiang YY, Li ZP, Yao M, Zhou QH. Standard opioid-containing versus opioid-sparing anesthesia on early postoperative recovery after video-assisted thoracic surgery: A propensity-weighted analysis. Front Surg 2022; 9:1015467. [PMID: 36338614 PMCID: PMC9634401 DOI: 10.3389/fsurg.2022.1015467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Opioids have several adverse effects. At present, there are no large clinical studies on the effects of opioid-sparing anesthesia on early postoperative recovery after thoracoscopic surgery. This study was to investigate the effects of opioid-sparing anesthesia on early postoperative recovery after thoracoscopic surgery. METHODS Adult patients who underwent video-assisted thoracic surgery from 1 January 2019 to 28 February 2021 were enrolled by reviewing the electronic medical records. Participants were divided into opioid-sparing anesthesia (OSA group) and opioid-containing anesthesia (STD group) based on intraoperative opioid usage. The propensity-score analysis was to compare the early postoperative recovery of two groups. The outcome measurements included the incidence of postoperative nausea and vomiting (PONV) during an entire hospital stay, need for rescue antiemetic medication, postoperative-pain episodes within 48 h after surgery, need for rescue analgesia 48 h postoperatively, duration of postoperative hospital stay, length of PACU stay, postoperative fever, postoperative shivering, postoperative atrial fibrillation, postoperative pulmonary infection, postoperative hypoalbuminemia, postoperative hypoxemia, intraoperative blood loss, and intraoperative urine output. RESULTS A total of 1,975 patients were identified. No significant difference was observed in patient characteristics between the OSA and STD groups after adjusting for propensity score-based inverse probability treatment weighting. The incidence of postoperative nausea and vomiting was significantly lower in the OSA group than in the STD group (14.7% vs. 18.9%, p = 0.041). The rescue antiemetic use rate was lower in the OSA group than in the STD group (7.5% vs.12.2%; p = 0.002). PACU duration was longer in the OSA group than in the STD group (70.8 ± 29.0 min vs. 67.3 ± 22.7 min; p = 0.016). The incidence of postoperative fever was higher in the STD group than that in the OSA group (11.0% vs.7.7%; p = 0.032). There were no differences between the groups in terms of other outcomes. CONCLUSIONS Our results suggest that opioid-sparing anesthesia has a lower incidence of postoperative complications than opioid-based anesthetic techniques.
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Affiliation(s)
- Yan-yu Jiang
- Graduate School, Bengbu Medical College, Bengbu, China,Graduate School, Bengbu Medical College, Bengbu, China
| | - Zhen-ping Li
- Graduate School, Bengbu Medical College, Bengbu, China
| | - Ming Yao
- Graduate School, Bengbu Medical College, Bengbu, China
| | - Qing-he Zhou
- Graduate School, Bengbu Medical College, Bengbu, China,Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, China,Correspondence: Qing-he Zhou
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20
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Kintz P. Soumission chimique : stop aux contre-vérités. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2022.06.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Lee NK, Kim S, Kim JS, Yon CJ, Im BE, Chang CB. Reduction of postoperative nausea and vomiting risk in the second stage during bilateral total knee arthroplasty with a 1-week interval. Knee Surg Sports Traumatol Arthrosc 2022; 30:3114-3119. [PMID: 35124714 DOI: 10.1007/s00167-022-06902-x] [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: 11/09/2021] [Accepted: 01/16/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Total knee arthroplasty (TKA) is often performed sequentially on both sides during a single hospital stay. Patients who experience postoperative nausea and vomiting (PONV) after the first operation are concerned about PONV recurrence after the second operation. However, there are few studies regarding the incidence of PONV in staged bilateral TKA with a ≥ 1-week interval. This study aimed to identify the differences in (1) PONV incidence, (2) use of rescue antiemetics, and (3) the amount of opioid consumption between the first and second operations for staged bilateral TKA with a 1-week interval. Based on our anecdotal experience, the hypothesis of this study was that during staged bilateral TKA at a 1-week interval, the PONV incidence and rescue antiemetic requirement after the second operation will be lower than those after the first operation, regardless of opioid consumption. METHODS Fifty-eight consecutive patients who underwent staged bilateral TKA with a 1-week interval were retrospectively reviewed. All second-stage operations were performed with the same anaesthesia protocol and perioperative patient management protocol as the first-stage operation. PONV incidence was the primary outcome. The requirement for rescue antiemetic drugs and the amount of opioid consumption were secondary outcome variables. The outcome variables were recorded during three postoperative days (Days 0-2) for each stage and were compared between the first and second operations. RESULTS The incidence rates of nausea and vomiting on Day 0 (p = 0.001 and p = 0.004, respectively) and nausea on Day 1 (p = 0.008) were significantly lower after the second operation. Rescue antiemetic use on Day 0 was significantly lower after the second operation (p = 0.001). The total opioid consumption 72 h after surgery was significantly higher after the second operation (61.76 vs. 34.28 mg, p < 0.001). CONCLUSION During staged bilateral TKA with a 1-week interval, PONV incidence was lower after the second operation, even with increased opioid consumption. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Na-Kyoung Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnamsi, Gyeonggido, 13620, South Korea
| | - Sanghyo Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnamsi, Gyeonggido, 13620, South Korea
| | - Jong Seop Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnamsi, Gyeonggido, 13620, South Korea
| | - Chang-Jin Yon
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnamsi, Gyeonggido, 13620, South Korea
| | - Byeong-Eun Im
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnamsi, Gyeonggido, 13620, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnamsi, Gyeonggido, 13620, South Korea. .,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
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22
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Ma W, Qi Y, Liu C, Wang M, Zhang Y, Yao W. Effect of individualized treatment strategy on postoperative nausea and vomiting in gynaecological laparoscopic surgery: a double-blind, randomized, controlled trial. BMC Anesthesiol 2022; 22:266. [PMID: 35986239 PMCID: PMC9389684 DOI: 10.1186/s12871-022-01809-z] [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: 04/26/2022] [Accepted: 08/12/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) have always been a concern of clinicians and may increase medical costs for patients. Consensus guidelines recommend using multiple antiemetics with different mechanisms as prophylaxis in patients at high risk of PONV. Individualized risk scores for nausea and vomiting and individualized treatment strategies are feasible. This study evaluated the effect of individualized treatment strategies on postoperative nausea and vomiting after laparoscopic gynaecological operations. METHODS This was a double-blind, randomized, controlled trial. A total of 119 adult patients who underwent gynaecological laparoscopic surgery under general anaesthesia were randomly divided into an individualized treatment group or a control group, with the individualized treatment group receiving individualized prevention according to a preoperative risk score of nausea and vomiting and the control group receiving no individualized prevention. Vomiting, retching, nausea, and use of rescue medication were all recorded for 24 h after the operation. The primary outcome variable was complete response, defined as no emesis or the use of rescue medication 24 h postoperatively. RESULTS The complete response rate was higher in the individualized treatment group (56.7%) than in the control group (23.7%) (95% CI, 0.01-0.27; P < 0.001). The incidences of emesis (18.3% vs. 44.1%, P = 0.002) were significantly lower in the individualized treatment group than in the control group. There were no differences in any nausea (26.7% vs. 33.9%, P = 0.391) or rescue medication use (6.7% vs. 8.5%, P = 0.743). Adverse events and laboratory and electrocardiogram abnormalities occurred no more frequently in the individualized treatment group than in the control group. CONCLUSION In conclusion, this single-centre, double-blind, randomized study suggests that an individualized PONV prophylactic treatment strategy based on the number of PONV risk factors could be a safe and effective regimen to reduce the incidence of PONV in adult patients undergoing laparoscopic gynaecological surgery.
