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Introducción : El ondasentrón es un agente farmacológico de uso frecuente para el tratamiento sintomático de los vómitos originados por gastroenteritis. Sin embargo, podría enmascarar patologías más graves que ameriten reconsultas y hospitalización. Objetivo: Indagar si la administración del ondansetrón como tratamiento sintomático de los vómitos en el departamento de emergencias pediátricas (DEP) retrasó el diagnóstico de patologías graves. Materiales y métodos: Estudio observacional, descriptivo de corte transverso retrospectivo. Fueron elegibles pacientes que consultaron en el DEP, recibieron tratamiento con ondansetron, y reconsultaron dentro de las 24 horas. Los datos fueron recolectados de la base de datos de consultas del DEP, el comando reconsultas y entrevista telefónica a los padres. Las variables fueron edad, sexo, procedencia, motivo de la segunda consulta, diagnósticos finales en la segunda consulta. Los datos fueron analizados en SPSS utilizando estadística descriptiva. Resultados En el periodo de estudio consultaron por vómitos y recibieron ondasentrón 2018 pacientes. Reconsultaron dentro de las 24 horas 212, cumpliendo con los criterios de inclusión 205 pacientes. Se constató un 24,8% nuevos diagnósticos durante la reconsulta, de los cuales 35% requirieron hospitalización. Los diagnósticos fueron fiebre sin foco 2,9%, neumonía 2,4%, infección de vías urinarias 1%, sospecha de chikunguya 1,5%, adenitis mesentérica 0,5%, abdomen agudo quirúrgico 0,5%. Conclusión: Se identificó diagnósticos diferentes a la primera consulta en pacientes que recibieron ondansetrón como tratamiento sintomático de los vómitos en urgencias pediátricas, requiriendo hospitalización el 35% de los mismos.
Introduction: Ondansetron is a pharmacological agent frequently used for the symptomatic treatment of vomiting caused by gastroenteritis. However, it could mask more serious pathologies that require repeat consultations and hospitalization. Objective: To investigate whether the administration of ondansetron as a symptomatic treatment of vomiting in the pediatric emergency department (PED) delayed the diagnosis of serious pathologies. Materials and methods: This was an observational, descriptive, retrospective and cross-sectional study. Patients who consulted at the PED, received treatment with ondansetron, and returned for consultation within 24 hours were eligible. Data were collected from the PED consultation database, the follow-up consultation request, and a telephone interview with parents. The variables were age, sex, origin, reason for the second consultation, and final diagnoses in the second consultation. The data were analyzed in SPSS using descriptive statistics. Results: During the study period, 2018 patients consulted for vomiting and received ondansetron. 212 were consulted again within 24 hours, with 205 patients meeting the inclusion criteria. There were 24.8% new diagnoses during the follow-up consultation, of which 35% required hospitalization. The diagnoses were fever without source 2.9%, pneumonia 2.4%, urinary tract infection 1%, suspected chikunguya 1.5%, mesenteric adenitis 0.5%, and surgical acute abdomen 0.5%. Conclusion: Diagnoses different from the first consultation were identified in patients who received ondansetron for symptomatic treatment of vomiting in pediatric emergencies, with 35% requiring hospitalization.
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Objective:To investigate the effect of goal-directed fluid therapy(GDFT)under the guidance of LIDCOrapid hemodynamic monitor on postoperative nausea and vomiting(PONV)of patients after gynecological laparoscopic surgery.Methods:A total of 90 patients who underwent laparoscopic extensive hysterectomy under general anesthesia in Affiliated Hospital of Shandong Second Medical University from August 2020 to June 2021 were selected,and they were divided into observation group and control group as random number table,with 45 cases in each group.Patients in control group supplemented fluid according to the guidance of urine output and mean arterial pressure(MAP).Patients in observation group supplemented fluid according to GDFT under guidance of stroke volume variation(SVV).The MAP values,heart rates(HR),SVV values and cardiac index(CI)values at the 10th min after patients entered the operation room(T0),the 3rd min after anesthesia induction(T1),and the 3rd min(T2),the 30th min(T3)and the 1st h(T4)after Terndelenburg position,and the time of completing surgery(T5)were observed.In addition,the intraoperative intake and output volume of liquid,the indicators of gastrointestinal function recovery after surgery,and the length of stay also were observed.The PONV incidence of main outcome indicators,and the PONV scores of postoperative 0-6h(T6),6-12 h(T7),12-24 h(T8)and 24-48 h(T9)of secondary outcome indicators,as well as the number of patients who received the treatment of antiemetic compensation after surgery,were analyzed.Results:The PONV incidence of observation group was significantly lower than that of control group(x2=6.40,P<0.05).The PONV scores of postoperative T6 and T7 of observation group were significantly lower than those of control group(t=4.92,3.42,P<0.05),respectively.The HR and CI value at T4 of observation group were significantly higher than those of control group(t=0.73,0.64,P<0.05),while the SVV of observation group increased from T3 to T5,with significant differences(t=2.28,3.42,4.10,P<0.05),respectively.The intraoperative crystalline fluid input and total infusion volume decreased,while colloidal fluid input increased,and the differences of them between two groups were significant(t=15.10,12.36,8.19,P<0.05),respectively.The postoperative exhaust time,defecation time and feeding time of observation group were significantly earlier than these of control group(t=3.79,2.09,2.54,P<0.05),respectively.But there was no statistical difference in the length of stay between the two groups.Conclusion:GDFT,which is guided by LIDCOrapid hemodynamic monitor,may decrease the incidence of PONV of gynecological laparoscopic surgery and the severity of PONV within 12 hours after surgery.
