Perioperative Presentations of Kounis Syndrome: A Systematic Literature Review.

Kounis syndrome commonly is described as a complex multisystem phenomenon mainly affecting coronary arteries, resulting in coronary vasospasm in the context of an allergic manifestation. This article reviews the literature regarding perioperative presentations of the syndrome. A systematic search in MEDLINE and Embase databases was performed for case reports through June 16, 2021, on Kounis syndrome triggered by medications administered in the perioperative setting. The authors' search resulted in 35 perioperative reports of Kounis syndrome, with the majority of the cases occurring in men between 40 and 80 years of age, manifesting within 20 minutes following the administration of the suspected trigger. Chest pain and ischemic changes on the electrocardiograph were the most frequent presentations, while intravenous antibiotics and neuromuscular blocking agents were the most common triggers. In most instances, the patients had a good recovery following the event. Coronary vasospasm is often less frequently recognized as a form of allergic manifestation in the perioperative setting. Many potential triggers, such as antibiotics and neuromuscular blocking agents, are routinely administered during surgery. Awareness of this condition, early diagnosis, and effective management of this condition can lead to good outcomes.

NK1 receptor antagonists versus other antiemetics in the prevention of postoperative nausea and vomiting following laparoscopic surgical procedures: a systematic review and meta-analysis.

A systematic electronic search of MEDLINE, EMBASE, and CINAHL databases aimed at comparing neurokinin-1 receptor antagonists with other antiemetics in their prevention of postoperative nausea and vomiting in adult patients undergoing laparoscopic surgery identified seven randomized controlled trials for review and meta-analysis. Preoperative aprepitant 80 mg was found to reduce nausea (RR: 0.56, 95% CI: 0.41-0.75, I2 = 0%, P = 0.89) and vomiting (RR: 0.20, 95% CI: 0.05-0.77, I2 = 0%, P = 0.96) and resulted in complete response (RR: 1.61 (1.25-2.08), I2 = 0%, P = 0.70) within the first 2 hours following surgery as well as vomiting in 2-24 hours (RR: 0.09, 95% CI: 0.02-0.36, I2 = 0%; P = 0.81) when compared to placebo or no antiemetic therapy. Preoperative aprepitant 80 mg has a superior overall effect compared to placebo or other antiemetics in the first two hours postoperatively, and thereafter reduces the risk of vomiting alone in the first 24 hours following laparoscopic surgeries.