The incidence of postoperative nausea and vomiting after thyroidectomy using three anaesthetic techniques

The choice of anaesthetics can affect the incidence of postoperative nausea and vomiting (PONV). This study compared the incidence of PONV in 177 female patients who underwent thyroidectomy, with anaesthesia induced and maintained using one of three regimens: (i) sevoflurane (thiopental sodium 4 - 5 mg/kg and sevoflurane 2.0 - 2.5 vol% in 50% air); (ii) total intravenous anaesthesia (TIVA; propofol-remifentanil [target blood concentrations 2.5 - 3.5 μg/ml and 3.5 - 4.5 ng/ml, respectively]); or (iii) combined inhalation and intravenous anaesthesia (sevoflurane 1.0 vol% in 50% air plus propofol-remifentanil [target blood concentrations 1.5 - 2.5 μg/ml and 2.5 - 3.5 ng/ml, respectively]). The incidence and severity of PONV and the need for rescue antiemetics were assessed at 0 - 24 h postoperatively. Overall, the incidence of PONV was significantly lower in the TIVA and combined groups compared with the sevoflurane group (33.9%, 39.0% and 64.4%, respectively). In conclusion, the maintenance of anaesthesia with propofol-remifentanil or sevoflurane-propofol-remifentanil decreased the incidence of PONV compared with sevoflurane alone.     

Total intravenous anesthesia (TIVA) and balanced anesthesia with short-acting anesthetics for ENT surgery in children

It was the aim of this study to compare total intravenous anaesthesia (TIVA) with balanced anaesthesia using modern short-acting anaesthetics for ENT-surgery in children regarding the influence on haemodynamics, recovery, side-effects and costs. After approval of the Ethics Committee of the Medical Faculty of the University of Rostock, 80 children in the age of 3 to 12 years, rectally premedicated with midazolam (0.3 mg/kg) and atropine (0.01 mg/kg), were randomly assigned to TIVA (group 1, n = 41) and balanced anaesthesia (group 2, n = 39), respectively. TIVA was induced with propofol (2 mg/kg) and remifentanil (1 microgram/kg) and maintained with propofol (6 mg/kg/h) and remifentanil (0.2 microgram/kg/min). Controlled ventilation was performed with an air/oxygen mixture (1:1). Balanced anaesthesia was induced with the method of "single breath induction" using sevoflurane (8 Vol.%) in a mixture of nitrous oxide/oxygen (2:1). For maintaining balanced anaesthesia under low flow conditions, sevoflurane concentration was reduced to 1 Vol.% while the nitrous oxide/oxygen mixture was kept constant. Additionally 0.1 microgram/kg/min of remifentanil was given. For controlled ventilation, the patients of both groups were primarily relaxed for intubation with mivacurium (0.2 mg/kg) under continuous monitoring using TOF-stimulation (TOF-Guard). Further relaxation was performed with doses of 0.05 mg/kg of mivacurium after relaxometric control reached T1-level > 20% and T2-level > 0. Haemodynamic parameters (heart rate, mean arterial blood pressure), awakening time (time until the first spontaneous movements occurred), recovery time (according to Aldrete-Score > 8), side-effects (sevoflurane-induced excitation and propofol-induced pain due to the injection during induction of anaesthesia, postoperative vomiting) and costs for anaesthetic agents and relaxants were registered. The investigation showed significantly higher heart rate (p < 0.05) and significantly lower mean arterial pressure (p < 0.05) during balanced anaesthesia than during TIVA. Between the two groups there were no statistically significant differences regarding awakening time, recovery time and incidence of postoperative vomiting. In the TIVA-group, pain due to injection of propofol occurred in 10 patients (24.4%) and in group 2 sevoflurane-induced excitation during induction was registered in 22 patients (56.4%). Based on our presently existing purchase prices for the drugs used, there were no significant differences between the costs for TIVA and balanced anaesthesia. We conclude that both TIVA and balanced anaesthesia performed with short-acting anaesthetics, are suitable anaesthetic methods for ENT operations in children. Because balanced anaesthesia with sevoflurane led to higher heart rates, this kind of anaesthesia should be used with caution in children with heart diseases. The main advantage of both methods is their short recovery time.     

