Intramuscular ephedrine reduces emesis during the first three hours after abdominal hysterectomy

BACKGROUND: We tested the hypothesis that intramuscularly administered ephedrine prevents postoperative nausea and vomiting. Ephedrine is cheap, and for this indication poorly documented. METHODS: One hundred and nine patients undergoing elective abdominal hysterectomy under general anaesthesia were studied in a randomized, double-blind placebo-controlled study. Ten minutes before the end of the procedure patients received either ephedrine 0.5 mg/kg i.m. or placebo. The patients were closely observed for 24 h for postoperative nausea or vomiting (PONV) and received a standardized two-step antiemetic treatment of i.v. metoclopramide 10 mg, supplemented with ondansetron 4 mg i.v. if needed. RESULTS: The ephedrine treated patients had significantly less nausea, retching and vomiting, and need of antiemetic rescue during the first 3 h postoperatively compared with the placebo patients. No difference between the groups was evident in the 3-24 h postoperative observation period. All the patients with PONV during 0-3 h experienced PONV in the 3-24 h period. Treatment or prophylaxis with one drug was less efficient than two or more drugs combined. No significant differences in hypotension, tachycardia or other side-effects between the groups were noted. CONCLUSION: Ephedrine 0.5 mg/kg i.m. administered at the end of abdominal hysterectomy has a significant antiemetic effect during the first 3 h after administration with no evident side-effects.     

Propofol anaesthesia reduces early post-operative emesis after paediatric strabismus surgery

Propofol anaesthesia may reduce postoperative emesis. The purpose of this study was to compare the incidence of emesis after propofol anaesthesia with and without nitrous oxide, compared with thiopentone and halothane anaesthesia, in hospital and up to 24 hr postoperatively, in outpatient paediatric patients after strabismus surgery. Seventy-five ASA class I or II, unpremedicated patients, aged 2–12 yr were randomly assigned to one of three groups: Thiopentone, 6.0 mg · kg^{? 1} iv induction followed by halothane and N₂O/O₂ for maintenance (T/H); propofol for induction, followed by propofol and oxygen for maintenance (P/O₂); and propofol for iv induction, followed by propofol infusion and N₂O/O₂ for maintenance (P/N₂O). All received vecuronium, controlled ventilation, and acetaminophen pr. Morphine was given as needed for postoperative analgesia. There were no differences in age, weight, number of eye muscles operated upon, duration of anaesthesia or surgery. The P/N₂O group (255 ± 80 μg· kg^{? 1}· min^{? 1}) received less propofol than the P/O₂ group (344 ± 60 μg · kg^{? 1}· min^{? 1}) (P ≤ 0.0001) and had shorter extubation (P < 0.001) and recovery (P < 0.01) times. Emesis in the hospital, in both the P/N₂O (4.0%) and P/O₂ group (4.0%) was less than in the T/H group (32%) (P < 0.01). Antiemetics were required in four patients in the T/H group (16.0%). Overall emesis after surgery was not different among the groups: T/H (48%), P/O₂ (28%) and P/N₂O (42%). The use of propofol anaesthesia with and without N₂O decreased only early emesis. This supports the concept of a short-acting, specific antiemetic effect of propofol.     

Scopolamine patch reduces postoperative emesis in paediatric patients following strabismus surgery

Scopolamine patch was evaluated for the prevention of post-operative emesis in 50 children undergoing strabismus surgery. All subjects were premeditated, with none receiving narcotic premedicants. Anaesthesia included controlled ventilation with the use of muscle relaxants, atropine, and halothane. Before operation, the subjects were randomly assigned to one of two groups: a treatment group received a scopolamine patch at a dose of either 0.75 mg or 0.375 mg, and a control group received no patch. Both the incidence and frequency of vomiting in the scopolamine-treated group were significantly (P < 0.05) lower than in the control group.     