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Objective To explore the effect of transcutaneous electrical acupoint stimulation bracelet at Neiguan acupoint on the postoperative nausea and vomiting after thyroidectomy under general an-esthesia.Methods Seventy-two female patients underwent thyroidectomy,aged 18-50 years,ASA physical status Ⅰ or Ⅱ,were enrolled.The patients were assigned 1 ∶ 1 to two groups by permuted block randomization:the electrical stimulation group and the control group,36 patients in each group.Before an-esthesia induction,patients in both groups wore domestic transcutaneous electrical acupoint stimulation bracelets,and the electrodes were aimed at Neiguan acupoint.The electrical stimulation group started to stimulate Neiguan acupoint,and adjusted the proper intensity to make the patient feel tingling in the related area of the hand.When the bracelet was fixed firmly,turned it off.At the end of the operation,the bracelet was turned on with the stimulation intensity set before induction for 24 hours.Patients in the control group also wore the bracelet for 24 hours,but it was never turned on.The number of cases of postoperative nausea and vomiting(PONV)and the number of remedial cases of antiemetic drugs were recorded.Results Compared with the control group,the incidence of PONV and postoperative vomiting in the electrical stimula-tion group were significantly reduced within 24 hours after surgery(P＜0.05),and the differences were mainly in 1-6 hours after surgery(P＜0.05).There was no significant difference in the rate of remedial ca-ses of antiemetic drugs between the two groups at different time periods.Conclusion Transcutaneous electri-cal stimulation bracelet at Neiguan acupoint can effectively reduce the incidence of PONV within 24 hours after thyroidectomy.
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Objective To assess the correlation between the severity of postoperative nausea and vomiting(PONV)with the quality of postoperative recovery and capacity of mobility in patients after video-assisted thoracoscopic surgery.Methods A total of 125 patients,80 males and 45 females,aged 18-64 years,BMI 18-35 kg/m2,ASA physical status Ⅰ-Ⅲ,undergoing video-assisted thoracoscopic surgery were observed.The severity of PONV was assessed using the simplified PONV impact scale day 1 after sur-gery.The patients were divided into three groups according to the severity of PONV:non-PONV group(n = 87),mild PONV group(n = 31),and moderate to severe PONV group(n = 7).The quality of recovery was assessed using the quality of recovery-15(QoR-15)on the first day after surgery,and the capacity of mobility was assessed using the 6-minute walk test(6-MWT)on the second day after surgery.The multiple linear regression model was used to analyze the correlation between the severity of PONV and quality of post-operative recovery and capacity of mobility.Results The results of the corrected multiple linear regression model showed that,compared with the patients without PONV,the QoR-15 scores of the patients with mild and moderate-severe PONV on the first day after surgery were reduced by 4.5 scores(95%CI-8.9 to-0.04 scores,P = 0.048)and 15.8 scores(95%CI-24.8 to-6.8 scores,P = 0.001),respectively.Mild(MD =-27.4 m,95%CI-70.1 to 15.4 m,P = 0.207)and moderate-severe PONV(MD =-57.0 m,95%CI-145.7 to 31.6 m,P = 0.204)were not significantly associated with 6-MWT distance shortening on the second day after surgery.Conclusion Increased PONV severity is associated with poorer recovery quality in patients undergoing pulmonary surgery.Active prevention and treatment of PONV may contribute to early recovery of patients.
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Objective:To develop a risk assessment tool for chemotherapy induced nausea and vomiting after transcatheter arterial chemoembolization in patients with primary liver cancer, and to verify its predictive efficiency, so as to provide reference for risk assessment and nursing intervention of nausea and vomiting in patients with primary liver cancer.Methods:A cross-sectional survey was used. The risk assessment tool was compiled by using literature analysis, Delphi expert consultation and analytic hierarchy process. 153 patients with primary liver cancer who underwent transcatheter arterial chemoembolization in the Department of Intervention, Jiangsu Cancer Hospital from May 2022 to April 2023 were selected for assessment by using convenience sampling method. Receiver operating characteristic curve, sensitivity, specificity and Youden index were used to test the prediction efficiency of risk assessment tools.Results:Among 153 patients, there were 78 males, 75 females, aged (48.44 ± 7.76) years old. The expert positive coefficient of the three rounds of inquiry letters was all 100%, the expert authority coefficient was 0.936, 0.950 and 0.960 respectively, and the Kendall harmony coefficient was 0.490, 0.327 and 0.414 respectively (all P<0.01). The risk assessment tool for chemotherapy induced nausea and vomiting after transcatheter arterial chemoembolization in patients with primary liver cancer included 14 items. The results of prediction efficiency analysis showed that the area under the receiver operating characteristic curve was 0.938 (95% CI 0.903-0.974, P<0.01). When the cut-off score was 56.2, the sensitivity, specificity and Youden index of the risk assessment tool were 0.926, 0.881 and 0.807, which had the best prediction efficiency. Conclusions:The risk assessment tool for chemotherapy induced nausea and vomiting after transcatheter arterial chemoembolization in patients with primary liver cancer has high scientificity, predictive efficiency and practicability, and is suitable for the risk assessment for chemotherapy induced nausea and vomiting after transcatheter arterial chemoembolization in patients with primary liver cancer in China.