A randomized, double-blind trial of palonosetron compared with ondansetron in preventing postoperative nausea and vomiting after gynaecological laparoscopic surgery

This randomized, double-blind study evaluated the relative efficacy of palonosetron (a new, selective 5-hydroxytryptamine type 3 [5-HT(3)] receptor antagonist) and ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing gynaecological laparoscopic surgery. Patients received either palonosetron 0.075 mg (n = 45) or ondansetron 8 mg (n = 45), intravenously, immediately before induction of general anaesthesia. The occurrence of nausea and vomiting and the severity of nausea according to a visual analogue scale were monitored immediately after the end of surgery and during the following 24 h. The incidence of PONV was significantly lower in the palonosetron group compared with the ondansetron group (42.2% vs 66.7%, respectively). There were no significant statistical differences in the visual analogue scale for nausea. In conclusion, palonosetron 0.075 mg was more effective than ondansetron 8 mg in preventing PONV.     

Control of the haemodynamic response to surgical stimuli in semi-closed circuit or closed circuit anaesthesia using a multifunctional anaesthesia system

This study compared the ability of the Zeus multifunctional anaesthesia system to control haemodynamic response to surgical stimulation in semi-closed (SCA) or closed circuit anaesthesia (CCA) modes. Fifty patients undergoing gynaecological surgery were randomly assigned to SCA or CCA. Anaesthesia was induced with 2 mg propofol and 0.9 mg/kg rocuronium, intravenously, and maintained using sevoflurane (minimum alveolar concentration [MAC], 1.0) using 2 l/min oxygen plus 2 l/min nitrous oxide (SCA 4 l/min group) or 50% oxygen plus 50% nitrous oxide (CCA group). An increase in mean arterial pressure (MAP) > 20% above baseline in response to surgical stimulation provoked a stepwise increase in sevoflurane (1.3 MAC and then 1.6 MAC), followed by fentanyl 1 pg/kg intravenously (rescue drug). The time required for MAP to return to within 10% of baseline was significantly shorter in the CCA group (6.4 +/- 3.6 min) compared with the SCA 4 l/min group (10.2 +/- 6.0 min). The percentage of patients requiring fentanyl was significantly greater in the SCA 4 l/min group than in the CCA group. In conclusion, CCA controlled acute haemodynamic responses to surgical stimuli more successfully and rapidly than SCA 4 l/min, using a multifunctional anaesthesia machine.     

Comparison of granisetron with granisetron plus droperidol combination prophylaxis in post-operative nausea and vomiting after laparoscopic cholecystectomy

The aim of this study was to evaluate the effects of granisetron and granisetron plus droperidol combination therapy on post-operative nausea and vomiting (PONV) in 60 patients who had undergone elective laparoscopic cholecystectomy. Induction of anaesthesia was achieved using 5 mg/kg thiopentone, 2 micrograms/kg fentanyl and 0.5 mg/kg atracurium, and anaesthesia was maintained with 2-2.5% sevoflurane. The patients were randomly assigned to two groups: group G (granisetron) (n = 30) patients received 3 mg granisetron and group GD (granisetron plus droperidol) (n = 30) patients received 3 mg granisetron and 1.25 mg droperidol shortly before the induction of anaesthesia. PONV incidence was recorded post-operatively at 15 min, 30 min, 60 min, 2 h, 4 h, 12 h and 24 h. While PONV prophylaxis provided almost complete emetic control in patients who received the granisetron plus droperidol combination, patients who received granisetron prophylaxis alone experienced PONV more frequently at 30 min and 60 min post-operatively. We conclude that addition of a low dose of droperidol to granisetron prophylaxis is more effective than granisetron prophylaxis alone for successful control of PONV.     

Predictive models for post-operative nausea and vomiting in patients using patient-controlled analgesia

This study identified predictive factors for post-operative nausea and vomiting (PONV) in patients using patient-controlled analgesia (PCA) and developed five predictive model pathways to calculate the probability of PONV using decision tree analysis. The sample consisted of 1181 patients using PCA. Data were collected using: a specifically designed check-off form to collect patient-, surgery-, anaesthesia- and post-operation-related data; the Beck Anxiety Inventory to measure pre-operative anxiety; and a visual analogue scale, to measure post-operative pain. The incidence of PONV was 27.7%. Nine factors were highly predictive of PONV in our five model pathways: gender, obesity, anxiety, history of previous PONV, history of motion sickness, inhalation of nitrous oxide during operation, use of inhalational agents, starting oral fluid/food intake after operation, and post-operative pain. With these five predictive model pathways, we can predict the probability of PONV in an individual patient according to their individual characteristics.     

