RESUMEN
OBJECTIVE: Back to the sources, postoperative nausea and vomiting, hypo- and hypertension, heart rate alterations, and hypoxemia due to laryngospasm might be considered perioperative complications. METHODS: This cross-sectional study was conducted at an Education and Research Hospital between January 2018 and June 2023. The study included a total of 437 cases of thyroid surgery. The demographic data such as age, sex, co-morbidities of the instances, hypotension, hypertension, bradycardia, hypoxemia, and postoperative nausea and vomiting, as well as laboratory data were obtained and analyzed. RESULTS: Of 437 cases, 334 (76%) were females and 103 (24%) were males, with a mean age of 51.83±11.91 years and 55.32±11.87 years, respectively. No statistical significance was realized between the complications, co-morbid diseases, and age. Notably, no liaison between the complications after awakening from the anesthesia and preoperative laboratory parameters was discerned. However, a high but no significant relationship was revealed between the platelet-to-lymphocyte ratio (P/L) in cases with hypoxemia and hypotension. Finally, no significance between laboratory values, bradycardia, hypertension, and postoperative nausea and vomiting was distinguished. CONCLUSION: We postulate that the so-called inflammatory biomarkers measured at the time of preoperative examination in the blood count concept selectively do not enrich for anticipating complications that arise in the perioperative echelon.
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Biomarcadores , Complicaciones Posoperatorias , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Transversales , Biomarcadores/sangre , Adulto , Anciano , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/sangre , Tiroidectomía/efectos adversos , Náusea y Vómito Posoperatorios/etiología , Náusea y Vómito Posoperatorios/sangre , Hipoxia/sangre , Hipoxia/etiología , Enfermedades de la Tiroides/cirugía , Enfermedades de la Tiroides/sangre , HipertensiónRESUMEN
INTRODUCTION: Transversus abdominis plane (TAP) block is a widely used anesthetic technique of the abdominal wall, where ultrasound guidance is considered the gold standard. In this study, we aimed to compare the effectiveness of laparoscopic-assisted TAP (LTAP) block with ultrasound-assisted TAP (UTAP) block for post-operative pain, nausea, vomiting, duration of the block, and bowel function. MATERIALS AND METHODS: This study included 60 patients who were randomly assigned to two groups to undergo either the LTAP or UTAP block technique after laparoscopic cholecystectomy. The time taken for administering the block, post-operative nausea and vomiting, post-operative pain, respiratory rate, bowel movements, and analgesia requirements were reported. RESULTS: The time taken for the LTAP block was shorter (p < 0.001). Post-operative mean tramadol consumption, paracetamol consumption, and analgesic requirement were comparable between the two groups (p = 0.76, p = 0.513, and p = 0.26, respectively). The visual analog scale at 6, 24, and 48 h was statistically not significant (p = 0.632, p = 0.802, and p = 0.173, respectively). Nausea with vomiting and the necessity of an antiemetic medication was lower in the UTAP group (p = 0.004 and p = 0.009, respectively). CONCLUSION: The LTAP block is an easy and fast technique to perform in patients as an alternative method where ultrasound guidance or an anesthesiologist is not available.
ANTECEDENTES: El bloqueo del plano transverso del abdomen (TAP) es una técnica anestésica de la pared abdominal ampliamente utilizada, en la cual la guía ecográfica se considera el método de referencia. OBJETIVO: Comparar la efectividad del bloqueo TAP asistido por laparoscopia (LTAP) con el bloqueo TAP asistido por ultrasonido (UTAP) para el dolor posoperatorio, las náuseas y los vómitos, y la función intestinal. MÉTODO: El estudio incluyó 60 pacientes que fueron asignados aleatoriamente a dos grupos para someterse a la técnica de bloqueo LTAP o UTAP después de una colecistectomía laparoscópica. Se informaron el tiempo de administración del bloqueo, las náuseas y los vómitos posoperatorios, el dolor posoperatorio, la frecuencia respiratoria, las evacuaciones y los requerimientos de analgesia. RESULTADOS: El tiempo de bloqueo LTAP fue menor (p < 0.001). El consumo medio de tramadol, el consumo de paracetamol y el requerimiento de analgésicos posoperatorios fueron comparables entre los dos grupos (p = 0.76, p = 0.513 y p = 0.26, respectivamente). El dolor en la escala analógica visual a las 6, 24 y 48 horas no fue estadísticamente significativo (p = 0.632, p = 0.802 y p = 0.173, respectivamente). CONCLUSIONES: El bloqueo PATL es una técnica fácil y rápida de realizar en pacientes como método alternativo cuando no se dispone de guía ecográfica o anestesióloga.
