The effect of acupuncture on postoperative nausea and vomiting after pediatric tonsillectomy: A meta-analysis and systematic review.

OBJECTIVES/HYPOTHESIS: Tonsillectomy is one of the most frequently performed pediatric surgical procedures worldwide. The complications of this procedure include postoperative nausea and vomiting (PONV) and pain; therefore, both the treatment and prevention of PONV are important. Classical antiemetics include drug therapies such as ondansetron, which are undesirable because they often carry a high cost and several side effects. Therefore, in this study we aimed to evaluate the antiemetic effect of acupuncture after pediatric tonsillectomy. METHODS: We searched for eligible articles that reported on the antiemetic effects of acupuncture after tonsillectomy using the three databases, MEDLINE, Embase, and Cochrane, through July 2015. We included full-length original articles with adequate data for evaluating the antiemetic effects on pediatric tonsillectomy in the form of a relative ratio. The Newcastle-Ottawa scale was used to assess the quality of case control and cohort studies, and the Cochrane risk of bias tool was employed for randomized controlled trials (RCTs). RESULTS: The search identified 415 publications. After screening, we selected eight articles for review (4 RCTs, 3 prospective cohorts, and 1 pilot study). A meta-analysis of acupuncture in pediatric tonsillectomy revealed that the number of patients with PONV was significantly reduced with acupuncture compared to the control group, with a risk ratio of 0.77 (95% confidence interval: 0.63-0.94, P < 0.05). CONCLUSION: When acupuncture at PC6 (neiguan) was used to prevent PONV after pediatric tonsillectomy, the risk ratio was significantly lower compared to that of conventional drug therapy. Although further randomized controlled trials are needed, acupuncture at PC6 is considered an economic and effective treatment for emesis after pediatric tonsillectomy. Laryngoscope, 126:1761-1767, 2016.

Comparative safety analysis of surgical smoke from transurethral resection of the bladder tumors and transurethral resection of the prostate.

OBJECTIVE: To analyze the gas generated from the transurethral resection of the prostate (TURP) and transurethral resection of bladder (TURB) tumor. METHODS: Thirty-six smoke samples were collected from a continuous irrigation suction system during the TURP and the TURB. Then, they were subdivided into 2 groups: the group I (n = 18; gases generated from the TURP) and the group II (n = 18; gases generated from the TURB). We performed qualitative and quantitative analysis of the samples on gas chromatography/mass spectrometry. RESULTS: A more diverse type of gas was generated from the TURB as compared with the TURP. A further quantitative analysis was performed for 7 of 16 gases and 13 of 39 gases in the group I and group II, respectively. This showed that there was no significant difference in the concentration of propylene (propylene: 148.36 ± 207.72 ug/g vs 96.956 ± 135.138 ug/g) and 1-pentene (5137.08 ± 2935.48 ug/g vs 4478.259 ± 5787.351 ug/g) between the TURP and the TURB (P >.05). CONCLUSION: Our results showed that 39 and 16 types of gases were generated from the TURB and the TURP, respectively. There were differences in the types of gases between benign hypertrophic prostate and malignant bladder tumor tissues. This indicates that electrosurgery of malignant tissue is possibly more hazardous to those who are involved in the surgical operation.

Comparison of harmful gases produced during GreenLight High-Performance System laser prostatectomy and transurethral resection of the prostate.