Remifentanil-propofol in vertebral disk operations: Hemodynamics and recovery versus desflurane-N<Subscript>2</Subscript>O inhalation anesthesia

The purpose of this study was to ascertain whether total intravenous anesthesia (TIVA) with propofol and remifentanil differs from inhalational anesthesia with desflurane and nitrous oxide in terms of hemodynamics, recovery profile, and postoperative analgesic demand in patients undergoing elective microsurgical vertebral disk resection. A total of 60 patients were randomly assigned to receive TIVA with propofol and remifentanil or inhalational anesthesia with desflurane and nitrous oxide. The TIVA group (n=30) then received 50%/50% N₂O/O₂. A constant infusion of remifentanil was provided at 0.125 μg/kg/min accompanied by propofol at 10 mg/kg/h in the first 10 min, 6 mg/kg/h in the second 10 min, then 4 mg/kg/h. The desflurane group (n=30) received 50%/ 50% N₂O/O₂, with 5% desflurane after intubation and 6% before incision; desflurane was administered in a minimum alveolar concentration 1 fashion during the operation. Hemodynamic, O₂ saturation, and end-tidal CO₂ data were recorded before induction, after intubation, after prone positioning, 5, 10, 15, 20, and 30 min into the operation, and at 15-min intervals thereafter until the end of the operation. Details on perioperative bradycardia, hypotension or hypertension, spontaneous breathing, extubation, eye opening, recovery time of ability to give name and date of birth, postoperative nausea and vomiting, shivering, agitation, and hypoxia were recorded. Patients anesthetized with desflurane responded to skin incision with increasing blood pressure and tachycardia; however, no other hemodynamic differences were noted between the 2 groups. In the TIVA group, recovery times were shorter for spontaneous ventilation (2.33–3.53 min), extubation (3.13–3.88 min), eye opening (4.06–6.23 min), and being able to give name and date of birth (5.4–7.9 min) compared with times in the desflurane group (P<.05). In theTIVA group, more postoperative shivering (16.7% of patients) and greater analgesic demand were seen than in the desflurane group. Although nausea and vomiting were more common in the desflurane group, no difference in bronchospasm was reported. In theTIVA group, a shorter recovery period and a greater demand for postoperative analgesia were seen. Because of the lack of residual analgesic effects, postoperative analgesic treatment should be initiated immediately in patients undergoing TIVA.     

Perioperative management with short-acting intravenous anesthetics

Total intravenous anaesthesia (TIVA) with short-acting drugs is a standard procedure for day case surgery and is increasingly used for neurosurgical, cardiac surgical and paediatric surgical operations. The combination of propofol with alfentanil or remifentanil is frequently applied due to its favourable pharmacological properties. Propofol is characterized by a large volume of distribution at steady state and a relatively long elimination half time (t1/2 beta). Because of a high metabolic clearance, the clinical effects of propofol decline rapidly even after prolonged intravenous drug infusion. In patients with increased age, obesity or liver or renal failure, decreased doses of propofol for induction of anaesthesia are recommended. The short-acting opioids alfentanil and remifentanil provide small volumes of distribution at steady state, a short blood-brain equilibration time and decreased t1/2 beta. Remifentanil has unique pharmacological properties due to an ester binding and its elimination via extrahepatic hydrolysis by non-specific blood and tissue esterases. The context sensitive half time of remifentanil is significantly shorter than that of other opioids. Its analgetic potency is equal to fentanyl and 20 to 30 times higher than alfentanil. The advantages of total intravenous anaesthesia include fewer haemodynamic side-effects, a decreased incidence of postoperative nausea and vomiting and less neurohumoral stress response to surgery. Adequate pain therapy is mandatory after total intravenous anaesthesia with short-acting drugs. Continuous infusion of remifentanil for postoperative analgesia or supplementation of regional anaesthesia requires careful monitoring of vital functions. The economic aspects of TIVA remain to be determined.     

