The impact of remifentanil on incidence and severity of postoperative nausea and vomiting in a university hospital-based ambulatory surgery center: a retrospective observation study.

BACKGROUND: Ambulatory surgery, including short-stay surgery, has become a common choice in clinical practice. For the success of ambulatory surgery, perioperative care with safe and effective anesthesia and postoperative analgesia, which can reduce the occurrence of postoperative nausea and vomiting (PONV), is essential. The effect of remifentanil on the occurrence and severity of PONV has not been thoroughly examined, particularly, in an ambulatory surgery setting. Here, we investigate whether remifentanil influences the occurrence and severity of PONV in a university hospital-based ambulatory unit. METHODS: We retrospectively analyzed a total of 1,765 cases of patients who had undergone general anesthesia at our ambulatory surgery unit. Parameters, such as occurrence and severity of nausea, vomiting or retching, use of antiemetic drugs, amount of postoperative analgesic and patient satisfaction, were extracted from the records and analyzed between the groups that received and not received remifentanil. RESULTS: Within 565 patients of the RF group, 39 patients (6.6%) experienced nausea, 7 patients (1.2%) experienced vomiting or retching, and 10 patients (1.8%) were given antiemetic; in addition, the maximum VAS value for nausea was 12.1 mm. In 1,200 patients of the non RF group, 102 patients (8.5%) experienced nausea, 19 patients (1.6%) experienced vomiting or retching, and 34 patients (2.8%) were given antiemetic, and the maximum VAS value was 13.2 mm. There were no statistically significant differences between the two groups. CONCLUSIONS: Our results indicate that remifentanil did not increase the occurrence of PONV in patients within the ambulatory surgery unit.

[Postextubation laryngeal edema seven years after undergoing neck dissection].

We report a case of upper airway obstruction after extubation in a 69-year-old female patient who underwent transurethral ureterolithotripsy (TUL). She had underwent bilateral modified radical neck dissection 7 years previously. TUL went smoothly in Trenderenburg position, and the extubation was performed after antagonism of neuromuscular block. The patient was closely observed in the operating theater, but about 10 minutes after extubation, she was noted to have dyspnea and tracheal tug. Dexamathasone 2 mg IV was given but was unsuccessful. Although we could support the airway with bag-mask ventilation, continuous stridor required re-intubation. Direct laryngoscopy revealed severe obstruction caused by laryngeal edema. An otolaryngologist was consulted and he performed tracheostomy. We transferred the patient to the intensive care unit for observation. Flexible fiberoptic scope examination performed on postoperative day (POD) 1 showed the decrease of the laryngeal edema. Tacheal tube was removed on POD 7 and she was discharged from the hospital POD 10 without further complications. Patients after a neck dissection may be at elevated risk for postoperative laryngeal edema caused by lymphatic destruction or venous congestion of the neck.

[Anesthetic management of total aortic arch reconstruction by transluminally placed Inoue endovascular branched stent graft].

Two aged patients with aortic arch aneurysm underwent total aortic arch reconstruction using three branched Inoue transluminal endovascular graft. Epidural tubes were placed for intraoperative analgesia the day before operation. General anesthesia was induced with propofol and midazolam, and maintained with sevoflurane in nitrous oxide and oxygen. Laryngeal mask airways were inserted and the patients breathed spontaneously. In the first case, she awoke smoothly without any complications during and after the operation. In the second case, she did not awake after the operation. The CT scan revealed multiple cerebral embolization. She died from multiple organ failure several days after the operation. Endovascular total aortic arch reconstruction with Inoue branched stent graft may be less invasive for aged patients than conventional surgical repair. But long-term mortality and effectiveness for this treatment remain unclear and severe complications such as cerebral infarction may occur. It is very important to let patients awake smoothly after operation and to estimate neurological findings as soon as possible.

[Anesthetic management of a boy with 7 q trisomy syndrome].

A 5-year-old boy with 7 q trisomy received general anesthesia for tracheostomy. He was born with multiple morphological malformations including anomalies of ears, eyes, face and vertebral, accompanying difficulty in tracheal intubation. At first we inserted a laryngoscope under awake condition to estimate the difficulty in intubation. Then, we performed intubation under sevoflurane-N2O-O2 anesthesia. After intubation, there was no problem during the operation. A child with chromosome abnormality has multiple malformations and we should be ready for possible difficulties.