Asunto(s)
Colecistectomía Laparoscópica , Bloqueo Nervioso , Dolor Postoperatorio , Náusea y Vómito Posoperatorios , Ultrasonografía Intervencional , Humanos , Colecistectomía Laparoscópica/métodos , Femenino , Masculino , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Persona de Mediana Edad , Ultrasonografía Intervencional/métodos , Bloqueo Nervioso/métodos , Adulto , Náusea y Vómito Posoperatorios/epidemiología , Náusea y Vómito Posoperatorios/prevención & control , Náusea y Vómito Posoperatorios/etiología , Músculos Abdominales/inervación , Músculos Abdominales/diagnóstico por imagen , Estudios ProspectivosRESUMEN
BACKGROUND: Postoperative symptoms and pain after laparoscopic cholecystectomy (LC) are common in women. However, there is no evidence of differences in incidence and severity among different age groups. We evaluated whether adverse postoperative symptoms were more common in younger than in older women after LC. METHODS: One hundred and fifty premenopausal (mean age 37.6 ± 3.6 y) and 145 postmenopausal women (59 ± 5.2 y) were included in this retrospective cohort study. Clinical and anthropometric parameters were analyzed. Study endpoints were the incidences of postoperative nausea and vomiting (PONV) and pain, and the additional analgesics and antiemetics needed after surgery. RESULTS: Body mass index was normal in 42.7% of patients in the younger group and 64.8% in the older group (P < 0.001). Reported pain was more frequent and intense in the younger group throughout the study period (P < 0.01). Additional narcotics were required in 18% of premenopausal versus 7.6% of postmenopausal women (P = 0.001), and the doses used to reduce pain were higher for premenopausal women (P = 0.02). PONV was more frequent in the younger group at 1 and 6 h after surgery (P < 0.005). Rescue antiemetics were required in 29 premenopausal and 13 postmenopausal women (P = 0.01). Hospital stay was shorter for the older patients (P = 0.01). Minor morbidity was observed in both groups (0.7% and 2.1%). There was no mortality. CONCLUSIONS: Early PONV and pain after LC were more frequent in premenopausal women, who also required more rescue analgesic and antiemetic medication.
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Colecistectomía Laparoscópica , Adulto , Anciano , Colecistectomía Laparoscópica/efectos adversos , Método Doble Ciego , Femenino , Humanos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/etiología , Posmenopausia , Náusea y Vómito Posoperatorios/epidemiología , Náusea y Vómito Posoperatorios/etiología , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
Abstract Background: Postoperative Nausea and Vomiting (PONV) risk factors have not been defined for obstetric patients. In this study, our objective was to identify potential risk factors for PONV after cesarean sections performed under spinal anesthesia. Methods: One cohort of patients submitted to cesarean under spinal anesthesia was used to investigate potential risk factors for PONV. The best numerical risk factors were dichotomized using chi-squared method. A conditional independence (incremental association method) casual network was used to select the best predictors for PONV. Results: Two hundred and fifty of 260 patients remained in the study. Odds ratio for PONV of younger maternal age (< 25 years: 2.9 [1.49−5.96]), lower spinal bupivacaine dose (< 13 mg, inf [2.4-inf]), lower spinal morphine dose (< 80 mg, 0.03 [0−0.97]), history of motion sickness (2.5 [1.27−5.25]), significant nausea during the first trimester (0.3 [0.16−0.64]), intraoperative nausea and vomiting (8.2 [3.67−20.47]), and lower gestational age (< 38 weeks, 2.0 [1.01−4.08]) were statistically significant. The causal network selected absence of significant nausea during the first gestational trimester, intraoperative nausea, and gestational age < 38 weeks as the main direct risk factors for PONV. Conclusions: Intraoperative nausea and maternal age < 25 years were the main risk factors for PONV after cesareans under spinal anesthesia. Absence of self-reported nausea during the first trimester was a protective factor for post-cesarean nausea and vomiting.
Resumo Introdução: Os fatores de risco para náusea e vômitos pós-operatórios (NVPO) ainda não foram definidos para pacientes de obstetrícia. Neste estudo, nosso objetivo foi identificar potenciais fatores de risco para NVPO após parto cesariano realizado sob raquianestesia. Método: Uma coorte de pacientes submetidas a cesariana sob raquianestesia foi usada para investigar potenciais fatores de risco para NVPO. Os melhores fatores de risco numéricos foram dicotomizados por meio do método qui-quadrado. Uma rede casual de independência condicional (método de associação adicional) foi usada para selecionar os melhores preditores de NVPO. Resultados: Das 260 pacientes iniciais, 250 completaram o estudo. A razão de chances para NVPO foi estatisticamente significante para menor idade materna (< 25 anos: 2,9 [1,49−5,96]), dose mais baixa de bupivacaina raquidiana (< 13 mg, inf [2,4-inf]), dose mais baixa de morfina raquidiana (< 80 mg, 0,03 [0−0,97]), histórico de enjoo de movimento (2,5 [1,27−5,25]), náuseas importantes durante o primeiro trimestre (0,3 [0,16−0,64]), náusea e vômitos intraoperatórios (8,2 [3,67−20,47]) e menor idade gestacional (< 38 semanas, 2,0 [1,01−4,08]). A rede causal selecionou ausência de náuseas significativas durante o primeiro trimestre gestacional, náusea intraoperatória e idade gestacional < 38 semanas como os principais fatores de risco diretos para NVPO. Conclusões: Náusea intraoperatória e idade materna < 25 anos foram os principais fatores de risco para NVPO após cesariana sob raquianestesia. A ausência de náusea autorreferida durante o primeiro trimestre foi um fator protetor para náusea e vômitos após cesariana.
