scholarly journals Comparison of three different prophylactic treatments for postoperative nausea and vomiting after total joint arthroplasty under general anesthesia: a randomized clinical trial

2020 ◽  
Author(s):  
Jinwei Xie ◽  
Yingcun Cai ◽  
Jun Ma ◽  
Qiang Huang ◽  
Zongke Zhou ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Blood Glucose Level ◽  
General Anesthesia ◽  
Glucose Level ◽  
Total Joint Arthroplasty ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Complete Response ◽  
Joint Arthroplasty ◽  
Rescue Antiemetic

Abstract Background: Postoperative nausea and vomiting (PONV) after total joint arthroplasty is common and associated with delayed recovery. This study was performed to evaluate the efficacy of three different prophylactic regimens for PONV after total joint arthroplasty under general anesthesia. Methods: Patients undergoing primary total hip or knee arthroplasty were randomized to Group A (8 mg ondansetron, n= 108), Group B (10 mg dexamethasone plus mosapride, n= 108), or Group C (three doses of 10 mg dexamethasone plus mosapride, n=116). The primary outcome was the total incidence of PONV during postoperative 48 hours. The secondary outcomes were complete response, rescue antiemetic treatment, opioid consumption, time until first defecation, postoperative appetite score, satisfaction score, length of hospital stay, blood glucose level, and complications. Results: Patients in Group C experienced a lower incidence of total PONV (29.3%, p= 0.001), severe nausea (1.72%, p<0.001) and a higher incidence of complete response (70.69%, p=0.001) than did patients in Groups A and B. Moreover, less rescue antiemetic treatment and postoperative opioid consumption was needed in Group C (p<0.05). Additionally, a shorter time until first defecation, shorter length of stay, and better postoperative appetite scores and satisfaction scores were detected in patients in Group C. A slight increase in the fasting blood glucose level was observed in Group C, and the complications were comparable among the groups. Conclusion: Prophylactic use of mosapride and three doses of dexamethasone can provide better antiemetic effectiveness, postoperative appetite, bowel function recovery, and pain relief than a single dose or ondansetron only.

scholarly journals Comparison of three different prophylactic treatments for postoperative nausea and vomiting after total joint arthroplasty under general anesthesia: a randomized clinical trial

2020 ◽  
Author(s):  
Jinwei Xie ◽  
Yingcun Cai ◽  
Jun Ma ◽  
Qiang Huang ◽  
Zongke Zhou ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Total Joint Arthroplasty ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Complete Response ◽  
Joint Arthroplasty ◽  
Nausea And Vomiting ◽  
Rescue Antiemetic

Abstract Background: Postoperative nausea and vomiting (PONV) after total joint arthroplasty is common and associated with delayed recovery. This study was performed to evaluate the efficacy of three different prophylactic regimens for PONV after total joint arthroplasty under general anesthesia.Methods: Patients undergoing primary total hip or knee arthroplasty were randomized to Group A (8 mg ondansetron), Group B (10 mg dexamethasone plus mosapride), or Group C (three doses of 10 mg dexamethasone plus mosapride). The primary outcome was the incidence of PONV. The secondary outcomes were complete response, rescue antiemetic treatment, opioid consumption, time until first defecation, postoperative appetite score, satisfaction score, length of hospital stay, blood glucose level, and complications.Results: Patients in Group C experienced a lower incidence of severe PONV (1.72%, p<0.001) and a higher incidence of complete response (70.69%, p=0.001) than did patients in Groups A and B. Moreover, less rescue antiemetic treatment and postoperative opioid consumption was needed in Group C (p<0.05). Additionally, a shorter time until first defecation, shorter length of stay, and better postoperative appetite scores and satisfaction scores were detected in patients in Group C. A slight increase in the fasting blood glucose level was observed in Group C, and the complications were comparable among the groups.Conclusion: Prophylactic use of mosapride and three doses of dexamethasone can provide better antiemetic effectiveness, postoperative appetite, bowel function recovery, and pain relief than a single dose or ondansetron only.

