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1.
BMC Anesthesiol ; 22(1): 292, 2022 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-36109691

RESUMO

PURPOSE: To observe the effect of different antiemetic drugs for the prevention of postoperative nausea and vomiting (PONV) after gynaecological day surgery under remimazolam general anesthesia. METHODS: One hundred ninety-two patients were selected for gynaecological day surgery and randomly divided into three groups: droperidol group (DD group), tropisetron group (DT group) and control group (DC group). Flurbiprofen axetil 50 mg and dexamethasone 5 mg were given intravenously before induction of anesthesia, and 2 min later droperidol 1 mg was given intravenously to the DD group, tropisetron 5 mg to the DT group and saline (5 ml) to the DC group. Induction of anesthesia: remimazolam 6 mg/kg/h was continuously infused until sleep, mivacurium 0.2 mg/kg and alfentanil 20ug/kg were slowly pushed, 3 min later intubation was performed to control breathing. Maintenance of anesthesia: 40ug/kg/h of alfentanil, 1 mg/kg/h of remimazolam continuous infusion. After awakening and extubation, the patient was transferred to the PACU. PONV were recorded in the PACU and an electronic questionnaire was pushed 24 h after surgery. RESULTS: The incidence of PONV within the PACU was significantly lower in the DD (14.5%)and DT(26.7%) groups than in the DC(50%) group (p < 0.01), there was no significantly difference between the DT and DD groups. There were no significant difference in the incidence of PONV in 24 h after surgery between the three groups(DD:DT:DC = 44.5%:45.1%:63.8%,p > 0.05). CONCLUSIONS: Droperidol or tropisetron combined with dexamethasone is superior to dexamethasone alone for the prevention of PONV in the PACU after remimazolam combined with alfentanil anesthesia, with no significant difference in the incidence of PONV in 24 h after surgery.


Assuntos
Antieméticos , Náusea e Vômito Pós-Operatórios , Alfentanil , Procedimentos Cirúrgicos Ambulatórios , Anestesia Geral/efeitos adversos , Antieméticos/uso terapêutico , Benzodiazepinas , Dexametasona/uso terapêutico , Droperidol/uso terapêutico , Feminino , Humanos , Mivacúrio , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Tropizetrona
2.
Ann Med Surg (Lond) ; 81: 104409, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36147069

RESUMO

Background: Perioperative obstetric care is vital in clinical practice to improve maternal and neonatal outcomes. The standardized practice of perioperative obstetrics care service has a great role in the reduction of both expected and unexpected adverse outcomes. So, the purpose of this study was to assess the implementation of perioperative obstetric care services based on standards of Enhanced Recovery after Cesarean Delivery and the Society of Anesthesiology and Perinatology. Method and materials: A cross-sectional study was conducted on 161 mothers with an elective cesarean delivery from August 10, 2021, to May 15, 2022. The standard of this study was taken from evidence-based practice guidelines of perioperative practice for an elective cesarean delivery. Informed consent was taken from all study participants. The data was collected through direct observation using a standard checklist changed to standardized question forms with two checking components ("Yes", and "No"), and data were entered into SPSS version 20 for analysis and interpretation. Descriptive analysis was done and the results were expressed in numbers and percentages using a table. Results: A total of 161 elective cesarean sections were involved to identify the level of perioperative care. Administration of first-generation antibiotics prophylaxis, aqueous povidone-iodine solution-based skin preparations, and preparation for immediate neonatal resuscitation were fully performed based on the standards. Conclusions: The majority of elective caesarian deliveries were carried out below the recommended level as per the checklists for perioperative practice. So, added interventions are needed to improve perioperative obstetrics care services on those standards which are not totally applied and partially performed.