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Adulto Joven , Cesárea/métodos , Náusea y Vómito Posoperatorios/epidemiología , Anestesia Raquidea/métodos , Pronóstico , Bupivacaína/administración & dosificación , Cesárea/efectos adversos , Estudios Prospectivos , Factores de Riesgo , Estudios de Cohortes , Edad Materna , Náusea y Vómito Posoperatorios/etiología , Anestesia Raquidea/efectos adversos , Anestésicos Locales/administración & dosificación , Morfina/administración & dosificaciónRESUMEN
BACKGROUND: Postoperative Nausea and Vomiting (PONV) risk factors have not been defined for obstetric patients. In this study, our objective was to identify potential risk factors for PONV after cesarean sections performed under spinal anesthesia. METHODS: One cohort of patients submitted to cesarean under spinal anesthesia was used to investigate potential risk factors for PONV. The best numerical risk factors were dichotomized using chi-squared method. A conditional independence (incremental association method) casual network was used to select the best predictors for PONV. RESULTS: Two hundred and fifty of 260 patients remained in the study. Odds ratio for PONV of younger maternal age (< 25 years: 2.9 [1.49-5.96]), lower spinal bupivacaine dose (< 13 mg, inf [2.4-inf]), lower spinal morphine dose (< 80 mg, 0.03 [0-0.97]), history of motion sickness (2.5 [1.27-5.25]), significant nausea during the first trimester (0.3 [0.16-0.64]), intraoperative nausea and vomiting (8.2 [3.67-20.47]), and lower gestational age (< 38 weeks, 2.0 [1.01-4.08]) were statistically significant. The causal network selected absence of significant nausea during the first gestational trimester, intraoperative nausea, and gestational age < 38 weeks as the main direct risk factors for PONV. CONCLUSIONS: Intraoperative nausea and maternal age < 25 years were the main risk factors for PONV after cesareans under spinal anesthesia. Absence of self-reported nausea during the first trimester was a protective factor for post-cesarean nausea and vomiting.
Asunto(s)
Anestesia Raquidea/métodos , Cesárea/métodos , Náusea y Vómito Posoperatorios/epidemiología , Adulto , Anestesia Raquidea/efectos adversos , Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Cesárea/efectos adversos , Estudios de Cohortes , Femenino , Humanos , Edad Materna , Morfina/administración & dosificación , Náusea y Vómito Posoperatorios/etiología , Embarazo , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Postoperative pain management is challenging in low- and middle-income countries (LMICs). This study assesses the safety and efficacy of transversus abdominis plane (TAP) blocks as an adjunct for postoperative pain control after an open cholecystectomy in LMICs during short-term surgical missions (STSMs). TAP block is a regional anesthesia technique that has been shown to be effective in providing supplementary analgesia to the anterolateral wall post abdominal surgery. METHODS: A retrospective chart review of patients undergoing open cholecystectomy during STSMs was performed. STSMs took place in Guatemala, the Philippines, and Peru from 2009 to 2019. Measured outcomes including pain scores, presence of postoperative nausea or vomiting, and opioid consumption were compared between TAP block and non-TAP block groups. RESULTS: Of the 48 patients analyzed, 28 underwent TAP block (58%). Non-TAP block patients received, on average, 8 mg of oral morphine equivalents more than the TAP patients (P = 0.035). No significant difference was noted in pain scores, which were taken immediately after surgery, 2 h after surgery, and at multiple times between these time points to calculate an average. Of the patients who received a TAP block, 11% reported nausea or vomiting compared with 45% in the standard group (P < 0.01). There were no reported procedure-related complications. CONCLUSIONS: TAP blocks are safe and effective adjuncts for postoperative pain management on STSMs to LMICs. Additional studies are needed to investigate the potential advantages and disadvantages of more widespread use of TAP blocks in LMICs.
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Músculos Abdominales/inervación , Colecistectomía/efectos adversos , Bloqueo Nervioso/métodos , Dolor Postoperatorio/terapia , Náusea y Vómito Posoperatorios/epidemiología , Adulto , Países en Desarrollo/estadística & datos numéricos , Femenino , Guatemala , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/efectos adversos , Manejo del Dolor/efectos adversos , Manejo del Dolor/métodos , Dolor Postoperatorio/etiología , Perú , Filipinas , Náusea y Vómito Posoperatorios/etiología , Náusea y Vómito Posoperatorios/prevención & control , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: Nausea and vomiting occur in up to 70% of children after adenotonsillectomy, ingested blood during procedure being one of the reasons for emesis. Hypopharyngeal packing (HP) is a common practice among otolaryngologists to prevent blood from being swallowed, but studies in nasal surgeries in adults failed to show efficacy of this technique in reducing postoperative nausea and vomiting (PONV). There are no studies evaluating the effect of HP in adenotonsillectomy in children. The aim of this study is to evaluate the efficacy HP during adenotonsillectomy in children in the prevention of PONV. METHODS: This is a randomized, double-blinded, controlled trial. Children aged 4-16 years, scheduled for adenotonsillectomy due to sleep-disordered breathing were enrolled in Hospital da Criança Santo Antônio (Brazil). 192 participants were screened, while 129 were enrolled and completed follow-up for primary outcome. Patients were randomized in a consecutive manner to receive HP or not during adenotonsillectomy. PONV occurrence was assessed in the first 24 h after surgery in HP and control group and relative risk with 95% confidence interval was calculated. RESULTS: There were 129 patients randomized, 64 in the HP and 65 in the control group. Female were 40.3% and mean ± SD age was 7.3 ± 2.9. Baseline characteristics and surgery variables were distributed similarly between the groups. Incidence of PONV was 20.3% in the HP and 23.1% in the control group. The relative risk for PONV was 0.88 (95% CI 0.46-1.70). CONCLUSION: Our results suggest that there is no benefit of HP during adenotonsillectomy in children for the prevention of PONV. TRIAL REGISTRATION: Brazilian Register of Randomized Trials (REBEC) identifier: RBR-3zjn27; Universal Trial Number U1111-1197-7461.
