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Luo J, Xie C, Fan D. Historical Development and Experience of Day Surgery in China: From the Perspective of Anesthesiologists. Paediatr Anaesth 2025; 35:412-423. [PMID: 39921339 PMCID: PMC12060084 DOI: 10.1111/pan.15078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Revised: 01/01/2025] [Accepted: 01/27/2025] [Indexed: 02/10/2025]
Abstract
BACKGROUND Day surgery has become the main mode of surgery in American and European countries, but it is still in the early stage in developing countries due to the limitation of medical technology and the backward management concept. At present, day surgery accounts for more than 60% of elective surgery in many countries in Europe and North America and more than 85% in countries such as the United Kingdom and the United States. There are 8469 ambulatory surgery centers in the United States in 2023. In China, the first ambulatory surgery center was established in 2001. In 2018, more than half of the tertiary hospitals (high-level hospitals) in China carried out day surgery, of which 639 hospitals set up ambulatory surgery centers; the proportion of day surgery in elective surgery increased to 12.8%. The annual number of day surgeries exceeded 1.25 million. In 2022, our hospital established an ambulatory surgery center managed by anesthesiologists. Day surgery requires anesthesiologists to participate in the whole process of patient management from preoperative preparation to postoperative recovery. The establishment of ambulatory surgery centers managed by anesthesiologists is of great significance to China, developing countries, and the whole world. OBJECTIVES So this study aimed to review the development of day surgery in China, combine Chinese government policy evolution, summarize the management model of Chinese ambulatory surgery centers, guide the establishment of ambulatory surgery centers in low- and middle-income countries, and highlight and analyze the advantages of anesthesiologist-managed ambulatory surgery centers as distinct from other physician-managed ones. DISCUSSION We call on anesthesiologists, other physicians, surgeons, nurses, and health system managers around the world to promote efficient, low-cost day surgery in developing countries and thereby increase access to surgical treatment for the world's poor.
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Affiliation(s)
- Jiangrong Luo
- Department of Anesthesiology, Ambulatory Surgery Center, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Chunbao Xie
- Department of Laboratory Medicine and Sichuan Provincial key Laboratory for Uman Disease Gene Study, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Dan Fan
- Department of Anesthesiology, Ambulatory Surgery Center, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
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Shanthanna H, Khaled MATM, Diaz A, Farsinejad P, Clements S. Low-dose remifentanil as an adjunct analgesic is not associated with clinically important opioid-induced hyperalgesia: secondary analysis from a randomized controlled trial. Reg Anesth Pain Med 2025:rapm-2025-106483. [PMID: 40274406 DOI: 10.1136/rapm-2025-106483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Accepted: 04/11/2025] [Indexed: 04/26/2025]
Abstract
BACKGROUND Remifentanil, as the primary opioid or in high doses, is associated with opioid-induced hyperalgesia. We assessed outcomes of pain and opioid use with low-dose remifentanil as an adjunct analgesic after same-day surgeries. METHODS This prospective cohort study was nested within a randomized controlled trial showing no difference in achieving satisfactory analgesia in the postanesthetic care unit with morphine or hydromorphone. Primary outcomes were pain scores in the postanesthetic care unit and 24 hours after surgery between patients who received remifentanil (R group) or those who received non-remifentanil opioid regimens (C group). We also evaluated pain scores in the day surgical unit, dose of long-acting opioids, and need for non-steroidal anti-inflammatory drugs. The association of remifentanil dose with outcomes was explored using linear regression. RESULTS Patients in both groups (R=276, C=126) had comparable baseline characteristics. There were no differences in maximum postanesthetic care unit pain scores or average pain scores 24 hours after surgery: mean difference 0.3 (95% CI -0.9 to 0.2) and 0.4 (95% CI -1.7 to 0.9), respectively. In the R group, the dose of long-acting opioids in postanesthetic care unit was higher: mean difference 0.97 mg (95% CI 0.2 to 1.7) intravenous morphine equivalents, p=0.01. Adjusted analyses indicated that higher doses of remifentanil (25 mcg increments) were associated with higher maximum pain scores in day surgical unit: 0.23 units (95% CI 0.05 to 0.41), p=0.01; higher average pain scores 24 hours after surgery: 0.25 units (95% CI 0.036 to 0.46), p=0.02; and higher long-acting opioid doses in postanesthetic care unit: 0.14 mg intravenous morphine equivalents (95% CI 0.02 to 0.25), p=0.02. CONCLUSION Opioid-induced hyperalgesia and increased opioid requirement after low-dose remifentanil use is unlikely to be clinically significant. TRIAL REGISTRATION NUMBER NCT02223377.
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Affiliation(s)
- Harsha Shanthanna
- Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Maram A T M Khaled
- Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Perioperative and Surgery Research Program, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Alvaro Diaz
- Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | | | - Sarah Clements
- Anesthesia, McMaster University, Hamilton, Ontario, Canada
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Portilho AS, Olivé MLV, de Almeida Leite RM, Tustumi F, Seid VE, Gerbasi LS, Pandini RV, Horcel LDA, Araujo SEA. The Impact of Enhanced Recovery After Surgery Compliance in Colorectal Surgery for Cancer. J Laparoendosc Adv Surg Tech A 2025; 35:185-197. [PMID: 40040518 DOI: 10.1089/lap.2024.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2025] Open
Abstract
Background: This study aimed to assess the impact of Enhanced Recovery After Surgery (ERAS) compliance and to identify which components of this protocol are most likely to affect postoperative outcomes in patients undergoing colorectal cancer surgery. Methods: This is a retrospective cohort evaluating patients who underwent elective colon resection. ERAS compliance was assessed based on adherence to the protocol components. The study examined the following outcomes: postoperative complications, readmission rates, mortality, conversion to open surgery, stoma creation, and length of hospital stay. Results: Of the 410 patients studied, 59% achieved ≥75% compliance. Comparison between compliance groups (<75% versus ≥75%) showed significant differences in overall complications (P = .002), severe complications (P = .001), and length of hospital stay (P < .001). The area under the receiver operating characteristic curve for predicting the absence of severe complications based on ERAS compliance was 0.677 (95% confidence interval: 0.602-0.752). Logistic regression analyses demonstrated that ERAS compliance was significantly associated with a reduced risk of severe complications (P < .001), as well as that the following items: avoiding prophylactic drains (P < .001), minimal use of postoperative opioids (P = .045), avoidance of postoperative salt and water overload (P < .001), postoperative nutritional support (P = .048), and early mobilization (P = .025). Conclusion: High ERAS compliance is associated with improved postoperative outcomes in colorectal cancer surgery. Key protocol components for preventing severe complications include avoiding prophylactic drains, minimal postoperative opioid use, avoiding salt and water overload, nutritional support, and early mobilization.
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Affiliation(s)
- Ana Sarah Portilho
- Department of Health Sciences, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Francisco Tustumi
- Department of Health Sciences, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Victor Edmond Seid
- Department of Health Sciences, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Lucas Soares Gerbasi
- Department of Health Sciences, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rafael Vaz Pandini
- Department of Health Sciences, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Xie G, Estevez M, Heybati K, Vogt M, Smith M, Moshe C, Chan J, Kumbhari V, Chadha R. Single-agent versus combination regimens containing propofol: a retrospective cohort study of recovery metrics and complication rates in a hospital-based endoscopy suite. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2025; 75:844602. [PMID: 40023496 PMCID: PMC11951190 DOI: 10.1016/j.bjane.2025.844602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Revised: 01/29/2025] [Accepted: 01/31/2025] [Indexed: 03/04/2025]
Abstract
BACKGROUND Anesthesiologists are often tasked with overseeing sedation in non-surgical settings. We aim to determine whether adding adjuvant sedatives to propofol affects the recovery times and complication rates after endoscopy. METHODS We conducted a retrospective cohort study of adults (≥18) who received propofol while undergoing esophagogastroduodenoscopy (EGD) and/or colonoscopy (COL) at a large academic institution over a four-year period. Patients receiving propofol alone were compared against patients receiving propofol in combination with midazolam, fentanyl, ketamine, or dexmedetomidine. The primary outcome was PACU length of stay, adjusted for age, sex, and ASA Score. Secondary outcomes included incidence of PACU postoperative nausea and vomiting, hypoxemia (SpO2 < 90%), bradycardia (HR < 60 bpm), and escalation of care (hospital admission), reported in adjusted odds ratios and their 95% confidence intervals. RESULTS Across the study period, 28,532 cases were included. Colonoscopies performed under propofol+fentanyl sedation were associated with significantly longer PACU LOS compared to propofol alone. Adjusted mean PACU LOS was significantly longer in patients receiving adjuvant fentanyl, compared to propofol alone (p < 0.01) and propofol + dexmedetomidine (p < 0.01). Patients receiving propofol alone exhibited a 9.4% incidence of bradycardia, 16.0% hypoxia, 0.89% PONV, and 0.40% hospitalization. Adjuvant fentanyl use was associated with higher odds of hypoxia across all procedure types (p < 0.05). Adjuvant dexmedetomidine was associated with higher rates of bradycardia, but lower rates of hypoxia, PONV, and hospitalization (p < 0.05). CONCLUSIONS With the exception of fentanyl, combining propofol with other sedatives was not associated with longer recovery times. The incidence of complications differed significantly with the use of adjuvant fentanyl or dexmedetomidine.
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Affiliation(s)
- Guozhen Xie
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, USA
| | - Maria Estevez
- Clinical Studies Unit, Mayo Clinic Jacksonville, FL, USA
| | - Kiyan Heybati
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, USA
| | - Matthew Vogt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Jacksonville, FL, USA
| | - Christine Moshe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Jacksonville, FL, USA
| | - Johanna Chan
- Department of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL, USA
| | - Vivek Kumbhari
- Department of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL, USA
| | - Ryan Chadha
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Jacksonville, FL, USA.
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Xie G, Estevez M, Heybati K, Vogt M, Smith M, Moshe C, Chan J, Kumbhari V, Chadha R. Outcomes of anesthesia-supported versus endoscopist-driven sedation modalities: a retrospective cohort study. Gastrointest Endosc 2025:S0016-5107(25)00048-3. [PMID: 39880215 DOI: 10.1016/j.gie.2025.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 12/09/2024] [Accepted: 01/19/2025] [Indexed: 01/31/2025]
Abstract
BACKGROUND AND AIMS The use of anesthesia has become commonplace in many procedural settings. The goal of this study is to compare sedation modalities used by endoscopists and anesthesiologists in the endoscopy suite, particularly with respect to recovery time and adverse events. METHODS We conducted a retrospective cohort study including adults (≥18 years of age) undergoing outpatient EGD and/or colonoscopy at Mayo Clinic in Jacksonville, Florida between October 1st, 2018 and December 31st, 2022. Cases were classified as using propofol only, propofol ± adjuvants (PA; including dexmedetomidine, ketamine, fentanyl, and midazolam), general anesthesia (GA) with endotracheal tube, or fentanyl/midazolam (FM) only. The primary outcome was length of stay (LOS) in the postanesthesia care unit (PACU), and secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), hypoxemia (Spo2 risk 90%), bradycardia (heart rate <60 bpm), and escalation of care (hospital admission). RESULTS The analysis included 56,361 cases. Among patients who received FM sedation, the mean PACU LOS was 52.01, 49.68, and 53.24 minutes for EGD, colonoscopy, and combined procedures, respectively. This was significantly higher than the mean PACU LOS for GA (44.65, 41.41, and 41.92 minutes, respectively), for PA (32.35, 35.75, and 33.42 minutes, respectively), and for propofol (31.63, 32.61, and 33.29 minutes, respectively; P < .0001). Of patients receiving FM, 8.39% experienced bradycardia, 6.12% experienced hypoxia, 0.24% experienced PONV, and 0.05% were hospitalized. These were substantially lower than the rates for other sedation groups, and odds ratios were significantly lower than 1.00 (P < .05) in 30 of 36 comparisons across procedural, sedative, and outcome categories. CONCLUSIONS Sedation achieved with FM correlated with a lower rate of adverse events but a significantly longer PACU LOS compared with propofol, PA, or GA.
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Affiliation(s)
- Guozhen Xie
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Estevez
- Clinical Studies Unit, Mayo Clinic, Jacksonville, Florida, USA
| | - Kiyan Heybati
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew Vogt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Christine Moshe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Johanna Chan
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Vivek Kumbhari
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Ryan Chadha
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA.