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Affiliation(s)
- Wenjing Ma
- grid.452929.10000 0004 8513 0241Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan Street, Wuhu, 241000 Anhui China
| | - Yupeng Qi
- grid.452929.10000 0004 8513 0241Department of Critical Care Medicine, First Affiliated Hospital of Wannan Medical College, No.2 Zheshan Street, Wuhu, 241000 Anhui China
| | - Can Liu
- grid.452929.10000 0004 8513 0241Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan Street, Wuhu, 241000 Anhui China
| | - Mingfang Wang
- grid.452929.10000 0004 8513 0241Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan Street, Wuhu, 241000 Anhui China
| | - Yun Zhang
- grid.452929.10000 0004 8513 0241Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan Street, Wuhu, 241000 Anhui China
| | - Weidong Yao
- grid.452929.10000 0004 8513 0241Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan Street, Wuhu, 241000 Anhui China
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Wang J, Zhang Z. Gastric Negative Pressure Suction Method Reduces the Incidence of PONV after Orthognathic Surgery. Front Surg 2022; 9:882726. [PMID: 35669253 PMCID: PMC9163440 DOI: 10.3389/fsurg.2022.882726] [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: 02/24/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate the effect of gastric negative pressure suction on the incidence of postoperative nausea and vomiting (PONV) in patients undergoing orthognathic surgery.MethodsA retrospective study of 772 patients who underwent orthognathic surgery from October 2016 to January 2021 was performed, excluding possible confounding factors. The patients were divided into a negative gastric suction group (group 1) and a group without gastric suction (group 2), according to whether gastric suction was used after general anaesthesia. There were 386 patients in each group. The incidence of PONV was compared between the two groups.ResultsThe incidence of PONV was 29% in the negative gastric suction group and 58.8% in the non-gastric suction group. The incidence of PONV in the gastric negative pressure suction group was significantly lower than that in the non-gastric negative pressure suction group, and the difference was statistically significant (p < 0.05).ConclusionBy reducing the risk of perioperative bleeding in orthognathic surgery, gastric negative pressure aspiration can reduce the incidence and operation time of PONV after orthognathic surgery.
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Affiliation(s)
- Jia Wang
- R.N., School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
- Correspondence: Jia Wang
| | - Zhenzhen Zhang
- Resident, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
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De Decker I, De Graeve L, Hoeksema H, Monstrey S, Verbelen J, De Coninck P, Vanlerberghe E, Claes KEY. Enzymatic debridement: past, present, and future. Acta Chir Belg 2022; 122:279-295. [PMID: 35440290 DOI: 10.1080/00015458.2022.2068746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Early surgical debridement of the deep second and third-degree burns is still the standard of care (SOC) to prepare the wound bed for skin grafting. However, this technique has some drawbacks that explain the growing interest in enzymatic debridement as an alternative. In this article, we provide a historic overview as well as the current state-of-the-art and future prospective of this type of non-surgical debridement. MATERIALS AND METHODS A narrative review of the available literature was conducted using a systematic search. RESULTS A total of 32 articles were included. The only enzyme mixture still used nowadays for burn eschar removal is bromelain-based. There is increasing evidence that this type of enzymatic debridement is a powerful tool to selectively remove the eschar in deep burns, thereby reducing the need for autologous skin grafting compared to surgical SOC. Moreover, off-label use of enzymatic debridement with NexoBrid® (facial, pediatric, and >15%TBSA burns) has proven to be effective and safe. CONCLUSION There is increasing evidence that bedside administered NexoBrid®, preferably under regional anesthesia, is a powerful tool for selective burn eschar removal. However, the clinical wound bed evaluation post-NexoBrid® procedure in relation to the optimal treatment decision-conservative treatment vs. surgery-is not yet completely elucidated. More high-quality prospective clinical trials are necessary to compare enzymatic debridement of objectively confirmed deep burns with the current standard treatment and assess the effectiveness of the eschar removal, the need for surgery, the healing time of such wounds, and the long-term scar quality.
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Affiliation(s)
| | - Liesl De Graeve
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Henk Hoeksema
- Burn Center, Ghent University Hospital, Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Stan Monstrey
- Burn Center, Ghent University Hospital, Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Karel E. Y. Claes
- Burn Center, Ghent University Hospital, Ghent, Belgium
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
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Oliveira De Jesus A, Lacerda de Toledo G, Marques de Oliveira Chiavaioli G, Henrique Nogueira Guimarães de Abreu M, Alves Mesquita R, Bruno Figueiredo Amaral M. Efficacy of gastric aspiration to reduce postoperative vomiting after orthognathic surgery: double-blind randomised clinical trial. Br J Oral Maxillofac Surg 2022; 60:493-498. [PMID: 35367091 DOI: 10.1016/j.bjoms.2021.09.003] [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: 04/03/2021] [Accepted: 09/05/2021] [Indexed: 11/28/2022]
Abstract
Orthognathic surgery is a treatment modality indicated to correct dentofacial deformities. Postoperative vomiting can be associated with multifactorial origin mainly correlated to patient-related symptoms, anaesthetic and surgical factors. Swallowed blood has been related to one of those multifactorial vomiting causes. This present study was to compare the efficacy of gastric aspiration after bimaxillary orthognathic surgery. A double blind randomised clinical trial was carried out and patients were divided in two groups (n = 44/39 respectively). There was statistically significant difference between the control and study groups in the overall incidence of vomiting (p = 0.031) A stratified analysis by sex between both groups was performed demonstrating a four-fold eduction in the odds for vomiting events independent of patient gender (OR = 0.24; 95% CI 0.07 to 0.72). Gastric aspiration after orthognathic surgery can reduce the effects of postoperative vomiting decreasing inpatient period and, consequently, hospitalisation costs.
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Affiliation(s)
- Alessandro Oliveira De Jesus
- Residency Program of the Oral and Maxillofacial Surgery Service - Hospital João XXIII/FHEMIG, Belo Horizonte, MG, Brazil; Department of Oral and Maxillofacial Surgery - Hospital da Baleia/CENTRARE, Belo Horizonte, MG, Brazil
| | | | | | | | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marcio Bruno Figueiredo Amaral
- Residency Program of the Oral and Maxillofacial Surgery Service - Hospital João XXIII/FHEMIG, Belo Horizonte, MG, Brazil; Department of Oral and Maxillofacial Surgery - Hospital da Baleia/CENTRARE, Belo Horizonte, MG, Brazil.
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Zhang W, Wang R, Li B, Zhao Y, Liu X, Yuan J. The Effect of Dexmedetomidine on Postoperative Nausea and Vomiting in Patients Undergoing Thoracic Surgery-A Meta-Analysis of a Randomized Controlled Trial. Front Surg 2022; 9:863249. [PMID: 35433815 PMCID: PMC9008250 DOI: 10.3389/fsurg.2022.863249] [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: 01/27/2022] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Dexmedetomidine reduces the occurrence of postoperative nausea and vomiting (PONV); however, the effect of dexmedetomidine on PONV in patients undergoing thoracic surgery remains inconclusive. In addition, the effect of different dexmedetomidine application methods, anesthetics, and surgical procedures on the effects of dexmedetomidine on PONV remains unclear. Therefore, the purpose of this meta-analysis was to study the effect of dexmedetomidine on PONV in patients undergoing thoracic surgery. Methods Electronic databases were searched to identify randomized controlled trials studying the effects of dexmedetomidine on nausea and vomiting after thoracic surgery. In total, 12 articles that met the inclusion criteria were obtained. The primary outcome of this comprehensive analysis was the incidence of PONV; secondary outcomes included the incidence of postoperative nausea, the incidence of postoperative vomiting, postoperative visual analog score (VAS), the amount of intraoperative sufentanil, and the number of times postoperative salvage analgesia was administered. Results Twelve trials involving 905 participants undergoing thoracic surgery were included. Compared with placebo, dexmedetomidine reduced the incidence of nausea and vomiting after thoracic surgery [12 trials; 905 participants; risk ratio (RR) = 0.32; 95% CI (0.23, 0.44); P < 0.00001, I2 = 0%]. The subgroup analysis revealed that dexmedetomidine reduces the occurrence of PONV in both thoracotomy and thoracoscopic surgery. In addition, both intravenous and local infusion of dexmedetomidine can reduce the occurrence of PONV, and intravenous or inhaled anesthetics do not affect the effect of dexmedetomidine on reducing PONV. Dexmedetomidine can reduce the postoperative resting VAS of patients, and no statistically significant differences in the amount of intraoperative sufentanil and the number of salvage analgesia procedures after surgery were noted. Conclusion Compared with placebo, dexmedetomidine can reduce the occurrence of PONV in patients undergoing thoracic surgery, and this effect is not affected by the method of dexmedetomidine administration, use of minimally invasive surgery, and use of a combination of intravenous or inhalation anesthetics. Systematic Review Registration https://www.crd.york.ac.uk/prospero/#myprospero, PROSPERO, identifier: CRD42021269358.