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Adenoidectomía , Tonsilectomía , Adolescente , Adulto , Brasil , Niño , Preescolar , Disección , Método Doble Ciego , Femenino , Humanos , Náusea y Vómito Posoperatorios/epidemiología , Náusea y Vómito Posoperatorios/etiología , Náusea y Vómito Posoperatorios/prevención & controlRESUMEN
OBJECTIVE: The aim of this study was to evaluate the incidence of postoperative nausea and vomiting (PONV) after fast-track cardiac anesthesia (FTCA) in the first 24-48 hours in the cardiac intensive care unit (CICU) after open-heart surgery, risk factors for PONV and its influence on CICU length of stay. METHODS: A prospective observational study from January 1, 2013 to the end of December 2015 was performed in the CICU of a university hospital in the north of Jordan and Queen Alia Heart Institute, Amman, Jordan. Three hundred consecutive patients undergoing fast-track cardiac anesthesia in elective cardiac surgery were enrolled in the study. Nausea and vomiting were assessed after tracheal extubation, which was performed within 6-10 hours after surgery and during the first 24-48 hours in the CICU. Metoclopramide 10 mg intravenously was used as the initial antiemetic drug, but ondansetron 4 mg intravenously was also used as second line of management. RESULTS: Nausea was reported in 46 (15.3%) patients, and vomiting in 31 (10.3%). Among females, 38 (33.9%) patients developed nausea and 20 (17.9%) developed vomiting. Among males, 8 (4.3%) patients developed nausea and 11 (5.9%) developed vomiting. CONCLUSION: PONV are relatively low after FTCA and the prophylactic administration of antiemetic drug before anesthesia or after extubation is not necessary.
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Anestesia en Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos , Náusea y Vómito Posoperatorios/epidemiología , Náusea y Vómito Posoperatorios/etiología , Adulto , Anciano , Anciano de 80 o más Años , Antieméticos/uso terapéutico , Femenino , Humanos , Incidencia , Unidades de Cuidados Intensivos/estadística & datos numéricos , Jordania/epidemiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Náusea y Vómito Posoperatorios/tratamiento farmacológico , Estudios Prospectivos , Factores de Riesgo , Distribución por Sexo , Factores de Tiempo , Adulto JovenRESUMEN
Abstract Objective: The aim of this study was to evaluate the incidence of postoperative nausea and vomiting (PONV) after fast-track cardiac anesthesia (FTCA) in the first 24-48 hours in the cardiac intensive care unit (CICU) after open-heart surgery, risk factors for PONV and its influence on CICU length of stay. Methods: A prospective observational study from January 1, 2013 to the end of December 2015 was performed in the CICU of a university hospital in the north of Jordan and Queen Alia Heart Institute, Amman, Jordan. Three hundred consecutive patients undergoing fast-track cardiac anesthesia in elective cardiac surgery were enrolled in the study. Nausea and vomiting were assessed after tracheal extubation, which was performed within 6-10 hours after surgery and during the first 24-48 hours in the CICU. Metoclopramide 10 mg intravenously was used as the initial antiemetic drug, but ondansetron 4 mg intravenously was also used as second line of management. Results: Nausea was reported in 46 (15.3%) patients, and vomiting in 31 (10.3%). Among females, 38 (33.9%) patients developed nausea and 20 (17.9%) developed vomiting. Among males, 8 (4.3%) patients developed nausea and 11 (5.9%) developed vomiting. Conclusion: PONV are relatively low after FTCA and the prophylactic administration of antiemetic drug before anesthesia or after extubation is not necessary.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Náusea y Vómito Posoperatorios/etiología , Náusea y Vómito Posoperatorios/epidemiología , Anestesia en Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos , Factores de Tiempo , Incidencia , Estudios Prospectivos , Factores de Riesgo , Distribución por Sexo , Náusea y Vómito Posoperatorios/tratamiento farmacológico , Unidades de Cuidados Intensivos/estadística & datos numéricos , Jordania/epidemiología , Tiempo de Internación , Antieméticos/uso terapéuticoRESUMEN
AIM: This study aims to address and assess possible factors associated with nausea and vomiting (NV) following oral and maxillofacial surgery. MATERIAL AND METHODS: A prospective study was carried out in the period from December 2013 to January 2016 targeting all attended cases in that period. For statistical analysis, Pearson chi-square and Fisher tests were used to verify association and ANOVA and Student's t tests to test for significant difference, p was defined as ≤0.05. The sample group consisted of 207 patients with an average age of 33.56 years (±13.23), and 70.5% of subjects were male. RESULTS: Calculations based on the predictive model showed that a female patient with prior history of nausea and vomiting who used opioids and had intra-oral surgical access would have a 96% chance of experiencing a nausea and vomiting episode. Other factors like age, being overweight, anesthesia, surgery duration, and duration of hospital stay also contribute so that these aspects must be paid careful attention prior to surgery to ensure a suitably orientated treatment that will avoid disturbances caused by post-operative nausea and vomiting. CONCLUSION: The occurrence of post-operative nausea and vomiting after oral and maxillofacial surgery was found to be more higher incidence associated to female patients who used opioids, who had a prior history of NV, whose surgery involved intra-oral access, who were in the second or third decades of their lives, who have above average weight, and who have long anesthesia when undergoing surgery, resulting in a long hospital stays.