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Day surgery has the advantages of fast turnover of beds,high patient satisfaction,low medical cost and low nosocomial infection rate,which is a kind of surgical mode vigorously explored and developed at home and abroad.Safety is the bottom line of day surgery,comfort is the core pursuit of day surgery,both of which cannot be guaranteed without high-quality perioperative anesthesia management.Therefore,under the fast-turnover day surgery mode,this paper focus on how to implement standardized anesthesia management strategies from the aspects of the formulation of clinical anesthesia pathways,facilities and personnel allocation,pre-anesthesia evaluation and preoperative preparation,anesthesia type selection,perioperative pain management,postoperative nausea and vomiting management,post-anesthesia monitoring and treatment,and postoperative follow-up.
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OBJECTIVE To evaluate the efficacy of the triple therapy of 5-HT3 receptor antagonists， neurokinin-1 receptor antagonists and dexamethasone （referred to as “triple therapy”） in the prevention and treatment of acute nausea and vomiting caused by moderately and highly emetogenic chemotherapy drugs. METHODS Retrieved from PubMed， Embase， the Cochrane Library， CNKI and Wanfang data， randomized controlled trials （RCTs） about triple therapy or 5-HT3 receptor antagonist combined with dexamethasone （referred to as “dual therapy”） were collected during the inception to May 2023. After literature screening， data extraction and literature evaluation， network meta-analysis was performed by using Stata 16.0 software. RESULTS A total of 59 RCTs were included， involving 23 418 patients and 15 interventions. Results of network meta-analysis showed that fosaprepitant + palonosetron + dexamethasone （FPD） was most effective in terms of acute nausea and vomiting control rate， followed by fosaprepitant + granisetron + dexamethasone （FGD） and aprepitant + ramosetron + dexamethasone （AMD）. In terms of acute nausea control rate， FPD was the most effective， followed by aprepitant + palonosetron + dexamethasone （APD） and FGD. In terms of acute vomiting control rate， FPD was the most effective， followed by FGD and APD. CONCLUSIONS Fosaprepitant + palonosetron + dexamethasone is better than other triple therapy or dual therapy in preventing acute nausea and vomiting caused by moderately and highly emetogenic chemotherapy drugs.
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Abstract Background: We tested the hypothesis that, within the margin of 15% of risk difference, palonosetron is not inferior to ondansetron in reducing the incidence of postoperative nausea and vomiting (PONV) in laparoscopic cholecystectomy. Methods: We conducted a double-blind, non-inferiority, randomized, controlled trial of 212 patients aged 18 to 65 years undergoing laparoscopic cholecystectomy under general anesthesia in two secondary care hospitals. Patients were randomly assigned to receive either palonosetron (0.075 mg) or ondansetron (8 mg) intravenously at induction of anesthesia. Ondansetron (8 mg) was also administered 8 and 16 hours postoperatively. All anesthetic and surgical procedures were standardized. Patients were evaluated for 24 hours postoperatively for the occurrence of PONV. Results: A high incidence of PONV was observed at 2-6 hours postoperatively, with a rate of 36.8% (95% confidence interval [CI] 28.2-46.3) in the palonosetron group, as compared to 43.4% (95% CI 34.4-52.9) in the ondansetron group. The risk difference (95% CI) between palonosetron and ondansetron for PONV was 0 (-10.9 to 10.9) at 0-2 hours, -6.6 (-19.4 to 6.5) at 2-6 hours, -0.9 (-11.0 to 9.2) at 6-12 hours, and -2.8 (-9.6 to 3.6) at 12-24 hours. There was no statistically significant difference between the palonosetron and ondansetron groups in the use of rescue medication (dimenhydrinate). There were no adverse events associated with the medications under study. Conclusion: Palonosetron is not inferior to ondansetron in patients at risk of PONV undergoing laparoscopic cholecystectomy, providing a good option for PONV prophylaxis, as it can be administered in a single dose.