Anti-emetic prophylaxis with oral tropisetron and/or dexamethasone

BACKGROUND: The corticosteroid dexamethasone and the serotonine3 -antagonist tropisetron are both effective drugs for the prophylaxis of post-operative nausea and vomiting (PONV) when given intravenously. The aim of this trial was to evaluate the oral use of both drugs as part of a routine oral premedication and to compare their single and combined effectiveness. MATERIALS AND METHODS: In this randomized, placebo-controlled, double-blind study, 320 inpatients with a moderate-high risk of PONV (> or = 40% according to two validated risk scores) received an oral premedication 1-2 h pre-operatively with placebo, a fixed dose of tropisetron 5 mg, dexamethasone 8 mg, or a combination of both drugs. A standardized general anaesthesia was performed, including benzodiazepine premedication, propofol, rocuronium, desflurane in air/O2, fentanyl or sufentanil followed by a continuous infusion of remifentanil. Post-operative analgesia and anti-emetic rescue medication were standardized. The main outcome measures were the severity of PONV within the first 24 h (rated by a standardized scoring algorithm). The incidence of PONV was used as the secondary outcome. RESULTS: Data from 310 patients were analyzed. The mean severity score in the placebo-, tropisetron-, dexamethasone- and the combined-groups was 1.37, 0.8, 0.8 and 0.38, respectively. The incidence of PONV of any severity was 59.2%, 37.5%, 40% and 22.8%, respectively. The reduction of the incidence and the severity of PONV were statistically significant with all three interventions. Results from additional analyses suggested that both drugs were equally effective and that there was a simple additive effect of tropisetron and dexamethasone compared with placebo. CONCLUSION: Oral tropisetron and dexamethasone were both equally effective in reducing the severity and incidence of post-operative nausea and vomiting. The latter could be reduced by approximately 35% in a population of moderate-high risk for PONV. Both drugs had an additive effect. However, even in the combination group there still remained an unacceptably high incidence of PONV of more than 20%. This highlighted the need for a multimodal anti-emetic approach in high-risk patients and the importance of treatment of PONV.     

七氟醚吸入麻醉和瑞芬太尼复合丙泊酚静脉麻醉用于小儿手术的临床观察

目的：比较七氟醚吸入麻醉和丙泊酚、瑞芬太尼静脉麻醉用于小儿手术的临床效果。方法：100例1～8岁的患儿随机分为丙泊酚、瑞芬太尼组（A组）与七氟醚吸入组（B组）。麻醉诱导后,A组持续输注丙泊酚和瑞芬太尼维持麻醉,B组吸入七氟醚维持麻醉。术中根据生命体征调整丙泊酚、瑞芬太尼的输注速度及七氟醚的吸入浓度,记录术中循环变化、术后麻醉恢复情况。结果：与B组相比,A组术中MAP下降明显（P〈0.05）。结论：与A组相比,B组术中生命体征控制平稳;术后清醒迅速、完全、平稳,拔管时间无明显差异。     

Comparison of propofol and sevoflurane for laryngeal mask airway insertion

In this study, we compared haemodynamic changes, laryngeal mask airway (LMA) insertion time, and complications in patients anesthetized by inhalation of sevoflurane with those of intravenous induction with propofol. One hundred patients, aged between 20-40 years were enrolled in this study. Group 1 received propofol (2.5 mg/kg i.v.) and group 2 received sevoflurane (6%+50% N2O+50% O2) by inhalation using the tidal volume technique. LMA insertion time was found to be significantly longer in sevoflurane group than in propofol group. Mean arterial blood pressure was significantly lower within each group after induction in comparison to before induction values. In both groups, the LMA was successfully inserted in all patients. The quality of anaesthesia according to patients was significantly higher in the propofol group (80%) than in sevoflurane group (30%). Odor perception was significantly higher in sevoflurane group (84%) than in propofol group (38%). Apnoea was significantly higher in propofol group (40%) than in sevoflurane group (0%). Sevoflurane is an alternative to propofol for induction of anaesthesia and has a lower incidence of apnoea. Other complication rates are not higher than which propofol but the longer duration of induction time is a disadvantage.     