3.
Acta Anaesthesiol Scand ; 66(9): 1051-1060, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35924389

RESUMO

BACKGROUND: Despite improved medical treatment strategies, postoperative pain, nausea, and vomiting remain major challenges. This systematic review investigated the relationship between perioperative respiratory and hemodynamic interventions and postoperative pain, nausea, and vomiting. METHODS: PubMed and Embase were searched on March 8, 2021 for randomized clinical trials investigating the effect of perioperative respiratory or hemodynamic interventions in adults undergoing non-cardiac surgery. Investigators reviewed trials for relevance, extracted data, and assessed risk of bias. Meta-analyses were performed when feasible. GRADE was used to assess the certainty of the evidence. RESULTS: This review included 65 original trials; of these 48% had pain, nausea, and/or vomiting as the primary focus. No reduction of postoperative pain was found in meta-analyses when comparing recruitment maneuvers with no recruitment, high (80%) to low (30%) fraction of oxygen, low (5-7 ml/kg) to high (9-12 ml/kg) tidal volume, or goal-directed hemodynamic therapy to standard care. In the meta-analysis comparing recruitment maneuvers with no recruitment maneuvers, patients undergoing laparoscopic gynecological surgery had less shoulder pain 24 h postoperatively (mean difference in the numeric rating scale from 0 to 10: -1.1, 95% CI: -1.7, -0.5). In meta-analyses, comparing high to low fraction of inspired oxygen and goal-directed hemodynamic therapy to standard care in patients undergoing abdominal surgery, the risk of postoperative nausea and vomiting was reduced (odds ratio: 0.45, 95% CI: 0.24, 0.87 and 0.48, 95% CI: 0.27, 0.85). The certainty in the evidence was mostly very low to low. The results should be considered exploratory given the lack of prespecified hypotheses and corresponding risk of Type 1 errors. CONCLUSION: There is limited evidence regarding the impact of intraoperative respiratory and hemodynamic interventions on postoperative pain or nausea and vomiting. More definitive trials are needed to guide clinical care within this area.


Assuntos
Dor Pós-Operatória , Náusea e Vômito Pós-Operatórios , Adulto , Hemodinâmica , Humanos , Oxigênio/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Náusea e Vômito Pós-Operatórios/prevenção & controle
4.
Arch Gynecol Obstet ; 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35931899

RESUMO

PURPOSE: Regional anesthesia (RA) is considered as a "minimally invasive technique" to achieve anesthesia. To assess the feasibility and the perioperative outcomes of laparoscopic hysterectomy in regional anesthesia from the point of view of the surgeon, anesthesiologist and patient. METHODS: A retrospective search was performed to identify patients who underwent laparoscopic hysterectomy under RA from April 2020 to September 2021. Five patients affected by benign gynecological disease (atypical endometrial hyperplasia or uterine leiomyomas) were included. RESULTS: The postoperative pain, nausea, and vomiting (PONV) and the antiemetic/analgesic intake were evaluated. Postoperative surgical and anesthesiological variables were recorded. Duration of surgery was 84 ± 4.18 and no conversion to GA was required. According to VAS score, the postoperative pain during the whole observation time was less than 4 (median). A faster resumption of bowel motility (≤ 9 h) and patient's mobilization (≤ 4 h) were observed as well as a low incidence of post-operative nausea and vomit. Early discharge and greater patient's satisfaction were recorded. Intraoperatively pain score was assessed on Likert scale during all the stages of laparoscopy in RA, with only 2 patients complaining scarce pain (= 2) at pneumoperitoneum. CONCLUSION: RA showed to have a great impact on surgical stress and to guarantee a quicker recovery without compromising surgical results. RA technique could be a viable option for patients undergoing laparoscopic hysterectomy.