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Abstract Background: End-stage renal diseases patients have a high risk of postoperative nausea and vomiting (PONV), which is multifactorial and need acute attention after renal transplantation for a successful outcome in term of an uneventful postoperative period. The study was done to compare the efficacy of palonosetron and ondansetron in preventing early and late-onset PONV in live donor renal transplantation recipients (LDRT). Methods: The prospective randomized double-blinded study was done on 112 consecutive patients planned for live donor renal transplantation. Patients of both sexes in the age group of 18-60 years were randomly divided into two groups: Group O (Ondansetron) and Group P (Palonosetron) with 56 patients in each group by computer-generated randomization. The study drug was administered intravenously (IV) slowly over 30 seconds, one hour before extubation. Postoperatively, the patients were accessed for PONV at 6, 24, and 72 hours using the Visual Analogue Scale (VAS) nausea score and PONV intensity scale. Results: The incidence of PONV in the study was found to be 30.35%. There was significant difference in incidence of PONV between Group P and Group O at 6 hours (12.5% vs. 32.1%, p = 0.013) and 72 hours (1.8% vs. 33.9%, p < 0.001), but insignificant difference at 24 hours (1.8% vs. 10.7%, p = 0.113). VAS-nausea score was significantly lower in Group P as compared to Group O at a time point of 24 hours (45.54 ± 12.64 vs. 51.96 ± 14.70, p = 0.015) and 72 hours (39.11 ± 10.32 vs. 45.7 ± 15.12, p = 0.015). Conclusion: Palonosetron is clinically superior to ondansetron in preventing early and delayed onset postoperative nausea and vomiting in live-related renal transplant recipients.
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Abstract Objective We aimed to investigate the effect of bilateral sphenopalatine ganglion blockade (SPGB) on the main postoperative complications in septorhinoplasty operations. Methods In this randomized, controlled, prospective study, 80 cases planned for Septorhinoplasty operations under general anesthesia were included in the study. The cases were divided into two groups; SPGB was performed with 2 mL of 0.25% bupivacaine bilaterally 15 min before the end of the operation in the SPGB group (Group S, n = 40). In the control group (Group C, n = 40), 2 mL of 0.9% NaCl solution was applied into both SPG areas. In the recovery unit after the operation; the pain and analgesic needs of the patients at 0, 2, 6 and 24 h were evaluated. Results There was no statistically significant difference between the groups in terms of hemodynamic parameters (ASA, MBP, HR) (p> 0.05) All VAS values were statistically lower in Group S than in Group C (p< 0.05). In Group S, the need for analgesic medication was found in 5 cases between 0-2 h, whereas in Group C, this rate was found in 17 cases, and it was statistically significant (p< 0.05). Conclusion Bilateral SPGB application was determined to provide better analgesia in the early postoperative period compared to the control group, it was concluded that further studies are needed to say that there are significant effects on laryngospasm and nausea-vomiting. Level of evidence: 2, degree of recommendation B.
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Abstract Background: The antiemetic effectiveness of olanzapine, as a prophylactic off-label antiemetic drug, for Postoperative Nausea and Vomiting (PONV) is unknown. In this systematic review and meta-analysis, the authors evaluate the efficacy and side effects of olanzapine as a prophylactic antiemetic in adult patients who undergo general anesthesia and assess adverse effects. Methods: A systematic search was done on electronic bibliographic databases in July 2023. Randomized controlled trials of olanzapine as a prophylactic antiemetic for PONV in adults who underwent general anesthesia were included. The authors excluded non-RCTs and retracted studies. The authors set no date of publication or language limits. The outcomes were the incidence of PONV within 24 h postoperatively and the safety of olanzapine. The risk of bias was assessed according to the tool suggested by the National Heart, Lung, and Blood Institute. Results: Meta-analysis included 446 adult patients. Olanzapine reduced on average 38 % the incidence of PONV. The estimated risk ratio (95 % CI) of olanzapine versus control was 0.62 (0.42-0.90), p = 0.010, I2 = 67 %. In the subgroup meta-analysis, doses of olanzapine (10 mg) reduced on average 49 % of the incidence of PONV (RR = 0.51 [0.34-0.77], p = 0.001, I2 = 31 %). Conclusion: This systematic review with meta-analysis indicated that olanzapine as a prophylactic antiemetic alone or combined with other antiemetic agents reduced the incidence of postoperative nausea and vomiting. However, this conclusion must be presented with some degree of uncertainty due to the small number of studies included. There was a lack of any evidence to draw conclusions on side effects.
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Abstract Introduction: Postoperative nausea and vomiting is still a common complication. Serotonin receptor antagonists are commonly used in clinical practice for antiemetic prophylaxis. Interin-dividual variations in drug response, including single nucleotide polymorphisms, are related to pharmacokinetic and pharmacodynamic changes in these drugs and may lead to a poor therapeutic response. This study aimed to evaluate the influence of CYP2D6 isoenzyme and ABCB1 gene polymorphisms on the frequency of postoperative nausea and vomiting with the use of ondansetron or palonosetron. Methods: A randomized, double-blind clinical trial including 82 women aged 60 years or over undergoing laparoscopic cholecystectomy was conducted. Patients were randomized to receive either ondansetron or palonosetron for postoperative nausea and vomiting prophylaxis. DNA was extracted from saliva. Genetic polymorphisms were analyzed by real-time polymerase chain reaction. The following polymorphisms were analyzed: rs3892097 C/T, rs1128503 A/G, rs16947A/G, rs1065852 A/G, rs1045642 A/G, rs2032582 C/A, and rs20325821 C/A. Results: Overall, vomiting, and severe nausea occurred in 22.5% and 57.5% of patients, respectively. In the palonosetron group, patients with the GG genotype (rs16947 A/G) experienced more severe nausea (p = 0.043). In the ondansetron group, patients with the M genotype (rs16947 A/G) presented mild nausea (p = 0.034), and those with the AA genotype (rs1065852 A/G) experienced more vomiting (p = 0.034). Conclusion: A low antiemetic response was observed with ondansetron in the presence of the AA genotype (rs16947 A/G) and the AA genotype (rs1065852 A/G), and a low therapeutic response was found with palonosetron in the presence of the GG genotype (rs16947 A/G) in laparoscopic cholecystectomy. Register: ClinicalTrials.gov.