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Huidekoper JE, Routman JS. Postoperative Management of the Ambulatory Surgery Patient. Int Anesthesiol Clin 2025; 63:81-91. [PMID: 39651670 DOI: 10.1097/aia.0000000000000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2024]
Affiliation(s)
- John E Huidekoper
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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George Iii J, Min K, Ayad S, Shenoy R, Peerzada W. Postoperative Nausea and Vomiting Management for Adults in the Ambulatory Surgical Setting. Int Anesthesiol Clin 2025; 63:92-99. [PMID: 39651671 DOI: 10.1097/aia.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2024]
Affiliation(s)
- John George Iii
- Department of Anesthesiology, The Cleveland Clinic, Cleveland
| | - Kevin Min
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Sabry Ayad
- Department of Anesthesiology, The Cleveland Clinic, Cleveland
| | - Renuka Shenoy
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Wasif Peerzada
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Tubog TD, Kane TD. Pharmacological Strategies for Postdischarge Nausea and Vomiting: Evidence-based Review Update. J Perianesth Nurs 2024:S1089-9472(24)00462-3. [PMID: 39708024 DOI: 10.1016/j.jopan.2024.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 09/03/2024] [Accepted: 09/12/2024] [Indexed: 12/23/2024]
Abstract
PURPOSE Evaluate the effectiveness of various drugs in preventing postdischarge nausea and vomiting (PDNV). DESIGN Systematic review. METHODS A search for evidence was conducted in PubMed, CINAHL, Cochrane Collaboration, and Google Scholar and gray literature. Only randomized controlled trials examining a pharmacological agent to prevent PDNV were included in the study. The quality appraisal of the literature was conducted using the proposed algorithm described in the Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide. FINDINGS A total of 8 randomized controlled trials involving 1,441 patients were analyzed. The efficacy of pharmacological agents, including dexamethasone, olanzapine, ondansetron, palonosetron, ramosetron, promethazine, and casopitant in the prevention of PDNV, varied. Additionally, a combination of two or more drugs is a more effective therapy than using a single drug in mitigating PDNV. The review also underscored the individual patient factors that can play a significant role in identifying appropriate prevention and treatment modalities. CONCLUSIONS There is limited evidence on the efficacy of pharmacological agents in preventing PDNV. The scarcity of large-scale, clinical trials specifically focusing on PDNV restricts the ability to recommend prophylactic drug therapy for reducing its incidence.
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Affiliation(s)
- Tito D Tubog
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX.
| | - Terri D Kane
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
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Lei X, Zhang T, Huang X. Comparison of a single intravenous infusion of alfentanil or sufentanil combined with target-controlled infusion of propofol for daytime hysteroscopy: a randomized clinical trial. Ther Adv Drug Saf 2024; 15:20420986241292231. [PMID: 39493926 PMCID: PMC11528634 DOI: 10.1177/20420986241292231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 10/02/2024] [Indexed: 11/05/2024] Open
Abstract
Background The administration of either alfentanil or sufentanil as a single injection, combined with target-controlled infusion (TCI) of propofol, represents a frequently employed anesthetic regimen for daytime hysteroscopy. Objectives This study was designed to evaluate and compare the safety and efficacy of alfentanil and sufentanil in the context of daytime hysteroscopy. Design A total of 160 patients, scheduled for daytime hysteroscopy, were randomly allocated into two groups: Group A and Group S respectively received alfentanil 10 μg/kg or sufentanil 0.15 μg/kg as a single intravenous injection. Both groups were given propofol with TCI for sedation. Methods Monitoring of vital signs was conducted from pre-anesthesia through to 2 h postoperatively. The primary outcome measured was hypoxemia, defined as SpO2 levels below 92% for a duration of 30 s, which necessitated manual positive pressure ventilation. Secondary outcomes included various perioperative complications, such as postoperative nausea and vomiting (PONV) occurring 2 h after surgery, as well as hemodynamic indicators, NRS scores for pain, and other anesthesia-related data. This comprehensive dataset was meticulously documented and subsequently analyzed for comparative purposes. Results The analyses revealed that Group A had a significantly lower incidence of hypoxemia (p = 0.002) and PONV (p = 0.021). Additionally, group A demonstrated overall more stable blood pressure and heart rate, as well as higher SpO2 levels. Conclusion For daytime hysteroscopy, alfentanil at a dose of 10 μg/kg is safer than sufentanil at a dose of 0.15 μg/kg when combined with propofol TCI. Trial registration This study was registered with the Chinese Clinical Trial Registry (The URL of registration is https://www.chictr.org.cn/showproj.html?proj=177784; registration number: ChiCTR2200063939). The date of first registration was September 21, 2022.
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Affiliation(s)
- Xiaofeng Lei
- Department of Anesthesiology, Women and Children’s Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
| | - Tinghuan Zhang
- Department of Anesthesiology, Chongqing Rongchang Health Center for Women and Children, Chongqing, China
| | - Xuezhu Huang
- Department of Anesthesiology, Women and Children’s Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), 120 Longshan Road, Yubei District, Chongqing 401147, China
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Mo Y, Zhang W, Tang X, Zhang R, Wang Y, Zheng L. Evaluation of Postoperative Discomfort After Strabismus Surgery Under General Anesthesia in Children: A Prospective Observational Study. J Pain Res 2024; 17:2717-2726. [PMID: 39188912 PMCID: PMC11346475 DOI: 10.2147/jpr.s468977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024] Open
Abstract
Purpose Strabismus surgery is most commonly performed on children under general anesthesia. However, few studies have focused on the postoperative discomfort in children after strabismus surgery. This study aimed to evaluate postoperative discomfort and the associated risk factors in children who underwent strabismus surgery under general anesthesia. Patients and Methods A single-center prospective observational study including 300 children who underwent strabismus surgery after general anesthesia was conducted. Patients' characteristics, preoperative anxiety, surgical and anesthesia data, discomfort within 24 hours after postanesthesia care unit were recorded. The primary outcome was the incidence of postoperative discomfort. Results Approximately 51.33% of the children complained of at least one of the following types of postoperative discomfort: postoperative nausea and vomiting (PONV) (23.00%), headache (4.33%), dizziness (20.33%) and emergence agitation (EA) (5.33%). Multivariate analysis indicated that history of motion sickness (P<0.001, odds ratio [OR]=3.72), and surgery in the dominant eye (P=0.010, OR=2.00) were independent predictors of postoperative discomfort; age was an independent predictor of EA (P<0.001, OR=0.36); prism diopter≥40 was an independent predictor of headache (P=0.005, OR=5.53); age (P=0.020, OR=1.12) and history of motion sickness (P=0.001, OR=2.80) were independent predictors of dizziness; history of motion sickness (P=0.001, OR=2.63) and surgery of inferior oblique anterior transposition (IOAT) (P=0.004, OR=3.10) were independent predictors of PONV. Conclusion The most frequent postoperative symptoms in children after undergoing strabismus surgery under general anesthesia are PONV, dizziness, EA, and headache. Younger age, larger angle of strabismus, history of motion sickness, surgery on the dominant eye, and surgery of IOAT may be additional risk factors for postoperative discomfort.
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Affiliation(s)
- Yawen Mo
- Department of Strabismus and Amblyopia, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
| | - Wenjuan Zhang
- Department of Strabismus and Amblyopia, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
| | - Xiangcheng Tang
- Department of Strabismus and Amblyopia, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
| | - Rui Zhang
- Department of Anesthesia, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
| | - Yinghuan Wang
- Department of Strabismus and Amblyopia, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
| | - Lingling Zheng
- Department of Nursing Administration, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, People’s Republic of China
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Hoshijima H, Miyazaki T, Mitsui Y, Omachi S, Yamauchi M, Mizuta K. Machine learning-based identification of the risk factors for postoperative nausea and vomiting in adults. PLoS One 2024; 19:e0308755. [PMID: 39146357 PMCID: PMC11326632 DOI: 10.1371/journal.pone.0308755] [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: 05/25/2023] [Accepted: 07/30/2024] [Indexed: 08/17/2024] Open
Abstract
Postoperative nausea and vomiting (PONV) is a common adverse effect of anesthesia. Identifying risk factors for PONV is crucial because it is associated with a longer stay in the post-anesthesia care unit, readmissions, and perioperative costs. This retrospective study used artificial intelligence to analyze data of 37,548 adult patients (aged ≥20 years) who underwent surgery under general anesthesia at Tohoku University Hospital from January 1, 2010 to December 31, 2019. To evaluate PONV, patients who experienced nausea and/or vomiting or used antiemetics within 24 hours after surgery were extracted from postoperative medical and nursing records. We create a model that predicts probability of PONV using the gradient tree boosting model, which is a widely used machine learning algorithm in many applications due to its efficiency and accuracy. The model implementation used the LightGBM framework. Data were available for 33,676 patients. Total blood loss was identified as the strongest contributor to PONV, followed by sex, total infusion volume, and patient's age. Other identified risk factors were duration of surgery (60-400 min), no blood transfusion, use of desflurane for maintenance of anesthesia, laparoscopic surgery, lateral positioning during surgery, propofol not used for maintenance of anesthesia, and epidural anesthesia at the lumbar level. The duration of anesthesia and the use of either sevoflurane or fentanyl were not identified as risk factors for PONV. We used artificial intelligence to evaluate the extent to which risk factors for PONV contribute to the development of PONV. Intraoperative total blood loss was identified as the potential risk factor most strongly associated with PONV, although it may correlate with duration of surgery, and insufficient circulating blood volume. The use of sevoflurane and fentanyl and the anesthesia time were not identified as risk factors for PONV in this study.
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Affiliation(s)
- Hiroshi Hoshijima
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Tomo Miyazaki
- Graduate School of Engineering, Tohoku University, Miyagi, Japan
| | - Yuto Mitsui
- Graduate School of Engineering, Tohoku University, Miyagi, Japan
| | | | - Masanori Yamauchi
- Department of Anesthesiology, Tohoku University Hospital, Miyagi, Japan
| | - Kentaro Mizuta
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Miyagi, Japan
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Bell J, Bindelglass A, Morrone J, Park S, Costa A, Bergese S. Postoperative Nausea and Vomiting in the Ambulatory Surgery Center: A Narrative Review. MEDICINES (BASEL, SWITZERLAND) 2024; 11:16. [PMID: 39189162 PMCID: PMC11348043 DOI: 10.3390/medicines11070016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/17/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024]
Abstract
Postoperative nausea and vomiting (PONV) is a common complication of ambulatory surgery, leading to numerous deleterious effects such as decreased patient satisfaction, prolonged recovery unit stays, and rarely, more serious complications such as aspiration pneumonia or wound dehiscence. In this paper, we present a narrative review of the literature regarding common risk factors for PONV including patient factors, surgical factors, and anesthetic factors. We then will review anesthetic techniques and antiemetic drugs demonstrated to mitigate the risk of PONV. Finally, we discuss the potential economic benefits of PONV prophylaxis in the perioperative ambulatory setting.
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Affiliation(s)
- Justin Bell
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.B.); (A.B.); (S.P.); (A.C.)
| | - Adam Bindelglass
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.B.); (A.B.); (S.P.); (A.C.)
| | - Jennifer Morrone
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Sherwin Park
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.B.); (A.B.); (S.P.); (A.C.)
| | - Ana Costa
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.B.); (A.B.); (S.P.); (A.C.)
| | - Sergio Bergese
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.B.); (A.B.); (S.P.); (A.C.)
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Li ZP, Song YC, Li YL, Guo D, Chen D, Li Y. Association between operative position and postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy. World J Gastrointest Surg 2024; 16:2088-2095. [PMID: 39087131 PMCID: PMC11287665 DOI: 10.4240/wjgs.v16.i7.2088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/18/2024] [Accepted: 06/18/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity, and postoperative nausea and vomiting (PONV) is one of the common complications after bariatric surgery. At present, the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained, and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery. AIM To explore the effect of the operative position during bariatric surgery on PONV. METHODS Data from obese patients, who underwent laparoscopic sleeve gastrectomy (LSG) in the authors' hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed. Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV. RESULTS There were 15 cases of PONV in the supine split-leg group (incidence rate, 50%) and 11 in the supine group (incidence rate, 36.7%) (P = 0.297). The mean operative duration in the supine split-leg group was 168.23 ± 46.24 minutes and 140.60 ± 32.256 minutes in the supine group (P < 0.05). Multivariate analysis revealed that operative position was not an independent risk factor for PONV (odds ratio = 1.192, 95% confidence interval: 0.376-3.778, P = 0.766). CONCLUSION Operative position during LSG may affect PONV; however, the difference in the incidence of PONV was not statistically significant. Operative position should be carefully considered for obese patients before surgery.