COMPARISON OF THE EFFECT OF DEXAMETHASONE ON THE BLOOD GLUCOSE LEVEL IN PREGNANT AND NON-PREGNANT WOMEN UNDER GENERAL ANESTHESIA

2021 ◽  
Vol 74 (9) ◽  
pp. 2277-2280
Author(s):  
Hanan Fawzi ◽  
Alaa Hussen Ali
Keyword(s):  
Blood Glucose ◽  
Blood Glucose Level ◽  
General Anesthesia ◽  
Pregnant Women ◽  
Glucose Level ◽  
Elective Cesarean Section ◽  
Glucose Levels ◽  
Anesthetic Drugs ◽  
Study Results ◽  
Blood Glucose Concentrations

The aim: To compared blood glucose concentrations after intravenous injection of dexamethasone in the pregnant and non-pregnant women under general anesthesia. Materials and methods: Eighty patients aged 18-50 years took part in the study (ASA class 1 and 2). Forty of patients were undergoing elective cesarean section under G/A and the other forty undergoing elective laparoscopic Cholecystectomy under G/A. Anesthesia was induced using IV anesthetic drugs (0.5mg/kg ketamine, sleeping dose of propofol up to 2mg/kg, muscle relaxant was 0.6 mg/kg rocuronium and maintained with isoflurane). All of patients have been injected with 0,1mg/kg dexamethasone intravenously, at induction of anesthesia, Blood glucose concentrations were measured at induction and then in 60min, 180min and in 360 min after injection of dexamethasone and results were compared between the groups; IV fluid added was normal saline (0.9%) during the study. Results: Regarding to blood glucose levels, we noticed that its level significantly increased over time and peaked in 180min after dexamethasone injection in both groups. The difference percentage between the lower reading (pre injection) and the upper reading (in 180min after) was 33.5% in pregnant woman and 46.2%for non-pregnant women, this difference was statistically significant relative to the pre injection, as this difference was lower in the pregnant women. In 360min after blood glucose level began to drop in both groups. After giving 0.1 mg/kg of dexamethasone, blood glucose level increased in both groups, but it was lower in pregnant women.

scholarly journals A Comparison of Fosaprepitant and Ondansetron for Preventing Postoperative Nausea and Vomiting in Moderate to High Risk Patients: A Retrospective Database Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Chiaki Murakami ◽  
Nami Kakuta ◽  
Katsuyoshi Kume ◽  
Yoko Sakai ◽  
Asuka Kasai ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Receptor Antagonist ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Complete Response ◽  
Nausea And Vomiting ◽  
Nk1 Receptor Antagonist ◽  
Risk Patients ◽  
Neurokinin 1 ◽  
Type 3

Postoperative nausea and vomiting (PONV) occur in 30–50% of patients undergoing general anesthesia and in 70–80% of high PONV risk patients. In this study, we investigated the efficacy of fosaprepitant, a neurokinin-1 (NK1) receptor antagonist, compared to ondansetron, a selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, in moderate to high PONV risk patients from our previous randomized controlled trials. Patients (171 patients from 4 pooled studies) with the Apfel simplified score ≥ 2 and undergoing general anesthesia were randomly allocated to receive intravenous fosaprepitant 150 mg (NK1 group, n=82) and intravenous ondansetron 4 mg (ONS group, n=89) before induction of anesthesia. Incidence of vomiting was significantly lower in the NK1 group compared to the ONS group 0–2, 0–24, and 0–48 hours after surgery (2 versus 17%, 2 versus 28%, and 2 versus 29%, resp.). However, no significant differences in PONV, complete response, rescue antiemetic use, and nausea score were observed between groups 0–48 hours after surgery. In moderate to high PONV risk patients, fosaprepitant decreased the incidence of vomiting and was superior to ondansetron in preventing postoperative vomiting 0–48 hours after surgery.

scholarly journals Effect of Adding Midazolam to Dual Prophylaxis for Preventing Postoperative Nausea and Vomiting