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Procedimientos Quirúrgicos Orales , Náusea y Vómito Posoperatorios/etiología , Adulto , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
PURPOSE: To evaluate the predictors of postoperative nausea and vomiting (PONV) in women with gynecologic tumor. METHODS: The analysis was based on prospectively collected data of 82 adult patients with gynecologic tumor, who were submitted to open surgical treatment and undergoing general anesthesia. The predictors included were age ≥50 years, non-smoker, use of postoperative opioids, mechanical bowel preparation, intraoperative intravenous hydration (IH) ≥10 mL/kg/h, and IH in the immediate postoperative, first and second postoperative days (PO1 and PO2) ≥30 mL/kg. A score with predictor variables was built. A multiple logistic regression was fitted. To estimate the discriminating power of the chosen model, a receiver operating characteristic (ROC) curve was plotted and the area under the ROC curve (AUC) was calculated. Statistical significance was set at p value <0.05 and the confidence interval at 95 %. RESULTS: The incidence (%) of nausea, vomiting and both, in the general population, was 36.6, 28.1, 22.0, respectively. The highest incidences of PONV were found in non-smokers and in patients who received >30 mL/kg of IH in the PO2. The results of the adjusted model showed an increased risk of PONV for each 1-point increase in the score punctuation. The relative risk was higher than 2.0 for vomiting in all period and in the PO1. The ROC curve showed great discrimination of postoperative nausea and vomiting from the proposed score (AUC >0.75). CONCLUSIONS: The study population was at high risk of PONV. Therefore, institutional guidelines abolishing modificable variables following temporal evaluation of the effectiveness should be undertaken.
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Antieméticos/uso terapéutico , Neoplasias de los Genitales Femeninos/complicaciones , Atención Perioperativa/métodos , Náusea y Vómito Posoperatorios/etiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Neoplasias de los Genitales Femeninos/patología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de RiesgoRESUMEN
PURPOSE: To evaluate the preemptive analgesia effects of ketamine for postoperative pain. METHODS: PubMed, EMBASE and Cochrane Library were searched to identify randomized controlled trials (RCTs) involved in ketamine for preemptive analgesic up to March 2013. The relative risk (RR) or mean difference (MD) as well as the confounding 95% confidence interval (CI) were calculated by the Revman 5.0 software. RESULTS: A total of five studies including 266 patients were included in this meta-analysis. Overall, ketamine could reduce the postoperative morphine consumption and significantly prolong the time to first analgesic (p < 0.00001, MD = 0.91, 95% CI: 0.56 to 1.26). However, there was no significant difference in indicators of nausea and vomiting (p = 0.87, RR = 1.04, 95% CI: 0.67 to 1.60), surgical time (p = 0.41, MD = -2.13, 95% CI: -7.21 to 2.95) and anesthetic time (p = 0.53, MD = -1.54, 95% CI: -6.34 to -3.26) between ketamine and control group. CONCLUSIONS: Ketamine was able to accomplish some preemptive analgesic effects of reducing postoperative morphine consumption and prolonging the time to first analgesic. Meanwhile, ketamine was as safe as physiological saline in side effects of nausea and vomiting.
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Analgésicos/uso terapéutico , Ketamina/uso terapéutico , Dolor Postoperatorio/prevención & control , Analgésicos/efectos adversos , Analgésicos Opioides/administración & dosificación , Humanos , Ketamina/efectos adversos , Morfina/administración & dosificación , Tempo Operativo , Dimensión del Dolor , Náusea y Vómito Posoperatorios/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the preemptive analgesia effects of ketamine for postoperative pain. METHODS: PubMed, EMBASE and Cochrane Library were searched to identify randomized controlled trials (RCTs) involved in ketamine for preemptive analgesic up to March 2013. The relative risk (RR) or mean difference (MD) as well as the confounding 95% confidence interval (CI) were calculated by the Revman 5.0 software. RESULTS: A total of five studies including 266 patients were included in this meta-analysis. Overall, ketamine could reduce the postoperative morphine consumption and significantly prolong the time to first analgesic (p < 0.00001, MD = 0.91, 95% CI: 0.56 to 1.26). However, there was no significant difference in indicators of nausea and vomiting (p = 0.87, RR = 1.04, 95% CI: 0.67 to 1.60), surgical time (p = 0.41, MD = -2.13, 95% CI: -7.21 to 2.95) and anesthetic time (p = 0.53, MD = -1.54, 95% CI: -6.34 to -3.26) between ketamine and control group. CONCLUSIONS: Ketamine was able to accomplish some preemptive analgesic effects of reducing postoperative morphine consumption and prolonging the time to first analgesic. Meanwhile, ketamine was as safe as physiological saline in side effects of nausea and vomiting. .