熵指数监测下观察七氟烷在全麻过程中的应用

目的 研究熵指数指导下七氟烷在全麻过程中的应用，并与丙泊酚比较，初步探讨熵指数与OAA/S评分的相关性。方法 选择40例ASAⅠ或Ⅱ级在全麻下行择期腹腔镜下胆囊切除术的患者。随机分为七氟烷组和丙泊酚组，每组20例，麻醉期间分别采用七氟烷、雷米芬太尼和阿曲库铵或丙泊酚，雷米芬太尼和阿曲库铵维持。采用熵指数监测麻醉深度，将熵指数控制在40～60之间，术毕采用镇静/警觉评分OAA/S反映患者全麻后意识恢复程度，并记录到达不同评分的时间及相应熵值（RE和SE）,同时记录麻醉过程中及术毕清醒时对应的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳(PETCO2),并计算比较两组参数的变化情况。 结果 手术维持在同等熵指数下，切皮时两组平均动脉压均高于术前，手术进行至10分钟时丙泊酚组的MAP持续升高，当30分钟时，丙泊酚组的SE值低于七氟烷组。手术结束苏醒时，最终到达OAA/S评分和定向力恢复时间，两组无统计学意义。结论 两组在麻醉维持有效性和安全性及苏醒时间上无明显差别，七氟烷的血流动力学稳定性优于丙泊酚,熵指数与OAA/S评分有良好相关性.     

靶控输注瑞芬太尼伍用丙泊酚或七氟醚在妇科腹腔镜手术中的麻醉效果比较

[目的]比较靶控输注瑞芬太尼与丙泊酚全凭静脉麻醉和靶控输注瑞芬太尼与七氟醚静吸复合麻醉在妇科腹腔镜术中的麻醉效果.[方法]选择ASAⅠ或Ⅱ级择期行妇科腹腔镜手术患者52例,随机均分为瑞芬太尼-丙泊酚全凭静脉麻醉组（RP组）与瑞芬太尼-七氟醚静吸复合麻醉组（RS组）.RP组麻醉维持用瑞芬太尼与丙泊酚靶控输注,RS组采用靶控输注瑞芬太尼及吸入七氟醚维持麻醉.观察和测定麻醉前10 min（T0）、插管后1 min（T1）、气腹后15 min（T2）及停气腹后15 min（T3）4个时间点的平均动脉压（MAP）、心率（HR）、血糖（BG）、皮质醇（Cor）,并记录两组患者术毕停药后自主呼吸恢复时间、呼之睁眼时间、拔管时间及定向力恢复时间.术后24 h 随访恶心、呕吐、躁动发生率,有无术中知晓以及患者满意度.[结果]两组4个时间点的MAP、HR、Cor、BG组间比较差异无统计学意义（P〉0.05）;组内比较,两组MAP、HR在T1、T2两时点与T0比较均下降（P〈0.05）,两组Cor在T2、T3与T0时点比较均明显下降（P0.05）.两组均无术中知晓,RS组的恶心、呕吐例数多于RP组（P〈0.05）.患者术后满意度均为100%.[结论]靶控输注瑞芬太尼复合丙泊酚或七氟醚用于妇科腹腔镜手术,均能维持术中血流动力学稳定以及较好的抑制插管和气腹造成的应激反应,术后苏醒迅速,尽管RS组术后恶心、呕吐多于RP组,但两种方法均能被病人较好的接受.     

Anesthesia with remifentanil combined with desflurane or sevoflurane in lumbar intervertebral disk operations

Recovery characteristics, haemodynamic profile, analgesic requirement and costs were evaluated and compared in patients undergoing elective lumbar discectomy with remifentanil-based anaesthesia using either desflurane or sevoflurane as the volatile anaesthetic agent. Sixty-two patients (ASA I/II status) were randomly assigned to receive either desflurane and remifentanil or sevoflurane and remifentanil (in oxygen/air) for anaesthesia. After induction with 0.5 microgram/kg/min remifentanil, 4 to 5 mg/kg thiopentone and 0.5 mg/kg atracurium, the patients received 0.25 microgram/kg/min remifentanil and 0.5 +/- 0.05 MAC of one of the volatile anaesthetic agents for further maintenance of anaesthesia. At the end of surgery, early emergence from anaesthesia was recorded by assessing the time to sufficient spontaneous respiration, eye opening and tracheal extubation. The total demand of piritramide in the postoperative period was determined using patient-controlled analgesia (PCA device). Quality of pain therapy was assessed via a verbal ranking scale (VRS). Side-effects such as postoperative nausea, vomiting or shivering were recorded in the postanaesthetic care unit. In both groups, the haemodynamic profile was nearly identical. Mean arterial pressure (-18%) and heart rate (-23%) were significantly reduced throughout anaesthesia in both groups. All recovery parameters were significantly shorter in the desflurane group in comparison with the sevoflurane group (e.g. time to tracheal extubation: 8.5 +/- 3.0 min vs. 11.9 +/- 4.6 min). No significant differences between the groups were observed concerning the amount of piritramide required, side-effects such as nausea and vomiting or the total cost of anaesthesia. In conclusion, both anaesthetic techniques provide adequate haemodynamic stability and postoperative pain control in a surgical procedure with minimal trauma. Incidence and severity of side-effects such as nausea, vomiting or shivering did not differ between the groups and were acceptable under clinical conditions. Costs for desflurane were significantly higher than those for sevoflurane, but total costs were not different between the groups. Concerning recovery profile, desflurane/remifentanil seems to have small advantages over sevoflurane/remifentanil in patients undergoing lumbar vertebral disc resection.     