2021 ◽  
Vol 10 (21) ◽  
pp. 4857
Author(s):  
Jiyoung Lee ◽  
In Kyong Yi ◽  
Jung Youn Han ◽  
Eun Duc Na ◽  
Chunghyun Park ◽  
...  
Keyword(s):  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Complete Response ◽  
Nausea And Vomiting ◽  
Saline Control ◽  
Control Group ◽  
Midazolam Group ◽  
Post Surgery ◽  
Gynecologic Laparoscopy ◽  
Rescue Antiemetic

Multimodal prophylaxis for postoperative nausea and vomiting (PONV) has been recommended, even in low-risk patients. Midazolam is known to have antiemetic properties. We researched the effects of adding midazolam to the dual prophylaxis of ondansetron and dexamethasone on PONV after gynecologic laparoscopy. In this prospective, randomized, double-blinded trial, 144 patients undergoing gynecological laparoscopic surgery under sevoflurane anesthesia were randomized to receive either normal saline (control group, n = 72) or midazolam 0.05 mg/kg (midazolam group, n = 72) intravenously at pre-induction. All patients were administered dexamethasone 4 mg at induction and ondansetron 4 mg at the completion of the laparoscopy, intravenously. The primary outcome was the incidence of complete response, which implied the absence of PONV without rescue antiemetic requirement until 24 h post-surgery. The complete response during the 24 h following laparoscopy was similar between the two groups: 41 patients (59%) in the control group and 48 patients (72%) in the midazolam group (p = 0.11). The incidence of nausea, severe nausea, retching/vomiting, and administration of rescue antiemetic was comparable between the two groups. The addition of 0.05 mg/kg midazolam at pre-induction to the dual prophylaxis had no additive preventive effect on PONV after gynecologic laparoscopy.

scholarly journals Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy

1970 ◽  
Vol 6 (3) ◽  
pp. 319-328 ◽  
Author(s):  
B Gautam ◽  
BR Shrestha ◽  
P Lama ◽  
S Rai
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Complete Response ◽  
Nausea And Vomiting ◽  
General Anaesthetic ◽  
Antiemetic Prophylaxis ◽  
Dexamethasone Group ◽  
Group D ◽  
Rescue Antiemetic

Background: Postoperative nausea and vomiting (PONV) is a common distressing experience in patients following laparoscopic surgeries. This study was aimed at comparing the efficacies of Ondansetron-Dexamethasone combination with each drug alone as a prophylaxis against PONV in patients after elective laparoscopic cholecystectomy done under general anaesthesia. Materials and methods: Hundred and fifty ASA I and II patients, aged 23 to 65 yrs, were enrolled in this prospective, randomized, double-blind trial to receive one of three treatment regimens: 4 mg Ondansetron (Group O), 8 mg Dexamethasone (Group D) or 4 mg Ondansetron plus 8 mg Dexamethasone (Group OD) (n=50 for each). A standardized balanced general anaesthetic technique was employed. Any episode of PONV and need for rescue antiemetic were assessed at six, 12 and 24 hrs post operation. Complete response was defined as no PONV in 24 hrs and need for rescue antiemetic was considered as failure of prophylaxis. Pain scores, time to first analgesia demand, amount of Meperidine consumption, adverse event(s) and duration of hospital stay were recorded. Results: Complete response occurred in 66.7, 66.0 and 89.4% in Groups O, D and OD respectively. Rescue antiemetics were required in 29.2, 31.9 and 8.5% of patients in Groups O, D, and OD respectively. Significantly high incidence of vomiting and failure of prophylaxis (19.1%) occurred in group D during the first six hrs (P=0.023 versus O & 0.008 versus OD). More frequent antiemetic rescue was required in group O at 6 to 24 hr interval as compared to group OD (P=0.032). Conclusion: Combination of Ondansetron and Dexamethasone is better than each drug alone in preventing PONV after laparoscopic cholecystectomy. Dexamethasone alone is significantly less effective in preventing early vomiting compared to its combination with Ondansetron; whereas Ondansetron alone is less effective against late PONV as compared with combination therapy. Key words: Antiemetic prophylaxis; Dexamethasone; laparoscopic cholecystectomy; Ondansetron; postoperative nausea and vomiting (PONV) doi: 10.3126/kumj.v6i3.1706 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 319-328

scholarly journals Intravenous Dexamethasone and Its Effect on Blood Glucose in Adult Nondiabetic Patients undergoing General Anesthesia for Superficial Surgery