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Humanos , Analgésicos/uso terapéutico , Ketamina/uso terapéutico , Dolor Postoperatorio/prevención & control , Analgésicos Opioides/administración & dosificación , Analgésicos/efectos adversos , Ketamina/efectos adversos , Morfina/administración & dosificación , Tempo Operativo , Dimensión del Dolor , Náusea y Vómito Posoperatorios/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Many patients may experience postoperative nausea and vomiting (PONV) following laparoscopic sleeve gastrectomy (LSG). We evaluated the efficacy of the combination of haloperidol, dexamethasone, and ondansetron for prevention of PONV after LSG. METHODS: Ninety patients were included in this prospective, randomized, double-blinded, three-arm study (group O: ondansetron 8 mg; group DO: dexamethasone 8 mg and ondansetron 8 mg; group HDO: haloperidol 2 mg, dexamethasone 8 mg, and ondansetron). Nausea, vomiting, rescue antiemetic use, morphine consumption, adverse events, and volume of intravenous fluids infused were recorded at regular intervals for 36 h postoperatively. RESULTS: The incidence of nausea was lower 0-2 h postoperatively in group HDO compared to group O (23.7 versus 56.7 %, p = 0.016) and at 12-24 h postoperatively was lower in group HDO (23.3 %) and group DO (26.7 %) compared to group O (60 %) (p = 0.008 and p = 0.009, respectively). At 0-36 h postoperatively, nausea was lower in group HDO compared to group O (53.3 versus 86.7 %, p = 0.013). Vomiting at 0-36 h postoperatively was lower in group HDO compared to group O (20 versus 53.3 %, p = 0.015). Rescue antiemetic drug and morphine consumption were less used in group HDO compared to group O (p <0.01). The volume of fluids infused in group O was approximately 1 l greater than in group HDO (p = 0.026). CONCLUSION: The combination of haloperidol, dexamethasone, and ondansetron reduced PONV and the necessity of rescue antiemetics and also reduced morphine consumption and the volume of fluids infused postoperatively.
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Antieméticos/administración & dosificación , Dexametasona/administración & dosificación , Gastroplastia/efectos adversos , Haloperidol/administración & dosificación , Ondansetrón/administración & dosificación , Náusea y Vómito Posoperatorios/tratamiento farmacológico , Adulto , Analgésicos Opioides/administración & dosificación , Brasil/epidemiología , Método Doble Ciego , Quimioterapia Combinada , Femenino , Fluidoterapia/estadística & datos numéricos , Gastroplastia/métodos , Humanos , Tiempo de Internación , Masculino , Morfina/administración & dosificación , Náusea y Vómito Posoperatorios/etiología , Náusea y Vómito Posoperatorios/prevención & control , Estudios Prospectivos , Calidad de Vida , Resultado del TratamientoRESUMEN
BACKGROUND: Roux-en-Y gastric bypass (RYGBP) controls obesity and comorbidities. However, there is no consensus on ring placement due to its complications. Surgical ring removal has been the standard approach, despite its inherent morbidity risks. Endoscopic dilation with achalasia balloon is a novel and minimally invasive option. We aimed to evaluate safety and efficacy of aggressive dilation as an outpatient procedure to treat food intolerance after banded RYGBP without stenosis; we also analyzed long-term weight regain. METHODS: This prospective study included 63 patients presenting with more than four vomiting episodes per week. Therapeutic endoscopy with a 30-mm balloon (Rigiflex®) was performed with radioscopic guidance in the first 16 patients (25.4 %). Four dilation sessions were performed in 12 patients (19 %), three in 14 (22.2 %), two in 24 (38 %), and one in 13 (20.6 %). RESULTS: Complete symptom improvement was achieved in 59 patients (93.6 %), partial improvement in 2 (3.2 %), and failure in 2, leading to ring removal by laparotomy. Complications rate was 9.5 %, including three cases of bleeding, two intragastric ring erosions, and one pneumoperitoneum; all treated clinically with no need for reintervention. Mean preoperative body mass index (BMI) was 42.4 kg/m(2) and postoperative (before endoscopic treatment) BMI was 25.3 kg/m(2). At a mean follow-up of 46.1 months after endoscopic intervention, mean BMI was 27.8 kg/m(2). CONCLUSIONS: Aggressive endoscopic dilation for food intolerance is a safe and minimally invasive method that promotes symptom improvement. It avoided reoperation in 96.8 % of patients and led to a low rate of weight regain.
