七氟醚和异丙酚复合麻醉下妇科腹腔镜手术患者脑血流量和颅内压的比较

Objective To compare the cerebral blood flow (CBF) and intracranial pressure (ICP) during laparoscopic gynecologic surgery performed under propofol and sevoflurane combined anesthesia.Methods Forty ASAⅠ orⅡ patients aged 20-59 yr weighing 44-69 kg were randomly divided into 2 groups(n=20 each):propofol group (group P) and sevoflurane group (group S).Anesthesia was induced with TCI of propofol (Ce 4μg/ml) in group P or 8% sevoflurane in group S combined with TCI of remifentanil (Ce 6 ng/ml).Tracheal intubation was facilitated with cis-atracurium 0.15 mg/kg.The patients were mechanically ventilated.PETCO2 was maintained at 35-40 mm Hg.Anesthesia was maintained with TCI of propofol or sevoflurane.inhalation combined with TCI of remifentanil.BIS value was maintained at 45-50 by adjusting Ce of propofol or concentration of sevoflurane.Intraabdominal pressure (IAP) was maintained at 12-14 mm Hg.Transcranial Doppler monitoring wag used.Cerebral blood flow velocity (CBFV) and pulsatility index (PI) were recorded at 5 min after supine position(T1)and 5 min after supine lithotomy position before induction(T2),while tracheal tube was being inserted(T3),5 min after tracheal intubation(T4),immediately and 15 min after abdominal CO2 iusnfflation in trendelenburglithotomy position (T5,T6) and at 10 min after deflation of abdomen(T7).Results CBFV was significandy decreased at T3,T4 and T7 in group P and at T4 and T7 in group S as compared with the baseline at T1.CBFV at T3 was significantly lower in group P than in group S.PI at T3,T4 was significantly decreased in group P as compared with the baseline at T1 and was significantly lower than in group S.PI at T5,6 was significantly increased as compared with the baseline in both groups but was not significantly different between the 2 groups.Conclusion When combined with remifentanil.propofol could decrease CBF and ICP while sevoflurane has no significant effect on CBF and ICP after induction.CBF and ICP are significantly increased in both groups after abdominal CO2 insufflation.     

不同麻醉方法对神经外科手术患者脑血管自身调节功能影响的比较

Objective To compare the effect of different methods of anesthesia on cerebral autoregulation in patients undergoing neurosurgery.Methods Sixty-nine ASA Ⅱ orⅢ patients with brain tumor, aged 23-62 yr, scheduled for neurosurgery under general anesthesia, were randomly divided into 3 groups ( n = 23 each) : propofol-remifentanil group (group PR), sevoflurane-remifentanil group (group SR) and propofol-sevoflurane-remifentanil group (group PSR) . Anesthesia was induced with target-controlled infusion (TCI) of propofol (target plasma concentration3 μg/ml, PR and PSR groups) or inhalation of 8% sevoflurane (group SR) and iv injection of remifentanil 1 mg/kg and atracurium 0.5 mg/kg. The patients were mechanically ventilated after tracheal intubation. PETCO2 was maintained at 32-35 mm Hg. Anesthesia was maintained with TCI of propofol (target plasma concentration 2.0-3.5 μg/ml) in group PR, with inhalation of 1.5%-2.5% sevoflurane in group SR, with TCI of propofol (target plasma concentration 1.5-3.0 μg/ml) and inhalation of 1% sevoflurane in group PSR, and with TCI of remifentanil (target plasma concentration 2.0-4.5 ng/ml) and iv infusion of atracurium at 6 μg · kg-1 · min-1 in all groups. Auditory evoked potential index was maintained between 40-45. The middle cerebral artery time-average peak flow velocity was recorded before induction (baseline) , immediately after intubation, immediately before craniotomy and at the beginning of skin suture. The unilateral carotid artery was compressed for 7 s at the corresponding time points mentioned above. The transient hyperemic response ratio (THRR) was calculated to reflect cerebral autoregulation. Results Compared with the baseline value at T0, THRR was significantly increased at T2in group PR and decreased at T2,3 in group SR (P <0.05) ,while no significant change was found in THRR at T1-3in group PSR (P >0.05). The THRR was significantly lower in SR and PSR groups than in group PR, and higher in group PSR than in group SR ( P < 0.05). Conclusion Propofol-remifentanil anesthesia can improve cerebral autoregulation, sevoflurane-remifentanil anesthesia can reduce cerebral autoregulation, and propofol-sevofluraneremifentanil anesthesia exerts no effect on cerebral autoregulation in patients undergoing neurosurgery.     