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Affiliation(s)
- Zhao-Peng Li
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266033, Shandong Province, China
| | - Yan-Cheng Song
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266033, Shandong Province, China
| | - Ya-Li Li
- Department of Operation Room, The Affiliated Hospital of Qingdao University, Qingdao 266033, Shandong Province, China
| | - Dong Guo
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266033, Shandong Province, China
| | - Dong Chen
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266033, Shandong Province, China
| | - Yu Li
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266033, Shandong Province, China
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Chae MS, Lee S, Choi YJ, Koh HJ. Impact of Preoperative Gum Chewing on Postoperative Anti-Emetic Use in Robot-Assisted Laparoscopic Surgery for Benign Ovarian Masses: A Prospective, Single-Blinded Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1135. [PMID: 39064564 PMCID: PMC11279347 DOI: 10.3390/medicina60071135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/11/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Postoperative nausea and vomiting (PONV) is a common issue for females undergoing gynecological surgeries, including those assisted by robotic systems. Despite available prophylactic measures, the incidence of PONV remains high, negatively impacting recovery and increasing healthcare costs. This study evaluates whether preoperative gum chewing reduces the need for anti-emetic drugs in females undergoing robot-assisted laparoscopic surgery for benign ovarian mass. Materials and Methods: This prospective, single-blinded, randomized controlled trial enrolled 92 adult females scheduled for robot-assisted laparoscopic surgery to treat benign ovarian mass. Following exclusions, the remaining participants were randomly assigned to either a gum-chewing group or a no-gum-chewing group. The gum-chewing group chewed sugar-free gum for 15 min in the holding area before surgery. The primary outcome measured was the need for anti-emetics to control PONV during the first hour in the post-anesthesia care unit (PACU). Secondary outcomes included the number of anti-emetic requests. No preemptive anti-emetics were administered during surgery. Results: Out of the initial 92 patients, 88 were included in the final analysis, with 44 in each group. The incidence of PONV requiring anti-emetics in the PACU was significantly lower in the gum-chewing group (79.5%) compared to the no-gum-chewing group (95.5%). Additionally, the number of anti-emetic requests was higher in the no-gum-chewing group. No postoperative complications such as tooth or jaw pain/injury or gastric content regurgitation were reported. Conclusions: Preoperative gum chewing for 15 min immediately before surgery significantly reduced the incidence of PONV in females undergoing robot-assisted laparoscopic surgery for benign ovarian mass. This simple, non-pharmacological intervention improved patient comfort and reduced the need for anti-emetic medications without any adverse effects. Further studies are needed to confirm these findings and to develop guidelines for incorporating preoperative gum chewing into clinical practice.
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Affiliation(s)
- Min Suk Chae
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Subin Lee
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Youn Jin Choi
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyun Jung Koh
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
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Liu J, Fang S, Cheng L, Wang L, Wang Y, Gao L, Liu Y. A web-based dynamic predictive model for postoperative nausea and vomiting in patient receiving gynecological laparoscopic surgery. J Obstet Gynaecol Res 2024; 50:1216-1228. [PMID: 38644529 DOI: 10.1111/jog.15956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/10/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE The aim of this study was to develop a web-based dynamic prediction model for postoperative nausea and vomiting (PONV) in patients undergoing gynecologic laparoscopic surgery. METHODS The patients (N = 647) undergoing gynecologic laparoscopic surgery were included in this observational study. The candidate risk-factors related to PONV were included through literature search. Lasso regression was utilized to screen candidate risk-factors, and the variables with statistical significance were selected in multivariable logistic model building. The web-based dynamic Nomogram was used for model exhibition. Accuracy and validity of the experimental model (EM) were evaluated by generating receiver operating characteristic (ROC) curves and calibration curves. Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model. Decision curve analysis (DCA) was used to evaluate the clinical practicability of the risk prediction model. RESULTS Ultimately, a total of five predictors including patient-controlled analgesia (odds ratio [OR], 4.78; 95% confidence interval [CI], 1.98-12.44), motion sickness (OR, 4.80; 95% CI, 2.71-8.65), variation of blood pressure (OR, 4.30; 95% CI, 2.41-7.91), pregnancy vomiting history (OR, 2.21; 95% CI, 1.44-3.43), and pain response (OR, 1.64; 95% CI, 1.48-1.83) were selected in model building. Assessment of the model indicates the discriminating power of EM was adequate (ROC-areas under the curve, 93.0%; 95% CI, 90.7%-95.3%). EM showed better accuracy and goodness of fit based on the results of the calibration curve. The DCA curve of EM showed favorable clinical benefits. CONCLUSIONS This dynamic prediction model can determine the PONV risk in patients undergoing gynecologic laparoscopic surgery.
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Affiliation(s)
- Jiang Liu
- School of Nursing, Shandong Second Medical University, Weifang, China
| | | | - Lin Cheng
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Liwei Wang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Yuwen Wang
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Lunan Gao
- School of Nursing, Shandong Second Medical University, Weifang, China
| | - Yuxiu Liu
- School of Nursing, Shandong Second Medical University, Weifang, China
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Thiel B, Blaauboer J, Seesing C, Radmanesh J, Koopman S, Kalkman C, Godfried M. Patient self-reported pain and nausea via smartphone following day care surgery, first year results: An observational cohort study. PLOS DIGITAL HEALTH 2024; 3:e0000342. [PMID: 38985704 PMCID: PMC11236166 DOI: 10.1371/journal.pdig.0000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 05/22/2024] [Indexed: 07/12/2024]
Abstract
Contact with the hospital is usually limited for patients after day care surgery. Dedicated smartphone applications can improve communication and possibly enhance outcomes. The objective of this retrospective study was to evaluate patients' self-reported pain and nausea and assess the success of routine implementation of a smartphone application for outcome reporting. During preoperative assessment, patients were instructed to download and activate the smartphone application to report pain, nausea and to be in contact with the hospital after discharge. Main outcome was the number of patients actively using the smartphone application and the incidence of pain and nausea on postoperative day 1 to 7. In total, 4952 patients were included in the study. A total of 592 (12%) participants downloaded the application, of whom 351 (7%) were active users. A total of 4360 (88%) participants refrained from downloading the application. 56% (2,769) were female, the median age was 46 (18-92), and 4286 (87%) were classified as 1 or 2 American Society of Anesthesiologists Physical Status (ASA). Postoperative pain was experienced by 174 (76%) of 229 active users on postoperative day (POD) 1 and decreased to 44 (44%) of 100 active users on POD7. Postoperative nausea was experienced by 63 (28%) of 229 active users on POD1 and decreased to 12 (12%) of 100 active users on POD7. Female sex (p .000), socioeconomic status (p .001), and surgical severity (p .001) showed statistically significant differences between active users, non-active users, and non-downloaders. Most patients active with the application experienced pain and nausea on the first and second day after discharge. Only a minority of the patients used the application. Those who used it were satisfied with the possibilities offered to them. Future research should focus on increasing the uptake and effect of this application on the quality of recovery.
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Affiliation(s)
- Bram Thiel
- Department of anaesthesia, OLVG Hospital, Amsterdam, the Netherlands
| | - Jamey Blaauboer
- Faculty of medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - Chiem Seesing
- Faculty of medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - Jamshid Radmanesh
- Department of information technology, OLVG Hospital, Amsterdam, the Netherlands
| | - Seppe Koopman
- Department of anaesthesia, Maasstad Hospital, Rotterdam, the Netherlands
| | - Cor Kalkman
- Department of anaesthesia, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marc Godfried
- Department of anaesthesia, OLVG Hospital, Amsterdam, the Netherlands
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Shanthanna H, Wang L, Paul J, Lovrics P, Devereaux PJ, Bhandari M, Thabane L. A prospective cohort study of chronic postsurgical pain after ambulatory surgeries. Curr Med Res Opin 2024; 40:1187-1193. [PMID: 38809229 DOI: 10.1080/03007995.2024.2360128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/26/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE The incidence and factors associated with chronic postsurgical pain (CPSP) after ambulatory surgeries have not been well studied. Our primary objective was to determine the incidence of CPSP and secondary objectives included assessment of intensity of CPSP, incidence of moderate-to-severe CPSP, and exploration of factors associated with CPSP. METHODS This is a prospective cohort study of ambulatory surgery patients having procedures with a potential to cause moderate-to-severe postoperative pain. All patients had participated in a randomized controlled trial (RCT) showing no difference in achieving satisfactory analgesia in a recovery unit with either morphine or hydromorphone. CPSP was defined as chronic pain that developed or increased in intensity after the surgical procedure and is localized to the surgical field or within the innervation territory of a nerve in the surgical field, and has persisted for 3 months post-surgery, with the exclusion of other causes of pain. Incidences of CPSP were reported as rate (%) with 95% CI, and intensity using a 0-10 numerical rating scale (95% CI). We used logistic regression to explore factors associated with CPSP adjusting for baseline catastrophizing and depression. RESULTS Among 402 RCT patients, 208 provided data for the 3-month outcome. Incidence of CPSP was 18.8% (39/208), 95% CI = 13.7%-24.7% and 78% (28/39) of them had moderate-to-severe CPSP. Average CPSP intensity was 5.5, 95% CI = 4.7-6.4. Every unit increase in pain over the first 24 h was significantly associated with increased odds of moderate-to-severe CPSP at 3 months; odds ratio = 1.28, 95% CI = 1.04-1.58. CONCLUSIONS Nearly one in five patients develop CPSP after ambulatory surgeries with the majority of them having moderate-to-severe pain. Considering that acute pain after discharge is associated with CPSP and that there are no formal care pathways to address this need, studies need to focus on evaluating feasible strategies to provide continuing care.
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Affiliation(s)
- Harsha Shanthanna
- Department of Anesthesia, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Li Wang
- Department of Anesthesia, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Peter Lovrics
- Department of Surgery, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - P J Devereaux
- Departments of Health Research Methods, Evidence, and Impact and Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Departments of Health Research Methods, Evidence, and Impact and Medicine, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Deb B, Saini K, Arora S, Kumar S, Soni SL, Saini M. Olanzapine versus standard antiemetic prophylaxis for the prevention of post-discharge nausea and vomiting after propofol-based general anaesthesia: A randomised controlled trial. Indian J Anaesth 2024; 68:566-571. [PMID: 38903258 PMCID: PMC11186532 DOI: 10.4103/ija.ija_1162_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/22/2024] Open
Abstract
Background and Aims Post-discharge nausea and vomiting (PDNV) is a pertinent problem in patients undergoing ambulatory surgery. The objective of this study was to assess the efficacy of the novel drug olanzapine, which has proved its efficiency in patients undergoing highly emetogenic chemotherapy for PDNV prevention. Methods This randomised controlled trial recruited 106 adult patients (18-65 years) undergoing highly emetogenic daycare surgeries with propofol-based general anaesthesia (GA). Group O received preoperative oral olanzapine 10 mg, and Group C, acting as a control, received 8 mg of intravenous dexamethasone and 4 mg of ondansetron intraoperatively. The primary outcome was nausea (numeric rating scale >3) and/or vomiting 24 h after discharge. Secondary outcomes included nausea and vomiting in the post-anaesthesia care unit (PACU), severe nausea, vomiting and side effects. Normality was assessed using the Shapiro-Wilk test, and the independent samples t-test or the Mann-Whitney U test was used to compare continuous variables. Fisher's exact test was used to assess any non-random associations between the categorical variables. Results The incidence and severity of postoperative nausea and vomiting were similar in both groups within PACU (four patients experienced nausea and vomiting, three had severe symptoms in Group O, P = 0.057) and in the post-discharge period (three patients in Group O had nausea and vomiting compared to five patients in Group C, of which four were severe, P = 0.484). The side effects (sedation, dizziness, and light-headedness) were comparable between the two groups. Conclusion A single preoperative oral olanzapine can be an effective alternative to standard antiemetic prophylaxis involving dexamethasone and ondansetron for preventing PDNV in highly emetogenic daycare surgeries with propofol-based GA.
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Affiliation(s)
- Binayak Deb
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Kulbhushan Saini
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Suman Arora
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Sanjay Kumar
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Shiv L. Soni
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Manu Saini
- Department of Ophthalmology, PGIMER Chandigarh, India
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Backmund T, Bohlender T, Gaik C, Koch T, Kranke P, Nardi-Hiebl S, Vojnar B, Eberhart LHJ. [Comparison of different prediction models for the occurrence of nausea and vomiting in the postoperative phase : A systematic qualitative comparison based on prospectively defined quality indicators]. DIE ANAESTHESIOLOGIE 2024; 73:251-262. [PMID: 38319326 DOI: 10.1007/s00101-024-01386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Various prognostic prediction models exist for evaluating the risk of nausea and vomiting in the postoperative period (PONV). So far, no systematic comparison of these prognostic scores is available. METHOD A systematic literature search was carried out in seven medical databases to find publications on prognostic PONV models. Identified scores were assessed against prospectively defined quality criteria, including generalizability, validation and clinical relevance of the models. RESULTS The literature search revealed 62 relevant publications with a total of 81,834 patients which could be assigned to 8 prognostic models. The simplified Apfel score performed best, primarily because it was extensively validated. The Van den Bosch score and Sinclair score tied for second place. The simplified Koivuranta score was in third place. CONCLUSION The qualitative analysis highlights the strengths and weaknesses of each prediction system based on predetermined standardized quality criteria.