5.
AANA J ; 90(4): 263-270, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35943751

RESUMO

The effectiveness of propofol infusion on postoperative nausea and vomiting (PONV) is poorly understood in relation to various patient and procedure characteristics. This retrospective cohort study aimed to quantify the effectiveness of propofol infusion when administered either via total intravenous administration (TIVA) or combined intravenous anesthesia (CIVA) with inhalational agents on PONV. The relationship between propofol infusion and PONV was characterized controlling for patient demographics, procedure characteristics, PONV risk factors, and antiemetic drugs in adult patients (age ≥18 years) undergoing general anesthesia. Learned coefficients from multivariate regression models were reported as "lift" which represents the percentage change in the base likelihood of observing PONV if a variable is present versus absent. In a total of 41,490 patients, models showed that propofol infusion has a naive effect on PONV with a lift of -41% (P < .001) when using TIVA and -17% (P < .001) when using CIVA. Adding interaction terms to the model resulted in the loss of statistical significance in these relationships (lift of -30%, P = .23, when using TIVA, and -42%, P = .36, when using CIVA). It was further found that CIVA/TIVA are ineffective in short cases (CIVA * short surgery duration: lift = 49%, P < .001 and TIVA * short surgery duration: lift = 56%, P < .001).


Assuntos
Náusea e Vômito Pós-Operatórios , Propofol , Adolescente , Adulto , Anestesia Intravenosa , Anestésicos Intravenosos/efeitos adversos , Ciência de Dados , Humanos , Náusea e Vômito Pós-Operatórios/prevenção & controle , Propofol/efeitos adversos , Estudos Retrospectivos
6.
Trials ; 23(1): 497, 2022 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-35710447

RESUMO

BACKGROUND: The efficacy of pericardium 6 (P6) acupoint stimulation to reduce the incidence of postoperative nausea and vomiting (PONV) has been proven in several randomised controlled clinical trials. However, little is known about the effectiveness in daily practice and its use in combination with traditional pharmacologic approaches. METHODS: The primary objective of the P6NV study is to determine whether intraoperative acustimulation (acupuncture or acupressure) at the point P6 provides additional benefit when applied along with customary prophylactic intravenous antiemetics administered according to the local standard operating procedures (SOP). The primary endpoint is the incidence and severity of PONV within the first 24 h postoperatively reported with a validated postoperative nausea and vomiting intensity scale. The patient-reported outcome of perioperative quality of life (using the PPP33-questionnaire) and the detection of antiemetic-related side effects as well as the severity of PONV (via a standardised questionnaire) are secondary study objectives. P6NV is a national, multicentre, randomised, prospective, patient- and examiner-blinded interventional study and will be performed on 3500 adult patients with ASA classification I-III undergoing elective surgery under general anaesthesia and hospitalised for at least 24 h. Participating anaesthesiologists commit themselves to administer customised conventional antiemetic prophylaxis according to the local SOP by signing a statement before randomisation. The intervention group receives bilateral acupuncture or acupressure at P6. The control group receives no intervention. Before extubation, acustimulation is removed. DISCUSSION: Since P6 acustimulation is performed by a wide range of anaesthesiologists receiving written and verbal information on acustimulation beforehand, this trial will provide information on the effectiveness of an ad hoc implementation of P6 stimulation techniques in anaesthesia departments using traditional pharmacologic PONV prophylaxis. TRIAL REGISTRATION: DRKS DRKS00015272 . Registered on August 15, 2018.


Assuntos
Terapia por Acupuntura , Antieméticos , Terapia por Acupuntura/efeitos adversos , Terapia por Acupuntura/métodos , Adulto , Humanos , Estudos Multicêntricos como Assunto , Pericárdio , Náusea e Vômito Pós-Operatórios/diagnóstico , Náusea e Vômito Pós-Operatórios/etiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
J Perianesth Nurs ; 2022 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-35690545

RESUMO

PURPOSE: To evaluate the impact of an informational presentation on acquisition cost-awareness and likelihood to consider acquisition costs for post-operative nausea and vomiting (PONV) medications among military anesthesia providers. DESIGN: A descriptive, longitudinal survey was conducted between March 9, 2020, and April 3, 2020. METHODS: Military anesthesia providers (n = 12) estimated the institutional acquisition costs of 9 PONV-related medications and rated their likelihood to consider costs before and after an informational presentation. FINDINGS: Nine paired surveys were completed and returned. After an informational presentation, providers significantly improved estimation accuracy for 4 medications and significantly increased the likelihood to consider costs. CONCLUSIONS: A survey evaluation highlighted deficiencies in acquisition cost-awareness and likelihood to consider acquisition costs for PONV medications among military anesthesia providers that improved after an informational presentation.