不同麻醉方法对神经外科手术患者脑血管自身调节功能影响的比较

Objective To compare the effect of different methods of anesthesia on cerebral autoregulation in patients undergoing neurosurgery.Methods Sixty-nine ASA Ⅱ orⅢ patients with brain tumor, aged 23-62 yr, scheduled for neurosurgery under general anesthesia, were randomly divided into 3 groups ( n = 23 each) : propofol-remifentanil group (group PR), sevoflurane-remifentanil group (group SR) and propofol-sevoflurane-remifentanil group (group PSR) . Anesthesia was induced with target-controlled infusion (TCI) of propofol (target plasma concentration3 μg/ml, PR and PSR groups) or inhalation of 8% sevoflurane (group SR) and iv injection of remifentanil 1 mg/kg and atracurium 0.5 mg/kg. The patients were mechanically ventilated after tracheal intubation. PETCO2 was maintained at 32-35 mm Hg. Anesthesia was maintained with TCI of propofol (target plasma concentration 2.0-3.5 μg/ml) in group PR, with inhalation of 1.5%-2.5% sevoflurane in group SR, with TCI of propofol (target plasma concentration 1.5-3.0 μg/ml) and inhalation of 1% sevoflurane in group PSR, and with TCI of remifentanil (target plasma concentration 2.0-4.5 ng/ml) and iv infusion of atracurium at 6 μg · kg-1 · min-1 in all groups. Auditory evoked potential index was maintained between 40-45. The middle cerebral artery time-average peak flow velocity was recorded before induction (baseline) , immediately after intubation, immediately before craniotomy and at the beginning of skin suture. The unilateral carotid artery was compressed for 7 s at the corresponding time points mentioned above. The transient hyperemic response ratio (THRR) was calculated to reflect cerebral autoregulation. Results Compared with the baseline value at T0, THRR was significantly increased at T2in group PR and decreased at T2,3 in group SR (P <0.05) ,while no significant change was found in THRR at T1-3in group PSR (P >0.05). The THRR was significantly lower in SR and PSR groups than in group PR, and higher in group PSR than in group SR ( P < 0.05). Conclusion Propofol-remifentanil anesthesia can improve cerebral autoregulation, sevoflurane-remifentanil anesthesia can reduce cerebral autoregulation, and propofol-sevofluraneremifentanil anesthesia exerts no effect on cerebral autoregulation in patients undergoing neurosurgery.     

