Postoperative Nausea and Vomiting in the Plastic Surgery Patient

Despite great advances in modern medicine, postoperative nausea and vomiting (PONV) continue to be a significant problem without a definitive cure. This article describes a prospective study conducted with 143 plastic surgery patients at a single institution between 1998 and 2000 to identify preoperative risk factors for PONV that may be specific to plastic surgery patients. In addition, a prophylactic regimen was identified that demonstrated a decrease in the incidence of PONV from the published incidence of 22% to 3%. The regimen includes the use of multiple antiemetic agents including ondansetron (Zofran) promethazine (Phenergan), and metoclopramide (Reglan), with the addition of dexamethasone (Decadron) in selected casesPresented at the 69th Annual Scientific Meeting of the American Society of Plastic Surgeons, Los Angeles, CA, October 2000     

针灸预防术后恶心呕吐的研究进展

术后恶心呕吐（PONV）,是术后最常见和最主要的并发症。针灸预防PONV是一种有效安全的非药物疗法。本文就从穴位．针灸方式．干预时间的选择及针灸治疗的副作用等方面综述近年来针灸预防PONV的研究进展。     

Factors Associated with Postoperative Cognitive Dysfunction in Patients Undergoing Cardiac Surgery

Purpose Central nervous system complications continue to be major causes of morbidity and mortality after cardiac surgery. The purpose of this study was to identify the risk factors for postoperative cognitive dysfunction after coronary artery bypass graft (CABG) surgery. Methods Eighty-eight patients scheduled for elective CABG were studied. After the induction of anesthesia, a fiberoptic oximetry oxygen saturation catheter was inserted into the right jugular bulb for the continuous monitoring of jugular venous oxygen hemoglobin saturation (SjvO₂). The hemodynamic parameters and arterial and jugular venous blood gases were measured during cardiopulmonary bypass (CPB). All patients underwent a battery of neurological and neuropsychological tests one day before the operation and at 6 months after the operation. Results The incidence of a cognitive decline at 6 months was 24/88 (27.3%). Greater age (P = 0.04), the presence of renal failure (P < 0.001), and diabetes mellitus (P < 0.001) were more frequent in the patients with postoperative cognitive dysfunction at 6 months after the operation than in patients without cognitive dysfunction. Age (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.0–1.7; P = 0.04), diabetes mellitus (OR, 1.8; 95% CI, 1.2–2.4; P < 0.01), and presence of renal failure (OR, 2.8; 95% CI, 2.4–4.3; P < 0.01) were associated with cognitive impairment at 6 months postoperatively. However, there was no relationship between the presence of atherosclerosis in the ascending aorta and postoperative cognitive dysfunction after CABG surgery. Conclusions A greater age, diabetes mellitus, and renal failure were found to be risk factors for development of cognitive impairment at 6 months after CABG with CPB.     

Propofol Decreases Early Postoperative Nausea and Vomiting in Patients Undergoing Thyroid and Parathyroid Operations

BACKGROUND: As the practice of parathyroid and thyroid surgery shifts toward short stay and outpatient treatment, the occurrence and management of postoperative nausea and vomiting (PONV) increases in importance due to its potential to delay discharge. PONV also may contribute negatively to the patient's experience and thus their level of satisfaction. The purpose of this study was to determine whether anesthetic technique based on propofol decreases the incidence of PONV and, consequently, improves patient satisfaction with their care. METHODS: A prospective, randomized trial included patients undergoing thyroidectomy and parathyroidectomy under general anesthetic with (75 patients) or without (73 patients) propofol. Occurrences of nausea, vomiting, and the resultant treatment were tracked during the perioperative period. Repeated questionnaires at multiple time points determined patient expectations and experiences related to PONV after their operation. Statistical analyses compared differences between the propofol and non-propofol groups. RESULTS: PONV was significantly less likely in the propofol group at the early time points (in the operating room and postanesthesia care unit) but not at later time points (postoperative day 1 or 2). Patients were largely satisfied with different aspects of their management despite the specifics of their anesthetic regimen. CONCLUSIONS: A propofol-based anesthetic decreases PONV immediately after the operation but this influence does not persist throughout the episode of care or significantly contribute to patient perceptions of satisfaction.     