8.
Front Surg ; 9: 882726, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35669253

RESUMO

Objective: To investigate the effect of gastric negative pressure suction on the incidence of postoperative nausea and vomiting (PONV) in patients undergoing orthognathic surgery. Methods: A retrospective study of 772 patients who underwent orthognathic surgery from October 2016 to January 2021 was performed, excluding possible confounding factors. The patients were divided into a negative gastric suction group (group 1) and a group without gastric suction (group 2), according to whether gastric suction was used after general anaesthesia. There were 386 patients in each group. The incidence of PONV was compared between the two groups. Results: The incidence of PONV was 29% in the negative gastric suction group and 58.8% in the non-gastric suction group. The incidence of PONV in the gastric negative pressure suction group was significantly lower than that in the non-gastric negative pressure suction group, and the difference was statistically significant (p < 0.05). Conclusion: By reducing the risk of perioperative bleeding in orthognathic surgery, gastric negative pressure aspiration can reduce the incidence and operation time of PONV after orthognathic surgery.

9.
Asia Pac J Oncol Nurs ; 9(7): 100047, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35647224

RESUMO

Background: We reviewed internal data and the current literature to update our enhanced recovery protocol (ERP) for patients undergoing a total breast mastectomy. Following implementation, the protocol was audited by chart review and compliance reminders were sent through email. Objective: Our primary research aim was to examine the protocol compliance following the update. Our secondary aims were to examine the association between the change in protocol and the rates of postoperative nausea and vomiting (PONV) and hematoma formation requiring reoperation. Methods: We retrospectively obtained data extracted from the electronic medical record. To test for a difference in outcomes before versus after implementation of the protocol we used multivariable logistic regression with the primary comparisons excluding a â€‹± â€‹one-month window and secondary comparisons excluding a â€‹± â€‹three-month window from the date of implementation. Results: Our cohort included 5853 unique patients. Total intravenous anesthesia (TIVA) compliance increased by 17%-52% (P â€‹< â€‹0.001) and the use of intraoperative ketorolac dropped from 44% to nearly no utilization (0.7%; P â€‹< â€‹0.001). The rate of reoperation due to bleeding decreased from 3.6% to 2.6% after implementation with the adjusted decrease being 1.0% (bootstrap 95% CI, 0.11%, 1.9%; P â€‹= â€‹0.053) excluding a â€‹± â€‹1 month window and 1.2% (bootstrap 95% CI, 0.24%, 2.0%; P â€‹= â€‹0.028) excluding a â€‹± â€‹3-month window. The rate of rescue antiemetics dropped by 6.4% (95% CI, 3.9%, 9.0%). Conclusions: We were able to improve compliance for nearly all components of the protocol which translated to a meaningful change in an important patient outcome.

10.
Transl Cancer Res ; 11(4): 736-744, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35571644

RESUMO

Background: Anesthesia with desflurane or propofol enables rapid emergence. In patients undergoing lung cancer surgery, however, the speed of emergence from desflurane, but not from propofol, may be affected by the deteriorated postoperative respiratory function. We prospectively compared the speed and quality of emergence between desflurane and propofol. Methods: We conducted a parallel study. Eighty patients scheduled for lung cancer surgery were randomly allocated to Desflurane group (Group D) and Propofol group (Group P). Combined general and epidural anesthesia was performed in the identical way except for the anesthetic. Results: There was no significant difference between the groups in the time to awakening, extubation, or orientation. However, emergence agitation (EA) occurred more frequently in Group D than in Group P (20/40 vs. 4/40, P<0.001). Numbers of patients not achieving full scores in respiration and circulation components of the modified Aldrete score 5 min after extubation were more in Group D (4/40 vs. 0/40, P=0.040; and 8/40 vs. 2/40, P=0.043, respectively). More patients required antiemetics during postoperative 24 hours in Group D (15/40 vs. 7/40, P=0.045). Conclusions: Desflurane was not inferior to propofol in the speed of emergence from anesthesia after lung cancer surgery, but it was slightly inferior to propofol in the quality of emergence. Trial Registration: UMIN-CTR identifier: UMIN000009221.