Propofol reduces emesis after sufentanil supplemented anaesthesia in paediatric squint surgery

Background. Squint surgery is associated with a high incidence of postoperative emesis. The purpose of this prospective study was to examine the influence of propofol and isoflurane anaesthesia on the incidence of postoperative nausea and vomiting in children.
Methods. Ninety children aged 3–10 years were randomly allocated to one of 3 groups. In all groups, children received 2 mg/kg propofol, 0.5 μg/kg sufentanil and 0.5 mg/ kg atracurium for induction of anaesthesia. In group 1, anaesthesia was maintained with 15–20 mg/kg·h propofol and children were ventilated with 30% O₂ in air. In group 2, anaesthesia was maintained with 10–15 mg/kg·h propofol and 30% O₂ in N₂O. In group 3, anaesthesia was maintained with 1.0–1.5 Vol% isoflurane and 30% O₂ in N₂O. The time of extubation, awakening and postoperative surveillance, the incidence and numbers of episodes of postoperative nausea and vomiting were registered as well as requirements of antiemetics. Statistics were made using ANO-VA and Chi-square test or Kruskal-Wallis test with P <0.05 considered as significant.
Results. The overall incidence of nausea ( P =0.0001) and vomiting ( P =0.002) was higher in group 3 (70%;73%) than in group 1 (13%; 23%) and 2 (20%;28%). Episodes of nausea ( P =0.0001) and vomiting ( P =0.0013) were more frequent in group 3 (74%;69%) than in group 1 (13%;15%) and 2 (13%;16%). Antiemetic requirements were higher and the time of postoperative sleep and surveillance was longer in group 3 than in group 1 and 2 ( P =0.04).
Conclusion. Propofol-sufentanil anaesthesia results in less emesis and treatment during the early postoperative phase irrespective of N₂O administration compared with propofol- induced isoflurane anaesthesia and may be recommended in children undergoing squint surgery.     

Positive end-expiratory pressure reduces pneumocephalus in spinal intradural tumor surgery

We tested the hypothesis that 5 cm H2O of positive end-expiratory pressure (PEEP) reduces the incidence of pneumocephalus in patients who undergo spinal intradural tumor surgery. Fifty-three ASA I to III patients who underwent thoracolumbar intradural tumor surgery between the years 2003 and 2006 were included in this study. All patients received propofol, fentanyl, and cisatracurium for induction of the anesthesia. Maintenance was provided by propofol infusion and, oxygen (50%) and air (50%). Group I (n=28) did not receive PEEP whereas group II (n=25) received PEEP as 5 cm H2O. Cranial computerized tomography was taken at 8 hours after the surgery and cases were evaluated for pneumocephalus using BAB Bs200ProP Image System software. Pneumocephalus areas between 0.03 and 4.24 cm2 were observed in 9 patients, 8 in group I and 1 patient in group II at the 8th postoperative hour, at various localizations. There were no neurologic findings in other patients except for 2 patients in group I who presented with headache and mental status change. Although the cerebrospinal fluid leakage is minimal, N2O is not used and the patients are well hydrated, pneumocephalus with neurologic deficits may occur in patients undergoing microsurgical spinal intradural tumor surgery in prone position. In our study, we showed that using 5 cm H2O PEEP perioperatively reduced the risk of pneumocephalus. However, more cases must be studied to support this hypothesis.     

Bi-atrial pacing significantly reduces the incidence of atrial fibrillation post cardiac surgery

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether either right atrial or bi-atrial pacing effectively reduces the incidence of Atrial fibrillation post cardiac surgery. Altogether 458 papers were found using the reported search, of which 16 represented the best evidence on this topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses were tabulated. We conclude that Right atrial pacing is of no benefit but bi-atrial pacing significantly reduces the incidence of atrial fibrillation with an odds ratio for benefit of 0.51 (95%CI 0.36-0.72) from 11 studies.     

子宫良性病变行子宫切除术后盆腔囊肿的临床分析

目的探讨子宫切除术中对卵巢的正确处理方式。方法回顾分析我院20多年来因子宫良性病变行子宫切除术后发生盆腔囊肿的28例病例，以探讨该病变的性质及子宫切除术中对卵巢的正确处理。结果22例行开腹手术治疗，术后病理结果良性有20例，恶性有2例，占9．09％。有6例给予了抗炎对症治疗。结论盆腔囊肿的性质以包裹性假囊、卵巢良性肿瘤为主，恶性肿瘤少见。应重视子宫切除术中卵巢的正确处理方法。     

Perioperative dextromethorphan reduces postoperative pain after hysterectomy.