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Affiliation(s)
- Wei Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Ruohan Wang
- Department of Anesthesiology and Perioperative Medicine, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Bing Li
- Department of Anesthesiology and Perioperative Medicine, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Ying Zhao
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xinmin Liu
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jingli Yuan
- Department of Anesthesiology and Perioperative Medicine, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
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Gao W, Zhang L, Han X, Wei L, Fang J, Zhang X, Zhang J, Wang H, Zhou Q, Wang C, Chen W, Ni X, Yang L, Du R, Wang G, Liu B, Li Y, Zhang S, Wang Q. Transcutaneous Electrical Acupoint Stimulation Decreases the Incidence of Postoperative Nausea and Vomiting After Laparoscopic Non-gastrointestinal Surgery: A Multi-Center Randomized Controlled Trial. Front Med (Lausanne) 2022; 9:766244. [PMID: 35360742 PMCID: PMC8964119 DOI: 10.3389/fmed.2022.766244] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
Importance Postoperative nausea and vomiting (PONV) gives patients a bad experience and negates their good recovery from surgery. Objective This trial aims to assess the preventive effectiveness of transcutaneous electrical acupoint stimulation (TEAS) on the incidence of PONV in high-risk surgical patients. Design The large sample size, multicenter, evaluator-blinded, and randomized controlled study was conducted between September 3, 2019 to February 6, 2021. Setting The 12 hospitals were from different Chinese provinces. Participants After obtaining ethics approval and written informed consent, 1,655 patients with Apfel score ≥ 3 points were enrolled for selective laparoscopic non-gastrointestinal surgery under general anesthesia. Interventions Patients were randomly allocated into the TEAS and Sham group with a 1:1 ratio. The TEAS group was stimulated on bilateral Neiguan and Zusanli acupoints after recovery from anesthesia on the surgical day and the next morning for 30 min, while the Sham group received an identical setting as TEAS but without currents delivered. Electronic patient self-reported scale was used to evaluate and record the occurrence of PONV. Main Outcomes and Measures Primary clinical end point is the incidence of PONV which was defined as at least one incidence of nausea, retching, or vomiting after operation within postoperative 24 h. Results Compared with the Sham treatment, the TEAS lowered the PONV incidence by 4.8% (29.4 vs. 34.2%, P = 0.036) and vomiting incidence by 7.4% (10.4 vs. 17.8%, P < 0.001). TEAS also lowered persistent nausea incidence and PONV scores and decreased PONV related complications and Quality of Recovery−40 scores (P < 0.05). TEAS lowered the 24 h PONV risk by 20% (OR, 0.80, 95% CI, 0.65 −0.98; P = 0.032), and lowered hazard ratio by 17% (HR, 0.83, 95% CI, 0.70–0.99; P = 0.035). Both TEAS and palonosetron were the independent PONV risk protective factors for 24 h PONV incidence and cumulative PONV incidence. The combination of TEAS and palonosetron was the most effective strategy to reduce the PONV incidence (P < 0.001). Conclusions and Relevance TEAS attenuated the PONV incidence and severity in high-risk surgical patients and may be applied clinically as a complement therapy to prevent PONV. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT04043247, identifier: NCT04043247.
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Affiliation(s)
- Wei Gao
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Linzhong Zhang
- Department of Anesthesiology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xuechang Han
- Department of Anesthesiology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Lai Wei
- Department of Anesthesiology, Hunan Provincial People's Hospital, Changsha, China
| | - Jie Fang
- Department of Anesthesiology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Xiaqing Zhang
- Department of Anesthesiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Jiaqiang Zhang
- Department of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Haiyun Wang
- Department of Anesthesiology, The Third Central Hospital of Tianjin, Tianjin, China
| | - Qi Zhou
- Department of Anesthesiology, The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Chenggang Wang
- Department of Anesthesiology, Shanxi Traditional Chinese Medicine Hospital, Taiyuan, China
| | - Wenting Chen
- Department of Anesthesiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinli Ni
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Lan Yang
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruini Du
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ge Wang
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bingyu Liu
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yajuan Li
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shanshan Zhang
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiang Wang
- Department of Anesthesiology, Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Qiang Wang
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Honca M, Honca T, Babayigit M, Bulus H. The Impact of Acupuncture on Postoperative Nausea and Vomiting in Obese Adult Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial. J Laparoendosc Adv Surg Tech A 2021; 32:775-780. [PMID: 34918967 DOI: 10.1089/lap.2021.0406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: We wanted to research the effect of acupuncture on postoperative nausea and vomiting (PONV) in morbidly obese adult patients who were scheduled for laparoscopic sleeve gastrectomy. Design: This prospective randomized controlled study included 62 American Society of Anesthesiologists physical status I-III, 18- to 60-year-old morbidly obese patients undergoing laparoscopic sleeve gastrectomy. Patients were assigned using a closed envelope method to both groups equally. Group I consisted of acupuncture and metoclopramide; Group II consisted of metoclopramide. Setting: The study was carried out in Kecioren Educational Research Hospital, University of Health Sciences, Ankara, Turkey. Interventions: Acupuncture was performed by needling PC6, LI4 acupoints bilaterally and Yin Tang acupoint in Group I. Metoclopramide was administered as an antiemetic drug in both groups. Measurements: Demographic parameters, SAMBA PONV risk, first analgesic requirement time and PONV of the patients at the recovery 0-1, 1-6, 6-12, and 12-24 hours after operation were recorded. We used the simplified PONV impact scale to determine the intensity of nausea and its effects on the patient. Results: Nausea was observed in 37.5% of patients in Group I and 63.3% of patients in Group II at the recovery. Nausea intensity was not different between the groups at the postoperative 1-6 hours, but vomiting count was found higher in Group II at the postoperative 12-24 hours. Apfel score of the patients were similar between the groups. PONV impact scale was found higher in Group II. First analgesic requirement time was found shorter and demand for additional analgesic treatment was found significantly higher in Group II. Conclusions: Combining acupuncture with antiemetic treatment reduced nausea intensity and vomiting in the postoperative follow-up period. Also, patient's first analgesic demand time was found longer and the requirement for additional analgesic treatment was found lower in the acupuncture group.