2017 ◽  
Vol 2 (2) ◽  
pp. 64-67
Author(s):  
Apeksha A Gala ◽  
Pritee H Bhirud ◽  
Shrividya Chellam
Keyword(s):  
Blood Glucose ◽  
General Anesthesia ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Glucose Profile ◽  
Healing Of Wounds ◽  
Blood Glucose Profile ◽  
Blood Glucose Concentrations

ABSTRACT Dexamethasone is commonly used for the prevention of postoperative nausea and vomiting (PONV). It also has significant postoperative analgesic benefits. In spite of these advantages, it is seen that intravenous (IV) dexamethasone may affect the blood glucose profile of the patient and healing of wounds. We have studied the effects of IV dexamethasone administered at induction on blood glucose concentrations in adult, nondiabetic patients under general anesthesia (GA) for superficial surgeries, e.g., ear surgeries, breast surgeries, and hernia surgeries. How to cite this article Gala AA, Bhirud PH, Chellam S. Intravenous Dexamethasone and Its Effect on Blood Glucose in Adult Nondiabetic Patients undergoing General Anesthesia for Superficial Surgery. Res Inno in Anesth 2017;2(2):64-67.

Amisulpride Prevents Postoperative Nausea and Vomiting in Patients at High Risk

2018 ◽  
Vol 128 (6) ◽  
pp. 1099-1106 ◽  
Author(s):  
Peter Kranke ◽  
Sergio D. Bergese ◽  
Harold S. Minkowitz ◽  
Timothy I. Melson ◽  
David G. Leiman ◽  
...  
Keyword(s):  
High Risk ◽  
General Anesthesia ◽  
Postoperative Nausea ◽  
Rescue Medication ◽  
Elective Surgery ◽  
Medication Use ◽  
Postoperative Nausea And Vomiting ◽  
Complete Response ◽  
Nausea And Vomiting ◽  
Control Group

Abstract Background Postoperative nausea and vomiting causes distress for patients and can prolong care requirements. Consensus guidelines recommend use of multiple antiemetics from different mechanistic classes as prophylaxis in patients at high risk of postoperative nausea and vomiting. The prophylactic efficacy of the dopamine D2/D3 antagonist amisulpride in combination with other antiemetics was investigated. Methods This double-blind, randomized, placebo-controlled, international, multicenter trial was conducted in 1,147 adult surgical patients having three or four postoperative nausea and vomiting risk factors. Patients were randomized to receive either intravenous amisulpride (5 mg) or matching placebo at induction of general anesthesia, in addition to one standard, nondopaminergic antiemetic, most commonly ondansetron or dexamethasone. Vomiting/retching, nausea, and use of rescue medication were recorded for 24 h after wound closure. The primary endpoint was complete response, defined as no emesis or rescue medication use in the 24-h postoperative period. Results Complete response occurred in 330 of 572 (57.7%) of the amisulpride group and 268 of 575 (46.6%) of the control group (difference 11.1 percentage points; 95% CI, 5.3 to 16.8; P &lt; 0.001). The incidences of emesis (13.8% vs. 20.0%, P = 0.003), any nausea (50.0% vs. 58.3%, P = 0.002), significant nausea (37.1% vs. 47.7%, P &lt; 0.001), and rescue medication use (40.9% vs. 49.4%, P = 0.002) were significantly lower in the amisulpride group. Adverse events and laboratory and electrocardiogram abnormalities occurred no more frequently with amisulpride than with placebo. Conclusions Intravenous amisulpride was safe and effective as prophylaxis of postoperative nausea and vomiting when given in combination with an antiemetic from another class to adult patients at high risk for suffering postoperative nausea and vomiting undergoing elective surgery under inhalational general anesthesia.