A randomized double blind study to evaluate efficacy of palonosetron with dexamethasone versus palonosetron alone for prevention of postoperative and postdischarge nausea and vomiting in subjects undergoing laparoscopic surgeries with high emetogenic risk

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) are common occurrences (50%-80%) after laparoscopic surgery. Palonosetron (Pal), the newest 5-HT3 antagonist, is an effective antiemetic that has advantages in treating PDNV due to its prolonged duration of action. We hypothesized that a combination of Pal and dexamethazone (Dex) could further improve the efficacy of the treatment in comparison to Pal alone in patients at high risk for PONV. Patients scheduled to undergo laparoscopic surgeries under general anesthesia were randomized to receive 8-mg dexamethasone + 0.075-mg palonosetron (Pal + Dex) or an equivalent volume of saline + 0.075 mg palonosetron (Pal). Data was collected at defined postoperative times (2, 6, 12, 24, and 72 hours). All patients also completed an 18-question QOL-Functional Living Index-Emesis instrument at 96 hours. We enrolled 118 patients, ASA 1-2, with at least 3 PONV risk factors, who were undergoing outpatient surgery. Both groups had a low incidence of vomiting in the PACU (Pal + Dex, 1.7%; Pal, 6.8%) and at 72 hours (0.0% both groups). Complete response (no vomiting, no rescue medication) was not different between treatment groups for any time intervals. Cumulative success rates over the entire 72 hours were 60.4% (Pal + Dex) versus 60.0% (Pal). The Pal + Dex group showed a trend toward greater satisfaction on the QOL- Functional Living Index-Emesis scores with the greatest differences in the "nausea domain". The combination therapy of palonosetron + dexamethasone did not reduce the incidence of PONV or PDNV when compared with palonosetron alone. There was no change in comparative efficacy over 72 hours, most likely due to the low incidence of PDNV in both groups.     

The effectiveness of inhalation isopropyl alcohol vs. granisetron for the prevention of postoperative nausea and vomiting

We evaluated preemptive treatment for postoperative nausea and vomiting (PONV) with intravenous (IV) granisetron, 0.1 mg, introoperatively as compared with the use of 70% inhalation isopropyl alcohol and a control group for the prevention of PONV. We randomly assigned 57 women, 18 to 50 years old, undergoing laparoscopic procedures to 1 of 3 groups: (1) inhalation of 70% isopropyl alcohol, (2) 0.1 mg granisetron IV, and (3) no prophylactic treatment control. Participants were asked to rate their nausea and vomiting preoperatively, on arrival to postanesthesia care unit (PACU), at discharge from PACU, 6 hours after extubation, and 24 hours after extubation and any occurrence of nausea and vomiting using the numeric rating scale (NRS), 0 to 10. Group 1 experienced more PONV episodes than groups 2 and 3 during the 6- to 24-hour postsurgical timeframe (P = .02). There were no significant differences among the 3 groups in demographics, first episode of PONV, total number of episodes in 24 hours, NRS rating at rescue, and anesthetic duration. PONV and menstrual cycle phase had no positive correlation (P > .05). History of smoking, PONV, and motion sickness had no significant difference against any measure of PONV (P > .05).     