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Affiliation(s)
- Mehtap Honca
- Department of Anesthesiology and Reanimation, Bozok University, Yozgat, Turkey
| | - Tevfik Honca
- Department of Biochemistry, Private Gurlife Hospital, Eskisehir, Turkey
| | - Münire Babayigit
- Department of Anesthesiology and Reanimation and Kecioren Training and Research Hospital, Ankara, Turkey
| | - Hakan Bulus
- Department of General Surgery, Kecioren Training and Research Hospital, Ankara, Turkey
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Wang LK, Cheng T, Yang XD, Xiong GL, Li N, Wang DX. Penehyclidine for prevention of postoperative nausea and vomiting following bimaxillary orthognathic surgery: a randomized, double-blind, controlled trial. J Anesth 2021; 36:122-136. [PMID: 34738161 PMCID: PMC8807454 DOI: 10.1007/s00540-021-03017-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/23/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate the efficacy and safety of low-dose bolus plus continuous infusion of penehyclidine in preventing postoperative nausea and vomiting (PONV) following bimaxillary surgery. METHODS Three hundred fifty-four patients were randomly allocated into three groups. In the Control group, placebo (normal saline) was injected before anesthesia and infused over 48 h after surgery; in the Bolus group, 0.5 mg penehyclidine was injected before anesthesia, whereas placebo was infused after surgery; in the Infusion group, 0.25 mg penehyclidine were injected before anesthesia, another 0.25 mg penehyclidine was infused after surgery. The primary endpoint was the incidence of PONV within 72 h. RESULTS A total of 353 patients were included in intention-to-treat analysis. The PONV incidence was 61.0% (72/118) in the Control group, 40.2% (47/117) in the Bolus group, and 28.0% (33/118) in the Infusion group. The incidence was significantly lower in the Bolus group than in the Control group (RR 0.66; 95% CI 0.51-0.86; adjusted P = 0.003) and in the Infusion group than in the Control group (RR 0.46; 95% CI 0.33-0.63; adjusted P < 0.001); the difference between the Infusion and Bolus groups was not statistically significant (RR 0.70; 95% CI 0.48-1.00; adjusted P = 0.144). Emergence agitation occurred more frequently in the Bolus group than in the Control group (36.8% [43/117] vs. 21.2% [25/118], adjusted P = 0.027), but did not differ significantly between the Infusion and Control groups. CONCLUSIONS A low-dose bolus plus continuous infusion of penehyclidine was effective in preventing PONV without increasing emergence agitation. TRIAL REGISTRATION Clinicaltrials.gov. Identifier: NCT04454866.
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Affiliation(s)
- Li-Kuan Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku street, Beijing, 100034, China.,Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Tong Cheng
- Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xu-Dong Yang
- Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Guo-Li Xiong
- Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Nan Li
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku street, Beijing, 100034, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku street, Beijing, 100034, China. .,Outcomes Research Consortium, Cleveland, OH, USA.
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Luo R, Tong X, Yan W, Liu H, Yang L, Zuo Y. Effects of erector spinae plane block on postoperative pain in children undergoing surgery: A systematic review and meta-analysis of randomized controlled trials. Paediatr Anaesth 2021; 31:1046-1055. [PMID: 34270146 DOI: 10.1111/pan.14255] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/13/2021] [Accepted: 06/25/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The erector spinae plane block is a novel regional anesthetic technique that is gaining popularity in pediatrics. However, the efficacy of erector spinae plane block in children is unclear. The aim of the systematic review and meta-analysis was to investigate effects of erector spinae plane block on postoperative pain relief in children. METHODS We searched MEDLINE, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wan fang databases for randomized controlled trials that compared erector spinae plane block with no block or other types of block in pediatric patients undergoing surgeries. The primary outcomes were pain intensity at rest within 24 h postoperatively and the number of patients requiring rescue analgesics. Data were analyzed using the fixed- or random-effects model, depending on whether the heterogeneity tested by the I2 statistic was >30%. We assessed the quality of evidence for the outcomes using the Grading of Recommendations, Assessment, Development, and Evaluation method. RESULTS Seven randomized controlled trials involving 379 patients were reviewed. Compared with no block, erector spinae plane block slightly reduced the pain scores at 0 h (standardized mean difference [SMD]: -1.07; 95% confidence interval [CI]: -1.60 to -0.54; I2 = 52%), 6 h (SMD: -0.82; 95% CI: -1.39 to -0.25; I2 = 79%) postoperatively at rest and significantly reduced the need for rescue analgesics (odds ratio 0.09; 95% CI: 0.04 to 0.21; I2 = 16%). One trial demonstrated the analgesic effect of erector spinae plane block was similar to a quadratus lumborum block, while another trial demonstrated the analgesic effect of ESPB was superior to an ilioinguinal nerve block. CONCLUSIONS This review provides low-quality evidence that erector spinae plane block exhibits superior analgesia compared to no block in children. Due to the limited data, evidence regarding the comparison with other regional blocks remains unclear. Future large-sized and well-designed randomized controlled trials are needed.
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Affiliation(s)
- Rong Luo
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Translational Neuroscience Center, Sichuan University, Chengdu, Sichuan, China
| | - Xin Tong
- Department of Anesthesiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital of Sichuan University, Sichuan University, Chengdu, China
| | - Weidong Yan
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardio-vascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haibei Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Translational Neuroscience Center, Sichuan University, Chengdu, Sichuan, China
| | - Lei Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Translational Neuroscience Center, Sichuan University, Chengdu, Sichuan, China
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Translational Neuroscience Center, Sichuan University, Chengdu, Sichuan, China
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Seok Y, Suh EE, Yu SY, Park J, Park H, Lee E. Effectiveness of Integrated Education to Reduce Postoperative Nausea, Vomiting, and Dizziness after Abdominal Surgery under General Anesthesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116124. [PMID: 34204087 PMCID: PMC8200998 DOI: 10.3390/ijerph18116124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
This study presents an anticipatory integrated education program for nausea, vomiting, and dizziness prevention (anti-NVD education program) for patients undergoing abdominal surgery under general anesthesia. The anti-NVD education program for nephrectomy patients consisted of the following: the causes of postoperative nausea, vomiting, and dizziness; effective deep breathing and how to use an inspirometer; postoperative nausea and vomiting; effective methods of patient-controlled analgesia; and the stepwise standing up method to prevent dizziness. A study was conducted among 79 adults (experimental group: n = 40, control group: n = 39). The degree of nausea and dizziness was measured using a numerical rating scale (NRS), and vomiting and the frequency of antiemetic use were measured in terms of the number of patients. The experimental group, which received the anti-NVD education, showed remarkably lower levels of nausea (p = 0.013) and dizziness (p < 0.001) than the control group. The frequency of antiemetic use 48 hours after surgery was significantly lower in the experimental group (p = 0.03). This study proved the efficacy of the anti-NVD education program for reducing postoperative nausea and dizziness. This program can be used as a noninvasive nursing intervention to prevent nausea, vomiting, and dizziness among patients undergoing abdominal surgery.
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Affiliation(s)
- Yoonhee Seok
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, College of Nursing, Seoul National University, Seoul 03080, Korea;
| | - Eunyoung E. Suh
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-740-8484
| | - Soo-Young Yu
- Department of Nursing, Chungbuk National University, Cheongju 28644, Korea;
| | - JeongYun Park
- Department of Clinical Nursing, Ulsan University, Seoul 05505, Korea;
| | - Hyunjin Park
- Department of Nursing, Asan Medical Center, Seoul 05505, Korea; (H.P.); (E.L.)
| | - Eunsil Lee
- Department of Nursing, Asan Medical Center, Seoul 05505, Korea; (H.P.); (E.L.)