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Affiliation(s)
- T Backmund
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Baldinger Straße, 35043 Marburg, Deutschland.
| | - T Bohlender
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Baldinger Straße, 35043 Marburg, Deutschland
| | - C Gaik
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Baldinger Straße, 35043 Marburg, Deutschland
| | - T Koch
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Baldinger Straße, 35043 Marburg, Deutschland
| | - P Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Deutschland
| | - S Nardi-Hiebl
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Baldinger Straße, 35043 Marburg, Deutschland
| | - B Vojnar
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Baldinger Straße, 35043 Marburg, Deutschland
| | - L H J Eberhart
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Baldinger Straße, 35043 Marburg, Deutschland
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Kim HI, Kim KJ, Kim S, Kim HD, Kim SH. Association between preoperative lumbar skeletal muscle index and postoperative nausea and vomiting in patients undergoing pylorus-preserving pancreatoduodenectomy: a retrospective study. Anesth Pain Med (Seoul) 2024; 19:161-168. [PMID: 38725172 PMCID: PMC11089290 DOI: 10.17085/apm.23142] [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: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Sarcopenia is associated with postoperative complications; however, its impact on the quality of postoperative recovery, such as postoperative nausea and vomiting (PONV) and pain, remains unclear. We investigated the association of preoperative lumbar skeletal muscle mass index (LSMI) with PONV, postoperative pain, and complications. METHODS Medical records of 756 patients who underwent pylorus-preserving pancreatoduodenectomy (PPPD) were retrospectively reviewed. The skeletal muscle areas were measured on abdominal computed tomography (CT) images. LSMI was calculated by dividing the skeletal muscle area by the square of the patient's height. We analyzed the correlations between preoperative LSMI calibrated with confounding variables and PONV scores, PONV occurrence, pain scores, rescue analgesic administration, postoperative complications, and length of hospital stay. RESULTS The median (1Q, 3Q) LSMI was 47.72 (40.74, 53.41) cm2/m2. The incidence rates of PONV according to time period were as follows: post-anesthesia care unit, 42/756 (5.6%); 0-6 h, 54/756 (7.1%); 6-24 h, 120/756 (15.9%); 24-48 h, 46/756 (6.1%); and overall, 234/756 (31.0%). The incidence of PONV was inversely correlated with LSMI 24-48 h post-surgery and overall. LSMI and PONV scores were negatively associated 6-24 h and 24-48 h post-surgery. There was no association between LSMI and postoperative pain scores, rescue analgesic administration, complications, or length of hospital stay. CONCLUSIONS Preoperative LSMI was associated with PONV in patients undergoing PPPD. Therefore, LSMI measured on preoperative abdominal CT can be a predictive indicator of PONV. Appropriate PONV prophylaxis is necessary in patients with low LSMI before PPPD.
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Affiliation(s)
- Hyun Il Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Jun Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sangil Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hae Dong Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyun Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Olsen SW, Lehmkuhl L, Hamborg LW, Torkov AKA, Fog-Nielsen R, Lauridsen J. Postoperative Pain Relief After Ambulatory Laparoscopic Surgery a Nonmatched Case-Control Study. J Perianesth Nurs 2024; 39:254-262. [PMID: 37999689 DOI: 10.1016/j.jopan.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE To examine whether patient involvement using a Patient Decision Aid has a positive effect on pain levels, by giving them an active role in choosing a pain schedule for postoperative pain assessment and pain management. DESIGN A nonmatched case-control study. METHODS 101 adults 18 years or older were included to choose between 1 of 3 possible schedules for postoperative pain management. Perioperative variables, for example, patients' assessments of pain were registered at the hospital and further variables after discharge at postoperative day 1 (POD1), POD3, and POD7, for example, patients' ability to sleep and assessment of nausea. FINDINGS Less pain after discharge was seen among patients choosing pain schedule II at POD1 (P = .0439). A significantly higher consumption of opioids (P = 0010) on POD1 in patients who have chosen pain schedule II. CONCLUSIONS Improved patient involvement by choosing a user-controlled pain schedule (pain schedule II) in postoperative pain management increased patient empowerment.
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Affiliation(s)
- Susanne W Olsen
- Department of Anesthesia and Intensive Care, Odense University Hospital, Svendborg, Denmark.
| | - Lene Lehmkuhl
- Department of Anaesthesiology and Intensive Care, OUH Svendborg Hospital, Svendborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Lone W Hamborg
- Department of Anesthesia and Intensive Care, Odense University Hospital, Svendborg, Denmark
| | - Anne-Karina A Torkov
- Department of Anesthesia and Intensive Care, Odense University Hospital, Svendborg, Denmark
| | | | - Jørgen Lauridsen
- Business and Social Science, Department of Economics, University of Southern Denmark, Odense, Denmark
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Jakobsdottir H, Tomasson AM, Karason S, Sigurdsson MI. Postoperative nausea and vomiting at Landspitali: A prospective study. Acta Anaesthesiol Scand 2024; 68:457-465. [PMID: 38262610 DOI: 10.1111/aas.14375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND In the last decade, anaesthesia practice has changed at Landspitali, where the majority of patients now receive antiemetic prophylaxis, and the use of total intravenous anaesthesia is the dominant mode for maintenance of anaesthesia. The aim of this study was to assess the incidence of postoperative nausea and vomiting (PONV) in a prospective way, the use of PONV prophylaxis, and clinical risk factors associated with PONV during this era. METHODS A prospective cohort study using a convenience sample of 438 patients ≥18 years old admitted to the postoperative care unit (PACU) after elective or emergency operations in May-July 2022 at Landspitali University Hospital in Iceland. Patients answered questionnaires in the PACU and 24 h after discharge from PACU. RESULTS The incidence of self-reported moderate/severe nausea (5/10 or higher on NRS) in PACU was 4% and 3% on postoperative day 1. A total of 91% of delivered anaesthetics were with intravenous medications only, and 82% of patients received at least one prophylactic medication for PONV. When asked to rate the worst nausea experienced, this was described as moderate/severe by 7% in PACU and 17% on postoperative day 1. Risk factors associated with PONV were female gender (OR 1.90, 95% CI 1.04-3.53) and a history of motion sickness or PONV (2.74, 1.51-4.94), but increasing age was protective (0.83 per decade, 0.71-0.98). Despite a more liberal administration of antiemetics, patients with more risk factors per Apfel PONV risk classification had a higher incidence of PONV. CONCLUSION The incidence of PONV is generally low in this diverse surgical population where anaesthesia is mostly maintained with total intravenous anaesthesia and PONV prophylaxis is common. PONV remains a predictable complication following anaesthesia, suggesting further improvement in its prevention is possible.
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Affiliation(s)
| | | | - Sigurbergur Karason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Anaesthesiology and Critical Care, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Martin I Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Anaesthesiology and Critical Care, The National University Hospital of Iceland, Reykjavik, Iceland
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Zhu H, Wang S, Wang R, Li B, Zhang J, Zhang W. Effect of dexmedetomidine on postoperative nausea and vomiting in female patients undergoing radical thoracoscopic lung cancer resection. Front Pharmacol 2024; 15:1353620. [PMID: 38333009 PMCID: PMC10850235 DOI: 10.3389/fphar.2024.1353620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/17/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction: Postoperative nausea and vomiting (PONV) is a prevalent postsurgical complication. The objective of our study was to compare the effect of different doses of dexmedetomidine on PONV in female patients undergoing radical thoracoscopic lung cancer resection. Methods: A total of 164 female patients undergoing elective thoracoscopic radical lung cancer surgery were enrolled and assigned to one of four groups. Patients received 0.2 μg/kg/h, 0.4 μg/kg/h, 0.8 μg/kg/h dexmedetomidine and normal saline in the Dex1, Dex2, Dex3 and Control groups, respectively. The primary outcome was the incidence of PONV during 48 h postoperatively. The second outcomes included the incidence of PONV and postoperative vomiting (POV) at four time points postoperatively (T1: PACU retention period; T2: PACU discharge to postoperative 12 h; T3: postoperative 12 h-postoperative 24 h; T4: postoperative 24 h-postoperative 48 h), the area under the curve of PONV grade (PONVAUC), PONV grade, POV grade and other postoperative recovery indicators. Results: The incidence of PONV differed among the four groups. The Dex2 group (29.27%) was lower than that in the Dex1 group (61.90%) and Control group (72.50%). The incidence of PONV at T2 in the Dex1 group (11.90%) and Dex2 group (9.76%) was lower than that in the Control group (42.50%). The incidence of PONV at T3 in the Dex2 group (29.27%) was lower than that in the Dex1 group (61.90%) and Control group (62.50%). The PONVAUC was lower in the Dex2 group than in the Control group. The incidence of POV at T3 in the Dex2 and Dex3 groups was lower than that in the Control group. The consumption of remifentanil, norepinephrine, PACU dwell time, VAS scores, postoperative PCA press frequency, and the time for the first postoperative oral intake were different among the four groups. The regression model shows that the Dex2 group is a protective factor for PONV. Conclusion: Dexmedetomidine can reduce the incidence of PONV and accelerate postoperative recovery in female patients undergoing radical thoracoscopic lung cancer resection. Compared with the other two dosages, 0.4 μg/kg/h dexmedetomidine is preferable. Clinical Trial Registration: chictr.org.cn, identifier ChiCTR2300071831.
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Affiliation(s)
- Haipeng Zhu
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Shichao Wang
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Ruohan Wang
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Bing Li
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Wei Zhang
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
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24
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Xiao M, Yao D, Fields KG, Sarin P, Macias AA, Eappen S, Juang J. Postoperative and postdischarge nausea and vomiting following ambulatory eye, head, and neck surgeries: a retrospective cohort study comparing incidence and associated factors. Perioper Med (Lond) 2024; 13:3. [PMID: 38245800 PMCID: PMC10800056 DOI: 10.1186/s13741-024-00360-4] [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: 04/04/2022] [Accepted: 01/02/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Ambulatory surgery is often followed by the development of nausea and/or vomiting (N/V). Although risk factors for postoperative nausea and vomiting (PONV) are frequently discussed, the distinction between PONV and postdischarge nausea and vomiting (PDNV) is unclear. This is especially troublesome given the potential consequences of postdischarge nausea and vomiting (PDNV), which include major discomfort and hospital readmission. METHODS In this retrospective cohort study, data from 10,231 adult patients undergoing ambulatory ophthalmology or otolaryngology procedures with general anesthesia were collected and analyzed. Binary and multinomial logistic regression was used to assess the association between patient and anesthetic characteristics (including age, body mass index (BMI), American Society of Anesthesiologists Physical Status (ASA P/S) classification, current smoker status, and intra- and postoperative opioid usage) and the odds ratios of experiencing only PDNV, only PONV, or both PONV and PDNV, as compared to not experiencing N/V at all. RESULTS We found that 17.8% of all patients developed N/V (PONV and/or PDNV). Patients who experienced PONV had a 2.79 (95% confidence interval 2.24-3.46) times greater risk of reporting PDNV. Binary logistic regression found that younger age, opioid use, and female sex were associated with an increased likelihood of experiencing any N/V. Increased use of nitrous oxide and a higher ASA P/S class was associated with elevated likelihood of PONV, but not PDNV or PONV plus PDNV. CONCLUSIONS Patients experiencing N/V in the PACU are observed to develop PDNV disproportionately by a factor of 2.79. The patients have distinct predictors, indicating important opportunities for care improvements beyond current guidelines.