异丙酚和七氟烷对全麻病人短时间吸入纯氧诱发氧化应激反应的影响

Objective To investigate the effects of propofol and sevoflurane on oxidative stess response induced by short period pure oxygen inhalation during general anesthesia.Methods Sixty ASA Ⅰ or Ⅱ patients aged 20-60 yr weighing 50-85 kg undergoing elective abdominal surgery under general anesthesia were randomly divided into 2 groups (n=30 each):group propofol (group P) and group sevoflurane (group S).Each group was further divided into 2 subgroups inhaling 40% O2 (P0.4,S0.4) and 100%O2(P1.0,S1.0) respectively during operation.Anesthesia was induced with propofol 1-2 mg/kg,midazolan 0.02 mg/kg and sufentanil 0.1-0.2 mg/kg.Tracheal intobation was facilitated with rocuronium 0.6-0.8 mg/kg.The patients were mechanically ventilated(VT 8 ml/kg,RR 12 bpm).PET CO2 was maintained at 35-40 mmHg.Anesthesia was maintained with in both groups.BIS was maintained at 40-60.Arterial blood samples were collected immediately before induction of anesthesia (baseline),at 2,4,6h after tracheal intubation(T1-3) and 24h after operation(T4) for determination of PaO2,serum 8-iso-PGF2α and MDA concentrations and SOD activity.PaO2/FiO2 was calculated.Results In subgroup S1.0 the serum 8-iso-PGF2α and MDA concentrations were significantly increased while serum SOD activity was significanfly decreased at T1-3 as compared with the baseline.Serum 8-iso-PGF2α and MDA concentrations were significantly higher while serum SOD activity and PaO2/FiO2 were significantly lower at T1-3 in subgroup S1.0 than in stress response induced by≤6h pure O2 inhalation but inhalation of 1.5%-3.0% sevoflurane can not.     

异丙酚和七氟烷对全麻病人短时间吸入纯氧诱发氧化应激反应的影响

Objective To investigate the effects of propofol and sevoflurane on oxidative stess response induced by short period pure oxygen inhalation during general anesthesia.Methods Sixty ASA Ⅰ or Ⅱ patients aged 20-60 yr weighing 50-85 kg undergoing elective abdominal surgery under general anesthesia were randomly divided into 2 groups (n=30 each):group propofol (group P) and group sevoflurane (group S).Each group was further divided into 2 subgroups inhaling 40% O2 (P0.4,S0.4) and 100%O2(P1.0,S1.0) respectively during operation.Anesthesia was induced with propofol 1-2 mg/kg,midazolan 0.02 mg/kg and sufentanil 0.1-0.2 mg/kg.Tracheal intobation was facilitated with rocuronium 0.6-0.8 mg/kg.The patients were mechanically ventilated(VT 8 ml/kg,RR 12 bpm).PET CO2 was maintained at 35-40 mmHg.Anesthesia was maintained with in both groups.BIS was maintained at 40-60.Arterial blood samples were collected immediately before induction of anesthesia (baseline),at 2,4,6h after tracheal intubation(T1-3) and 24h after operation(T4) for determination of PaO2,serum 8-iso-PGF2α and MDA concentrations and SOD activity.PaO2/FiO2 was calculated.Results In subgroup S1.0 the serum 8-iso-PGF2α and MDA concentrations were significantly increased while serum SOD activity was significanfly decreased at T1-3 as compared with the baseline.Serum 8-iso-PGF2α and MDA concentrations were significantly higher while serum SOD activity and PaO2/FiO2 were significantly lower at T1-3 in subgroup S1.0 than in stress response induced by≤6h pure O2 inhalation but inhalation of 1.5%-3.0% sevoflurane can not.     