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Wang X, Feng Y, Yang X, Li Z, Zhou D. Preoperative Ultrasound-Guided Trigeminal Nerve Block in Orthognathic Surgery: A Prospective Study About Its Efficacy of Intraoperative Anesthetic Dosage and Postoperative Analgesia. J Oral Maxillofac Surg 2021; 79:2042-2050. [PMID: 34023289 DOI: 10.1016/j.joms.2021.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Ultrasound-guided trigeminal nerve block is rarely used in orthognathic surgery, and its impact of postoperative analgesia and the auxiliary effect on hypotensive anesthesia have not been fully reported. The purpose of this study is to measure the efficacy of ultrasound-guided trigeminal nerve block on intraoperative anesthetic dosage and postoperative analgesia. PATIENTS AND METHODS In this single-blind, prospective, controlled trial, all patients were randomly assigned to 2 groups (n = 21/group): GEA group (general anesthesia) and TNB group (ultrasound-guided trigeminal nerve block [UGTNB] with general anesthesia). The primary variable was postoperative pain (visual analog scale scores, VAS scores) at postoperative 2, 4, 6, 12, and 24 hours. Satisfaction with postoperative pain management during postoperative 24 hours; the number of patients with moderate-to-severe pain (VAS score: >3) at postoperative 2, 4, 6, 12, 24 hours; and the consumption of opioids and nicardipine intraoperatively, etc. were secondary variables. Data were analyzed using the unpaired t, χ2, and Wilcoxon nonparametric tests. RESULTS In this study, 40 patients at the Peking University School and Hospital of Stomatology between January 2019 to March 2019 were included with a mean age of 24.13 ± 5.07 for statistical analysis and 37.5% were male. Compared to GEA group, the TNB group had a significantly lower VAS scores at postoperative 6 hours and 12 hours, which were 2[0,2] and 0[0,2], respectively. Furthermore, patients in TNB group were more satisfied with pain management at postoperative 24 hours than patients in GEA group (5[4,5] vs 4[3,5]; P = .03). Statistically less amount of opioids and nicardipine in TNB group were used intraoperatively (P < .01). CONCLUSION UGTNB use in orthognathic surgery may improve analgesia in the 24 hours after the operation, additionally, facilitate hypotensive anesthesia with fewer agents and fewer adverse effects postoperatively.
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Affiliation(s)
- Xiaodong Wang
- Attending, Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Yi Feng
- Professor, Department of Anesthesiology, Peking University People's Hospital, Beijing, China.
| | - Xudong Yang
- Associate Professor, Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
| | - Zili Li
- Professor, Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
| | - Dan Zhou
- Attending, Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
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Synthesis of arylamines and N-heterocycles by direct catalytic nitrogenation using N 2. Nat Commun 2021; 12:248. [PMID: 33431885 PMCID: PMC7801372 DOI: 10.1038/s41467-020-20270-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 11/17/2020] [Indexed: 11/08/2022] Open
Abstract
Ammonia and nitric acid are two key platform chemicals to introduce nitrogen atoms into organic molecules in chemical industry. Indeed, nitric acid is mostly produced through the oxidation of ammonia. The ideal nitrogenation would involve direct use of dinitrogen (N2) as a N source to construct N-containing organic molecules. Herein, we report an example of direct catalytic nitrogenation to afford valuable diarylamines, triarylamines, and N-heterocycles from easily available organohalides using dinitrogen (N2) as the nitrogen source in a one-pot/two-step protocol. With this method, 15N atoms are easily incorporated into organic molecules. Structurally diversified polyanilines are also generated in one pot, showing great potential for materials chemistry. In this protocol, lithium nitride, generated in situ with the use of lithium as a reductant, is confirmed as a key intermediate. This chemistry provides an alternative pathway for catalytic nitrogenation to synthesize highly valuable N-containing chemicals from dinitrogen.
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Bandarupalli S, Parripati L, Ramella M, Sandhya L. A comparison between intravenous ondansetron and granisetron in the preventive management of postoperative nausea and vomiting in patients undergoing cesarean section under spinal anesthesia. BALI JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.4103/bjoa.bjoa_233_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lee SU, Lee HJ, Kim YS. The effectiveness of ramosetron and ondansetron for preventing postoperative nausea and vomiting after arthroscopic rotator cuff repair: a randomized controlled trial. J Orthop Surg Res 2020; 15:523. [PMID: 33176845 PMCID: PMC7659046 DOI: 10.1186/s13018-020-02060-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Arthroscopic rotator cuff repair is a painful procedure, and treatment of emetic events associated with drugs used in the current multimodal pain management remains challenging. This study aimed to evaluate the effectiveness of ramosetron or ondansetron to relieve postoperative nausea and vomiting (PONV) and pain after arthroscopic rotator cuff repair. Methods In total, 122 consecutive patients undergoing arthroscopic rotator cuff repair were randomly allocated into three groups: ramosetron group (n = 39), ondansetron group (n = 43), and control group (n = 40). Then, 0.3 mg of ramosetron or 8 mg of ondansetron was administered intravenously at the end of surgery according to group. All patients received general anesthesia and multimodal pain management protocol including preemptive analgesic medication, fentanyl-based intravenous patient-controlled analgesia, and postoperative analgesic medication. Incidence of emetic events, rescue antiemetic requirements (10 mg of metoclopramide, IV), complete response, pain level, and side effects were recorded in three periods: 0–6, 6–24, and 24–48 h postoperatively. The severity of nausea and pain was evaluated using a visual analog scale. Results The ramosetron group tended to have a lower incidence and severity of nausea during the 6- to 24-h postoperative period and fewer rescue antiemetic drug requirements during the 0- to 48-h period than the control group, showing statistical significance. Additionally, the frequency of complete response of the ramosetron and ondansetron groups was significantly higher than that of the control group. No difference was found among the groups in the pain level except during the 0- to 6-h period. The two groups have a higher complete response during the 6- to 24-h period than the control group. Conclusions Ramosetron use led to a lower incidence, mild severity of nausea, and reduced use of rescue antiemetic drug after arthroscopic rotator cuff repair during the 6- to 24-h postoperative period than the control. Level of evidence Level I, randomized controlled trials, treatment study
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Affiliation(s)
- Sang-Uk Lee
- Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Hyo-Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
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Uribe AA, Bergese SD. What is the ideal combination antiemetic regimen? Best Pract Res Clin Anaesthesiol 2020; 34:701-712. [PMID: 33288120 DOI: 10.1016/j.bpa.2020.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/16/2020] [Accepted: 10/29/2020] [Indexed: 01/29/2023]
Abstract
Postoperative nausea and vomiting (PONV) and post-discharge nausea and vomiting (PDNV) are frequent unpleasant complaints that patients and clinicians report after surgery. PONV and PDNV have been associated with postoperative complications and hospital discharge delays. Despite the extensive evidence describing the use of several regimens in different surgical populations, the ideal regimen has not been established. Several antiemetic drugs have been evaluated in more than 1000 clinical controlled trials for management of this complex emetogenic pathway, including the 5-hydroxytryptamine (5-HT3) receptor antagonists, dopamine receptor antagonists, neurokinin-type receptor antagonists, antihistaminics, anticholinergics, and corticosteroids, with the 5-HT3 receptor antagonists being the most commonly used for PONV prophylaxis. Because of the complex emetogenic pathway and multifactorial etiology of PONV, a multimodal approach using two or more drugs that act at different neuro-receptor sites is suggested in patients with one or more risk factors to successfully address PONV and reduce its incidence. Nevertheless, the most studied regimens in randomized clinical trials (RCTs) are the combination of serotonin 5-HT3 receptor antagonists with dexamethasone or dopamine receptor antagonists (droperidol). Therefore, the safest and more effective combination regimen appears to be the use of serotonin 5-HT3 receptor antagonist antiemetic drugs with dexamethasone.