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Affiliation(s)
- Mark Xiao
- Department of Anesthesiology, Massachusetts Eye and Ear (MEE), 243 Charles St., Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Dongdong Yao
- Department of Anesthesiology, Massachusetts Eye and Ear (MEE), 243 Charles St., Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Brigham and Women's Hospital (BWH), 75 Francis St., Boston, MA, 02115, USA
| | - Kara G Fields
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Brigham and Women's Hospital (BWH), 75 Francis St., Boston, MA, 02115, USA
| | - Pankaj Sarin
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Brigham and Women's Hospital (BWH), 75 Francis St., Boston, MA, 02115, USA
| | - Alvaro Andres Macias
- Department of Anesthesiology, Massachusetts Eye and Ear (MEE), 243 Charles St., Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Brigham and Women's Hospital (BWH), 75 Francis St., Boston, MA, 02115, USA
| | - Sunil Eappen
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Brigham and Women's Hospital (BWH), 75 Francis St., Boston, MA, 02115, USA
| | - Jeremy Juang
- Department of Anesthesiology, Massachusetts Eye and Ear (MEE), 243 Charles St., Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA.
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25
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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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26
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Roh YH, Park SG, Lee SH. Regional versus General Anesthesia in Postoperative Pain Management after Distal Radius Fracture Surgery: Meta-Analysis of Randomized Controlled Trials. J Pers Med 2023; 13:1543. [PMID: 38003859 PMCID: PMC10671853 DOI: 10.3390/jpm13111543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Distal radius fractures are the most prevalent upper extremity fractures, posing a significant public health concern. Recent studies comparing regional and general anesthesia for postoperative pain management after these fractures have yielded conflicting results. This meta-analysis aimed to compare the effectiveness of regional and general anesthesia concerning postoperative pain management and opioid consumption following distal radius fracture surgery. A comprehensive search was conducted in PubMed, Cochrane Library, and EMBASE databases to identify relevant randomized controlled trials. Four randomized trials involving 248 participants were included in the analysis. A pooled analysis revealed that regional anesthesia led to significantly reduced postoperative pain scores at 2 h compared to general anesthesia (SMD -2.03; 95% CI -2.88--1.17). However, no significant differences in pain scores were observed between the two anesthesia types after 12 h post-surgery. Regional anesthesia was associated with lower total opioid consumption (SMD -0.76; 95% CI -1.25--0.26) and fewer occurrences of nausea and vomiting compared to the general anesthesia. Nonetheless, opioid consumption on the first day post-discharge was significantly higher in the regional anesthesia group (SMD 0.83; 95% CI 0.47-1.20). The analgesic superiority of regional anesthesia is confined to the early postoperative hours with overall lower opioid use but a notable increase in opioid consumption on the first day post-discharge, potentially attributable to rebound pain.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea; (S.G.P.); (S.H.L.)
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27
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Vittori A, Tritapepe L, Chiusolo F, Rossetti E, Cascella M, Petrucci E, Pedone R, Marinangeli F, Francia E, Mascilini I, Marchetti G, Picardo SG. Unplanned admissions after day-case surgery in an Italian third-level pediatric hospital: a retrospective study. Perioper Med (Lond) 2023; 12:53. [PMID: 37752610 PMCID: PMC10523757 DOI: 10.1186/s13741-023-00342-y] [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: 04/29/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Increasing procedures in day-case surgery can mitigate the costs of health service, without reducing safety and quality standards. The Ospedale Pediatrico Bambino Gesù has adopted an educational program for healthcare personnel and patients' families to increase the number of day-case surgery procedures performed without reducing the level of safety. The unplanned admission rate after day-case surgery can be a quality benchmark for pediatric day-case surgery, and in literature, there are no Italian data. METHODS We made a retrospective analysis of the hospital database and focused on children requiring unplanned admission to the central venue of the hospital for the night. The audit covered the period from September 2012 to April 2018. RESULTS We performed general anesthesia for 8826 procedures (urology 33.60%, plastic surgery 30.87%, general surgery 17.44%, dermatology 11.66%, dentistry 3.16%, orthopedics 1.64%, digestive endoscopy 1.63%). Unplanned admission for anesthetic reasons resulted in two cases: one case of syncope and one case of vomit (0.023% rate). No one major complication. CONCLUSIONS Good quality of patient selection, the safety of the structure, family education, and an efficient organizational model combined with an educational program for anesthesiologists can improve the safety of anesthesia for day-case surgery.
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Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Luigi Tritapepe
- Department of Anesthesiology, Critical Care, and Pain Medicine, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
- Unit of Anesthesia and Intensive Care, Sapienza University, Piazzale Aldro Moro 5 00185, Rome, Italy
| | - Fabrizio Chiusolo
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Emanuele Rossetti
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, Via Lorenzo Natali, 1, 67100, Coppito, L'Aquila, Italy
| | - Roberto Pedone
- Department of Psychology, University of Campania Luigi Vanvitelli, Viale Abramo Lincoln, 5, 81100, Caserta, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, , L'Aquila, Piazzale Salvatore Tommasi, 1, 67100, Coppito, AQ, Italy
| | - Elisa Francia
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Ilaria Mascilini
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Giuliano Marchetti
- Surgery Unit, Bios Medical Center, Via Domenico Chelini, 39, 00197, Rome, Italy
| | - Sergio Giuseppe Picardo
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
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28
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Coppens M, Steenhout A, De Baerdemaeker L. Adjuvants for balanced anesthesia in ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37:409-420. [PMID: 37938086 DOI: 10.1016/j.bpa.2022.12.003] [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: 11/28/2022] [Revised: 12/15/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023]
Abstract
Balanced anesthesia relies on the simultaneous administration of different drugs to attain an anesthetic state. The classic triad of anesthesia is a combination of a hypnotic, an analgesic, and a neuromuscular blocker. It is predominantly the analgesic pillar of this triad that became more and more supported by adjuvant therapy. The aim of this approach is to evolve into an opioid-sparing technique to cope with undesirable side effects of the opioids and is fueled by the opioid epidemic. The optimal strategy for balanced general anesthesia in ambulatory surgery must aim for a transition to a multimodal analgesic regimen dealing with acute postoperative pain and ideally reduce the most common adverse effects patients are faced with at home; sore throat, delayed awakening, memory disturbances, headache, nausea and vomiting, and negative behavioral changes. Over the years, this continuum of "multimodal general anesthesia" adopted many drugs with different modes of action. This review focuses on the most recent evidence on the different adjuvants that entered clinical practice and gives an overview of the different mechanisms of action, the potential as opioid-sparing or hypnotic-sparing drugs, and the applicability specifically in ambulatory surgery.
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Affiliation(s)
- Marc Coppens
- University Hospital Ghent, Belgium, Faculty of Medicine and Health Sciences, Department of Basic and Applied Medical Sciences, University Ghent, Belgium.
| | - Annelien Steenhout
- Department of Anesthesiology and Perioperative Medicine, University Hospital, Ghent, Belgium.
| | - Luc De Baerdemaeker
- University Hospital Ghent, Belgium, Faculty of Medicine and Health Sciences, Department of Basic and Applied Medical Sciences, University Ghent, Belgium.
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29
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Bloc S, Alfonsi P, Belbachir A, Beaussier M, Bouvet L, Campard S, Campion S, Cazenave L, Diemunsch P, Di Maria S, Dufour G, Fabri S, Fletcher D, Garnier M, Godier A, Grillo P, Huet O, Joosten A, Lasocki S, Le Guen M, Le Saché F, Macquer I, Marquis C, de Montblanc J, Maurice-Szamburski A, Nguyen YL, Ruscio L, Zieleskiewicz L, Caillard A, Weiss E. Guidelines on perioperative optimization protocol for the adult patient 2023. Anaesth Crit Care Pain Med 2023; 42:101264. [PMID: 37295649 DOI: 10.1016/j.accpm.2023.101264] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The French Society of Anesthesiology and Intensive Care Medicine [Société Française d'Anesthésie et de Réanimation (SFAR)] aimed at providing guidelines for the implementation of perioperative optimization programs. DESIGN A consensus committee of 29 experts from the SFAR was convened. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Four fields were defined: 1) Generalities on perioperative optimization programs; 2) Preoperative measures; 3) Intraoperative measures and; 4) Postoperative measures. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (population, intervention, comparison, and outcomes). Based on these questions, an extensive bibliographic search was carried out using predefined keywords according to PRISMA guidelines and analyzed using the GRADE® methodology. The recommendations were formulated according to the GRADE® methodology and then voted on by all the experts according to the GRADE grid method. As the GRADE® methodology could have been fully applied for the vast majority of questions, the recommendations were formulated using a "formalized expert recommendations" format. RESULTS The experts' work on synthesis and application of the GRADE® method resulted in 30 recommendations. Among the formalized recommendations, 19 were found to have a high level of evidence (GRADE 1±) and ten a low level of evidence (GRADE 2±). For one recommendation, the GRADE methodology could not be fully applied, resulting in an expert opinion. Two questions did not find any response in the literature. After two rounds of rating and several amendments, strong agreement was reached for all the recommendations. CONCLUSIONS Strong agreement among the experts was obtained to provide 30 recommendations for the elaboration and/or implementation of perioperative optimization programs in the highest number of surgical fields.
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Affiliation(s)
- Sébastien Bloc
- Clinical Research Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, France; Department of Anesthesiology, Clinique Drouot Sport, Paris, France.
| | - Pascal Alfonsi
- Department of Anesthesia, University of Paris Descartes, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, F-75674 Paris Cedex 14, France
| | - Anissa Belbachir
- Service d'Anesthésie Réanimation, UF Douleur, Assistance Publique Hôpitaux de Paris, APHP.Centre, Site Cochin, Paris, France
| | - Marc Beaussier
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Lionel Bouvet
- Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | | | - Sébastien Campion
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie-Réanimation, F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France
| | - Laure Cazenave
- Department of Anaesthesia and Critical Care, Hospices Civils de Lyon, Lyon, France; Groupe Jeunes, French Society of Anaesthesia and Intensive Care Medicine (SFAR), 75016 Paris, France
| | - Pierre Diemunsch
- Unité de Réanimation Chirurgicale, Service d'Anesthésie-réanimation Chirurgicale, Pôle Anesthésie-Réanimations Chirurgicales, Samu-Smur, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, Avenue Molière, 67098 Strasbourg Cedex, France
| | - Sophie Di Maria
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Guillaume Dufour
- Service d'Anesthésie-Réanimation, CHU de Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75013 Paris, France
| | - Stéphanie Fabri
- Faculty of Economics, Management & Accountancy, University of Malta, Malta
| | - Dominique Fletcher
- Université de Versailles-Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise-Paré, Service d'Anesthésie, 9, Avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Marc Garnier
- Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire Rive Droite, Paris, France
| | - Anne Godier
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, France
| | | | - Olivier Huet
- CHU de Brest, Anesthesia and Intensive Care Unit, Brest, France
| | - Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Villejuif, France
| | | | - Morgan Le Guen
- Paris Saclay University, Department of Anaesthesia and Pain Medicine, Foch Hospital, 92150 Suresnes, France
| | - Frédéric Le Saché
- Department of Anesthesiology, Clinique Drouot Sport, Paris, France; DMU DREAM Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Isabelle Macquer
- Bordeaux University Hospitals, Bordeaux, Anaesthesia and Intensive Care Medicine Department, Bordeaux, France
| | - Constance Marquis
- Clinique du Sport, Département d'Anesthésie et Réanimation, Médipole Garonne, 45 rue de Gironis - CS 13 624, 31036 Toulouse Cedex 1, France
| | - Jacques de Montblanc
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Yên-Lan Nguyen
- Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France
| | - Laura Ruscio
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France; INSERM U 1195, Université Paris-Saclay, Saint-Aubin, Île-de-France, France
| | - Laurent Zieleskiewicz
- Service d'Anesthésie Réanimation, Hôpital Nord, AP-HM, Marseille, Aix Marseille Université, C2VN, France
| | - Anaîs Caillard
- Centre Hospitalier Universitaire La Cavale Blanche Université de Bretagne Ouest, Anaesthesiology, Critical Care and Perioperative Medicine Department, Brest, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP, Nord, Clichy, France; University of Paris, Paris, France; Inserm UMR_S1149, Centre for Research on Inflammation, Paris, France
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He B, Zhang N, Peng M. Meta-analysis of the effect of entropy-assisted general anesthesia on the quality of postoperative recovery. Medicine (Baltimore) 2023; 102:e34091. [PMID: 37352057 PMCID: PMC10289486 DOI: 10.1097/md.0000000000034091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/27/2023] [Accepted: 04/06/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND To evaluate the effect of the quality of postoperative anesthetic resuscitation in patients with entropy index monitoring assisted general anesthesia versus standard clinical practice. METHODS The randomized controlled trials on the application of entropy index monitoring in general anesthesia were searched in PubMed, Web of Science, Embase, The Cochrane Library, CNKI, Wanfang, VIP, and other databases by computer. The data were collected from inception to January 2022. Two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria and used Cochrane's risk-of-bias assessment criteria to evaluate the quality of the literature. The evaluation indicators included respiratory recovery time, extubation time, consciousness recovery time, emergence agitation, postoperative nausea and vomiting (PONV), and intraoperative awareness. The RevMan 5.4.1 software was used for the meta-analysis of the data. RESULTS A total of 860 patients from 10 eligible randomized controlled trials were included in this study. The results showed that compared with the control group, the respiratory recovery time (MD = -3.37, 95% CI: -5.09 to -1.85, P < .0001), extubation time (MD = -4.57, 95% CI: -6.08 to -3.95, P < .00001), and consciousness recovery time (MD = -4.95, 95% CI: -7.21 to -2.70, P < .00001) in the entropy index group were significantly shortened. The incidence of emergence agitation in the entropy index group (RR = 0.23, 95% CI: 0.11-0.47, P < .0001) decreased significantly. The incidence of PONV (RR = 0.46, 95% CI: 0.27-0.79, P = .004) was significantly reduced. However, the incidence of intraoperative awareness (RR = 0.33, 95% CI: 0.04-3.16, P = .34) wasn't significantly different. CONCLUSION The application of the entropy index can improve the recovery quality of patients under general anesthesia, not only shortening the postoperative recovery time but also reducing the occurrence of agitation and PONV. It does not affect the incidence of intraoperative awareness.