OBJECTIVE: To compare the gases generated from GreenLight High-Performance System (HPS) laser prostatectomy with Urosol or normal saline solution and transurethral resection and vaporization of the prostate (TURVP) with Urosol. METHODS: A total of 36 smoke samples were collected from a continuous irrigation suction system attached to a Tenax absorber during transurethral surgery of the prostate. The gases were qualitatively and quantitatively analyzed by gas chromatography-mass spectrometry equipped with a purge and trap sample injector. RESULTS: The gas produced during TURVP contained propylene, allene, isobutylene, 1,3-butadiene, vinyl acetylene, mercaptomethane, ethyl acetylene, diacetylene, 1-pentene, ethanol, piperylene, propenylacetylene, 1,4-pentadiene, cyclopentadiene, acrylnitrile, and butyrolacton. The types and amount of gas produced during HPS laser prostatectomy were fewer and smaller than during TURVP. However, 1,3-butadiene, a well-known human carcinogen, was also generated by HPS laser prostatectomy. HPS laser prostatectomy with saline produced a greater amount and number of gases than HPS laser prostatectomy with Urosol. CONCLUSION: The surgical smoke produced from TURVP and HPS laser prostatectomy contains potentially harmful chemical compounds, although HPS laser prostatectomy produced less surgical smoke than TURVP. Urosol produced fewer types and a smaller amount of gas than normal saline during HPS laser prostatectomy.

Harmful gases including carcinogens produced during transurethral resection of the prostate and vaporization.

OBJECTIVE: To determine the chemical composition of surgical smoke produced during transurethral resection of the prostate (TURP) and vaporization. METHODS: A total of 12 smoke samples were collected from a continuous irrigation suction drainage system to a Tenax absorber at a 0.05L/min flow rate during TURP and vaporization. The gases were quantitatively and qualitatively analyzed by gas chromatography-mass spectrometry (GC-MS) equipped with a purge and trap sample injector. RESULTS: The main chemical constituents of surgical smoke produced during TURP and vaporization include propylene, allene, isobutylene, 1,3-butadiene, vinyl acetylene, mecaptomethane, ethyl acetylene, diacetylene, 1-pentene, EtOH, piperylene, propenylacetylene, 1,4-pentadiene, cyclopentadiene, acrylnitrile and butyrolactone. Three of the constituents are very toxic and carcinogenic (1,3-butadiene, vinyl acetylene and acrylonitrile). The amount (mean±standard deviation) of chemical components in the 45L of gas and room air mixture produced during TURP and vaporization were as follows: propylene, 0.80±0.52mg; isobutylene, 212.85±75.65mg; 1,3-butadiene, 0.93±0.34mg; ethyl acetylene, 0.09±0.05mg; 1-pentene, 6.75±1.62mg; 1,4-pentadiene, 0.06±0.02mg; and acrylonitrile, 1.62±1.19mg. CONCLUSIONS: Three of the toxic gases generated during TURP and vaporization are carcinogens (1,3-butadiene, vinyl acetylene and acrylonitrile). Therefore, higher quality filter masks, smoke evacuation devices and/or smoke filters should be developed for the safety of the operating room personnel and patients during TURP and vaporization.

Is warm temperature necessary to prevent urethral stricture in combined transurethral resection and vaporization of prostate?

OBJECTIVES: To compare the effect of warm and room temperature irrigation solution on the incidence of urethral stricture during combined transurethral resection and vaporization of the prostate (CTURVP). Urethral stricture after transurethral surgery of the prostate is a bothersome complication. Warm irrigation improves the blood flow and might decrease the incidence of urethral stricture compared with the use of room temperature irrigation, which decreases the blood flow in the urethral mucosa, resulting in ischemic injury. METHODS: The patients who underwent CTURVP were divided into those receiving only room temperature irrigation solution (group 1, 75 patients) or warm irrigation solution with a system maintaining the temperature of the ventral penile skin at about 36 degrees C continuously (group 2, 78 patients). At follow-up, 1, 3, and 6 months later, the International Prostate Symptom Score and peak urine flow rate were evaluated. RESULTS: The temperature of the ventral penile skin was 20 degrees C and 36 degrees C in groups 1 and 2, respectively. The rate of urethral stricture was 21.3% in group 1 and 6.3% in group 2 at the end of 6 months of follow-up (P = .002). CONCLUSIONS: The results of our study have shown that maintaining the temperature of the urethra with warm irrigation solution during CTURVP probably decreases the incidence of urethral stricture. The temperature in the urethra could be another important factor in stricture formation after CTURVP.