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Affiliation(s)
- Alberto A Uribe
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Sergio D Bergese
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
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Ahmadzadeh Amiri A, Karvandian K, Ashouri M, Rahimi M, Ahmadzadeh Amiri A. [Comparison of post-operative nausea and vomiting with intravenous versus inhalational anesthesia in laparotomic abdominal surgery: a randomized clinical trial]. Rev Bras Anestesiol 2020; 70:471-476. [PMID: 33032806 DOI: 10.1016/j.bjan.2020.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/23/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Postoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients' characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV. METHODS A single-blinded prospective randomized clinical trial on 105 patients aged 18-65 years was carried out. Patients were divided in two groups of Total Intravenous Anesthesia (TIVA) and Inhalational anesthesia. The incidence and severity of PONV were examined at 0, 2, 6, 12, and 24hours after the surgery. The use of a rescue antiemetic was also evaluated. RESULTS Fifty point nine percent of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p <0.001). The incidence of vomiting was reported in 11.3% of the Inhalational group and 3.8% of the TIVA group (p=0.15), and 24.5% of patients in the Inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p=0.043). CONCLUSION The incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug, and the severity of nausea in patients were significantly lower in the TIVA group.
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Affiliation(s)
| | - Kasra Karvandian
- Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Department of Anesthesiology, Tehran, Irã.
| | - Mohammad Ashouri
- Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Department of General Surgery, Tehran, Irã
| | - Mojgan Rahimi
- Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Department of Anesthesiology, Tehran, Irã
| | - Ali Ahmadzadeh Amiri
- Tehran University of Medical Sciences, Imam Khomini Hospital Complex, Tehran, Irã
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Sun Y, Lin D, Wang J, Geng M, Xue M, Lang Y, Cui L, Hao Y, Mu S, Wu D, Liang L, Wu A. Effect of Tropisetron on Prevention of Emergence Delirium in Patients After Noncardiac Surgery: A Trial Protocol. JAMA Netw Open 2020; 3:e2013443. [PMID: 33052400 PMCID: PMC7557499 DOI: 10.1001/jamanetworkopen.2020.13443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Postoperative delirium is a frequent disorder for patients undergoing surgery and is associated with poor outcomes. Delirium may occur in the immediate period after anesthesia administration and surgery. Tropisetron, which is frequently administrated for postoperative nausea and vomiting, is also a partial agonist of α7 nicotinic acetylcholine receptors associated with neuroprotective effects. Tropisetron may be the potential pharmacological treatment to decrease delirium after noncardiac surgery. OBJECTIVE To perform a randomized clinical trial to determine the efficacy and safety of tropisetron for prevention of emergence delirium in patients undergoing noncardiac surgery. DESIGN, SETTING, AND PARTICIPANTS This single-center, 2-arm randomized, double-blind, placebo-controlled trial will include 1508 patients undergoing noncardiac surgery. The intervention group will receive 5 mg of intravenous tropisetron before anesthesia induction, and patients in the control group will receive a placebo. The primary end point is the incidence of emergence delirium within 1 hour after tracheal tube removal, measured by the Confusion Assessment Method for the Intensive Care Unit score. The main secondary outcome is the incidence of postoperative delirium measured at 3 days of follow-up. An intention-to-treat principle will be used for all analyses. DISCUSSION Delirium remains the most common neuropsychiatric complication for patients after surgery. This will be the first randomized clinical study to evaluate whether tropisetron is effective in preventing emergence delirium. Results from this study will provide evidence for alteration of daily practice. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04027751.
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Affiliation(s)
- Yi Sun
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Dandan Lin
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Mengwen Geng
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Mei Xue
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yayun Lang
- Department of Anesthesiology, Beijing Civil Aviation General Hospital, Beijing, China
| | - Lina Cui
- Department of Anesthesiology, Beijing Huairou District Hospital of Traditional Chinese Medicine, Beijing, China
| | - Yanan Hao
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shanshan Mu
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Dan Wu
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lirong Liang
- Department of Clinical Epidemiology and Tobacco Dependence Treatment Research, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
| | - Anshi Wu
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Jiménez-Tornero J, Cortés-Flores AO, Chávez-Tostado M, Morgan-Villela G, Zuloaga-Fernández Del Valle C, Zuloaga-Fernández Del Valle R, García-González LA, Fernández-Avalos VS, Miranda-Ackerman RC, Alvarez-Villaseñor AS, Ambriz-González G, Barbosa-Camacho FJ, Fuentes-Orozco C, Contreras-Cordero VS, González-Ojeda A. Effect of a preoperative single-dose steroid on pulmonary function and postoperative symptoms after modified radical mastectomy: results of a randomized clinical trial. Gland Surg 2020; 9:1313-1327. [PMID: 33224806 DOI: 10.21037/gs-20-366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Evidence suggests that a preoperative single-dose steroid improves lung function and decreases the incidence of postoperative symptoms; however, this has not been sufficiently proved in modified radical mastectomy for cancer. This study aimed to evaluate the efficacy of preoperative single-dose steroid administration for postoperative lung function and postoperative symptoms in women undergoing modified radical mastectomy for breast cancer. Methods In this controlled clinical trial, conducted between June 2014 and October 2018, we examined 81 patients. Patients received a preoperative single dose of 8 mg dexamethasone (n=41; treatment group) or placebo (sterile injectable water; n=40; control group). We obtained data on postoperative nausea and vomiting and pain intensity and performed spirometry 1 h before and 1, 6, 12, and 24 h after surgery. The use of additional analgesic or antiemetic drugs was recorded. We followed up patients 30 days after discharge and recorded any surgical or medical complications. Results The age distribution and anthropometric variables of the two groups were similar. Almost 50% of the patients in each group also underwent breast reconstruction. In the treatment group, pain intensity was always lower, the incidence of postoperative nausea and vomiting was lower at 6, 12, and 24 h, and additional analgesics or antiemetics were required less frequently (P<0.05 for all). Both treatment and control groups demonstrated a restrictive ventilatory pattern immediately after surgery, which in the treatment group was reversed after 24 h. However, the reconstructed patients had a more intense and prolonged restrictive pattern (P<0.05). Surgical morbidity included one seroma observed in the control group. No infections occurred at the surgical site or at any other level, and no patient developed any metabolic disorder. No mortality was observed in either group. Conclusions This study establishes that a single preoperative dose of dexamethasone markedly decreased the incidence of postoperative nausea and vomiting and pain, improved respiratory parameters, and decreased the need for additional postoperative analgesic or antiemetic drugs. Clinical Trial Registration ClinicalTrials.gov (ID NCT02305173).
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Affiliation(s)
| | - Ana Olivia Cortés-Flores
- San Javier Hospital, Guadalajara, Jalisco, Mexico.,ANKER Global Oncology, Guadalajara, Jalisco, Mexico
| | - Mariana Chávez-Tostado
- Department of Human Reproduction, Health Sciences University Center, Universidad de Guadalajara, Jalisco, México
| | | | | | | | | | | | | | | | - Gabriela Ambriz-González
- Surgical Division, Pediatric Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Francisco José Barbosa-Camacho
- Biomedical Research Unit 02, Specialties Hospital of the Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Clotilde Fuentes-Orozco
- Biomedical Research Unit 02, Specialties Hospital of the Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Vianca Seleste Contreras-Cordero
- Biomedical Research Unit 02, Specialties Hospital of the Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Alejandro González-Ojeda
- Biomedical Research Unit 02, Specialties Hospital of the Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
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Tilahun Bantie A, Admasu W, Mulugeta S, Bacha AR, Getnet Demsie D. Effectiveness of Propofol versus Dexamethasone for Prevention of Postoperative Nausea and Vomiting in Ear, Nose, and Throat Surgery in Tikur Anbessa Specialized Hospital and Yekatit 12th Hospital, Addis Ababa, Ethiopia. Anesthesiol Res Pract 2020; 2020:4258137. [PMID: 32963522 PMCID: PMC7492878 DOI: 10.1155/2020/4258137] [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: 04/30/2020] [Revised: 08/07/2020] [Accepted: 08/21/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) remain as common and unpleasant and highly distressful experience following ear, nose, and throat surgery. During ENT surgery, the incidence of PONV could be significantly reduced in patients who receive dexamethasone and propofol as prophylaxis. However, the comparative effectiveness of the two drugs has not been assessed. The aim of this study was to compare the effectiveness of propofol and dexamethasone for prevention of PONV in ear, nose, and throat surgery. METHODS This study was conducted in 80 patients, with ASA I and II, aged 18-65 years, and scheduled for ENT surgery between December 20, 2017, and March 20, 2018. Patients were randomly assigned to Group A and Group B. Immediately after the procedure, Group A patients received single dose of intravenous (IV) dexamethasone (10 mg/kg) and Group B patients were given propofol (0.5 mg/kg, IV), and equal follow-up was employed. The incidence of PONV was noted at 6th, 12th, and 24th hour of drug administration. Independent t-test and Mann-Whitney test were used for comparison of symmetric numerical and asymmetric data between groups, respectively. Categorical data were analyzed with the chi-square test, and p value of < 0.05 was considered as level of significance. RESULTS The incidences of PONV throughout the 24-hour postoperative period were 35% in the propofol group and 25% in the dexamethasone group. Statistical significance was found in incidence of PONV (0% versus 22.5%) and use of antiemetic (0% versus 5%) between dexamethasone and propofol groups, respectively, at 12-24 hours. Over 24 hours, 5% in dexamethasone group and 12.5% in propofol group developed moderate PONV, while none of the participants felt severe PONV. CONCLUSIONS Dexamethasone was more effective than propofol to prevent PONV with lower requirements of rescue antiemetics.