We studied the effect of dextromethorphan, an N-methyl-D-aspartate antagonist, on analgesic consumption and pain scoring after abdominal hysterectomy. In this double-blinded study, 50 patients were randomized into two groups. Group DM was given oral dextromethorphan 40 mg with their premedication, then 40 mg three times per day for the next 2 days. Group P received placebo at identical times. Postoperative analgesic requirements were assessed using a patient-controlled analgesia system and subsequent oral analgesic intake using a set protocol. Pain was assessed at rest and on movement using a visual analog scale 4, 24, 48, and 72 h after the operation. Median pain scores at rest were significantly lower at 48 and 72 h and also for the sum of all resting pain scores. Mean morphine consumption was less in Group DM (1.1 vs 1.5 mg/h; P = 0.054). Usage of oral diclofenac, given every 8 h as needed, did not differ between groups, but consumption of codydramol (paracetamol 500 mg and dihydrocodeine 10 mg) was significantly less in Group DM. We conclude that the use of oral dextromethorphan has an analgesia-sparing effect and some beneficial effects on pain scoring at rest after abdominal hysterectomy. Implications: Patients given dextromethorphan before and after surgery had a significant reduction in some pain scores at rest, but not on movement. There was a trend to lower morphine requirements in the first 24 h. Over the next 48 h, oral analgesic usage was significantly reduced.     

术前应用小剂量地塞米松对减少单侧膝关节置换术后恶心呕吐及疼痛的效果

目的：探讨术前静脉用小剂量地塞米松对减少单侧全膝关节置换（TKA）术后恶心呕吐及术后早期疼痛的有效性及安全性。方法将90例拟行 TKA 患者随机分为 A 组（45例）与 B 组（45例）。A 组患者于术前1 h 静推地塞米松10 mg,手术完成后立即静推0．3 mg 雷莫司琼;B 组患者仅术后静推同等剂量的雷莫司琼。观察记录：患者术后6、24、48、72 h 的恶心呕吐发生率、严重程度、是否完全缓解,患者术后6、24、48、72h VAS 评分及术后3、6、12个月 KSS 评分,术后手术切口情况及1年内假体感染等并发症。结果A 组患者术后3 d 总的恶心呕吐发生率及0～6 h 恶心呕吐发生率低于 B 组,差异有统计学意义（P ＜0．05）,其余时间段恶心呕吐发生率两组差异均无统计学意义（P ＞0．05）。A 组术后24、48 h VAS 评分低于 B 组,差异有统计学意义（P ＜0．05）。术后 KSS 评分两组比较差异无统计学意义（P ＞0．05）。两组患者术后血糖值均在正常范围之内,术后手术切口均一期愈合。术后随访1年均未发生关节感染等并发症。结论单侧 TKA 患者术前预防性静推小剂量地塞米松及术后联合雷莫司琼可以减少术后恶心呕吐及早期疼痛,并不增加手术后相关并发症。     

Ondansetron with propofol reduces the incidence of emesis in children following tonsillectomy

PURPOSE: This study tested the hypothesis that the antiemetic effects of a combination of ondansetron and propofol were superior to propofol alone in children undergoing tonsillectomy surgery. METHODS: A prospective, randomized, double-blind, placebo-controlled study design was employed. Young children underwent mask induction with halothane, nitrous oxide and oxygen and then had i.v. access established: older children had i.v. induction with propofol. All patients received 0.3 mg x kg(-1) mivacurium and 2-4 microg x kg(-1) fentanyl i.v. and 30 mg x kg(-1) acetaminophen pr to a maximum dose of 650 mg. Following induction, patients received either 100 microg x kg(-1) ondansetron or placebo. Anaesthesia was maintained with 120-140 microg x kg(-1) x min(-1) propofol, nitrous oxide and oxygen to maintain vital signs within 20% of baseline. After surgery, in all patients the tracheas were extubated in the operating room without use of neuromuscular reversing agents. Episodes of emesis were recorded by PACU nurses for four to six hours. A telephone interview on the following day was also used for data recovery. Groups were compared in relation to age using the Mann-Whitney test, and with respect to sex and number of episodes of vomiting using the Fisher Exact Test. RESULTS: Three of the 45 patients who received ondansetron vomited (6.7%), whereas 10 of the 45 patients who received placebo vomited (22.2%). (P = 0.035) CONCLUSION: Ondansetron in a dose of 100 microg x kg(-1), when combined with propofol for children undergoing tonsillectomy reduced the incidence of postoperative vomiting to very low levels.     