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Introducción: la acalasia es una entidad poco frecuente en pediatría. Es un desorden de la motilidad esofágica de tipo neurovegetativo, idiopático; aunque también puede ser secundario a infecciones, neoplasias y enfermedades autoinmunes. Se caracteriza por síntomas como disfagia, regurgitaciones, dolor y descenso ponderal. En adultos la manometría de alta resolución es el gold standard. En niños las dificultades técnicas complejizan su realización. En la actualidad la asociación de la impedanciometría intraesofágica con la manometría es el método diagnóstico más eficaz. El objetivo del tratamiento es mejorar el vaciamiento esofágico mediante la disminución del tono del esfínter esofágico inferior por métodos farmacológicos, endoscópicos o quirúrgicos. Actualmente la miotomía de Heller es de elección. Caso clínico: escolar de 6 años, previamente sano, ingresado por regurgitaciones, dolor abdominal y adelgazamiento. Estudio radiográfico con bario con hallazgos compatibles con acalasia esofágica. Se descartaron causas secundarias. El tratamiento definitivo fue la miotomía de Heller con funduplicatura anterior de Dorr, presentando buena evolución clínica. Discusión: si bien la disfagia es el síntoma clave y en general guía el diagnóstico, es importante estar alertas a las formas clínicas atípicas con presentaciones inespecíficas, como en el caso clínico presentado, esto permite establecer un diagnóstico oportuno, evitando el impacto nutricional y psicosocial del niño y su familia.
Introduction: achalasia is a rare entity in pe-diatrics. It is an idiopathic neurovegetative esophageal motility disorder; although it can also be secondary to infections, neoplasias and autoimmune diseases. It is characterized by symptoms such as dysphagia, regurgitation, pain, and weight loss. In adults, high-resolution manometry is the gold standard. In children, technical difficulties complicate its realization. Currently, the association of intraesophageal impedance measurement with manometry is the most effective diagnostic method. The goal of treatment is to improve esophageal emptying by reducing the tone of the lower esophageal sphincter by pharmacological, en-doscopic, or surgical methods. Heller's myotomy is currently the treatment of choice. Clinical case: a 6-year-old schoolboy, previous-ly healthy, admitted for regurgitation, abdomi-nal pain, and weight loss. Barium radiographic study with findings compatible with esopha-geal achalasia. Secondary causes were ruled out. The definitive treatment was Heller's myotomy with Dorr's anterior fundoplication, presenting good clinical evolution. Discussion: although dysphagia is the key symptom and in general it leads the diagnosis, it is important to be aware of atypical clinical forms with non-specific presentations as in the clinical case presented, which allows timely diagnosis, preventing the nutritional and psychosocial impact of the child and his family.
Introdução: a acalasia é uma entidade rara em pediatria. É um distúrbio neurovegetativo da motilidade esofágica idiopática; embora também possa ser secundária a infecções, neoplasias e doenças autoimunes. É caracterizada por sintomas como disfagia, regurgitação, dor e perda de peso. Em adultos, a manometria de alta resolução é o padrão ouro. Nas crianças, as dificuldades técnicas tornam a sua implementação mais complexa. Atualmente, a associação da impedanciometria intraesofágica com a manometria é o método diagnóstico mais eficaz. O objetivo do tratamento é melhorar o esvaziamento esofágico, reduzindo o tônus do esfíncter esofágico inferior por métodos farmacológicos, endoscópicos ou cirúrgicos. Atualmente a miotomia de Heller é de escolha. Caso clínico: escolar de 6 anos, previamente hígido, internado por regurgitação, dor abdominal e emagrecimento. Estudo radiográfico com bário com achados compatíveis com acalasia esofágica. As causas secundárias foram descartadas. O tratamento definitivo foi miotomia de Heller com fundoplicatura anterior de Dorr, com boa evolução clínica. Discussão: embora a disfagia seja o sintoma chave e geralmente oriente o diagnóstico, é importante estar atento às formas clínicas atípicas e com apresentações inespecíficas, como no caso clínico apresentado, isso permite estabelecer um diagnóstico oportuno, evitando o impacto nutricional e psicossocial da criança e de sua família.