scholarly journals Perbandingan Perubahan Kadar Gula Darah Sebelum Pembedahan, 30 Menit dan 60 Menit Saat Pembedahan dengan Anestesi Umum dan Anestesi Spinal

e-CliniC ◽  
2017 ◽  
Vol 5 (2) ◽  
Author(s):  
Muh A.N Yaqin ◽  
Harold F. Tambajong ◽  
Barry I. Kambey
Keyword(s):  
Blood Glucose ◽  
Stress Response ◽  
Blood Glucose Level ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Glucose Level ◽  
The Body ◽  
Consecutive Sampling ◽  
Significant Difference ◽  
Mean Blood Glucose

Abstract: Anesthesia and surgery could cause stress response within the body that affects blood glucose level. This study was aimed to compare blood glucose levels at 30 minutes and 60 minutes during surgery using general anesthesia and spinal anesthesia. This as an observational prospective analytical stdy with a cross-sectional design performed on 12 patients gathered through consecutive sampling that fulfilled inclusion and exclusion criteria. The patients were divided into 2 groups: those undergoing surgery with general anesthesia and those with spinal anesthesia. Measurement of blood glucose level was done 3 times, 2 hours before premedication induction, 30 minutes and 60 minutes during surgery. Data were analyzed statistically by using the Shapiro-Wilk test, the T-independent test, and the Mann Whitney. The results showed that there was no significant difference between blood glucose level at 30 minutes during surgery using general anesthesia and spinal anesthesia (P = 0.23), however, there was a significant difference between blood glucose level at 60 minutes during surgery using general anesthesia and spinal anesthesia (P=0.03). Mean blood glucose level at30 minutes during surgery with general anesthesia was 103 mg/dl and at 60 minutes during surgery was 116.7 mg/dl, while mean blood glucose level at 30 minutes during surgery using spinal anesthesia was 93.50 mg/dl and at 60 minutes during surgery was 94.50 mg/dl. Conclusion: There was a significant difference in blood glucose level between general anesthesia and spinal anesthesia at 60 minutes during surgery.Keywords: stress response, blood glucose level, general anesthesia, spinal anesthesia Abstrak: Anestesi dan pembedahan dapat menyebabkan terjadinya suatu respon stres pada tubuh yang memengaruhi kadar gula darah. Penelitian ini bertujuan untuk membandingkan kadar gula darah 30 menit dan 60 menit saat pembedahan dengan anestesi umum dan anestesi spinal. Jenis penelitian ialah observasional analitik prospektif dengan desin potong lintang. Penelitian dilakukan terhadap 12 pasien yang didapatkan secara consecutive sampling dan memenuhi kriteria inklusi dan eksklusi, lalu dibagi menjadi 2 kelompok, yaitu kelompok yang menjalani pembedahan dengan anestesi umum dan kelompok yang menjalani menjalani pembedahan dengan anestesi spinal. Pengukuran kadar gula darah dilakukan 3 kali, yaitu 2 jam sebelum induksi premedikasi, serta 30 menit dan 60 menit saat pembedahan. Analisis statistik dilakukan dengan uji Shapiro-Wilk, uji T-Independen,, dan uji Mann Whitney. Hasil penelitian menunjukkan tidak terdapat perbedaan bermakna antara kadar gula darah 30 menit saat pembedahan dengan anestesi umum dan anestesi spinal (P=0,23) sedangkan pada 60 menit saat pembedahan menunjukkan adanya perbedaan bermakna antara kadar gula darah 60 menit saat pembedahan dengan anestesi umum dan anestesi spinal (P=0,03). Rerata kadar gula darah 30 menit saat pembedahan dengan anestesi umum yaitu 103 mg/dl dan 60 menit saat pembedahan yaitu 116,7 mg/dl, sedangkan rerata kadar gula darah 30 menit saat pembedahan dengan anestesi spinal yaitu 93,50 mg/dl dan 60 menit saat pembedahan yaitu 94,50 mg/dl. Simpulan: Perubahan kadar gula darah yang bermakna antara anestesi umum dan anestesi spinal terjadi pada 60 menit saat pembedahan.Kata kunci: respon stres, kadar gula darah, anestesi umum, anestesi spinal

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