Impact of extending prevention of postoperative nausea and vomiting for cancer surgical patients in the PACU: a before and after retrospective study

Abstract Backgrounds Procedures for Postoperative Nausea and Vomiting (PONV) prevention are mostly based on identification of the risk factors before administering antiemetic drugs. The purpose of this study was to evaluate the impact of the extended use of antiemetic on the PONV in the Postanesthetic Care Unit (PACU). Methods Two separate 4-year periods (2007-2010, P1, and (2015-2018, P2) were evaluated. During P1, the protocol consisted of dexamethasone and droperidol for patients with a locally adapted high PONV score, followed by ondansetron for rescue in the PACU. For Period 2, dexamethasone (8 mg) and ondansetron (4 mg) were administered in patients under general or regional anesthesia, or sedation longer than 30 minutes, while droperidol (1.25 mg) in rescue was injected in cases of PONV in the PACU. An Anesthesia Information Management System was used to evaluate the intensity score of PONV (1 to 5), putative compliance, sedation, and perioperative opioid consumption upon arrival in the PACU. Results A total of 27,602 patients were assessed in P1 and 36,100 in P2. The administration of dexamethasone and ondansetron increased several fold (p < 0.0001). The high PONV scores were more improved in P2 than in P1, with scores (3+4+5) for P1 vs. P2, p < 0.0001. Overall, 99.7% of the patients in P2 were asymptomatic at discharge. Morphine consumption decreased from 6.9±1.5 mg in P1 to 3.5 ± 1.5 mg in P2 (p < 0.0001). Discussion The extension of pharmacological prevention of PONV was associated with a decrease in the intensity of severe PONV. However, uncertainty regarding confounding factors should not be ignored. IRB nº 92012/33465

Neuroleptanalgesia en oftalmología / Neuroleptanalgesia in ophtalmology

Se estudiaron los resultados obtenidos utilizando los medicamentos droperidol-fentanyl, drogas que producen el estado de neuroleptanalgesia para la premedicación en intervenciones de catarata o glaucoma, en 50 pacientes a los que se les realizaron investigaciones previas al acto quirúrgico; se detectaron alteraciones en los estudios radiográficos y del electrocardiograma en algunos casos. La cooperación de los pacientes en el acto quirúrgico fue satisfactoria y no se detectaron cambios desfavorables en las mediciones de la tensión arterial, frecuencia cardíaca y espírometría

Hipotensäo arterial grave após medicaçäo pré-anestésica com Inoval / Severe hypotension following pre-medication with Inovar

The authors describe a case of several hypotension in a healthy, 19 years old man, scheduled for surgical correction of a short Achiles tendon, following premedication with 1 ml of Inovar i.m. The patient was premedicated 20 minuts before being admitted to the O. R. the patient was drowsy, the blood pressure was 50 x 25 mm Hg and the heart rate 60 bpm. The hypotension did not respond either to atropine (1 mg) or to fluid therapy with lactated Ringer. After 2 mg of paredrinol i.v., the patient developed junctional rhythn for to minutes followed by recovery of the sinus rhythm and of blood pressure to 110 x 80 mm Hg