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Affiliation(s)
- Bingyuan He
- Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Na Zhang
- Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Mingqing Peng
- Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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Ioannidis O, Ramirez JM, Ubieto JM, Feo CV, Arroyo A, Kocián P, Sánchez-Guillén L, Bellosta AP, Whitley A, Enguita AB, Teresa M, Anestiadou E. The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol for Bowel Obstruction: Recommendations for Perioperative Care. J Clin Med 2023; 12:4185. [PMID: 37445224 PMCID: PMC10342611 DOI: 10.3390/jcm12134185] [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: 04/26/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
Mechanical bowel obstruction is a common symptom for admission to emergency services, diagnosed annually in more than 300,000 patients in the States, from whom 51% will undergo emergency laparotomy. This condition is associated with serious morbidity and mortality, but it also causes a high financial burden due to long hospital stay. The EUPEMEN project aims to incorporate the expertise and clinical experience of national clinical specialists into development of perioperative rehabilitation protocols. Providing special recommendations for all aspects of patient perioperative care and the participation of diverse specialists, the EUPEMEN protocol for bowel obstruction, as presented in the current paper, aims to provide faster postoperative recovery and reduce length of hospital stay, postoperative morbidity and mortality rate.
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Affiliation(s)
- Orestis Ioannidis
- Fourth Department of Surgery, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece
| | - Jose M. Ramirez
- Institute for Health Research Aragón, 50009 Zaragoza, Spain; (J.M.R.); (J.M.U.); (A.P.B.); (M.T.)
- Department of Surgery, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Javier Martínez Ubieto
- Institute for Health Research Aragón, 50009 Zaragoza, Spain; (J.M.R.); (J.M.U.); (A.P.B.); (M.T.)
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Carlo V. Feo
- Department of Surgery, Azienda Unità Sanitaria Locale Ferrara—University of Ferrara, 44121 Ferrara, Italy;
| | - Antonio Arroyo
- Department of Surgery, Universidad Miguel Hernández Elche, Hospital General Universitario Elche, 03203 Elche, Spain; (A.A.); (L.S.-G.)
| | - Petr Kocián
- Department of Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic;
| | - Luis Sánchez-Guillén
- Department of Surgery, Universidad Miguel Hernández Elche, Hospital General Universitario Elche, 03203 Elche, Spain; (A.A.); (L.S.-G.)
| | - Ana Pascual Bellosta
- Institute for Health Research Aragón, 50009 Zaragoza, Spain; (J.M.R.); (J.M.U.); (A.P.B.); (M.T.)
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Adam Whitley
- Department of Surgery, University Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic;
| | | | - Marta Teresa
- Institute for Health Research Aragón, 50009 Zaragoza, Spain; (J.M.R.); (J.M.U.); (A.P.B.); (M.T.)
| | - Elissavet Anestiadou
- Fourth Department of Surgery, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece
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Moraitis A, Myrberg T, Hultin M, Nyström H, Walldén J. Palonosetron as prophylaxis for post-discharge nausea and vomiting: a prospective, randomised, double-blind, placebo-controlled trial in ambulatory surgery. Br J Anaesth 2023:S0007-0912(23)00227-1. [PMID: 37246062 DOI: 10.1016/j.bja.2023.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/31/2023] [Accepted: 04/27/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Approximately 25% of ambulatory surgery patients experience post-discharge nausea and vomiting (PDNV). We aimed to investigate whether palonosetron, a long-acting anti-emetic, decreases the incidence of PDNV in high-risk patients. METHODS In this prospective, randomised, double-blind, placebo-controlled trial, 170 male and female patients undergoing ambulatory surgery under general anaesthesia, with a high predicted risk for PDNV, were randomised to receive either palonosetron 75 μg i.v. (n=84) or normal saline (n=86) before discharge. During the first 3 postoperative days (PODs), we measured outcomes using a patient questionnaire. The primary outcome was the incidence of a complete response (no nausea, vomiting, or use of rescue medication) until POD 2. Secondary outcomes included the incidence of PDNV each day until POD 3. RESULTS The incidence of a complete response until POD 2 was 48% (n=32) in the palonosetron group and 36% (n=25) in the placebo group (odds ratio 1.69 [95% confidence interval: 0.85-3.37]; P=0.131). No significant difference in the incidence of PDNV was observed between the two groups on the day of surgery (47% vs 56%; P=0.31). Significant differences in the incidence of PDNV were found on POD 1 (18% vs 34%; P=0.033) and POD 2 (9% vs 27%; P=0.007). No differences were observed on POD 3 (15% vs 13%; P=0.700). CONCLUSIONS Compared with placebo, palonosetron did not reduce the overall incidence of PDNV up to POD 2. The lower incidence of PDNV on POD 1 and POD 2 in the palonosetron group requires further investigation. CLINICAL TRIAL REGISTRATION EudraCT 2015-003956-32.
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Affiliation(s)
- Antonio Moraitis
- Department of Surgical and Perioperative Sciences (Sundsvall), Faculty of Medicine, Umeå University, Umeå, Sweden.
| | - Tomi Myrberg
- Department of Surgical and Perioperative Sciences (Sunderbyn), Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences (Umeå), Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Helena Nyström
- Department of Surgical and Perioperative Sciences (Umeå), Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Jakob Walldén
- Department of Surgical and Perioperative Sciences (Sundsvall), Faculty of Medicine, Umeå University, Umeå, Sweden
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Frelich M, Vodicka V, Jor O, Bursa F, Formanek M, Sklienka P, Prochazka V. Postdischarge nausea and vomiting (PDNV) in children: A review and observational study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023. [PMID: 37222143 DOI: 10.5507/bp.2023.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Postdischarge nausea and vomiting (PDNV) cause substantial pediatric morbidity with potentially serious postoperative complications. However, few studies have addressed PDNV prevention and treatment in pediatric patients. Here we searched the literature and processed it in a narrative review describing PDNV incidence, risk factors, and management in pediatric patients.. A successful strategy for reducing PDNV considers both the pharmacokinetics of the antiemetic agents and the principle of multimodal prophylaxis, utilizing agents of different pharmacologic classes. Since many highly effective antiemetic agents have relatively short half-lives, a different approach must be used to prevent PDNV. A combination of oral and intravenous medications with longer half-lives, such as palonosetron or aprepitant, can be used. In addition, we designed a prospective observational study with the primary objective of determining PDNV incidence. In our study group of 205 children, the overall PDNV incidence was 14.6% (30 of 205), including 21 children suffering from nausea and 9 suffering from vomiting.
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Affiliation(s)
- Michal Frelich
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czech Republic
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Vojtech Vodicka
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czech Republic
| | - Ondrej Jor
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czech Republic
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Filip Bursa
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czech Republic
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Martin Formanek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Ostrava, Czech Republic
| | - Peter Sklienka
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czech Republic
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Vaclav Prochazka
- Radiodiagnostic Institute, University Hospital of Ostrava, Czech Republic
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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: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [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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Xie M, Deng Y, Wang Z, He Y, Wu X, Zhang M, He Y, Liang Y, Li T. Development and assessment of novel machine learning models to predict the probability of postoperative nausea and vomiting for patient-controlled analgesia. Sci Rep 2023; 13:6439. [PMID: 37081130 PMCID: PMC10119140 DOI: 10.1038/s41598-023-33807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/19/2023] [Indexed: 04/22/2023] Open
Abstract
Postoperative nausea and vomiting (PONV) can lead to various postoperative complications. The risk assessment model of PONV is helpful in guiding treatment and reducing the incidence of PONV, whereas the published models of PONV do not have a high accuracy rate. This study aimed to collect data from patients in Sichuan Provincial People's Hospital to develop models for predicting PONV based on machine learning algorithms, and to evaluate the predictive performance of the models using the area under the receiver characteristic curve (AUC), accuracy, precision, recall rate, F1 value and area under the precision-recall curve (AUPRC). The AUC (0.947) of our best machine learning model was significantly higher than that of the past models. The best of these models was used for external validation on patients from Chengdu First People's Hospital, and the AUC was 0.821. The contributions of variables were also interpreted using SHapley Additive ExPlanation (SHAP). A history of motion sickness and/or PONV, sex, weight, history of surgery, infusion volume, intraoperative urine volume, age, BMI, height, and PCA_3.0 were the top ten most important variables for the model. The machine learning models of PONV provided a good preoperative prediction of PONV for intravenous patient-controlled analgesia.
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Affiliation(s)
- Min Xie
- Laboratory of Mitochondria and Metabolism, Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Yan Deng
- Laboratory of Mitochondria and Metabolism, Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zuofeng Wang
- Department of Anesthesiology, Chengdu First People's Hospital, Chengdu, Sichuan, 610017, People's Republic of China
| | - Yanxia He
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Xingwei Wu
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, 610072, People's Republic of China
| | - Meng Zhang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Yao He
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Yu Liang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Tao Li
- Laboratory of Mitochondria and Metabolism, Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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Thiel B, Godfried MB, van Emst ME, Vernooij LM, van Vliet LM, Rumke E, van Dongen RTM, Gerrits W, Koopman JSHA, Kalkman CJ. Quality of recovery after day care surgery with app-controlled remote monitoring: study protocol for a randomized controlled trial. Trials 2023; 24:102. [PMID: 36759858 PMCID: PMC9909143 DOI: 10.1186/s13063-023-07121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/28/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The majority of surgical interventions are performed in day care and patients are discharged after the first critical postoperative period. At home, patients have limited options to contact healthcare providers in the hospital in case of severe pain and nausea. A smartphone application for patients to self-record pain and nausea when at home after day care surgery might improve patient's recovery. Currently patient experiences with smartphone applications are promising; however, we do not know whether remote monitoring with such an application also improves the patient's recovery. This study aims to evaluate the experienced quality of recovery after day care surgery between patients provided with the smartphone application for remote monitoring and patients receiving standard care without remote monitoring. METHODS This non-blinded randomized controlled trial with mixed methods design will include 310 adult patients scheduled for day care surgery. The intervention group receives the smartphone application with text message function for remote monitoring that enables patients to record pain and nausea. An anaesthesia professional trained in empathetic communication, who will contact the patient in case of severe pain or nausea, performs daily monitoring. The control group receives standard care, with post-discharge verbal and paper instructions. The main study endpoint is the difference in perceived quality of recovery, measured with the QoR-15 questionnaire on the 7th day after day care surgery. Secondary endpoints are the overall score on the Quality of Recovery-15 at day 1, 4 and 7-post discharge, the perceived quality of hospital aftercare and experienced psychological effects of remote monitoring during postoperative recovery from day care surgery. DISCUSSION This study will investigate if facilitating patients and healthcare professionals with a tool for accessible and empathetic communication might lead to an improved quality of the postoperative recovery period. TRIAL REGISTRATION The 'Quality of recovery after day care surgery with app-controlled remote monitoring: a randomized controlled trial' is approved and registered on 23 February 2022 by Research Ethics Committees United with registration number R21.076/NL78144.100.21. The protocol NL78144.100.21, 'Quality of recovery after day care surgery with app-controlled remote monitoring: a randomized controlled trial', is registered at the ClinicalTrials.gov public website (registration date 16 February 2022; NCT05244772).