Hand Surgery in Different Countries: Hand Surgery in Japan

Japan has faced the most challenging times in the past. Through precise diligence by stalwarts and doyens of initial hand surgeons, it led an incredible path for the most significant moments of hand surgery. This article describes the early phase of development of Japanese Society for Surgery of the hand, substantial and innovative contributions from surgeons. A noteworthy and significant achievement in the hand surgery is microsurgery and its utilities for all hand-related diseases. The first replantation of the thumb, toe transfers and wrap-around flaps are the effective surgical techniques developed and imparted to the fellow hand surgeons worldwide. We had a particular interest in congenital hand surgery and developed a modification of congenital hand classifications and introduced many surgical techniques. Besides, we grew ourselves refining more in hand and microsurgery, innovating flexor tendon repair, peripheral nerve surgeries, wrist arthroscopy, joint replacements, external fixators, and implant arthroplasty for rheumatoid hand. We share our health care information, insurance working model and hand surgery training schedule in Japan.     

Hand Surgery in Different Countries: Hand Surgery in New Zealand

Hand surgery in New Zealand has steadily grown from its origins in plastic surgery and orthopaedic surgery into its own discipline. There has been much progress and innovation in hand surgery that has originated from New Zealand and this review acknowledges the historical figures and events that have led to our present position. The current and future directions of hand surgery in our country are also discussed. As a small and remote country, we are very fortunate to have close relationships with other international hand societies. Through these relationships and the efforts of committed regional hand surgeons, the art and science of hand surgery in New Zealand continues to progress.     

心脏瓣膜手术后呼吸衰竭相关危险因素分析

目的探讨影响心脏瓣膜手术后呼吸衰竭发生的相关危险因素。方法回顾性分析2001年1月至2010年11月兰州军区兰州总医院618例心脏瓣膜疾病患者的临床资料,其中男339例,女279例;年龄10～74(44.01±13.95)岁;风湿性心脏病387例,非风湿性心脏病231例;根据术后是否发生呼吸衰竭分为呼吸衰竭组(74例)和非呼吸衰竭组(544例),采用单因素及多因素logistic回归方法分析术后呼吸衰竭发生的危险因素。结果心脏瓣膜术后早期住院死亡率6.1%(38/618),呼吸衰竭发生率12.0%(74/618)。呼吸衰竭组住院死亡率为17.6%(13/74),非呼吸衰竭组住院死亡率4.6%(25/544),两组差异有统计学意义(χ2=18.994,P=0.000)。单因素分析显示,年龄>65岁(P=0.005)、心功能分级(NYHA)Ⅳ级(P=0.014)、射血分数(EF)<50.0%(P=0.003)、体外循环时间>3 h(P=0.001)、主动脉阻断时间>2 h(P=0.008)、复合手术(同期CABG、主动脉根部置换或射频消融迷宫手术P=0.000)、二次手术(P=0.012)、术后并发症(P=0.000)、输血量>2 000 ml(P=0.000)是心脏瓣膜手术后呼吸衰竭发生的潜在危险因素;多因素logistic回归分析结果显示,复合手术(P=0.003)、二次手术(P=0.010)、术后并发症(P=0.000)、输血量>2 000 ml(P=0.012)是心脏瓣膜手术后呼吸衰竭发生的独立预测因素。结论重视心脏瓣膜术后呼吸衰竭发生的危险因素,加强围手术期处理,缩短体外循环时间,减少并发症,以减少呼吸衰竭的发生,降低病死率。     

Preoperative Orthostatic Dysfunction Is Associated with an Increased Incidence of Postoperative Nausea and Vomiting

Background: Postoperative nausea and vomiting (PONV) occurs frequently after gynecologic surgery. Because hemodynamic condition seems to be influential, women presenting with preoperative orthostatic dysregulation may have an increased risk for PONV. The aim of the present study was to assess the relationship between preoperative orthostatic dysregulation and the incidence of PONV.

