Propofol for ambulatory gynecologic laparoscopy: does omission of nitrous oxide alter postoperative emetic sequelae and recovery?

The role of nitrous oxide in postoperative emesis is controversial. This prospective randomized study was performed to compare the emetic sequelae and quality of recovery between a group of patients anesthetized with propofol alone and a group anesthetized with propofol plus nitrous oxide. Seventy patients, ASA grade I or II, scheduled for ambulatory gynecologic laparoscopy under general anesthesia were included. Most factors which could influence the incidence of postoperative emesis were controlled. The overall incidence of emetic sequelae during the first 24 h postoperatively was 25% in the group anesthetized with propofol alone versus 29% for the group anesthetized with propofol and nitrous oxide. The incidence of emetic sequelae requiring therapeutic intervention was 13% and 6%, respectively. This difference was not statistically significant. The group of patients who received propofol alone required an average propofol dose of 221.5 +/- 71.9 micrograms.kg-1.min-1 to maintain anesthesia compared with 162.5 +/- 43.9 micrograms.kg-1.min-1 for the group receiving propofol plus nitrous oxide (P < 0.001). The time from discontinuation of propofol to eye-opening and orientation was significantly longer in patients anesthetized with propofol alone. Otherwise, the recovery variables were comparable between the two groups. We conclude that supplementing propofol with nitrous oxide in patients undergoing ambulatory laparoscopy reduces the requirements of propofol, expedites immediate recovery (emergence), and does not increase the incidence of postoperative emesis. This tends to confirm that there is no clinical advantage to omitting nitrous oxide.

Diaphragmatic endometriosis: CT and MR findings.

A case of endometrioma presenting as a diaphragmatic mass in a 36-year-old woman is described. The computed tomographic (CT) and magnetic resonance (MR) findings of the lesion at this rare site of involvement are illustrated, and the pertinent literature is briefly reviewed.

Fertility rate after hysterosalpingography with Sinografin.

Patients undergoing diagnostic hysterosalpingography because of infertility often become pregnant soon after the procedure. Since the discontinuation of Salpix in March 1980, the use of Sinografin for hysterosalpingography has increased. The pregnancy rate after hysterosalpingography using Sinografin has never been reported, however, and now 156 such patients have been evaluated. The pregnancy rate was 10.9% in those who had only a hysterosalpingogram and 26.3% in those who received adjunctive therapy. These results are comparable to those previously reported for hysterosalpingography using water-soluble contrast material, but less than the results using oil-soluble contrast.

Plasma estrogens in the assessment of fetoplacental function.

A retrospective study has been undertaken to assess the diagnostic value of plasma estriol (E3) determinations, as compared with determinations of other biochemical parameters, in predicting the outcome of pregnancy. The normal levels of plasma unconjugated and total E3 were determined on weekly samples obtained during the third trimester of 258 normal pregnancies. Weekly concurrent specimens of plasma and 24-hour urine collections were obtained from 17 high-risk pregnancies associated with hypertension, intrauterine growth retardation and diabetes. Determination of plasma unconjugated and total E3 were made along with human placental lactogen (HPL), urinary E3, and other biophysical parameters such as the oxytocin challenge test, non-stressed test, ultrasonography, etc. The results of plasma E3 were not reported nor used for the clinical management of the patient. The data suggests that weekly plasma determinations were of little value in the assessment of feto-placental status. Some observations on the extent of variability of plasma E3 are discussed.

Unusual protozoal infestation of the cervical mucus.

The transient colonization of the female genital tract with an unusual multiflagellated protozoan is reported. The presence of active organisms in large numbers in the mucus of the endocervical canal and their absence from the gastrointestinal tract and other areas indicates true colonization rather than contamination. The colonization resolved spontaneously. The organism has been classified as a Polymastigidan.