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Affiliation(s)
- B. Thiel
- grid.440209.b0000 0004 0501 8269Department of Anaesthesiology, OLVG Hospital (Oost), Amsterdam, 1090 HM the Netherlands
| | - M. B. Godfried
- grid.440209.b0000 0004 0501 8269Department of Anaesthesiology, OLVG Hospital (Oost), Amsterdam, 1090 HM the Netherlands
| | - M. E. van Emst
- grid.440209.b0000 0004 0501 8269Department of Anaesthesiology, OLVG Hospital (Oost), Amsterdam, 1090 HM the Netherlands
| | - L. M. Vernooij
- grid.7692.a0000000090126352Department of Anaesthesia and Intensive Care, University Medical Centre Utrecht (UMCU), Utrecht, 3508 GA The Netherlands
| | - L. M. van Vliet
- grid.5132.50000 0001 2312 1970University Leiden, Wassenaarseweg 52, Leiden, 233 AK the Netherlands
| | - E. Rumke
- grid.5132.50000 0001 2312 1970University Leiden, Wassenaarseweg 52, Leiden, 233 AK the Netherlands
| | - R. T. M. van Dongen
- grid.413327.00000 0004 0444 9008Department of Anaesthesiology, Canisius Wilhelmina Hospital (CWZ), Weg door Jonkerbos 100, Nijmegen, 6532 SZ The Netherlands
| | - W. Gerrits
- grid.413327.00000 0004 0444 9008Department of Anaesthesiology, Canisius Wilhelmina Hospital (CWZ), Weg door Jonkerbos 100, Nijmegen, 6532 SZ The Netherlands
| | - J. S. H. A. Koopman
- Department of Anaesthesiology, Maasstad Ziekenhuis, Maasstadweg 21, Rotterdam, 3079 DZ The Netherlands
| | - C. J. Kalkman
- grid.7692.a0000000090126352Department of Anaesthesia and Intensive Care, University Medical Centre Utrecht (UMCU), Utrecht, 3508 GA The Netherlands
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Ishikawa E, Hojo T, Shibuya M, Teshirogi T, Hashimoto K, Kimura Y, Fujisawa T. Risk factors for postoperative nausea and vomiting in patients of orthognathic surgery according to the initial onset time: a cross-sectional study. J Dent Anesth Pain Med 2023; 23:29-37. [PMID: 36819607 PMCID: PMC9911960 DOI: 10.17245/jdapm.2023.23.1.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
Background A high incidence (40-73%) of postoperative nausea and vomiting (PONV) has been reported following orthognathic surgery, and various risk factors have been associated with it. Identifying PONV risk factors based on initial onset time will help establish preventive measures. This study aimed to identify factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. Methods This study included 590 patients who underwent orthognathic surgery. Multivariate logistic regression analysis was performed to identify the risk factors that are significantly related to PONV. The objective variables were classified into three categories: no PONV, early PONV (initial onset time: 0-2 h after anesthesia), and late PONV (initial onset time: 2-24 h after anesthesia). The explanatory variables included relevant risk factors for PONV, as considered in previous studies. Results Total intravenous anesthesia with propofol was a significant depressant factor for early PONV (adjusted odds ratio [aOR] = 0.340, 95% confidence interval [CI] = 0.209-0.555) and late PONV (aOR = 0.535, 95% CI = 0.352-0.814). The administration of a combination of intraoperative antiemetics (vs. no administration) significantly reduced the risk of early PONV (aOR = 0.464, 95% CI = 0.230-0.961). Female sex and young age were significant risk factors for late PONV (aOR = 1.492, 95% CI = 1.170-1.925 and unit aOR = 1.033, 95% CI = 1.010-1.057, respectively). Conclusion We identified factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. Total intravenous anesthesia with propofol significantly reduced the risk of PONV not only in the early period (0-2 h after anesthesia) but also in the late period (2-24 h after anesthesia).
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Affiliation(s)
- Emi Ishikawa
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Hojo
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Makiko Shibuya
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Takahito Teshirogi
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Keiji Hashimoto
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yukifumi Kimura
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiaki Fujisawa
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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Schlesinger T, Meybohm P, Kranke P. Postoperative nausea and vomiting: risk factors, prediction tools, and algorithms. Curr Opin Anaesthesiol 2023; 36:117-123. [PMID: 36550611 DOI: 10.1097/aco.0000000000001220] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Postoperative/postdischarge nausea and vomiting (PONV/PDNV) remain relevant issues in perioperative care. Especially in ambulatory surgery, PONV can prevent discharge or lead to unplanned readmission. RECENT FINDINGS The evidence for the management of PONV is now quite good but is still inadequately implemented. A universal, multimodal rather than risk-adapted approach for PONV prophylaxis is now recommended. The evidence on PDNV is insufficient. SUMMARY PDNV management is based primarily on consequent prophylaxis and therapy of PONV.
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Affiliation(s)
- Tobias Schlesinger
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
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Lee S, You AH, Kim M, Kang HY. Postoperative Nausea and Vomiting According to Target-Controlled or Manual Remifentanil Infusion in Gynecological Patients Undergoing Pelviscopic Surgery: A Randomized Controlled Trial. J Pers Med 2023; 13:jpm13020176. [PMID: 36836410 PMCID: PMC9966727 DOI: 10.3390/jpm13020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/08/2023] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We compared the incidence of postoperative nausea and vomiting (PONV) and postoperative outcomes, according to the remifentanil infusion method, during surgery in patients with a high-risk of PONV. METHODS Ninety patients undergoing elective gynecological pelviscopic surgery were randomly allocated to either target-controlled infusion (TCI, T) or manual (M) infusion. The primary outcome was the incidence of PONV until postoperative day (POD) 2. The secondary outcomes were perioperative heart rate (HR), blood pressure (BP), numerical rating scale pain scores up to POD2, and postoperative hospital length of stay. RESULTS Forty-four patients in the T group and 45 patients in the M group were analyzed. The total dose of remifentanil infusion was significantly higher in the T group (T group: 0.093 (0.078-0.112) μg/kg/min; M group: 0.062 (0.052-0.076) µg/kg/min, p < 0.001). Within POD2, the overall PONV was not significantly different (27 (61.4%) vs. 27 (60.0%), p = 0.895). The HR (82 ± 11.5/min vs. 87 ± 11.1/min, p = 0.046) and mean BP (83 ± 17.2 mmHg vs. 90 ± 16.7 mmHg, p = 0.035) were significantly lower in the T group after tracheal intubation. The other postoperative outcomes were comparable between the two groups. CONCLUSIONS Although the total remifentanil infusion dose was higher in the T group than in the M group, the postoperative outcomes were similar. If stable vital signs are desired during tracheal intubation, remifentanil infusion with TCI should be considered.
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Affiliation(s)
| | | | | | - Hee Yong Kang
- Correspondence: ; Tel.: +82-2-958-8589; Fax: +82-2-958-8580
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Erdogan-Ongel E, Heung Y, Rozman de Moraes A, Geng Y, Bruera E. Inhalation of Isopropyl Alcohol for the Management of Nausea and Vomiting: A Systematic Review. J Palliat Med 2023; 26:94-100. [PMID: 36178929 DOI: 10.1089/jpm.2022.0332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: The use of inhaled isopropyl alcohol (IPA) has been proposed as a therapeutic intervention for the relief of nausea in various settings. The objective of this systematic review was to evaluate the existing evidence for the use of inhaled IPA in the management of nausea and vomiting. Methods: We performed a literature search on Medline, EMBASE, Web of Science, Scopus, CINAHL, PsycInfo, and Cochrane Library databases before November 2021. The following concepts were searched using subject headings and keywords as needed "aromatherapy," "alcohol," "ethylic alcohol," "ethanol," "isopropyl alcohol," "emesis," "chemotherapy-induced," "pregnancy," "hyperemesis gravidarum," "motion sickness," "emetics," "antiemetics," "inhalation," and "inhale." Searches were not limited to a specific language. The bibliographies of identified articles were also manually searched. Two authors independently assessed the included studies for risk of bias. Results: Thirteen randomized controlled trials out of 158 studies identified met the inclusion criteria, with a total of 1253 participants. Twelve studies were conducted in the postoperative anesthesia care unit and two studies were performed in the emergency department setting. Four studies were double blinded, one was single blind, and eight were open label. Three studies assessed the use of inhaled IPA for prevention, whereas 10 studies evaluated its use in the treatment of nausea and vomiting. Seven studies reported IPA to be more effective, four studies reported no difference, and two studies reported IPA to be ineffective. Participant satisfaction was high overall, regardless of intervention received. No adverse effects were reported. The overall quality of evidence was low. Conclusion: There is a lack of strong evidence to support the use of inhaled IPA in the management of nausea and vomiting. Additional trials are warranted to confirm this finding and to further explore the use of inhaled IPA in various populations and settings.
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Affiliation(s)
- Elif Erdogan-Ongel
- Department of Anesthesiology and Reanimation, Sancaktepe Martyr Prof. Dr. Ilhan Varank Education and Research Hospital, Istanbul, Turkey
| | - Yvonne Heung
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aline Rozman de Moraes
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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[Postoperative nausea and vomiting-recommendations for its prevention and therapy in paediatric medicine]. DIE ANAESTHESIOLOGIE 2023; 72:37-47. [PMID: 36602557 DOI: 10.1007/s00101-022-01248-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Post-operative nausea and/or vomiting (PONV/POV) are among the biggest problems occurring in the paediatric recovery room and in the course of the following post-operative period. Apart from pain and emergence delirium, PONV is one of the main causes of post-operative discomfort in children. The DGAI Scientific Working Group on Paediatric Anaesthesia already worked out recommendations for the prevention and treatment of PONV in children years ago. These recommendations have now been revised by a team of experts, the current literature has been reviewed, and evidence-based core recommendations have been consented. Key elements of the new recommendations consist of effective individual measures for prevention and therapy, next to the implementation of a fixed dual prophylaxis in the clinical routine applicable to all children ≥ 3 years of age.
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Gan TJ, Jin Z, Meyer TA. Rescue Treatment of Postoperative Nausea and Vomiting: A Systematic Review of Current Clinical Evidence. Anesth Analg 2022; 135:986-1000. [PMID: 36048730 DOI: 10.1213/ane.0000000000006126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although prophylactic antiemetics are commonly used perioperatively, an estimated 30% of surgical patients still suffer from postoperative nausea and vomiting (PONV). Very few prospective trials have studied rescue treatment of PONV after failure of prophylaxis, providing limited evidence to support clinical management. In patients who have failed PONV prophylaxis, administering a rescue antiemetic from the same drug class has been reported to be ineffective. For many antiemetics currently used in PONV rescue, significant uncertainty remains around the effective dose range, speed of onset, duration of effect, safety, and overall risk-benefit ratio. As prompt, effective PONV rescue after failure of prophylaxis is important to optimize postoperative recovery and resource utilization, we conduct this systematic review to summarize the current evidence available on the topic.
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Affiliation(s)
- Tong J Gan
- From the Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, New York
| | - Zhaosheng Jin
- From the Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, New York
| | - Tricia A Meyer
- Department of Anesthesiology, Texas A&M College of Medicine, Temple, Texas
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Al Sadah ZM, Alfaraj NH, AlAlwan NE, Al Dhaif LH, Khidr AM, Fallatah SM. Assessment of patients' satisfaction with the postanesthesia care unit service at University Hospital in Al Khobar, KSA. J Taibah Univ Med Sci 2022; 18:217-224. [PMID: 36817216 PMCID: PMC9926208 DOI: 10.1016/j.jtumed.2022.09.012] [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: 05/27/2022] [Revised: 07/06/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives The quality of health care is individually and subjectively reflected through patients' level of satisfaction, as well as the optimality and effectiveness of the provided postoperative pain management. The provision of postanesthesia care unit (PACU) service in hospitals has led to overall positive outcomes, in addition to the enhancement of patients' satisfaction with the provided pain management service. This study assessed patients' level of satisfaction with PACU service at a university hospital and discussed different factors that might have contributed to the level of satisfaction. Methods A prospective cross-sectional study was carried out among patients after being discharged from PACU. The study took place at King Fahad Hospital of the University in Al Khobar, KSA between November 2021 and February 2022. The data were collected using a three-section predesigned questionnaire. Results Two hundred patients were included in this study. Nearly all patients (95.5%) were satisfied with the provided pain management service. Almost all patients (99.5%) indicated that the PACU staff was courteous and professional during the entire pain management service. More patients complained about pain before using analgesia and this difference was statistically significant (Z = 8.642; p < 0.001). The satisfaction rate was significantly higher in the older age group (>45 years) (Z = 2.114; p = 0.035), in patients with American Society of Anesthesiology (ASA) 3 physical status (H = 13.130; p = 0.001), and those with a previous surgical history (Z = 2.139; p = 0.032). Conclusion This study concluded that the level of patients' satisfaction with PACU service was high, and established a statistically significant association with age, ASA score, and previous surgical history. Healthcare providers should consider patient education and effective communication to increase patients' satisfaction level and improve the overall quality of care.