Anesthetic techniques and postoperative emesis in pediatric strabismus surgery

BACKGROUND AND OBJECTIVES: Postoperative emesis after pediatric strabismus surgery continues to be a problem, despite the use of antiemetics. The purpose of this study was to identify an anesthetic technique associated with the lowest incidence of vomiting after pediatric strabismus surgery. METHODS: A prospective, randomized, double-blind study was conducted to evaluate the effect of intravenous fentanyl, meperidine, or peribulbar block with propofol infusion on emesis in 105 pediatric patients undergoing strabismus surgery. Anesthesia was maintained with nitrous oxide, oxygen, and propofol infusion. Ketorolac 1.0 mg/kg -1 intramuscular was administered to all patients after induction. Patients were given either a peribulbar block, intravenous fentanyl 2 microg/kg -1 , or intravenous meperidine 1mg/kg -1 for perioperative analgesia. The emesis scores were observed for the first 24 hours postoperatively. RESULTS: The incidence of emesis was significantly lower (1 of 35; 2.9%) in the peribulbar group compared with the meperidine group (9 of 35; 25.6%) (P <.01) in the first 24 hours. The fentanyl group had a higher incidence of postoperative vomiting (4 of 35; 11.4%) than did the peribulbar group; the difference, however, was not statistically significant. CONCLUSION: Among the three techniques, peribulbar block with propofol-based anesthesia is the technique with the lowest incidence of postoperative emesis. Fentanyl-propofol is an equally acceptable alternative; however, meperidine-propofol is associated with a high incidence of postoperative emesis.     

疾病诊断相关组时代GLIM营养不良诊断在腹部外科大手术中的应用价值及建议

2018年9月全球(营养)领导层倡议营养不良诊断标准共识(Global Leadership Initiative on Malnutrition diagnosis criteria consensus,GLIM)在线发表。对于腹部外科住院病人,因手术的应激反应会迅速耗尽机体的营养储备,从而影响其功能恢复和创口愈合。此外,腹部外科癌症病人会存在如糖尿病、亚临床器官功能障碍、免疫反应缺陷和实行新辅助治疗等情况,可能损害营养储备,进一步影响病人的恢复。对于腹部外科住院病人,入院时有营养风险或营养不良时,应进行营养干预,同时将营养风险和营养不良两个疾病名称填写在出院病案的首页,以便大数据收集系统看到代码,让需要营养支持的病人可以通过疾病诊断相关组(diagnosis related groups,DRG)和按病种分值付费(diagnosis-intervention packet,DIP)对其进行医疗补偿费用,减少病人经济负担。     

Perioperative intravenous flurbiprofen reduces postoperative pain after abdominal hysterectomy

PURPOSE: To assess whether perioperative intravenous administration of flurbiprofen, a non-steroidal anti-inflammatory drug, reduced postoperative pain after abdominal hysterectomy. METHODS: Forty-five patients undergoing abdominal hysterectomy were randomly assigned to one of three groups of equal size. A control group (CONT) received a placebo 30 min before and at the end of surgery. The other two groups, PRE and POST, received 1 mg x kg(-1) flurbiprofen iv 30 min before and at the end of surgery, respectively. All patients received identical general and epidural anesthesia. Postoperatively, 50 mg diclofenac pr was given for pain relief on patient demand. One of the authors assessed pain using a 10 cm visual analog scale at rest and during coughing at the first request for diclofenac, and at 15, 24, 48, and 72 hr after surgery. The number of times diclofenac was required during the first 24 hr after surgery was also recorded. RESULTS: The number of diclofenac requests in the PRE (1.8 +/- 0.4) and POST groups (2.0 +/- 0.4) were less than in the CONT group (3.0 +/- 0.4). The PRE group showed lower visual analog scale at rest at 15 and 24 hr and on coughing at 24, 48, and 72 hr after surgery than the CONT and POST groups. CONCLUSION: Intravenous 1 mg x kg(-1) flurbiprofen administered during anesthesia reduces postoperative rescue analgesic requirement after abdominal hysterectomy. Moreover, flurbiprofen is more effective when given before than after surgery.     

Preoperative low molecular weight heparin reduces heparin responsiveness during cardiac surgery