11.
J Perianesth Nurs ; 2022 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-35637077

RESUMO

PURPOSE: Measure effectiveness of a non-pharmacological approach to manage postoperative nausea (PON) by applying an ice pack to the posterior upper neck. DESIGN: This was an observational quality improvement project. The sample included adults 18 years old and older who received general anesthesia (inhalation and/or intravenous), recovering in Phase I or Phase II postoperative care unit (PACU) experiencing very mild to moderate nausea. Exclusion criteria were patients who experienced severe nausea or were actively vomiting; were admitted for head or neck plastic surgery; were hypothermic (< 36.0°C); patients who refused the ice pack, or the provider stated that placing an ice pack to the patient's posterior upper neck was contraindicated. METHODS: Patients who experienced mild to moderate PON had an ice pack applied to the posterior upper neck as first line management. If the patient's nausea continued to progress or did not improve within five minutes of ice pack application the patient was offered a different non-pharmacological approach or pharmacological approach to prevent vomiting as per standards of care. Demographics were collected and patient's level of nausea was documented at the time of ice pack application and after five minutes. FINDINGS: Of the 70 patients included in this study, 61% reported ice pack application as effective in mitigating their nausea, 14% were unsure, and 24% reported not effective. There was a significant decrease in nausea between baseline (2.3 ± 0.6; range 1-3) and five minutes post application (1.5 ± 1.1; range 0-4). The within subject baseline-post change (↓0.9 ± 1.1; P < .001) reflected a decrease in nausea. CONCLUSIONS: Application of an ice pack to the posterior upper neck, may effectively decrease very mild to moderate PON.

12.
J Perianesth Nurs ; 2022 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-35606249

RESUMO

PURPOSE: To evaluate the evidence for the effectiveness of music intervention on postoperative nausea and vomiting in the first 24 hours after surgery. DESIGN: A systematic review and meta-analysis of randomized controlled trials. METHODS: The study was conducted according to recommendations from Cochrane Handbook. The studies were selected based on PICOS inclusion and exclusion criteria. The revised Cochrane risk-of-bias tool for randomized trials was used for bias assessment and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used for reporting the study. Data was analyzed using the Comprehensive Meta-analysis version 3 software. A meta-analysis of randomized controlled trials was conducted using both fixed and random-effect models. FINDINGS: There were 576 patients in the seven studies who met the inclusion criteria. The number of participants ranged from 58 to 163. Music was implemented in postoperative, intraoperative, and perioperative periods. Meta-analyses revealed that music interventions significantly reduced postoperative vomiting (95% CI: 0.01 to 0.63, Z = 2.07, P < 0.05, Hedge's g = 0.32), and had no statistical significant effect on postoperative nausea (95% CI: -0.13 to 0.70, Z = 1.34, P > 0.05, Hedge's g = 0.28). CONCLUSION: Music intervention is effective in decreasing postoperative vomiting. Music intervention can be applied by healthcare professionals and the patients. However, more studies are still necessary to estimate the effects of postoperative nausea and vomiting and to increase the amount of available evidence. STUDY REGISTRATION NUMBER: CRD42020209691.

13.
Ann Med Surg (Lond) ; 75: 103433, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35386767

RESUMO

Introduction: Post-operative nausea and vomiting (PONV) are a common post-operative problem in anesthesia. The incidence of PONV in patients undergoing cesarean sections is very high. Post-operative nausea and vomiting have many negative impacts on the patient, baby, family, and health care system. Therefore, appropriate evidence-based knowledge regarding the prevention and management of PONV for those high-risk patients is a timely and very important issue to address to decrease the associated complications. Methods: A comprehensive literature search was conducted in Pubmed/Medline, Cochrane reviews, and google scholar including those studies published in the English language from 2010 up to 2021. The methodological quality of the included studies was appraised by the Cochrane risk of a biased assessment tool for intervention and non-interventional studies. Result: The search strategy identified a total of 10,540 articles from different electronic databases. 33 articles were selected for screening after duplicates were removed; finally, 17 articles were included for critical appraisal and 16 articles were excluded with reasons. The included articles consist of 15 RCT, 1 non-control prospective cohort, and 1 cross-sectional study. Conclusion: Pieces of evidence revealed that all obstetrics patients undergoing cesarean section should be given multimodal PONV prophylaxis. It is shown that a multimodal approach by a combination of different antiemetic agents should be preferred and most effective in preventing intraoperative and postoperative nausea and vomiting for patients undergoing cesarean section because of the complex pathophysiology of nausea and vomiting.