الموضوعات
Humans , Male , Child , Esophageal Achalasia/surgery , Esophageal Achalasia/diagnosis , Heller Myotomy , Treatment Outcomeالملخص
SUMMARY OBJECTIVE: Anticipatory nausea and vomiting are unpleasant symptoms observed before undergoing chemotherapy sessions. Less is known about the occurrence of symptoms since the advent of the new neurokinin-1 antagonist. METHODS: This prospective cohort study was performed at a single Brazilian Institution. This study included breast cancer patients who received doxorubicin and cyclophosphamide chemotherapy and an appropriate antiemetic regimen (dexamethasone 10 mg, palonosetron 0.56 mg, and netupitant 300 mg in the D1 followed by dexamethasone 10 mg 12/12 h in D2 and D4). Patients used a diary to record nausea, vomiting, and use of rescue medication in the first two cycles of treatment. The prevalence of anticipatory nausea and vomiting was assessed before chemotherapy on day 1 of C2. RESULTS: From August 4, 2020, to August 12, 2021, 60 patients were screened, and 52 patients were enrolled. The mean age was 50.8 (28-69) years, most had stage III (53.8%), and most received chemotherapy with curative intent (94%). During the first cycle, the frequency of overall nausea and vomiting was 67.31%, and that of severe nausea and vomiting (defined as grade>4 on a 10-point visual scale or use of rescue medication) was 55.77%. Ten patients had anticipatory nausea and vomiting (19.23%). The occurrence of nausea and vomiting during C1 was the only statistically significant predictor of anticipatory nausea and vomiting (OR=16, 95%CI 2.4-670.9, p=0.0003). CONCLUSION: The prevalence of anticipatory nausea is still high in the era of neurokinin-1 antagonists, and failure of antiemetic control in C1 remains the main risk factor. All efforts should be made to control chemotherapy-induced nausea or nausea and vomiting on C1 to avoid anticipatory nausea.
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Introducción: La hipertrofia del esfínter pilórico (EHP) es una condición que se caracteriza por la obstrucción del vaciamiento gástrico fisiológico y se considera una patología de resolución quirúrgica. Objetivo: Realizar la caracterización de los pacientes con hipertrofia congenita del píloro atendidos en el Hospital Regional de la Orinoquía entre 2010 y 2020. Metodología: Estudio observacional, descriptivo y retrospectivo en el cual se incluyeron los pacientes que consultaron al Hospital Regional de la Orinoquía entre el 01 de enero del 2010 y el 31 de diciembre del 2020 y que presentaron diagnóstico de hipertrofia congenita del píloro, identificados mediante los códigos CIE 10. Resultados: En total, se incluyeron 18 pacientes que cumplían con los criterios de selección. El promedio de edad de los participantes fue de 24,3 días de edad. La mayoría eran varones, asimismo, dos pacientes presentaban sobrepeso al nacer. El síntoma predominante fue la emesis posprandial en un 100 %. El diagnóstico se realizó mediante las medidas del píloro con ecografía abdominal y a la totalidad de los pacientes se les realizó piloromiotomía, de los cuales uno solo requirió una reintervención, sin embargo, ningún paciente falleció. Conclusiones: La hipertrofia congenita del píloro es una entidad patológica poco común, su síntoma clínico cardinal es la emesis postprandial. El método diagnóstico por excelencia es el estudio ecográfico. A pesar de su complejidad, esta entidad patológica tiene un buen pronóstico a corto y largo plazo.
Introduction: Hypertrophic pyloric stenosis (HPS) is a condition that is characterized by the obstruction of physiological gastric emptying and is considered a surgically-resolved pathology. Objective: To characterize patients with congenital hypertrophy of the pylorus treated at the Regional Hospital of Orinoquía between 2010 and 2020. Methods: Observational, descriptive and retrospective study of patients who were admitted at the Orinoquía Regional Hospital between January of 2010 and December of 2020. The patients that were included had a diagnosis of hypertrophic pyloric stenosis identified by the ICD-10 codes. Results: A total of patients were included by selection criteria. The average age of participants was 24.3 days old. Most of them were males and 2 patients were overweight at birth. The most common symptom was postprandial emesis in 100%. The diagnosis was made through measurements of pylorus measured with abdominal ultrasound. All the patients performed pyloromyotomy, and only one required a surgical reintervention, however, the mortality was 0. Conclusions: Congenital hypertrophy of pylorus is an uncommon pathology, whose cardinal symptom is postprandial emesis. The ideal diagnostic method is an ultrasound study. Despite its complexity, this pathology has a good short and long-term prognosis.
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Introduction: Postoperative nausea and vomiting (PONV) are common complications in surgical patients undergoing general anesthesia, and multiple strategies have been suggested to prevent them. Objective: To describe the available evidence on the effectiveness of pharmacological and non-pharmacological strategies for preventing PONV in adults undergoing surgery under general anesthesia, as reported in previous meta-analyses and systematic reviews. Methodology: An overview of systematic reviews and meta-analyses was conducted. Searches were performed in PubMed, EBSCO, EMBASE, Cochrane Database, Science Direct, and Scopus, without restrictions as to gender, clinical condition, or date of publication, including articles in Spanish, French, and English only. Two reviewers independently and in duplicate did the screening, data extraction, quality evaluation, and risk of bias assessment according to AMSTAR-2. The PRISMA and PRIOR statements were followed for reporting. PROSPERO registration number CRD42021251999. Results: Out of 80 candidate articles, three were viable for meta-analysis. 1.5 mg to 18 mg doses of Dexamethasone showed a significant reduction in the risk of PONV, with a RR of 0.48 (95 % CI 0.41-0.57; p<0.001), I2=63 % (p=0.07), and a NNTc of 5 and 7. Other effective strategies included the use of acoustic stimulation/acupuncture/acupressure, 5HT3 antagonists, NK1 antagonists, gabapentinoids, haloperidol, droperidol, metoclopramide, midazolam, mirtazapine, among others. The risk of publication bias was low. Conclusion: Different strategies are effective for PONV prophylaxis in surgeries under general anesthesia. Dexamethasone shows the best available evidence at the moment. The documented methodological quality suggests the need for better studies to establish the effectiveness of the strategies.