Pharmacological Prophylaxis and Management of Adult Postoperative/Postdischarge Nausea and Vomiting

Postoperative nausea and vomiting (PONV) is a relatively common complication that can adversely affect the quality of a patient's postoperative recovery. Factors to consider when determining a patient's risk for developing PONV include female gender, history of PONV, history of motion sickness, nonsmoking status, postoperative use of opioids, use of inhaled anesthetic agents, and use of nitrous oxide. Receptors that, when activated, can cause PONV include dopamine type-2, serotonin type-3, histamine type-1, muscarinic cholinergic type-1, and neurokinin type-1. Patients with a moderate-to-high risk of developing PONV will benefit from the administration of a prophylactic antiemetic agent that blocks one or more of these receptors. Effective agents for prophylaxis include transdermal scopolamine, prochlorperazine, promethazine, droperidol, ondansetron, dolasetron, granisetron, dexamethasone, and aprepitant. In the highest-risk patients, combining two or more prophylactic antiemetics with different mechanisms of action has been shown to be more effective than a single agent. In addition, the patient's risk could be reduced by considering the use of regional anesthesia, maintaining general anesthesia with propofol rather than with inhaled anesthetic agents, ensuring good intravenous hydration, and providing effective pain management using a multimodal approach (eg, minimizing the use of opioids). If PONV does occur in the immediate postoperative period, it is best treated with an antiemetic agent from a different pharmacologic class than the agent that was administered for prophylaxis. Once a patient is discharged, alternative formulations of antiemetics such as ondansetron oral or dissolving tablets or promethazine tablets or suppositories can be used.     

Comparison of the effects of sevoflurane and propofol anaesthesia on regional cerebral glucose metabolism in humans using positron emission tomography

This study compared brain glucose metabolism during sevoflurane anaesthesia and propofol anaesthesia using positron emission tomography (PET) in the same eight human volunteers. All the volunteers were anaesthetized twice, with a 1-week interval. Half of the volunteers received sevoflurane on the first occasion and propofol on the second; the other half received the two anaesthetics in the reverse order. PET scans using 18F-fluorodeoxyglucose were performed after sevoflurane or propofol anaesthesia. The relative glucose metabolic rate (rGMR) in the brain was assessed with statistical parametric mapping. Propofol suppressed the rGMR of the neocortex area more than sevoflurane, and sevoflurane suppressed the rGMR of the paleocortex and telencephalon more than propofol. These findings suggest that these two anaesthetics act via different mechanisms and may provide an important clue to the relationship between anaesthesia and the brain.     

三种不同麻醉方式对小儿术后躁动的影响

[目的]比较瑞芬太尼加异丙酚全凭静脉麻醉、七氟醚吸入麻醉、静吸复合麻醉三种不同麻醉方式对小儿术后躁动的影响.[方法]将60例2~5岁实施腺样体切除的患儿随机分为三组（每组20例）.瑞芬太尼加异丙酚全凭静脉组（P 组）、七氟醚组（S组）、静吸复合组（R 组）,术后送入术后复苏室（PACU）.观察各组的躁动发生率、苏醒时间和PACU停留时间.[结果]P组和R组的躁动发生率显著低于S 组（20%和35% vs 70%,P〈0.01）.与R组比较,P组、S组的苏醒时间明显延长（P〈0.01或P〈0.05）;PACU停留时间亦显著增加（P〈0.01或P〈0.05）.[结论]瑞芬太尼加异丙酚全静脉麻醉可有效的抑制小儿术后躁动的发生率,但是联合七氟醚吸入麻醉可以得到更好的苏醒质量.     

PPIP辅助笑气-七氟醚序贯吸入麻醉诱导的效果研究

目的:探讨小儿麻醉诱导期家长陪同在笑气-七氟醚序贯吸入模式的应用及护理对策.方法:选择择期手术患儿,随机分为观察组和对照组,观察组为家长陪同下笑气-七氟醚序贯吸入麻醉诱导,对照组则无家长陪同常规麻醉诱导程序,观察两组患儿麻醉诱导前的血压、心率、呼吸、血氧饱和度及情绪变化,通过问卷方式调查两组患儿术后心理行为、家长满意度.结果:对照组患儿麻醉诱导期血压及心率、呼吸显著高于观察组,血氧饱和度低于观察组(P<0.01),观察组术后心理行为明显优于对照组,观察组家长满意度提高.结论:PPIP辅助笑气-七氟醚序贯吸入麻醉诱导患儿安静合作、生命体征稳定,术后心理行为正常,家长满意.