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Affiliation(s)
- Abere Tilahun Bantie
- Department of Anesthesiology, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Wosenyeleh Admasu
- School of Anesthesiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sintayehu Mulugeta
- Department of Anesthesiology, College of Health Sciences, Mekelle University, Mek'ele, Ethiopia
| | - Abera Regassa Bacha
- Department of Anesthesiology, College of Medicine and Health Sciences, Axum University, Axum, Ethiopia
| | - Desalegn Getnet Demsie
- Department of Pharmacy, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
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Amiri AA, Karvandian K, Ashouri M, Rahimi M, Amiri AA. Comparison of post-operative nausea and vomiting with intravenous versus inhalational anesthesia in laparotomic abdominal surgery: a randomized clinical trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 33032806 PMCID: PMC9373333 DOI: 10.1016/j.bjane.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Postoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients' characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV. Methods A single-blinded prospective randomized clinical trial on 105 patients aged 18 − 65 years was carried out. Patients were divided into two groups of Total Intravenous Anesthesia (TIVA) and inhalational anesthesia. The incidence and the severity of PONV were examined at 0, 2, 6, 12 and 24 hours after the surgery. The use of a rescue antiemetic was also evaluated. Results 50.9% of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p < 0.001). The incidence of vomiting was reported in 11.3% of the inhalational group and 3.8% of the TIVA group (p = 0.15). 24.5% of patients in the inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p = 0.043). Conclusion The incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug and the severity of nausea in patients were significantly lower in the TIVA group.
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Cai Q, Liu GQ, Huang LS, Yang ZX, Gao ML, Jing R, Liu Z, Pan LH. Effects of erector spinae plane block on postoperative pain and side-effects in adult patients underwent surgery: A systematic review and meta-analysis of randomized controlled trials. Int J Surg 2020; 80:107-116. [DOI: 10.1016/j.ijsu.2020.05.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 01/12/2023]
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Stoops S, Kovac A. New insights into the pathophysiology and risk factors for PONV. Best Pract Res Clin Anaesthesiol 2020; 34:667-679. [PMID: 33288117 DOI: 10.1016/j.bpa.2020.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
Postoperative nausea and vomiting (PONV) affects patient outcomes and satisfaction. New research has centered on evaluation of post-discharge and opioid-related nausea and vomiting. Mechanical and drug effects stimulate the release of central nervous system neurotransmitters acting at receptors in the vomiting center, area postrema, and nucleus of the solitary tract. Brain surgery has allowed insight into specific central emetogenic areas. Stimuli from peripheral organs act through afferent vagus neurons and a parasympathetic response causing nausea and vomiting. Opioids stimulate mu receptors in the chemoreceptor trigger zone and cholinergic receptors in the vestibular system. Opioids also affect gastrointestinal (GI) tract mechanics by decreasing gastric emptying, intestinal motility, GI peristalsis, and secretions. Regional blocks and non-opioid multimodal analgesia help to decrease nausea and vomiting. Patient, surgery, and anesthesia factors contribute to risk and degree of PONV experienced. Pharmacogenetics plays a role in gene typing as antiemetic medication metabolism results in varying drug effectiveness. Risk scoring systems are available. Individualized multimodal plans can be designed as part of an enhanced recovery after surgery protocol.
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Affiliation(s)
- Shea Stoops
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 1034, Kansas City, KS 66160, USA.
| | - Anthony Kovac
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 1034, Kansas City, KS 66160, USA.
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Kim DH, Yun HJ, Park S, Leem JG, Karm MH, Choi SS. Comparison between total intravenous anesthesia and balanced anesthesia on postoperative opioid consumption in patients who underwent laparoscopic-assisted distal gastrectomy. Medicine (Baltimore) 2020; 99:e20224. [PMID: 32384519 PMCID: PMC7220423 DOI: 10.1097/md.0000000000020224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Remifentanil is the most frequently prescribed opioid for total intravenous anesthesia (TIVA) or balanced anesthesia (BA), due to its favorable pharmacological properties. However, several studies have reported opioid-induced hyperalgesia and/or acute tolerance after intraoperatively using remifentanil. In addition, it is imperative to control postoperative pain with lower doses of opioid anesthetic agents. Therefore, we compared the amount of opioid consumption between TIVA with propofol-remifentanil and BA with desflurane-remifentanil, to control postoperative pain in patients who underwent laparoscopic-assisted distal gastrectomy (LADG) with gastroduodenostomy.We retrospectively evaluated demographic variables (age, gender, height, weight, and smoking habits), the duration of general anesthesia (GA), and intraoperatively administered remifentanil consumption through the electronic medical records of patients who underwent LADG with gastroduodenostomy due to early stomach cancer. The primary outcome was postoperative opioid consumption during postoperative day (POD) 2. The secondary outcomes were the incidence of any rescue opioid analgesics administered, numeric rating scale, and various adverse effects during POD 2. We categorized the data in 2 patient groups to compare TIVA with propofol-remifentanil (TIVA group) to BA with desflurane-remifentanil (BA group) on the postoperative opioid analgesic consumption.We divided 114 patients into the TIVA (46 patients) and BA (68 patients) groups. Opioid consumption as a primary outcome was significantly higher in the BA group than in the TIVA group during POD 2 except in the post-anesthesia care unit. The cumulative opioid consumption was significantly higher in the BA than in the TIVA group. The incidence of rescue analgesic at POD 2 was higher in the BA than in the TIVA group. In the TIVA group, remifentanil consumption was higher, and the duration of GA was shorter than that in the BA group. No statistically significant differences were observed when comparing other variables.Our results indicated that the maintenance of GA with TIVA (propofol-remifentanil) reduces opioid consumption for postoperative pain control compared to BA (desflurane-remifentanil) in patients undergoing LADG with gastroduodenostomy.
