scholarly journals Multimodal Low-opioid Anesthesia as an Effective Way to Prevent Postoperative Nausea and Vomiting. Pathophysiological Aspects of this Complication

2021 ◽  
Vol 6 (1) ◽  
pp. 101-106
Author(s):  
Т. Ovsiienko ◽  
◽  
M. Bondar ◽  
O. Loskutov ◽  
◽  
...  
Keyword(s):  
General Anesthesia ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Control Group ◽  
Average Dose ◽  
Kidney Surgery ◽  
Group 2 ◽  
Total Average ◽  
Group 1

Postoperative nausea and vomiting are common adverse effects of anaesthesia and surgery. Up to 80% of patients may be affected. These outcomes are a major cause of patient dissatisfaction. In addition, postoperative nausea and vomiting can independently cause the occurrence of rather serious complications of the postoperative period, such as aspiration of gastric contents into the airways, hemodynamic disorders in patients with a compromised cardiovascular system, failure of surgical sutures, bleeding, dehydration and electrolyte imbalance which ultimately can lead to disability of patients, prolongation of their hospitalization and higher treatment costs. Material and methods. The paper presents the results of our own research on the use of multimodal low-opioid general anesthesia as one of the methods for the prevention of postoperative nausea and vomiting during anesthetic provision of laparoscopic kidney surgery. The study involved 38 patients who underwent laparoscopic kidney surgery. Results and discussion. To compare the incidence of postoperative nausea and vomiting, patients were randomly divided into two groups. Group 1 used multimodal general anesthesia with standard opioid doses, while group 2 used multimodal low-opioid general anesthesia. The total average dose of fentanyl that was used during the entire time of anesthesia in the control group was 373.3 ± 50.8 μg (4.34 μg / kg / h). The total average dose of fentanyl that was used during the entire time of anesthesia in the study group was 217.39 ± 49.1 μg (1.76 μg / kg / h). In group 1, vomiting occurred in 4 patients out of 15 in the postoperative period, in group 2 there were 4 patients with vomitting, but out of 23 operated patients. The standardized rate of postoperative nausea and vomiting in the control group was 26.6%, in the main group it was 17.3%. Conclusion. As a result of comparing the incidence of postoperative nausea and vomiting in patients of both study groups, we found that a decrease in the dose of perioperative use of opioids helps to reduce the incidence of this complication, which increased the safety of anesthetic management, greatly facilitated and accelerated the rehabilitation of patients after laparoscopic kidney surgery. The work also highlighted and systematized information on the morphology of structures involved in the formation of postoperative nausea and vomiting, on the physiology of this process

scholarly journals Impact of low-opioid anesthesia on the incidence of postoperative nausea and vomiting during laparoscopic kidney surgery

2021 ◽  
Vol 17 (2) ◽  
pp. 42-48
Author(s):  
T.V. Ovsiienko ◽  
M.V. Bondar ◽  
O.A. Loskutov
Keyword(s):  
General Anesthesia ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Average Dose ◽  
Kidney Surgery ◽  
Entire Time ◽  
Group 3 ◽  
Group 2 ◽  
Total Average

Background. The problem of postoperative nausea and vomiting has attracted the attention of specialists in various fields of surgery and anesthesiology for a long time and has not lost its relevance today, being the subject of active discussion in domestic and foreign literature. It can become an independent cause of other quite serious postoperative complications. The article presents the results of our own study of the use of multimodal low-opioid general anesthesia as one of the methods for the prevention of postoperative nausea and vomiting during anesthetic provision of laparoscopic kidney surgery. Materials and methods. The study involved 50 patients who underwent laparoscopic kidney surgery. To compare the incidence of postoperative nausea and vomiting, patients were randomly divided into three groups. Group 1 (control group) used multimodal general anesthesia with standard doses of opioids; group 2 used multimodal low-opioid general anesthesia with lidocaine, and group 3 used multimodal low-opioid anesthesia with dexmedetomidine. Results. The total average dose of fentanyl used during the entire time of anesthesia in the control group was 373.3 ± 50.8 μg (4.34 μg/kg/h). The total average dose of fentanyl used during the entire time of anesthesia in group 2 was 217.39 ± ± 49.1 μg (1.76 μg/kg/h). The total average dose of fentanyl used during the entire time of anesthesia in group 3 was 308.33 ± ± 51.49 µg (2.44 µg/kg/h). In group 1, vomiting in the postoperative period occurred in 4 patients out of 15 (26.7 % of cases), in group 2 — in 4 patients out of 23 operated (17.4 % of cases), in group 3 — in 1 patient out of 12 (8.3 % of cases). Conclusions. As a result of comparing the incidence of postoperative nausea and vomiting in the patients of the studied groups, it was found that a decrease in the dose of perioperative use of opioids helps to reduce the incidence of this complication, increases the safety of anesthesia, significantly facilitates and accelerates the rehabilitation of patients after laparoscopic surgery on the kidneys.