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Endoscopía Gastrointestinal/métodos , Balón Gástrico , Derivación Gástrica/efectos adversos , Obesidad Mórbida/cirugía , Náusea y Vómito Posoperatorios/terapia , Adulto , Índice de Masa Corporal , Brasil/epidemiología , Constricción Patológica/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Obesidad Mórbida/complicaciones , Obesidad Mórbida/epidemiología , Náusea y Vómito Posoperatorios/epidemiología , Náusea y Vómito Posoperatorios/etiología , Estudios Prospectivos , Reoperación , Resultado del TratamientoRESUMEN
BACKGROUND: Postoperative pain is the main symptom following a surgical event and is related to an inflammatory process involving cytokine secretion. This type of pain is usually treated with opioids such as morphine, whose analgesic efficacy is well known. However, it is unknown when compared with ketorolac in measuring proinflammatory cytokine levels. The aim of this study was to determine the postoperative analgesic effect with endovenous morphine on proinflammatory cytokine levels in patients who underwent laparoscopic choleystectomy. METHODS: We studied 40 patients who underwent laparoscopic cholecystectomy. Patients were randomized to receive morphine (0.05 mg/kg) or ketorolac (0.2 mg/kg) IV during gallbladder extraction and after the surgical event at the following dose: morphine (0.15 mg/kg) or ketorolac (0.7 mg/kg) for 40 min. Clinical evaluations included were hemodynamic, analgesic with visual analogue scale, and sedation (Ramsay scale). IL-1ß and TNF-a were measured pre- and postoperatively and after 12 h. Safety profile was evaluated with hemodynamic constants. Statistical analysis was carried out using Mann-Whitney U test and Fisher exact test. RESULTS: TNF-a was increased significantly in the immediate postoperative period and after 12 h in the morphine group. IL-1ß was not detected preoperatively, in the immediate postoperative period and 12 h after surgery the levels were similar in both groups. The main adverse event was respiratory depression, which occurred in the morphine group. CONCLUSIONS: Proinflammatory cytokines were increased after surgery, particularly TNF-a in the group receiving morphine. The use of morphine is safe postoperatively.
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Analgésicos no Narcóticos/farmacología , Colecistectomía Laparoscópica , Inflamación/prevención & control , Interleucina-1beta/sangre , Ketorolaco/farmacología , Morfina/farmacología , Narcóticos/farmacología , Dolor Postoperatorio/tratamiento farmacológico , Complicaciones Posoperatorias/etiología , Factor de Necrosis Tumoral alfa/análisis , Adulto , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/efectos adversos , Analgésicos no Narcóticos/uso terapéutico , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/farmacología , Antiinflamatorios no Esteroideos/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Inflamación/sangre , Inflamación/etiología , Inflamación/fisiopatología , Infusiones Intravenosas , Interleucina-1beta/metabolismo , Ketorolaco/administración & dosificación , Ketorolaco/efectos adversos , Ketorolaco/uso terapéutico , Persona de Mediana Edad , Morfina/administración & dosificación , Morfina/efectos adversos , Morfina/uso terapéutico , Narcóticos/administración & dosificación , Narcóticos/efectos adversos , Narcóticos/uso terapéutico , Dimensión del Dolor , Dolor Postoperatorio/fisiopatología , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/fisiopatología , Hemorragia Posoperatoria/etiología , Náusea y Vómito Posoperatorios/etiología , Insuficiencia Respiratoria/inducido químicamente , Factor de Necrosis Tumoral alfa/metabolismo , Adulto JovenRESUMEN
BACKGROUND: Dexamethasone has been reported to reduce postoperative symptoms after different surgical procedures. We evaluated the efficacy of preoperative dexamethasone in ameliorating postoperative nausea and vomiting (PONV), and pain after mastectomy. METHODS: In this prospective, double-blind, placebo-controlled study, 70 patients scheduled for mastectomy with axillary lymph node dissection were analyzed after randomization to treatment with 8 mg intravenous dexamethasone (n = 35) or placebo (n = 35). All patients underwent standardized procedures for general anesthesia and surgery. Episodes of PONV and pain score were recorded on a visual analogue scale. Analgesic and antiemetic requirements were also recorded. RESULTS: Demographic and medical variables were similar between groups. The incidence of PONV was lower in the dexamethasone group at the early postoperative evaluation (28.6% vs. 60%; p = 0.02) and at 6 h (17.2% vs. 45.8%; p = 0.03). More patients in the placebo group required additional antiemetic medication (21 vs. 8; p = 0.01). Dexamethasone treatment significantly reduced postoperative pain just after surgery (VAS score, 4.54 ± 1.55 vs. 5.83 ± 2.00; p = 0.004), at 6 h (3.03 ± 1.20 vs. 4.17 ± 1.24; p < 0.0005) and at 12 h (2.09 ± 0.85 vs. 2.54 ± 0.98; p = 0.04). Analgesics were required in more patients of the control group (21 vs. 10; p = 0.008). There were no adverse events, morbidity or mortality. CONCLUSIONS: Preoperative intravenous dexamethasone (8 mg) can significantly reduce the incidence of PONV and pain in patients undergoing mastectomy with axillary dissection for breast cancer. TRIAL REGISTRATION NUMBER: NCT01116713.