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Key Words
- ASA, American Society of Anesthesiology
- Analgesia
- Anesthesia
- BMI, Body Mass Index
- GA, General anesthesia
- ICU, Intensive care unit
- IRB, Institutional Review Board (IRB)
- IV, Intravenous
- KFHU, King Fahad Hospital of the University
- OR, Operating room
- PACU, Postanesthesia care unit
- Patient satisfaction
- Postanesthesia care unit
- Preoperative education
- SCRELC, Standing Committee for Research Ethics on Living Creatures
- SPSS, Statistical Packages for Software Sciences
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Affiliation(s)
- Zhra M. Al Sadah
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, KSA,Corresponding address: Zhra Muneer Al Sadah, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, KSA.
| | - Noor H. Alfaraj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Noor E. AlAlwan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Lamees H. Al Dhaif
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Alaa M. Khidr
- Department of Anesthesia, King Fahad Hospital of the University, Al Khobar, KSA
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Yi F, Xiao H, Zhu T, Man Y, Ji F. Prevention of postoperative nausea and vomiting after gynaecological day surgery under remimazolam general anesthesia: a randomized double-blind controlled study. BMC Anesthesiol 2022; 22:292. [PMID: 36109691 PMCID: PMC9476338 DOI: 10.1186/s12871-022-01835-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To observe the effect of different antiemetic drugs for the prevention of postoperative nausea and vomiting (PONV) after gynaecological day surgery under remimazolam general anesthesia. Methods One hundred ninety-two patients were selected for gynaecological day surgery and randomly divided into three groups: droperidol group (DD group), tropisetron group (DT group) and control group (DC group). Flurbiprofen axetil 50 mg and dexamethasone 5 mg were given intravenously before induction of anesthesia, and 2 min later droperidol 1 mg was given intravenously to the DD group, tropisetron 5 mg to the DT group and saline (5 ml) to the DC group. Induction of anesthesia: remimazolam 6 mg/kg/h was continuously infused until sleep, mivacurium 0.2 mg/kg and alfentanil 20ug/kg were slowly pushed, 3 min later intubation was performed to control breathing. Maintenance of anesthesia: 40ug/kg/h of alfentanil, 1 mg/kg/h of remimazolam continuous infusion. After awakening and extubation, the patient was transferred to the PACU. PONV were recorded in the PACU and an electronic questionnaire was pushed 24 h after surgery. Results The incidence of PONV within the PACU was significantly lower in the DD (14.5%)and DT(26.7%) groups than in the DC(50%) group (p < 0.01), there was no significantly difference between the DT and DD groups. There were no significant difference in the incidence of PONV in 24 h after surgery between the three groups(DD:DT:DC = 44.5%:45.1%:63.8%,p > 0.05). Conclusions Droperidol or tropisetron combined with dexamethasone is superior to dexamethasone alone for the prevention of PONV in the PACU after remimazolam combined with alfentanil anesthesia, with no significant difference in the incidence of PONV in 24 h after surgery.
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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: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [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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Togioka BM, Schenning KJ. Optimizing Reversal of Neuromuscular Block in Older Adults: Sugammadex or Neostigmine. Drugs Aging 2022; 39:749-761. [PMID: 35934764 DOI: 10.1007/s40266-022-00969-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
Residual neuromuscular paralysis, the presence of clinically significant weakness after administration of pharmacologic neuromuscular blockade reversal, is associated with postoperative pulmonary complications and is more common in older patients. In contemporary anesthesia practice, reversal of neuromuscular blockade is accomplished with neostigmine or sugammadex. Neostigmine, an acetylcholinesterase inhibitor, increases the concentration of acetylcholine at the neuromuscular junction, providing competitive antagonism of neuromuscular blocking drug and facilitating muscle contraction. Sugammadex, a modified gamma-cyclodextrin, antagonizes neuromuscular blockade by encapsulating rocuronium and vecuronium in a one-to-one ratio for renal clearance, a pharmacokinetic property that led to the recommendation that sugammadex not be administered to those with end-stage renal disease. While data are limited, reports suggest sugammadex is efficacious and well tolerated in individuals with reduced renal function. Sugammadex provides a more rapid and complete reversal of neuromuscular blockade than neostigmine. There is also accumulating evidence that sugammadex may provide a protective effect against the development of postoperative pulmonary complications, nausea, and vomiting, and that it may have beneficial effects on the rate of bowel and bladder recovery after surgery. Accordingly, sugammadex administration is beneficial for most older patients undergoing surgery.
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Affiliation(s)
- Brandon M Togioka
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA. .,Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Mail Code: UHN-2, Portland, OR, 97239-3098, USA.
| | - Katie J Schenning
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
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Abstract
Enhanced recovery after surgery (ERAS) protocols are a set of interventions which are carried out in the preoperative and perioperative period. They are aimed to decrease the harmful effects of surgery on the body and help the patient recover better post-surgery. The effectiveness of ERAS has been well established in various other surgical specialities. Earlier spine surgery was thought to be very complex for application of ERAS protocols. However, this has changed over the last decade with (ERAS) protocols gaining widespread popularity in spine surgery. Initial studies involving ERAS in spine surgery were limited to lumbar spine. However, over the years the horizon of ERAS has expanded to include anterior cervical surgeries, spine deformity, spinal tumors and spine surgery in the elderly. ERAS has been shown to reduce the length of hospital stay, overall hospital costs, opioid consumption in perioperative and postoperative period and to lower complication rates in spine surgery. In this narrative review, we discuss various aspects of ERAS in spine surgery including the benefits of ERAS in spine surgery, the various components of preoperative, intraoperative and postoperative measures of ERAS protocol.
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Berlier J, Carabalona JF, Tête H, Bouffard Y, Le-Goff MC, Cerro V, Abrard S, Subtil F, Rimmelé T. Effects of opioid-free anesthesia on postoperative morphine consumption after bariatric surgery. J Clin Anesth 2022; 81:110906. [PMID: 35716634 DOI: 10.1016/j.jclinane.2022.110906] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES The objective of this study was to determine whether postoperative morphine requirement in obese patients undergoing laparoscopic bariatric surgery was reduced by opioid-free anesthesia (OFA), as compared to an anesthetic strategy using opioids (opioid balanced anesthesia (OBA)) and to investigate the differences that may exist between the use of clonidine and dexmedetomidine in the context of OFA. DESIGN Retrospective cohort study. SETTING Academic medical center in Lyon, France. PATIENTS 257 patients who underwent laparoscopic bariatric surgery between March 2017 and March 2019. 77 patients were included in the OBA group and 180 in the OFA group. The OFA group was subdivided in two: 90 patients received OFA with clonidine (OFAC) and 90 received OFA with dexmedetomidine (OFAD). MEASUREMENTS Proportion of patients who did not receive morphine during the first 24 postoperative hours. MAIN RESULTS During the first 24 postoperative hours, the proportion of patients who did not require morphine was significantly higher in the OFA (87%) than in the OBA (52%) group (OR: 6.31; 95% CI [3.38; 11.80], P < 0.001). This difference remained significant after adjustment for age, body mass index, sex, type and duration of surgery (OR: 7.99; 95% CI [4.05; 16.48], P < 0.001). A greater proportion of patients in the OFAD (93%) than in the OFAC group (81%, P = 0.026) did not receive morphine during the same period. CONCLUSIONS OFA is associated with a lower morphine requirement than with OBA during the first 24 h after bariatric surgery. In addition, OFAD seems to be more effective than OFAC in order to reduce morphine consumption.
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Affiliation(s)
- Jean Berlier
- Département d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Bron, France.
| | - Jean-François Carabalona
- Département d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Bron, France
| | - Hugo Tête
- Département d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Bron, France
| | - Yves Bouffard
- Département d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Bron, France
| | - Mary-Charlotte Le-Goff
- Département d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Bron, France
| | - Valérie Cerro
- Département d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Bron, France
| | - Stanislas Abrard
- Département d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Bron, France
| | - Fabien Subtil
- Hospices Civils de Lyon, Lyon, Service de Biostatistique, Lyon, France; Université Claude Bernard Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR, 5558, Villeurbanne, France
| | - Thomas Rimmelé
- Département d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Bron, France; EA 7426 Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
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Relationship between the Use of Fentanyl-Based Intravenous Patient-Controlled Analgesia and Clinically Significant Events in Laparoscopic Gynecological Surgery: A Single-Center Retrospective Cohort Study. J Clin Med 2022; 11:jcm11113235. [PMID: 35683626 PMCID: PMC9181663 DOI: 10.3390/jcm11113235] [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: 04/23/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 02/01/2023] Open
Abstract
Background: This study examined the relationship between the use of fentanyl-based intravenous patient-controlled analgesia (ivPCA) and the incidence of a clinically significant event (CSE), while considering both the analgesic effects and side effects in laparoscopic gynecological surgery. Methods: This study included 816 patients undergoing laparoscopic gynecological surgery under general anesthesia at Kyoto University Hospital between 2012 and 2018. The primary exposure was the use of fentanyl-based ivPCA. We defined an outcome measure—CSE—that integrates severe wound pain and vomiting assumed to negatively affect patient recovery. We performed multivariable logistic regression analysis to assess the independent relationship between ivPCA use and CSE. Results: Multivariable logistic regression analysis revealed that fentanyl-based ivPCA was independently associated with increased CSE (adjusted odds ratio (95% confidence interval): 1.80 (1.24−2.61), p = 0.002). Use of ivPCA was associated with a reduced incidence of postoperative severe wound pain (adjusted odds ratio (95% confidence interval): 0.50 (0.27−0.90), p = 0.022), but was also associated with an increased incidence of vomiting (adjusted odds ratio (95% confidence interval): 2.65 (1.79−3.92), p < 0.001). Conclusion: The use of fentanyl-based ivPCA in laparoscopic gynecological surgery is associated with increased CSE.
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Shin HJ, Park YH, Chang M, Chae YJ, Lee HT, Lee OH, Min SK, Do SH. Effects of ramosetron orally disintegrating tablets on the prophylaxis of post-discharge nausea and/or vomiting in female patients undergoing day surgery under general anesthesia: a randomized controlled trial. Perioper Med (Lond) 2022; 11:17. [PMID: 35546414 PMCID: PMC9097429 DOI: 10.1186/s13741-022-00251-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was performed to evaluate the effectiveness of ramosetron orally disintegrating tablets (ODTs) in preventing post-discharge nausea and/or vomiting (PDNV) in female patients following outpatient surgery under general anesthesia. METHODS This multicenter randomized study included three South Korean tertiary hospitals. Before surgery, 138 patients were randomly allocated into two groups. In the ramosetron group, ramosetron ODT 0.1 mg was administered after discharge in the morning of postoperative days 1 and 2. Metoclopramide 10 mg was administered as a rescue antiemetic (capped at 30 mg per day). In the control group, patients were administered only metoclopramide 10 mg when nausea and/or vomiting occurred. The primary outcome was the incidence of nausea during 24 h after discharge. RESULTS We found significant differences in the incidence (13% vs. 33%, P = 0.008) and severity (P = 0.011) of nausea between the ramosetron and the control groups during 24 h after discharge. In addition, the rate of rescue antiemetic (metoclopramide) administration during 24 h after discharge was lower in the ramosetron group (6%) than in the control group (18%) (P = 0.033). Patient satisfaction score was higher in the ramosetron group than in the control group (P < 0.001). CONCLUSION Ramosetron ODT reduces the incidence and severity of postoperative nausea after discharge during the first 24 h and may be a valuable option for the prevention of PDNV in female patients after day surgery under general anesthesia. TRIAL REGISTRATION ClinicalTrials.gov, NCT04297293 . Registered on 05 March 2020.
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Affiliation(s)
- Hyun-Jung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Yong-Hee Park
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Minying Chang
- Department of Anesthesiology and Pain Medicine, Ajou Medical Center, Soowon-si, Republic of Korea
| | - Yun Jeong Chae
- Department of Anesthesiology and Pain Medicine, Ajou Medical Center, Soowon-si, Republic of Korea
| | - Hun-Taek Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Oh Haeng Lee
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sang-Kee Min
- Department of Anesthesiology and Pain Medicine, Ajou Medical Center, Soowon-si, Republic of Korea
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea. .,Seoul National University College of Medicine, Seoul, Republic of Korea.
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