scholarly journals Comparison of Anesthesia Depth Monitoring using Conventional and Bispectral Index on Incidence and Severity of Nausea and Vomiting after Urological Surgeries

2018 ◽  
Vol 6 (2) ◽  
pp. 25
Author(s):  
Reihan Shenasi ◽  
Hamzeh Hoseinzadeh ◽  
Hasan Mohammadpor-Anvari ◽  
Davod Aghamohammadi ◽  
Reza Sari-Motlagh
Keyword(s):  
General Anesthesia ◽  
Bispectral Index ◽  
Postoperative Nausea ◽  
Operating Time ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Control Group ◽  
Anesthetic Drugs ◽  
Urological Surgery ◽  
Anesthesia Depth

Bispectral index parameter is used to guide the titration of general anesthesia. This monitoring improves recovery times and hospital discharges, as well as minimizes adverse events. The objective of this study is the comparison of anesthesia depth monitoring by conventional and bispectral index on nausea and vomiting after urological surgery. 180 participants who were scheduled for abdominal urological surgery were studied. Patients before induction of anesthesia were randomize into two groups with and without bispectral index monitoring. Incidence and severity of nausea and vomiting were recorded every 30 minutes for 2 hours and every 6 hours to 24 hours after surgery. The incidence of postoperative nausea and vomiting in Bispectral index group is 14.4% and 8.9% and in control group 28.9% and 23.3%, respectively. The risk of nausea and vomiting after surgery was reduced by 14.5% and 14.4%, respectively in patients monitored with bispectral index.INTRODUCTIONNausea is the conscious perception of medulla stimulation that is associated with vomiting center and create vomiting response (1). General anesthesia with the use of inhalants can cause nausea and vomiting after surgery (Postoperative nausea and vomiting, PONV). The incidence of PONV is reported about 20-30 percent (2). It seems that multiple-factor can cause PONV and few items such as anesthetic drugs, kind of surgery and personal risk factors is effective on PONV. These factors make into two categories that includes factors out of control by anesthesiologists and factors can control by anesthesiologists.1. Factors out of control by anesthesiologists: some of these factors are age, gender, past history of PONV and motion sickness, smoking, kind of surgery, operating time and anesthesia time, anxiety of patients and parents. 2. Factors controlled by anesthesiologists: these factors are associated of anesthesia settings, including premedications, kind of anesthesia, anesthesia drugs during surPublishedby Australian

scholarly journals The prolonged sub-tenon block for long vitreoretinal surgery

2019 ◽  
Vol 11 (3) ◽  
pp. 13-22
Author(s):  
Nadezhda H. Marova ◽  
Yaroslav I. Vasilyev ◽  
Galina N. Vasilyeva ◽  
Polina A. Grib ◽  
Zemfira A. Dautova ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Postoperative Nausea ◽  
Vitreoretinal Surgery ◽  
Postoperative Nausea And Vomiting ◽  
Pain Syndrome ◽  
Muscle Relaxants ◽  
Laryngeal Mask ◽  
Nausea And Vomiting ◽  
Average Dose ◽  
Block Group

The purpose of this study was to compare efficiency and safety of the prolonged Sub-Tenon block in comparison with IV 100 mg tramadol for long vitreoretinal surgery ander general anesthesia. 74 patients were undergoing microinvasive vitrectomy. For the prolonged Sub-Tenon block 1% solution of lidocaine at the speed of 2 ml/hour was used. The value of block of oculovisceral reflexes, HR and MAP, the need for muscle relaxants, time of awakening and time of removal of a laryngeal mask, postoperative pain and analgesia requirements, and postoperative nausea and vomiting were recorded. In prolonged Sub-Tenon block group there was more effective blocking of oculocardiac and oculovasomotor reflexes, a smaller average dose of muscle relaxants, shorter awakening time and removal of a laryngeal mask, and also lower pain syndrome in the first 24 hours after surgery. Postoperative nausea and vomiting also was in Sub-Tenon block group considerably less frequent than in tramadol group. Use of the prolonged Sub-Tenon block with the general anesthesia is an effective and safe technique for vitreoretinal surgery.