14.
J Perianesth Nurs ; 37(4): 445-451, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35305914

RESUMO

PURPOSE: The quality improvement (QI) project implemented a postoperative nausea and vomiting (PONV) risk screening tool and introduced a risk-tailored prophylactic guideline to identify patients at risk for PONV and aimed to minimize PONV adverse events. DESIGN: This project represents the initial PDSA (Plan-Do-Study-Act) cycle for quality improvement with use of a pre-post design with two independent groups designed to compare PONV rates before and after implementation of an Apfel Simplified Risk Score screening and prophylactic guideline intervention. METHODS: The project implemented the screening of patient PONV risk using the Apfel Simplified Risk Score and a combination antiemetic drug class prophylactic guideline for adult patients undergoing elective same-day surgery procedures. An online education module was provided to anesthesia professionals and was reviewed in-person with the relevant anesthesia professional team prior to surgery. Pre-implementation (N=107) PONV outcomes were collected. Data collected from a retrospective chart review was used to compare pre- and post-implementation PONV rates (N=96) and determine post-implementation anesthesia professional adherence to guideline recommendations. FINDINGS: Forty percent of screened patients were identified as having an increased PONV risk with an Apfel Simplified Risk Score of 3 or 4. The PONV rates for the pre-group (19.6%) and post-group (22.9%) did not significantly differ (P=.5567). Anesthesia professional adherence to administration of the recommended number of antiemetic drug classes was 89.6%. A Spearman point-biserial correlation analysis indicated a significant positive relationship between Apfel Simplified Risk Score and PONV onset in the post-group (rs=0.21, P=.0428). CONCLUSIONS: The Apfel Simplified Risk Score and prophylactic guideline increased identification of patients at risk for PONV but did not affect PONV rate despite a high anesthesia professional adherence to the guideline recommendations.


Assuntos
Antieméticos , Náusea e Vômito Pós-Operatórios , Adulto , Procedimentos Cirúrgicos Ambulatórios , Antieméticos/uso terapêutico , Humanos , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/prevenção & controle , Estudos Retrospectivos , Fatores de Risco
15.
J Perianesth Nurs ; 37(3): 365-368, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35304019

RESUMO

PURPOSE: Postoperative nausea and vomiting is one of the most common side effects associated with anesthesia. The aim of this study is to determine the effect of ginger on severity and incidence of nausea and vomiting after lower and upper limb surgery. DESIGN: This was a triple-blinded clinical trial. METHODS: Sixty eligible patients were randomly assigned to the intervention and control groups. The intervention group received four 250 mg ginger capsules and the control group received four placebo capsules 2 hours before surgery. Incidence and severity of nausea and vomiting immediately after the surgery and 2, 4, 6, and 8 hours after the surgery were evaluated. FINDINGS: The results of this study showed that the use of ginger capsules significantly reduces the incidence and severity of postoperative nausea and vomiting at different hours after surgery compared to placebo, P < .05, irrespective of the gender and the age of the patients. CONCLUSIONS: Use of ginger is effective in decreasing postoperative nausea and vomiting. However, further studies in comorbid patients are required to verify these outcomes.