顺阿曲库铵的药效学及其对组胺释放的影响

Objective To evaluate and compare the histamine-releasing,potencies of cis-atracurium and atracurium during induction of general anesthesia.Methods Forty-five ASA Ⅰ or Ⅱ patients aged 16-71 yr undergoing elective surgery under general anesthesia were randomly divided into 3 groups (n=15 each):group Ⅰcis-atracurium (stored at 4-8℃)(group CIS1);groupⅡcis-atracurium (stored at room temperature)(group CIS2) and group Ⅲ atracurium (stored at 4-8℃)(group ATR).Anesthesia Was induced with TCI of propofol (Cp 3 μg/ml) and remifentanil (Ce 3-5 ng/ml).A bolus of cis-atracurium 0.15 mg/kg or atracurium 0.75 mg/kg Was given iv over 5-10 s as soon as the patients lost consciousness.Neuro-muscular block was monitored with TOF-Watch(R) SX(Organon,the Netherlands).Single stimulation (0.1 Hz) was apphed to the ulna nerve at wrist.The maximal degree of N-M block,onset time,duration of action and recovery index were recorded.The patients were intubated and mechanically ventilated when N-M block reached the maximal degree.The intubation condition Was evaluated.MAP and HR were continuously monitored.Changes in skin were scored (0=no change,Ⅰ=flushed>120 s,Ⅱ=erytbema,Ⅲ=urticaria).Blood samples were obtained before (T0,baseline),at 2 min after induction of anesthesia with TCI of propofol and remifentanil (T1) and 2 and 5 min after CIS/ATR administration (T2,T3) for determination of plasma histamine concentration using enzymatically amplified immunoassay.Results The onset time was significantly longer and the duration of action was significantly shorter in group CIS1 than in group ATR.The maximal degree of N-M block was 100%and the intubation condition was excellent in group CIS1 and ATR.There wag no significant difference in the recovery index between group CIS1 and ATR.The onset time was significantly longer and duration of action shorter in group CIS2 than in group CIS1.There was no significant difference in recovery index between group CIS1 and CIS2.There was no significant change in plasma histamine concentration at T1-3 as compared with the baseline at T0 in group CIS1 but plasma histamine concentration was significantly increased at T2,3 in group ATR.MAP was significantly decreased after induction of anesthesia with propofol and remifentanil,but CIS and ATR did not significantly change MAP.Conclusion The onset time is longer and duration of action is shorter after cis-atracurium than afar atracurium.The N-M block induced by cis-atracurium is significantly attenuated if stored at the room temperature.Cis-atracurium does not cause histamine release.     

顺阿曲库铵的药效学及其对组胺释放的影响

Objective To evaluate and compare the histamine-releasing,potencies of cis-atracurium and atracurium during induction of general anesthesia.Methods Forty-five ASA Ⅰ or Ⅱ patients aged 16-71 yr undergoing elective surgery under general anesthesia were randomly divided into 3 groups (n=15 each):group Ⅰcis-atracurium (stored at 4-8℃)(group CIS1);groupⅡcis-atracurium (stored at room temperature)(group CIS2) and group Ⅲ atracurium (stored at 4-8℃)(group ATR).Anesthesia Was induced with TCI of propofol (Cp 3 μg/ml) and remifentanil (Ce 3-5 ng/ml).A bolus of cis-atracurium 0.15 mg/kg or atracurium 0.75 mg/kg Was given iv over 5-10 s as soon as the patients lost consciousness.Neuro-muscular block was monitored with TOF-Watch(R) SX(Organon,the Netherlands).Single stimulation (0.1 Hz) was apphed to the ulna nerve at wrist.The maximal degree of N-M block,onset time,duration of action and recovery index were recorded.The patients were intubated and mechanically ventilated when N-M block reached the maximal degree.The intubation condition Was evaluated.MAP and HR were continuously monitored.Changes in skin were scored (0=no change,Ⅰ=flushed>120 s,Ⅱ=erytbema,Ⅲ=urticaria).Blood samples were obtained before (T0,baseline),at 2 min after induction of anesthesia with TCI of propofol and remifentanil (T1) and 2 and 5 min after CIS/ATR administration (T2,T3) for determination of plasma histamine concentration using enzymatically amplified immunoassay.Results The onset time was significantly longer and the duration of action was significantly shorter in group CIS1 than in group ATR.The maximal degree of N-M block was 100%and the intubation condition was excellent in group CIS1 and ATR.There wag no significant difference in the recovery index between group CIS1 and ATR.The onset time was significantly longer and duration of action shorter in group CIS2 than in group CIS1.There was no significant difference in recovery index between group CIS1 and CIS2.There was no significant change in plasma histamine concentration at T1-3 as compared with the baseline at T0 in group CIS1 but plasma histamine concentration was significantly increased at T2,3 in group ATR.MAP was significantly decreased after induction of anesthesia with propofol and remifentanil,but CIS and ATR did not significantly change MAP.Conclusion The onset time is longer and duration of action is shorter after cis-atracurium than afar atracurium.The N-M block induced by cis-atracurium is significantly attenuated if stored at the room temperature.Cis-atracurium does not cause histamine release.     