Maximal Pharmacologic Reduction of Postoperative Nausea and Vomiting in Patients Undergoing Aesthetic Breast Surgery Under General Anesthesia

2016 ◽  
Vol 33 (4) ◽  
pp. 189-192 ◽  
Author(s):  
Mauree NaShea Beard ◽  
Arup De
Keyword(s):  
General Anesthesia ◽  
Postoperative Nausea ◽  
Breast Surgery ◽  
Postoperative Nausea And Vomiting ◽  
Multimodal Analgesia ◽  
Nausea And Vomiting ◽  
Surgical Patients ◽  
Control Group ◽  
Limited Data ◽  
Aesthetic Breast

Postoperative nausea and vomiting (PONV) is a major patient dissatisfier in aesthetic ambulatory surgical patients. Limited data exist demonstrating single surgeon reduction in PONV after utilizing modern pharmacologic techniques for analgesia and PONV chemoprophylaxis for patients who receive general anesthesia. In our study, multimodal analgesia included pregabalin, oxycontin, ketamine, and opioids; PONV chemoprophylaxis included transdermal scopolamine, diphenhydramine, dexamethasone, and ondansetron. A treatment arm of 36 patients undergoing aesthetic breast surgery was evaluated prospectively and compared with a retrospective control group of 47 patients who underwent similar procedures in the prior year. The aggressive screening for PONV risk factors preoperatively and preemptive treatment resulted in an overall reduction in PONV rate from 31.9% to 5.6%.

Effect of intravenous lidocaine combined with dexmedetomidine on postoperative nausea and vomiting after laparoscopic total hysterectomy

2019 ◽  
Author(s):  
Si-Qi Xu ◽  
Xia Ju ◽  
Sheng-Bin Wang ◽  
Sheng-Hong Hu ◽  
Qing Li ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Control Group ◽  
Total Hysterectomy ◽  
Pacu Stay ◽  
Dexmedetomidine Infusion ◽  
Laparoscopic Total Hysterectomy

Abstract Background A few studies have manifested that intravenous (IV) lidocaine or dexmedetomidine decreased the incidence of postoperative nausea and vomiting (PONV). We investigated whether lidocaine plus dexmedetomidine infusion could better reduce the incidence of PONV than placebo after laparoscopic total hysterectomy. Methods This prospective, randomized controlled study enrolled 126 women undergoing elective laparoscopic total hysterectomy with general anesthesia. They divided into the following two groups: patients in the lidocaine combined with dexmedetomidine group (group LD) received lidocaine (1.5 mg/kg loading, 1.5 mg/kg/h infusion) and dexmedetomidine (0.5 μg/kg loading, 0.4 μg/kg/h infusion), respectively. Patients in the control group (group CON) received the equal volume of saline. The primary outcome was the incidence of nausea, vomiting and PONV for the first 48 hours after surgery. The secondary outcomes included intraoperative propofol and remifentanil consumption, postoperative fentanyl requirement, Ramsay sedation score, and the incidence of bradycardia during post-anesthesia care unit (PACU) stay period. Results Data of 59 in CON and 60 in LD groups were analyzed. The incidence of nausea, vomiting, and PONV in group LD during the 0 to 2 hours and 24 to 48 hours after the operation was slightly lower than group CON, but the difference was not statistically significant between the two groups. The incidence of nausea, vomiting, and PONV was much lower in group LD than group CON at 2 to 24 hours after surgery (P<0.05, P<0.01, P<0.01, respectively). The cumulative requirement of fentanyl during the first 48 hours after surgery was significantly reduced in group LD compared to group CON (P<0.01, P<0.01, P<0.05, respectively). Propofol and remifentanil total dose in the intraoperative period was significantly lower in group LD compared with group CON (P<0.01 and P<0.01). However, the level of sedation and incidence of bradycardia during the PACU stay period were markedly increased in group LD compared with group CON (P<0.01 and P<0.01). Conclusion Lidocaine plus dexmedetomidine infusion markedly decreased the occurrence of nausea, vomiting and PONV within the 2 to 24 hours after laparoscopic total hysterectomy with general anesthesia. However, it increased the incidence of bradycardia and the level of sedation during the PACU stay period.

