Perioperative use of low dose haloperidol safely reduces episodes of postoperative nausea/vomiting and length of stay following elective minimally invasive bariatric surgery.

INTRODUCTION: While total intravenous anesthesia (TIVA) protocols include Dexamethasone and Ondansetron prophylaxis, bariatric patients continue to be considered at particularly high risk for postoperative nausea/vomiting (PONV). A multimodal approach for prophylaxis is recommended by the Bariatric Enhanced Recovery After Surgery (ERAS) Society however, there remains a lack of consensus on the optimal strategy to manage PONV in these patients. Haloperidol has been shown at low doses to have a therapeutic effect in treatment of refractory nausea and in PONV prophylaxis in other high risk surgical populations. We sought to investigate its efficacy as a prophylactic medication for PONV in the bariatric population and to identify which perioperative strategies were most effective at reducing episodes of PONV. METHODS: An institutional bariatric database was created by retrospectively reviewing patients undergoing elective minimally invasive bariatric procedures from 2018 to 2022. Demographic data reviewed included age, gender, preoperative body mass index (BMI), ethnicity, and primary language. Primary endpoints included patient reported episodes of PONV, total doses of Ondansetron administered, need for a second antiemetic (rescue medication), complication rate (most commonly readmission within 30 days), and length of stay. Fisher's exact test, Mann-Whitney test, and ANOVA were used to evaluate the effect of perioperative management on various endpoints. RESULTS: A total of 475 patients were analyzed with Haloperidol being utilized in 15.8% of all patients. Patients receiving Haloperidol were less likely to require Ondansetron outside of the immediate perioperative period (34.7% vs. 49.8%, p = 0.02), experienced less PONV (41.3% vs. 64.3%, p = 0.01) and also had a decreased median length of stay (27.3 vs. 35.8 h, p < 0.0001). CONCLUSIONS: Addition of low dose Haloperidol to Bariatric ERAS protocols decreases incidence of PONV and the need for additional antiemetic coverage resulting in a significantly shorter length of stay, increasing the likelihood of safe discharge on postoperative day 1.

Prevalence and distribution of metabolic syndrome and its components among provinces and ethnic groups in Indonesia.

BACKGROUND: Global increase of metabolic syndrome (MetS) may have affected Indonesia, however, lack of data in this multiethnic group country warrants a nationwide study for MetS and its components. This study aims to determine the prevalence of metabolic syndrome and its components among Indonesian people based on the province and ethnic groups. METHODS: We obtained 8573 subjects from the Indonesian Family Life Survey Wave 4 (IFLS4), spread over 20 provinces in Indonesia and consisting of 27 ethnic groups. MetS was operationalized according to an adapted Harmonized MetS definition. Prevalence ratios with 95% confidence interval were estimated using log-binomial regression. RESULTS: The prevalence of MetS in Indonesia is 21.66% with provincial prevalence ranging from 0 to 50%, while the ethnic prevalence ranging from 0 to 45.45%. Significant higher MetS prevalence ratios were found in Jakarta (PR 1.826; 95CI 1.628-2.048), West Nusa Tenggara (PR 1.412; 95CI: 1.222-1.630), West Sumatra (PR 1.404; 95CI: 1.202-1.641), East Java province (PR 1.109; 95CI: 1.001-1.229) and in Sasak (PR 1.532; 95CI:1.304-1.800), Minangkabau (PR 1.469; 95CI:1.251-1.726), Betawi (PR 1.597; 95CI:1.346-1.895), Acehnese ethnic group (PR 2.101; 95CI:1.099-4.020) while significant lower prevalence ratios were observed in Central Java (PR 0.668; 95CI: 0.580-0.770), Yogyakarta (PR 0.695; 95CI: 0.575-0.840), Banten (PR 0.718; 95CI: 0.533-0.968), Bali province (PR 0.724; 95CI: 0.590-0.889) and in Javanese (PR 0.855; 95CI:0.788-0.928), also Balinese ethnic groups (PR 0.669; 95CI:0.535-0.836). The highest prevalence of MetS components among Indonesians was low HDL cholesterol (66.41%), followed by hypertension (64.45%), and central obesity (43.21%). CONCLUSIONS: The prevalence of MetS in Indonesia is moderate with provincial and ethnic prevalence varied. Provincial and ethnic group differences in MetS prevalence ratios were observed. The top two most prevalent MetS components in Indonesian were low HDL cholesterol and hypertension.