Assuntos
Antieméticos , Gengibre , Antieméticos/uso terapêutico , Cápsulas , Método Duplo-Cego , Humanos , Incidência , Extremidade Inferior/cirurgia , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Vômito/tratamento farmacológico
16.
Obes Surg ; 32(5): 1673-1680, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35294692

RESUMO

PURPOSE: Patients undergoing bariatric surgery are at particular high risk of postoperative nausea and vomiting (PONV). Few studies have shown the superiority of opioid-free anesthesia (OFA) over general anesthesia with opioids in bariatric surgery. The aim was to investigate the potential advantages of the OFA in bariatric surgery. MATERIALS AND METHODS: This is a retrospective study on a prospectively collected database that included bariatric patients over a 3-year period. All patients who underwent bariatric surgery at our institution were included and divided into opioid-free or standard anesthesia. The primary endpoint was the length of hospital stay. Data was collected and analyzed using a propensity score. RESULTS: We included 344 patients, of these 209 (60.8%) received opioid-free and 135 (39.2%) received a standard anesthesia. Mean age was 46.2 ± 11.2 years, 265 (77.0%) patients were female, and 238 (69.2%) had at least one associated medical problem. The two groups were similar in terms of age, gender, BMI, associated medical problems, and type of operations. Postoperatively, we observed no significant difference in opioid requirement, while significantly less doses of antiemetics were administered in the OFA group at postoperative day 1 (0.4 ± 0.7 vs. 0.7 ± 1.0 doses, p = 0.006) and 2 (0.1 ± 0.4 vs. 0.2 ± 0.6 doses, p = 0.022). Length of stay was significantly shorter in the OFA group (2.8 ± 0.9 vs. 3.5 ± 2.0 days, p < 0.001) both in the overall and in the propensity score-matched analyses. CONCLUSION: OFA is effective for patients undergoing bariatric surgery. Perioperative outcomes are similar, while OFA patients required less antiemetics and were discharged earlier from hospital.


Assuntos
Antieméticos , Cirurgia Bariátrica , Obesidade Mórbida , Adulto , Analgésicos Opioides/uso terapêutico , Anestesia Geral , Antieméticos/uso terapêutico , Cirurgia Bariátrica/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Pontuação de Propensão , Estudos Retrospectivos
17.
Anesthesiol Clin ; 40(1): 119-142, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35236576

RESUMO

The Enhanced Recovery After Surgery Society published guidelines for bariatric surgery reviewing the evidence and providing specific care recommendations. These guidelines emphasize preoperative nutrition, multimodal analgesia, postoperative nausea and vomiting prophylaxis, anesthetic technique, nutrition, and mobilization. Several studies have since evaluated these pathways, showing them to be safe and effective at decreasing hospital length of stay and postoperative nausea and vomiting. This article emphasizes anesthetic management in the perioperative period and outlines future directions, including the application of Enhanced Recovery After Surgery principles in patients with extreme obesity, diabetes, and metabolic disease and standardization of the pathways to decrease heterogeneity.


Assuntos
Anestesia , Anestésicos , Cirurgia Bariátrica , Recuperação Pós-Cirúrgica Melhorada , Cirurgia Bariátrica/métodos , Humanos , Náusea e Vômito Pós-Operatórios/prevenção & controle
18.
J Pain Res ; 15: 683-699, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35281481

RESUMO

Study Objective: Pain management plays a pivotal role in enhanced recovery after surgery (ERAS). Erector spinae plane block (ESPB) is widely used in many regions to treat perioperative pain, but its benefits are still somewhat controversial. We, therefore, intent to systematically review the available literature on ESPB, to elucidate its effects on opioid-sparing analgesia, and summarize its potential complications. Design: Systematic review of randomized controlled trials (RCTs) with meta-analysis. Setting: Postoperative opioid consumption for various surgeries. Patients: Patients undergoing various surgeries. Intervention: We searched relevant studies in PubMed, EMBASE, Medline, and the Cochrane Library up to May 16, 2021. All prospective and RCTs that compared ESPB and sham block or no block were enrolled. Measurements: The primary outcomes were postoperative opioid consumption during the first 24 hours. The secondary outcomes were the requirement of rescue analgesia, time to first rescue analgesic and ESPB-related adverse events. Results: We included 52 trials that reported postoperative opioid consumption during the first 24 hours. The results presented that compared to control group (ie, no intervention or a sham block), ESPB reduced the accumulated opioid consumption during the first 24 h after surgery [mean difference (MD) of - 12.83 (95% CI: - 17.29 to - 8.38; p < 0.001) mg; I2 = 100%]. Besides, ESPB could prolong time to first rescue analgesia after surgery [SMD = 5.31; 95% CI 4.01-6.61; p < 0.001; I2 = 97%]. The number of patients who received rescue analgesia after surgery in the ESPB group was less than that in the control group (OR 0.13; 95% CI 0.09, 0.21; p < 0.001; I2 = 54%), and the incidence of PONV was lower in the ESPB group (OR 0.51; 95% CI 0.43, 0.62; p < 0.001; I2 = 19%). Conclusion: ESPB is an effective technique on pain management with few complications.