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 INTRAVENOUS INFUSIONS OF LIDOCAINE IN SURGERY OF THE TRACHEA

2021 ◽  
Vol 29 (2) ◽  
pp. 198-206
Author(s):  
V.A. Zhikharev ◽  
◽  
A.M. Bostanova ◽  
A.S. Bushuev ◽  
V.A. Koryachkin ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Postoperative Nausea ◽  
Intravenous Infusion ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Tracheal Resection ◽  
Lidocaine Group ◽  
Tracheal Surgery ◽  
Group 2 ◽  
Group 1

Objective. To evaluate the possibility of using intravenous infusion of lidocaine in tracheal surgery. Methods. The analysis of case histories of patients (n=19) operated on for tracheal stenosis was carried out. Depending on the perioperative analgesia, the patients were divided into two groups: the 1<sup>st</sup> group (n=9) - intravenous infusion of lidocaine; the 2<sup>nd</sup> - (n = 10) - narcotic analgesics. Tracheal resection was carried out using the cervical access. Before tracheal transection and after tracheal anastomosis was applied, protective mechanical ventilation of the lungs was performed. The stage of tracheal resection and formation of anastomosis is high-frequency jet ventilation (HFJV). Anesthesia was maintained with sevoflurane, and after opening the tracheal lumen - with propofol 6-8 mg/kg/h. In the first group, an intravenous bolus of lidocaine 1.5 mg / kg was added to the induction, followed by a continuous infusion of 1.5 mg / kg / h during surgery. The concentration of lidocaine was determined 15 minutes after the bolus and 24 h after surgery. Hemodynamics, acid-base state, glycemia, response to the endotracheal tube, time of extubation, occurrence of postoperative nausea and vomiting were assessed. Pain syndrome was assessed using a visual analogue scale every 15 minutes for an hour, and then every 4 hours until the end of the first day, the consumption of opioids was recorded. Results. Group 1 patients were extubated without agitation; the pressor response to extubation was less pronounced. Mean arterial pressure, blood gas composition and glycemia did not differ between these groups. There were no signs of systemic toxicity of lidocaine. Group 1 patients did not need promedol and tramadol, and the median and percentiles in group 2 patients, both for promedol and tramadol, were 60 [30; 60] and 400 [200; 400] mg, respectively. Four patients in group 2 had postoperative nausea and vomiting. Conclusion. Intravenous infusion of lidocaineis considered to be an alternative to perioperative opioid analgesia in tracheal surgery performed from the cervical approach. What this paper adds For the first time, in the case of the impossibility and absence of the need for a thoracic epidural block the intravenous application of lidocaine for analgesic purposes in tracheal surgery was studied. It was found that the use of intravenous infusion of lidocaine reduces the incidence of postoperative nausea and vomiting (PONV) caused by the use of opioids, and also showed a trend toward adecreased pressor responseto the endotracheal tube upon awakening of patients.

scholarly journals Effects of COX 1-2 Inhibitors on Prevention of Rocuronium Injection Pain: Controlled, Randomised, Double Blind Study

2021 ◽  
Author(s):  
Mehmet Sahap ◽  
Handan Gulec ◽  
Esra ozayar ◽  
Ozlem zdemir ◽  
Merve Kacan ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Control Group ◽  
Anesthesia Induction ◽  
Movement Response ◽  
Rocuronium Bromide ◽  
Cox Inhibitors ◽  
Significant Difference ◽  
Group 2 ◽  
Withdrawal Response ◽  
Group 1

Purpose : Rocuronium bromide is a painful agent while general anesthesia induction. The aim of the study is to investigate the effects of cox inhibitors as a resque agent against the rocuronium pain Methodology : Sixty patients enrolled for the general anesthesia enrolled in this study. Patients were allocated into two groups (Group 1: Dexkethoprofen group, Group 2: Control group) .Pain was evaluated by during rocuronium injection, patients were scored by a scale showed below. 0;No movement response to injection 1;Mild movement response to injection 2;Hand withdrawal response to injection 3;Arm withdrawal response to injection We also evaluated the pain with 2 questions when the patient was in the recovery room.Question 1.What was the last feeling before you fall into sleep? and question 2. Did you feel any pain on your hand during medication injection for anesthesia? Results:There were differences between the groups in terms of total pain score for example in group 1 there were 16 (53%) patients who did not make any movement during rocuronium injection while there were 22 (73%) patients in group 2.There was significant difference in injection rocuronium bromide pain between group 1: dexkethoprofen group, Group 2: control group in terms of the answer to the second question.Patients felt less pain than the control group. Conclusion:The effect of cox inhibitors on rocuronium pain was seen in our study but check is also effective in reducing pain in vascular width.

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