Methods: In a prospective observer-blinded clinical trial, 200 women who were scheduled for elective gynecologic surgery underwent an orthostatic test on the day before surgery. Based on the orthostatic test results, women were stratified into orthostatic dysregulation (OR; systolic blood pressure decrease > 20 mmHg on standing up) and nonorthostatic dysregulation (NOR; systolic blood pressure decrease < 20 mmHg) groups.

Results: Forty-nine women were stratified to the OR group and 151 to the NOR group. Frequencies of PONV and vomiting during the study period were higher in the OR group compared with the NOR group (77.6%vs. 31.1% and 55.1 vs. 18.5%, respectively; all P < 0.001). Women with hypotension in their history showed a significantly higher frequency of PONV within 24 h (P < 0.05).     

Difference in Risk Factors for Postoperative Nausea and Vomiting

Background: It is commonly stated that risk factors for postoperative nausea are the same as for vomiting. The authors designed a prospective study to identify and differentiate the risk factors for postoperative nausea and vomiting in various surgical populations in a clinical audit setting.

Methods: The study included 671 consecutive surgical inpatients, aged 15 yr or more, undergoing various procedures. The study focused on postoperative nausea visual analog scale scores every 4 h and vomiting episodes within 72 h. Both vomiting and retching were considered as emetic events. Patient-, anesthesia-, and surgery-related variables that were considered to have a possible effect on the proportion of patients experiencing postoperative nausea and/or vomiting were examined. The bivariate Dale model for binary correlated outcomes was used to identify selectively the potential risk factors of postoperative nausea and vomiting.

Results: Among the 671 patients in the study, 126 (19%) reported one or more episodes of nausea, and 66 patients (10%) suffered one or more emetic episodes during the studied period. There was a highly significant association between the two outcomes. Some risk factors were predictive of both nausea and vomiting (female gender, nonsmoking status, and general anesthesia). History of migraine and type of surgery were mainly responsible for nausea but not for vomiting. The predictive effect of risk factors was controlled for postoperative pain and analgesic drugs.     

Hand Surgery in Different Countries: Hand Surgery in Cambodia

As a lower middle-income nation, Cambodia has made significant improvements in basic health but hand surgery development continues to lag behind due to scarcity of trained and quality surgical manpower. Most of the hand surgery development locally has been due to surgical volunteers from Asia, Europe, and the United States. The introduction of a structured and systematic community-oriented hand surgery training over a 5-year period was successful in producing local surgeons to meet the basic needs of hand surgery patients. Brachial plexus surgery has benefited significantly, with local surgeons able to independently manage cases with minimal support. With the expansion of local surgical manpower and guidance, motivation, and assistance of regional hand surgeons, the future of hand surgery in Cambodia looks promising.     

Hand Surgery in Different Countries: Hand Surgery in Saudi Arabia

Hand surgery is a unique field that incorporates multiple specialties, aiming to provide the patient with a best possible functional and aesthetic results. Hand surgeons deal with different pathologies that require skills in several aspects of surgery. The field of hand surgery has evolved significantly over the past decades across the globe. This specialty has also been evolving in Saudi Arabia over the past 25 years. Some of the services offered to patients include specialized centers for brachial plexus, peripheral nerve, and pediatric hand surgery as well as centers for work-related hand injuries. There has also been significant contribution to the hand surgery literature from the hand surgeons working in Saudi Arabia, with hundreds of papers published in journals pertaining to hand surgery, orthopedic surgery, and plastic surgery, as well as the publication of several novel mutations causing congenital hand defects in journals concerned with genetics. The recent approval of a hand and microsurgery fellowship program in Saudi Arabia will also help boost this field in the country and the region.