妇科腹腔镜手术患者气腹不同阶段伤害性刺激强度的变化

Objective To evaluate the changes in noxious stimulation intensity at different periods of pneumoperitoneum in gynecological laparoscopic surgery. Methods Forty-five ASA Ⅰ orⅡ patients, aged 25-36 yr, with body mass index 18-23 kg/m2 , undergoing elective gynecological laparoscopic surgery, were randomly divided into 3 groups ( n = 15 each) . In group Ⅰ , anesthesia was maintained with TCI of remifentanil (target plasma concentration 4-6 ng/ml) and propofol (target plasma concentration 2 μg/ml) , and the concentrations were ad-justed according to the changes in BP and HR to maintain hemodynamics stable. Ⅱ and Ⅲ groups received inhala-tion of isoflurane (end-tidal concentration 1%-2%) and TCI of remifentanil (target plasma concentration 2-4ng/ml) . TCI of remifentanil was then stopped at 5 min before pneumoperitoneum (group Ⅱ ) or at 5 min after theend of rapid inflation (group Ⅲ ) , and isoflurane was inhaled (end-tidal concentration 1%-2% ) to maintain anes-thesia until the end of operation in Ⅱ and Ⅲ group. Before anesthesia (T0 ), 5 min before pneumoperitoneum (T1), 5 and 15 min of pneumoperitoneum (T2,3), HR and MAP were monitored and venous blood samples were taken for determination of plasma cortisol (Cor) , norepinephrine ( NE) and epinephrine ( E) concentrations. Results HR, MAP and NE and E concentrations at T2,3 , and Cor concentrations at T3 were significantly higher than those at T0 ingroup Ⅱ , and in group Ⅱ than in group Ⅰ (P<0.05). HR, MAP and NE and E concentrations at T2,3 ,and Cur concentrations at T3 were significantly lower in group Ⅲ than in group Ⅱ ( P < 0.05). Conclusion The intensity of noxious stimulation is strongest during rapid inflation among the different periods of pneumoperitoneum in gynecological laparoscopic surgery and the depth of anesthesia should be regulated.     

妇科腹腔镜手术患者气腹不同阶段伤害性刺激强度的变化

Objective To evaluate the changes in noxious stimulation intensity at different periods of pneumoperitoneum in gynecological laparoscopic surgery. Methods Forty-five ASA Ⅰ orⅡ patients, aged 25-36 yr, with body mass index 18-23 kg/m2 , undergoing elective gynecological laparoscopic surgery, were randomly divided into 3 groups ( n = 15 each) . In group Ⅰ , anesthesia was maintained with TCI of remifentanil (target plasma concentration 4-6 ng/ml) and propofol (target plasma concentration 2 μg/ml) , and the concentrations were ad-justed according to the changes in BP and HR to maintain hemodynamics stable. Ⅱ and Ⅲ groups received inhala-tion of isoflurane (end-tidal concentration 1%-2%) and TCI of remifentanil (target plasma concentration 2-4ng/ml) . TCI of remifentanil was then stopped at 5 min before pneumoperitoneum (group Ⅱ ) or at 5 min after theend of rapid inflation (group Ⅲ ) , and isoflurane was inhaled (end-tidal concentration 1%-2% ) to maintain anes-thesia until the end of operation in Ⅱ and Ⅲ group. Before anesthesia (T0 ), 5 min before pneumoperitoneum (T1), 5 and 15 min of pneumoperitoneum (T2,3), HR and MAP were monitored and venous blood samples were taken for determination of plasma cortisol (Cor) , norepinephrine ( NE) and epinephrine ( E) concentrations. Results HR, MAP and NE and E concentrations at T2,3 , and Cor concentrations at T3 were significantly higher than those at T0 ingroup Ⅱ , and in group Ⅱ than in group Ⅰ (P<0.05). HR, MAP and NE and E concentrations at T2,3 ,and Cur concentrations at T3 were significantly lower in group Ⅲ than in group Ⅱ ( P < 0.05). Conclusion The intensity of noxious stimulation is strongest during rapid inflation among the different periods of pneumoperitoneum in gynecological laparoscopic surgery and the depth of anesthesia should be regulated.     