19.
J Anesth ; 36(2): 265-269, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35142931

RESUMO

PURPOSE: Postoperative nausea and vomiting (PONV) is a common adverse event after surgery. Remimazolam is a novel sedative agent recently approved for general anesthesia in Japan. This study evaluated the efficacy of remimazolam in the incidence of PONV after laparoscopic gynecological surgery under general anesthesia. METHODS: This prospective, randomized controlled trial included 64 women who underwent laparoscopic gynecological surgery. The patients were randomly assigned to undergo general anesthesia with either remimazolam (REM group) or desflurane (DES group, n = 30, each group). The primary outcome was the incidence of PONV in the two groups at 2 h and 24 h after the surgery. The incidence of vomiting, rescue antiemetic use, and severity of nausea were also evaluated. RESULTS: In the REM group, the incidence of PONV (27% versus 60%, respectively; P = 0.02), rescue antiemetic use (0 versus 7, respectively; P = 0.01), and nausea score (P = 0.01) were significantly decreased during the first 2 h after surgery. No parameters were significantly different 24 h after surgery between the two groups. CONCLUSION: Remimazolam can reduce the incidence of PONV after laparoscopic gynecological surgery compared to general anesthesia with desflurane during the early postoperative period.


Assuntos
Antieméticos , Laparoscopia , Antieméticos/uso terapêutico , Benzodiazepinas , Desflurano , Método Duplo-Cego , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Incidência , Laparoscopia/efeitos adversos , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Estudos Prospectivos
20.
Surg Endosc ; 36(10): 7717-7721, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35175414

RESUMO

INTRODUCTION: Postoperative nausea and vomiting (PONV) is a common complication of general anesthesia that is further potentiated in an obese patient undergoing a bariatric procedure. Literature shows trials of myriad of drugs used alone or in combination, as a prophylaxis for this cohort of patients with varied benefits. OBJECTIVE: The objective of the study was to determine the effect of intravenous scopolamine prior to stapling in obese patients undergoing sleeve gastrectomy. METHODOLOGY: A prospective randomized controlled trial of consecutive patients with BMI > 35 kg/m2, undergoing laparoscopic sleeve gastrectomy (LSG) was performed after approval of the hospital's ethical committee, explanation of trial to the patients and obtaining a consent. Patients were randomized into two groups; patients receiving intravenous scopolamine just before firing first stapler (Group 1) and patients receiving placebo (Group 2). Primary outcome parameter was PONV. The secondary outcome parameters were use of rescue antiemetic and time to oral intake. RESULTS: In our study, out of 100 cases of patients undergoing LSG, 50 received scopolamine before stapling and 50 were assigned to the control group. There was no significant difference between the two groups in terms of PONV. The group receiving scopolamine had lesser use of rescue antiemetic but no difference in time to oral intake. CONCLUSION: We concluded that incidence of PONV in obese patients undergoing LSG is not affected by scopolamine. Further trials are needed to validate the results.


Assuntos
Antieméticos , Náusea e Vômito Pós-Operatórios , Antieméticos/uso terapêutico , Método Duplo-Cego , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Humanos , Obesidade/complicações , Obesidade/cirurgia , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/etiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Estudos Prospectivos , Escopolamina/uso terapêutico
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