Introducción: Las náuseas y el vómito posoperatorios (NVPO) son comunes en pacientes quirúrgicos bajo anestesia general y se han planteado múltiples estrategias para prevenirlos. Objetivo: Describir la evidencia disponible sobre la efectividad de las estrategias farmacológicas y no farmacológicas para prevenir las NVPO en adultos sometidos a cirugía bajo anestesia general, según lo descrito en metaanálisis y revisiones sistemáticas previas. Metodología: Se realizó una metarrevisión de revisiones sistemáticas y metaanálisis. Se ejecutaron búsquedas en PubMed, EBSCO, Embase, Cochrane Database, ScienceDirect y Scopus, sin restricción por sexo, condición clínica ni fecha de publicación, solo de artículos en español, francés e inglés. Dos revisores llevaron a cabo tamizaje, extracción de datos, evaluación de calidad y riesgo de sesgo según AMSTAR-2, de manera independiente y en duplicado. Se siguieron las declaraciones PRISMA y PRIOR para el reporte, previo registro en Prospero CRD42021251999. Resultados: De 80 artículos candidatos, se seleccionaron tres viables para realización de metaanálisis. La dexametasona entre 1,5 mg y 18 mg mostró un RR=0,48 (IC95 % [0,41-0,57]; p<0,001), I2=63 % (p=0,07) y un NNTc 5 y 7. Otras estrategias efectivas incluyen el uso de acuestimulación/acupuntura/acupresión, antagonistas 5HT3, antagonistas NK1, gabapentinoides, haloperidol, droperidol, metoclopramida, midazolam, mirtazapina, entre otras. El riesgo de sesgo de las publicaciones fue bajo. Conclusión: Diferentes estrategias son efectivas para profilaxis NVPO en cirugías con anestesia general. Dexametasona presenta la mejor evidencia disponible al momento. La calidad metodológica documentada sugiere la necesidad de realizar mejores trabajos para determinar la efectividad de las estrategias.
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The aim of this special article is to summarize and discuss, from an anesthesia perspective, the network meta-analysis on drugs used for the prevention of postoperative nausea and vomiting after general anesthesia, in agreement with the Cochrane Colombia collaboration and within the framework of the Cochrane Corners strategy. Through the combination of indirect comparisons and based on the evidence, the use of aprepitant, ramosetron, granisetron, dexamethasone and ondansetron is recommended with a high degree of certainty for the reduction of postoperative nausea and vomiting.
Este artículo especial tiene el objetivo de resumir y discutir desde la perspectiva de la anestesiología, el metaanálisis en red sobre fármacos para prevenir náuseas y vómito posoperatorio luego de anestesia general, en acuerdo con la colaboración Cochrane Colombia y en el marco de la estrategia Cochrane Corners. Mediante la combinación de la evidencia y el uso de comparaciones indirectas, se ha recomendado con alto grado de certeza el uso de aprepitant, ramosetrón, granisetrón, dexametasona y ondansetrón para la reducción de náuseas y vómito posoperatorio.
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Abstract The objective of this article is to identify the prevalence and evaluate the factors associated with extreme weight loss behaviors among adolescents of Northeastern Brazil. Cross-sectional study with 2,439 adolescents from Sample 2 (2015) of the National School-based Health Survey. Extreme weight loss behaviors, such as self-induced vomiting, laxative use and use of medicines or formulas (outcome) and independent variables were evaluated using a self-administered electronic questionnaire. The statistical analysis was performed following a hierarchical conceptual model. The prevalence of extreme weight loss behaviors in the sample was 12.1%. Among the factors that showed significant association with the outcome, we emphasize the administration model of the private school (PR = 0.62; CI = 0.46-0.84), bullying related to body appearance and for other reasons (PR = 1.62; CI = 1.19-2.20), forced sexual intercourse (PR = 2.65; CI = 1.90-3.69), insomnia (PR = 1.84; CI = 1.43-2.37), and be perceived as fat or very fat (PR = 1.90; CI = 1.50-2.42). Moderate prevalence of extreme weight loss behaviors was identified among adolescents. Socioeconomic factors, exposure to violence, mental health, and body image were associated with the adoption of these behaviors.