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Affiliation(s)
- Doo-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Hye Joo Yun
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Sooin Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Jeong-Gil Leem
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
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Ghosh S, Rai KK, Shivakumar HR, Upasi AP, Naik VG, Bharat A. Incidence and risk factors for postoperative nausea and vomiting in orthognathic surgery: a 10-year retrospective study. J Korean Assoc Oral Maxillofac Surg 2020; 46:116-124. [PMID: 32364351 PMCID: PMC7222617 DOI: 10.5125/jkaoms.2020.46.2.116] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives Postoperative nausea and vomiting (PONV) is considered as one of the most incessant and anguishing factors for patients who have surgery under general anesthesia. The occurrence of PONV after orthognathic surgery can lead to dehydration, infection, bleeding at the surgical site, and patient discomfort, all of which leave a patient with a negative impression of anesthesia and surgery. The purpose of this study is to assess the incidence of PONV after orthognathic surgery and to correlate it with factors related to patient, anesthesia, and surgery. Materials and Methods A 10-year retrospective survey was done for patients who underwent orthognathic surgery between January 2008 and March 2018. The incidence of PONV was evaluated, correlations with factors related to patient, anesthesia, and surgery were studied, and the duration between the end of surgery and the occurrence of the first episode of PONV was tabulated. Results The medical records of 109 patients were screened, out of which 101 satisfied the inclusion criteria. Amongst these patients, 60 patients (59.4%) suffered from PONV. Patient’s sex, induction agent used, intravenous fluids administered intraoperatively, duration and type of surgery, and the presence of a nasogastric tube were seen to have a significant influence on precipitating PONV. It was noted that among the patients who suffered from PONV, 61.7% of them experienced it 48-96 hours after the end of surgery. Conclusion Despite the improved anesthetic equipments, drugs, and surgical techniques currently used, the incidence of PONV was high in our study. Certain factors that were seen to influence PONV in this study need to be considered in order to develop an efficacious protocol to reduce PONV in orthognathic surgeries.
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Affiliation(s)
- Subhabrata Ghosh
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, India
| | - Kirthi Kumar Rai
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, India
| | | | - Amarnath P Upasi
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, India
| | - Vinayak Gourish Naik
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, India
| | - Avijit Bharat
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, India
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Effects of menstrual cycle on nausea and vomiting after general anesthesia. J Anesth 2020; 34:519-526. [PMID: 32342186 DOI: 10.1007/s00540-020-02781-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the impact of menstrual cycle on patients undergoing gynecological endoscopic surgery. PATIENTS AND METHODS 220 patients scheduled for gynecological endoscopic surgery under general anesthesia were selected. The patients were divided into three groups based on 3 phases of menstrual cycle which are the follicular phase (Group F), ovulatory phase (Group O) or luteal phase (Group L). It is based on their duration of menstruation and the last day of menstrual bleeding from the date of surgery. Primary outcomes were the incidences of early and late postoperative nausea and vomiting (PONV) in the three patient groups. Preoperative venous blood was taken to determine the estrogen and progesterone levels of the patients. RESULTS A total of 207 patients were enrolled. The incidence of early PONV was highest in group O (22.22% vs 43.33% vs 17.86%, P < 0.01). Multivariate logistic regression showed that menstrual cycle (P < 0.01) and sufentanil dosage (P < 0.05) were independent risk factors for early PONV, menstrual cycle (P = 0.03) and intraoperative hypotension (P = 0.03) were independent risk factors for late PONV. After the propensity matching, the incidences of early and late PONV in group O were both higher than that in other two groups (19.23% vs 44.68% vs 16.90%, P < 0.01; 53.80% vs 72.34% vs 45.07%, P = 0.01). CONCLUSION The incidence of PONV after gynecological endoscopic surgery was different in patients with different menstrual cycles, with the highest incidence in ovulation.
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Abstract
Background
Suboptimal tissue perfusion and oxygenation during surgery may be responsible for postoperative nausea and vomiting in some patients. This trial tested the hypothesis that muscular tissue oxygen saturation–guided intraoperative care reduces postoperative nausea and vomiting.
Methods
This multicenter, pragmatic, patient- and assessor-blinded randomized controlled (1:1 ratio) trial was conducted from September 2018 to June 2019 at six teaching hospitals in four different cities in China. Nonsmoking women, 18 to 65 yr old, and having elective laparoscopic surgery involving hysterectomy (n = 800) were randomly assigned to receive either intraoperative muscular tissue oxygen saturation–guided care or usual care. The goal was to maintain muscular tissue oxygen saturation, measured at flank and on forearm, greater than baseline or 70%, whichever was higher. The primary outcome was 24-h postoperative nausea and vomiting. Secondary outcomes included nausea severity, quality of recovery, and 30-day morbidity and mortality.
Results
Of the 800 randomized patients (median age, 50 yr [range, 27 to 65]), 799 were assessed for the primary outcome. The below-goal muscular tissue oxygen saturation area under the curve was significantly smaller in patients receiving muscular tissue oxygen saturation–guided care (n = 400) than in those receiving usual care (n = 399; flank, 50 vs. 140% · min, P < 0.001; forearm, 53 vs. 245% · min, P < 0.001). The incidences of 24-h postoperative nausea and vomiting were 32% (127 of 400) in the muscular tissue oxygen saturation–guided care group and 36% (142 of 399) in the usual care group, which were not significantly different (risk ratio, 0.89; 95% CI, 0.73 to 1.08; P = 0.251). There were no significant between-group differences for secondary outcomes. No harm was observed throughout the study.
Conclusions
In a relatively young and healthy female patient population, personalized, goal-directed, muscular tissue oxygen saturation–guided intraoperative care is effective in treating decreased muscular tissue oxygen saturation but does not reduce the incidence of 24-h posthysterectomy nausea and vomiting.
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
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Ultrasound assessment of gastric content in fasted patients before elective laparoscopic cholecystectomy: a prospective observational single-cohort study. Can J Anaesth 2020; 67:810-816. [DOI: 10.1007/s12630-020-01668-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/12/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022] Open
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Fox G, Kranke P. A pharmacological profile of intravenous amisulpride for the treatment of postoperative nausea and vomiting. Expert Rev Clin Pharmacol 2020; 13:331-340. [PMID: 32245336 DOI: 10.1080/17512433.2020.1750366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The issue of postoperative nausea and vomiting (PONV) remains important in surgical practice, contributing to patient distress, slower recovery, and increased use of healthcare resources. Many surgical patients report it to be a worse problem than the pain. New antiemetics of different classes are still needed to help manage PONV effectively, especially the treatment of established PONV after the failure of common prophylactic antiemetics such as 5-HT3-antagonists and corticosteroids. Intravenous amisulpride, a drug with a long history of safe use in oral form as an antipsychotic, has recently been approved in the US (trade name: Barhemsys) as an intravenous antiemetic for the prevention and treatment of PONV. AREAS COVERED This review article summarizes the published data on the clinical pharmacology, safety, and efficacy of intravenous amisulpride as an antiemetic, supplemented by published data on oral amisulpride, where relevant to the intravenous form. Literature was obtained via the PubMed search terms 'intravenous amisulpride' and 'amisulpride AND safety.' Both primary and secondary pharmacology are covered, along with clinical pharmacokinetics (distribution, metabolism, and excretion). The review of clinical safety and efficacy includes data from four studies in the prevention of PONV, two in the treatment of PONV and two investigating effects on the QT interval of the electrocardiogram in healthy volunteers. EXPERT OPINION Given the importance of sufficient PONV prevention for patients and the healthcare system, the availability of intravenous amisulpride is helpful, restoring the dopamine-antagonist class as a potential mainstay in both combination prophylaxis and treatment.
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Affiliation(s)
- Gabriel Fox
- The Officers' Mess, Acacia Pharma Ltd , Cambridge, UK
| | - Peter Kranke
- Department of Anaesthesia and Critical Care, University Hospitals of Würzburg , Würzburg, Germany
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Salman N, Aykut A, Sabuncu Ü, Şaylan A, Yağar S, Şekerci S. Dextrose administration may reduce the incidence of postoperative nausea and vomiting after laparoscopic cholecystectomy: a double blind randomized controlled trial. Minerva Anestesiol 2020; 86:379-386. [DOI: 10.23736/s0375-9393.20.13484-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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