不同全麻对非心脏手术患者术后认知功能影响的比较

目的 比较不同全麻对非心脏手术患者术后认知功能的影响.方法 拟行非心脏手术患者1000例,年龄18～60岁,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为5组(n=200):异氟醚+异丙酚+芬太尼组(IPF组)、异氟醚+瑞芬太尼组(IR组)、七氟醚+异丙酚+芬太尼组(SPF组)、七氟醚+瑞芬太尼组(SR组)和异丙酚+瑞芬太尼组(PR组).麻醉维持:IPF组和SPF组分别吸入1.68%异氟醚或1.71%七氟醚,TCI异丙酚,血浆靶浓度2～5 μg/ml,间断静脉注射芬太尼;IR组、SR组和PR组分别吸入1.68%异氟醚或1.71%七氟醚或TCI异丙酚,血浆靶浓度2～5 μg/ml,TCI瑞芬太尼,血浆靶浓度2～6 ng/ml.选择同期住院的非手术患者200例作为对照组(C组).于术前1 d、出麻醉恢复室时、术后1和3 d时,采用MMSE量表进行认知功能评分.于出麻醉恢复室时、术后1和3 d时,采用Z计分法评判认知功能障碍.结果 与C组比较,IPF组、IR组、SPF组、SR组和PR组出麻醉恢复室时MMSE评分降低,出麻醉恢复室时及术后1 d时认知功能障碍的发生率升高(P＜0.05);与IPF组、IR组、SPF组和PR组比较,SR组术后认知功能障碍的发生率降低(P＜0.05).结论 七氟醚复合瑞芬太尼麻醉对非心脏手术患者术后认知功能的影响较小.

Abstract：

Objective To compare the effects of methods of general anesthesia on postoperative cognitive function in patients undergoing non-cardiac surgery. Methods One thousand ASA Ⅰ or Ⅱ patients, aged 18-60 yr, undergoing non-cardiac surgery were randomly divided into 5 groups ( n = 200 each) : isoflurane + propofol + fentanyl group (group IPF); isoflurane + remifentanil group (group IR) ; sevoflurane + propofol + fentanyl group (group SPF) ; sevoflurane + remifentanil group (group SR) ; propofol + remifentanil group (group PR) . Two hundred non-operative patients served as control group (group C) . In groups IPF and SPF, anesthesia was maintained with inhalation of 1.68% isoflurane or 1.71 % sevoflurane, TCI of propofol with the target plasma concentration of 2-5 μg/ml, and intermittent iv boluses of fentanyl. In groups IR, SR and PR, anesthesia was maintained with inhalation of 1.68% isoflurane or 1.71% sevoflurane, or TCI of propofol with the target plasma concentration of 2- 5 μg/ml, and TCI of remifentanil with the target plasma concentration of 2-6 ng/ml. The patients' cognitive function was assessed using mini-mental state examination (MMSE) at 1 d before operation, while leaving postanesthesia care unit (PACU) , and at 1 and 3 d after operation. The Z score was used to identify the cognitive dysfunction as recommended by Moller while leaving PACU, and at 1 and 3 d after operation. Results Compared with group C, the MMSE score was significantly decreased while leaving PACU , and the incidence of cognitive dysfunction increased while leaving PACU and at 1 d after operation in the other groups ( P ＜ 0.05). Compared with groups IPF,IR,SPF and PR, the incidence of cognitive dysfunction was significantly increased in group SR ( P ＜ 0.05) . Conclusion General anesthesia with sevoflurane combined remifentanil exerts less effect on the postoperative cognitive function in patients undergoing non-cardiac surgery.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.