Resumo O objetivo deste artigo é identificar a prevalência e avaliar os fatores associados aos comportamentos extremos para perda de peso em adolescentes do Nordeste brasileiro. Estudo transversal com 2.439 adolescentes da Amostra 2 (2015) da Pesquisa Nacional de Saúde do Escolar. Os comportamentos extremos para perda de peso (desfecho) e as variáveis independentes foram avaliadas por meio de um questionário eletrônico autoaplicável. A análise estatística foi realizada seguindo um modelo conceitual hierárquico. A prevalência de comportamentos extremos para perda de peso na amostra foi de 12,1%. Entre os fatores que mostraram associação significativa com o desfecho, destacam-se a situação administrativa da escola privada (RP = 0,62; IC = 0,46-0,84), ser vítima bullying relacionado à aparência corporal e pelos demais motivos (RP = 1,62; IC = 1,19-2,20), ser forçado a ter relação sexual (RP = 2,65; IC = 1,90-3,69), ter insônia (RP = 1,84; IC = 1,43-2,37) e se autoperceber como gordo ou muito gordo (RP = 1,90; IC = 1,50-2,42). Prevalência moderada de comportamentos extremos para perda de peso foi identificada entre os adolescentes. Os fatores socioeconômicos, de exposição à violência, de saúde mental e da imagem corporal se associaram à adoção de tais comportamentos.
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ABSTRACT Introduction: This study was performed to evaluate the degree of 3-day chemotherapy-induced nausea and vomiting (CINV) in children with cancer who received highly emetogenic chemotherapy (HEC) to ascertain the efficacy of aprepitant single-dose on dayL 1 plus granisetron and dexamethasone (DEX). Methods: This clinical trial study was conducted on 120 patients in the age range of 5 to 18 years old who received chemotherapy. Patients were divided into two groups; Group A received aprepitant at 125 mg/kg on day 1 orally, followed by 80 mg/kg daily on days 2 and 3 and Group B received a single dose of aprepitant 125 mg/kg on day 1 orally and placebo on days 2 and 3. All groups received granisetron 3 mg/m2 on day 1 and DEX on days 1 to 3. The primary and secondary endpoints were to evaluate the proportion of patients with acute, delayed and overall CINV within each group. Results: There were no significant differences between the two groups for vomiting, nausea or the use of rescue therapy. The number of patients without vomiting on day 1 was similar in both groups (96.5% vs. 98.3%, respectively; p = 0.848). Conclusion: According to the results of this study, a single dose of aprepitant 125 mg/kg was as effective as administering three doses of aprepitant on 3 days. Therefore, the use of a single dose of aprepitant in combination with other standard treatment regimens to prevent CINV in children who received HEC was safe and efficacious and can be beneficial.
الموضوعات
Humans , Child, Preschool , Child , Adolescent , Vomiting , Dexamethasone , Granisetron , Aprepitant , Nauseaالملخص
Introduction: Apfel simplified risk score for postoperative nausea and vomiting (PONV) has shown to be useful in anesthesia; however, since it has not been calibrated in regional anesthesia or in pregnant patients, its use in cesarean section is limited. Objective: To develop a prognostic predictive model for postoperative nausea and vomiting in pregnant patients undergoing cesarean section under spinal anesthesia. Methods: In a cohort of 703 term pregnant patients scheduled of cesarean section, 15 variables were prospectively assessed, to design a prognostic predictive model for the development of postoperative nausea and vomiting. A logistic regression analysis was used to construct the model and its calibration and discrimination were based on the Hosmer-Lemeshow test, the calibration curves, and C statistic. Additionally, the internal calibration was performed with the Bootstrap resampling method. Results: Postoperative nausea and vomiting were experienced by 27% of the patients during the first six hours after surgery. The model included as prognostic variables the development of intraoperative nausea and vomiting, age under 28 years, a history of PONV, the mother's BMI and the weight of the newborn baby. The model showed an adequate calibration (x2: 4.65 p: 0.5888), though a low discrimination (Statistic C = 0.68). Conclusions: A prognostic predictive model was created for the development of PONV in cesarean section. This model was used to build a prognostic scale for the classification of patients into risk groups.
Introducción: La escala de riesgo simplificada de Apfel para náuseas y vómito posoperatorio (NVPO) ha mostrado utilidad en anestesia; sin embargo, al no haber sido calibrada en anestesia regional o en pacientes embarazadas, su utilidad en cesárea es limitado. Objetivo: Desarrollar un modelo de predicción pronóstica para náuseas y vómito posoperatorios en pacientes embarazadas, llevadas a cesárea bajo anestesia espinal. Métodos: En una cohorte de 703 pacientes con embarazo a término programadas para cesárea, se evaluaron 15 variables de forma prospectiva para construir un modelo de predicción pronóstica para el desarrollo de náuseas y vómito posoperatorio. Se utilizó el análisis de regresión logística para la construcción del modelo y se calculó su calibración y discriminación con la prueba de Hosmer-Lemeshow, las curvas de calibración y el estadístico C. Además, se realizó la calibración interna con el método de remuestreo Bootstrap. Resultados: Las náuseas y vómito posoperatorio se presentaron en el 27% de las pacientes durante las primeras seis horas después de la cirugía. El modelo incluyó como variables pro-nósticas el desarrollo de náuseas y vómito en el intraoperatorio, edad menor de 28 años, antecedentes de NVPO, índice de masa corporal (IMC) de la madre y el peso del recién nacido. El modelo mostró una adecuada calibración (x2: 4,65 p: 0,5888), aunque una baja discriminación (Estadístico C = 0,68). Conclusiones: Se construyó un modelo de predicción pronóstica para el desarrollo de NVPO en cirugía cesárea, y con este se construyó una escala pronóstica que permite clasificar a las pacientes por grupos de riesgo.