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Analgésicos/administración & dosificación , Antieméticos/administración & dosificación , Neoplasias de la Mama/cirugía , Dexametasona/administración & dosificación , Mastectomía/efectos adversos , Dolor Postoperatorio/prevención & control , Náusea y Vómito Posoperatorios/prevención & control , Adulto , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Escisión del Ganglio Linfático , México , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/etiología , Efecto Placebo , Náusea y Vómito Posoperatorios/etiología , Estudios Prospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: During a previous study to define and compare incidence risks of postoperative nausea and vomiting (PONV) for elective laparoscopic and open cholecystectomy at two hospitals in Jamaica, secondary analysis comparing PONV risk in elective open cholecystectomy to that after emergency open cholecystectomy suggested that it was markedly reduced in the latter group. The decision was made to collect data on an adequate sample of emergency open cholecystectomy cases and further explore this unexpected finding in a separate study. METHODS: Data were collected for 91 emergency open cholecystomy cases identified at the two participating hospitals from May 2007 retrograde, as was done for the 175 elective open cholecystectomy cases (from the aforementioned study) with which the emergency cases were to be compared. Variables selected for extraction and statistical analysis included all those known, suspected and plausibly associated with the risk of PONV and with urgency of surgery. RESULTS: Emergency open cholecystectomy was associated with a markedly reduced incidence risk of PONV compared to elective open cholecystectomy (6.6% versus 28.6%, P < 0.001). The suppressive effect of emergency increased after adjustment for confounders in a multivariable logistic regression model (odds ratio 0.103, P < 0.001). This finding also identifies, by extrapolation, an association between reduced risk of PONV and preoperative nausea and vomiting, which occurred in 80.2% of emergency cases in the 72 hour period preceding surgery. CONCLUSIONS: The incidence risk of postoperative nausea and vomiting is markedly decreased after emergency open cholecystectomy compared to elective open cholecystectomy. The study, by extrapolation, also identifies a paradoxical association between pre-operative nausea and vomiting, observed in 80.2% of emergency cases, and suppression of PONV. This association, if confirmed in prospective cohort studies, may have implications for PONV prophylaxis if it can be exploited at a sub-clinical level.
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Colecistectomía/efectos adversos , Colecistectomía/métodos , Náusea y Vómito Posoperatorios/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Dexamethasone has been reported to reduce postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC). However, its effects on other surgical outcomes, such as pain and fatigue, have been unclear. We evaluated the efficacy of preoperative dexamethasone for ameliorating postoperative symptoms after LC. METHODS: In this prospective, double-blind, placebo-controlled study, 210 patients scheduled for elective LC were analyzed after randomization to intravenous dexamethasone (8 mg) or a placebo. All patients underwent standardized procedures for general anesthesia and surgery. Episodes of PONV and the pain and fatigue scores were recorded on a visual analog scale. Analgesic and antiemetic requirements were also recorded. RESULTS: There were no significant differences between groups with regard to medical or demographic variables. Significantly fewer patients experienced PONV in the dexamethasone group immediately after LC and at 6 and 12 h. The need for ondansetron to relieve PONV was higher in the placebo group (P = 0.001). Patients in the study group reported less postoperative pain during the first 24 h and less fatigue after 6, 12, and 24 h. The need for buprenorphine to relieve intolerable pain was also less in this group (P = 0.009). There were no side effects, and the morbidity was similar in the two groups (6.7 vs. 7.6%). CONCLUSIONS: The regimen we employed is safe and without apparent side effects. Thus, preoperative dexamethasone can significantly reduce the incidence of PONV, pain and fatigue after elective LC.
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Antieméticos/uso terapéutico , Colecistectomía Laparoscópica , Dexametasona/uso terapéutico , Náusea y Vómito Posoperatorios/tratamiento farmacológico , Adulto , Analgésicos/uso terapéutico , Colecistectomía Laparoscópica/efectos adversos , Método Doble Ciego , Procedimientos Quirúrgicos Electivos , Fatiga/tratamiento farmacológico , Femenino , Humanos , Masculino , Dolor Postoperatorio/tratamiento farmacológico , Náusea y Vómito Posoperatorios/etiología , Estudios ProspectivosRESUMEN
La timpanoplastia es la intervención quirúrgica para reparar una perforación de la membrana timpánica, que puede ocurrir en niños como complicación de una otitis media crónica. Dado que esta cirugía se efectúa bajo el microscopio, el cirujano requiere de un campo operatorio descongestionado y el paciente inmóvil. En el niño la anestesia general endotraqueal ofrece mejores condiciones. Entre las complicaciones más frecuentes de esta intervención se encuentran las náuseas y vómitos postoperatorios debido a la manipulación quirúrgica. En la presente revisión se abordan las consideraciones anestésicas que se deben tener presentes para realizar con éxito dicha cirugía...(AU)
Timpanoplasty is a surgical intervention to repair a perforation of the eardrum membrane that may occur in children as a complication of a chronic otitis media. As long as this surgery is made using the microscope, the surgeon requires an unblocked surgery field and a motionless patient. General endotracheal anesthesia offers better conditions in children. Among the most frequent complications we find postsurgery nausea and vomiting due surgery manipulation. In this review we talk about the anesthetic considerations that should be taken into account to make that surgery successfully...(AU)