PURPOSE: Cardiac surgery with cardiopulmonary bypass requires systemic anticoagulation, defined by an activated clotting time (ACT) of 400-480 sec. Patients with altered heparin responsiveness require disproportionately higher doses of heparin to achieve this target ACT. A common risk factor for heparin resistance is preoperative heparin therapy. Recently, therapy with low molecular weight heparin (LMWH) has become an acceptable substitute for prolonged heparin therapy. The current study examines the effect of preoperative LMWH therapy on subsequent heparin responsiveness during cardiac surgery. METHODS: Records of patients undergoing cardiac surgery with cardiopulmonary bypass over a period of four months were reviewed. We identified patients who, during the week preceding surgery, had received prolonged (>24 hr) therapy with either sc LMWH (LMWH group) or continuous iv unfractionated heparin (Heparin group). A Control group consisted of patients who received neither heparin nor LMWH preoperatively. The heparin sensitivity index (calculated as the first change in ACT from baseline divided by the first intraoperative heparin dose, normalized to body weight), was compared among groups using ANOVA. RESULTS: One hundred and thirty-nine patients were included in the analysis. The heparin sensitivity index was 33-45% higher in the Control group (1.6+/-0.7 sec.IU-1.kg-1; P<0.0001) compared to the LMWH (1.2+/-0.4 sec.IU-1.kg-1) and Heparin (1.1+/-0.5 sec.IU-1.kg-1) groups. In a multivariable model, the use of preoperative LMWH remained a significant predictor of reduced intraoperative heparin responsiveness (P=0.002). CONCLUSION: Prolonged preoperative LMWH therapy, similar to the known effect of prolonged unfractionated heparin infusion, reduces subsequent intraoperative response to heparin.     

深度肌松和中度肌松在单孔腹腔镜全子宫切除术中的比较

目的 比较术中维持深度肌松和中度肌松在单孔腹腔镜全子宫切除术中的应用效果.方法 选择2020年6—10月择期在全凭静脉麻醉下行单孔腹腔镜全子宫切除术的患者61例,年龄45～62岁,BMI 17～28 kg/m2,ASAⅡ或Ⅲ级.采用随机数字表法将患者分为两组:深度肌松组(n=31)和中度肌松组(n=30).深度肌松组麻...     

Epidural analgesia with bupivacaine reduces postoperative paralytic ileus after hysterectomy

This study was undertaken to compare the effects of postoperative bupivacaine epidural analgesia with those of intermittent injections of ketobemidone (a synthetic opioid) on postoperative bowel motility in patients who had had hysterectomies. The epidural group (N = 20) received continuous epidural anesthesia with bupivacaine postoperatively for 26-30 hours and the control group (N = 20) received intermittent injections of ketobemidone for postoperative pain relief. Postoperative bowel movements and propulsive colonic motility were estimated from the first passage of flatus and feces and by following radiopaque markers by serial abdominal radiographs. In the epidural group, the times for first passing of flatus (31 +/- 22 hours; mean +/- SD) and feces (70 +/- 44 hours) were significantly shorter than in the control group (flatus 58 +/- 14 hours and feces 103 +/- 26 hours). The average position of the markers was significantly more distally in the epidural group immediately after operation and the markers continued to move forward during the first postoperative day. In the control group, the markers did not move during this period. The results demonstrate that postoperative bowel peristalsis returned earlier in the patients given epidural analgesia with bupivacaine for pain relief than in patients given a narcotic.     

Pharmacologic C5-complement suppression reduces blood loss during on-pump cardiac surgery

BACKGROUND: Inflammation contributes to morbidity following on-pump cardiac surgery. Complement activation during cardiopulmonary bypass has been associated with the postoperative bleeding and tissue injury. This study examines the pharmacology and impact on blood loss of complement C5 suppression with pexelizumab in patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: Pexelizumab, a humanized monoclonal antibody single-chain fragment that binds to the human C5 complement component, was studied in a Phase II multicentered clinical trial. CABG (n = 800) and CABG with concomitant valve surgery (n = 114) patients were evaluated. Patients were randomized to either: pexelizumab bolus (2.0 mg/kg) + placebo infusion; pexelizumab bolus (2.0 mg/kg) + pexelizumab infusion (0.05 mg/kg/hour for 24 hours); or placebo bolus + placebo infusion. Pharmacology, chest tube drainage, and transfusion requirements were assessed. RESULTS: Mean maximum pexelizumab serum concentration was similar for bolus and bolus + infusion-treated patients. Complement-dependent serum hemolytic activity was completely suppressed within 1 hour following pexelizumab bolus, however, suppression was maintained for a longer duration in the bolus + infusion compared to the bolus-only treated patients. A reduction in chest tube drainage was observed for all pexelizumab-treated patients, although transfusion of blood products was similar across all study groups. CONCLUSION: Pexelizumab administration inhibits complement-dependent hemolytic activity and is associated with a reduction in postoperative chest tube drainage in patients undergoing cardiac surgery requiring cardiopulmonary bypass. Further, clinical studies are needed to assess the value of complement attenuation in this setting.