scholarly journals Dose-Ranging Study of Ramosetron for the Prevention of Nausea and Vomiting after Laparoscopic Gynecological Surgery: A Prospective Randomized Study

2019 ◽  
Vol 8 (12) ◽  
pp. 2188
Author(s):  
Jin Sun Cho ◽  
Sang Wun Kim ◽  
Sugeun Lee ◽  
Young Chul Yoo
Keyword(s):  
Patient Satisfaction ◽  
High Risk ◽  
Adverse Events ◽  
Randomized Study ◽  
Nausea And Vomiting ◽  
Gynecologic Surgery ◽  
High Risk Population ◽  
Patient Controlled Analgesia ◽  
Pain Scores ◽  
Nausea Severity

Patients undergoing laparoscopic gynecologic surgery and receiving postoperative analgesia with opioids have a high risk of postoperative nausea and vomiting (PONV). We compared the antiemetic efficacy of three doses of ramosetron in this high-risk population. In this prospective, double-blind trial, 174 patients randomly received ramosetron 0.3 mg (R0.3 group; n = 58), 0.45 mg (R0.45 group; n = 58), or 0.6 mg (R0.6 group; n = 58) at the end of surgery. The primary outcome was the incidence of PONV during the first postoperative 48 h. Nausea severity, pain scores, adverse events, and patient satisfaction (1–4; 4, excellent) were assessed. The incidence of PONV was not different between groups (35%, 38%, and 35% in R0.3, R0.45, and R0.6 groups; p = 0.905). Nausea severity, pain scores, and incidence of adverse events (dizziness, headache, or sedation) were similar between groups. Compared to the R0.3 group, the R0.45 and R0.6 groups had lower incidence of premature discontinuation of fentanyl-based patient-controlled analgesia primarily because of intractable PONV (9% and 5% vs. 24%; p = 0.038), and higher satisfaction scores (3.4 ± 0.8 and 3.3 ± 0.7 vs. 2.4 ± 0.9; p = 0.005). Compared to ramosetron 0.3 mg, ramosetron 0.45 and 0.6 mg did not reduce PONV, but reduced premature discontinuation of patient-controlled analgesia and increased patient satisfaction, without increasing adverse events.

Patient-Controlled Analgesia (PCA) with Remifentanil Versus Intermittent Epidural Boluses for Labor Analgesia

2017 ◽  
Vol 71 (2) ◽  
pp. 99-104
Author(s):  
Dafina Karadjova ◽  
Mirjana Shosholcheva ◽  
Atanas Sivevski ◽  
Emilija Ivanov ◽  
Ivo Kjaev ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Epidural Analgesia ◽  
Labor Analgesia ◽  
Nausea And Vomiting ◽  
Pain Patient ◽  
Patient Controlled Analgesia ◽  
Pain Scores ◽  
Significant Difference ◽  
Patient Pain ◽  
Remifentanil Group

Abstract Introduction. Remifentanil is becoming more and more popular for labor analgesia as an alternative for neuro-axial anesthesia. In this study we compared the severity of pain, patient satisfaction and side effects between two different types of labor analgesia. Methods. Eightyprimiparous patients ASA I or II, atterm pregnancy, were included in the study and divided in two groups. The first group (35 patients) received intravenous remifentanil on patient control pump in bolus doses. The second group (45 patients) received intermittent epidural boluses with highly diluted local anesthetic and opioid (Bupivacain and Fentanil). We analyzed oxygen saturation (SpO2), respiration rate, heart rate, blood pressure, sedation, nausea and vomiting as well as patient pain scores and satisfaction scores through 2 different VAS. Results. Mean SpO2 was significantly lower in the PCA remifentanil group 96.2%±1.6 versus 98.2±1.2 in the epidural group. Respiratory depression (RR<9 or SpO2 <90%) was not found in both groups. Sedation scores were significantly higher in the PCA remifentanil group, P<0.05. Incidence of nausea and vomiting was similar between the two groups, without significant difference. PCA remifentanil was inferior to epidural analgesia with respect to pain scores at all time points, but without significant difference in patient satisfaction between the two groups. Conclusion. Intravenous patient-controlled analgesia with remifentanil provides satisfactory level of labor analgesia, with lower SpO2 and more sedation. It could be an excellent alternative to epidural analgesia but continuous monitoring and oxygen supply is mandatory.

Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1)

Gut ◽  
2020 ◽  
Vol 69 (6) ◽  
pp. 1085-1091 ◽  
Author(s):  
Anthony Y B Teoh ◽  
Masayuki Kitano ◽  
Takao Itoi ◽  
Manuel Pérez-Miranda ◽  
Takeshi Ogura ◽  
...  
Keyword(s):  
High Risk ◽  
Adverse Events ◽  
Acute Cholecystitis ◽  
Clinical Success ◽  
Controlled Trial ◽  
Definitive Treatment ◽  
Percutaneous Cholecystostomy ◽  
Gallbladder Drainage ◽  
Pain Scores ◽  
Very High

ObjectiveThe optimal management of acute cholecystitis in patients at very high risk for cholecystectomy is uncertain. The aim of the current study was to compare endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) to percutaneous cholecystostomy (PT-GBD) as a definitive treatment in these patients under a randomised controlled trial.DesignConsecutive patients suffering from acute calculous cholecystitis but were at very high-risk for cholecystectomy were recruited. The primary outcome was the 1-year adverse events rate. Secondary outcomes include technical and clinical success, 30-day adverse events, pain scores, unplanned readmissions, re-interventions and mortalities.ResultsBetween August 2014 to February 2018, 80 patients were recruited. EUS-GBD significantly reduced 1 year adverse events (10 (25.6%) vs 31 (77.5%), p<0.001), 30-day adverse events (5 (12.8%) vs 19 (47.5%), p=0.010), re-interventions after 30 days (1/39 (2.6%) vs 12/40 (30%), p=0.001), number of unplanned readmissions (6/39 (15.4%) vs 20/40 (50%), p=0.002) and recurrent cholecystitis (1/39 (2.6%) vs 8/40 (20%), p=0.029). Postprocedural pain scores and analgesic requirements were also less (p=0.034). The technical success (97.4% vs 100%, p=0.494), clinical success (92.3% vs 92.5%, p=1) and 30-day mortality (7.7% vs 10%, p=1) were statistically similar. The predictor to recurrent acute cholecystitis was the performance of PT-GBD (OR (95% CI)=5.63 (1.20–53.90), p=0.027).ConclusionEUS-GBD improved outcomes as compared to PT-GBD in those patients that not candidates for cholecystectomy. EUS-GBD should be the procedure of choice provided that the expertise is available after a multi-disciplinary meeting. Further studies are required to determine the long-term efficacy.Trial registration numberNCT02212717

scholarly journals Comparison of the effects of preoperative melatonin or vitamin C administration on postoperative analgesia

2019 ◽  
Author(s):  
Demet Laflı Tunay ◽  
Murat Türkeün Ilgınel ◽  
Hakkı Ünlügenç ◽  
Merthan Tunay ◽  
Feride Karacaer ◽  
...  
Keyword(s):  
Vitamin C ◽  
Postoperative Analgesia ◽  
Nausea And Vomiting ◽  
Morphine Consumption ◽  
Patient Controlled Analgesia ◽  
Analgesic Requirement ◽  
Analgesic Effects ◽  
Placebo Tablet ◽  
Pain Scores ◽  
The Mean

The analgesic benefit of melatonin and vitamin C as primary or adjuvant agents has been reported in various studies; however, their analgesic effects in the treatment of postoperative pain remain unclear. Thus, we aimed to evaluate the effect of single preoperative dose of oral melatonin or vitamin C administration on postoperative analgesia. In this study, we recruited 165 adult patients undergoing elective major abdominal surgery under general anesthesia. Patients were randomly divided into three equal (n = 55) groups. One hour before surgery, patients received orally melatonin (6 mg) in group M, vitamin C (2 g) in group C, or a placebo tablet in group P. Pain, sedation, patient satisfaction, total morphine consumption from a patient-controlled analgesia device, supplemental analgesic requirement, and the incidence of nausea and vomiting were recorded throughout 24 h after surgery. The mean pain score and total morphine consumption were found significantly lower in both M and C groups compared with group P (p < 0.001). There were no significant differences between group M and C with respect to pain scores (p = 0.117) and total morphine consumption (p = 0.090). Patients requested less supplemental analgesic and experienced less nausea and vomiting in groups M and C compared with group P. In conclusion, preoperative oral administration of 6 mg melatonin or 2 g vitamin C led to a reduction in pain scores, total morphine consumption, supplemental analgesic requirement, and the incidence of nausea and vomiting compared with placebo.

The Premature Infant

2018 ◽  
pp. 213-222
Author(s):  
Jeana E. Havidich ◽  
Rebecca H. Evans
Keyword(s):  
High Risk ◽  
Adverse Events ◽  
Airway Management ◽  
Preterm Neonates ◽  
High Risk Population ◽  
Critical Component ◽  
Metabolic Functions ◽  
Increased Risk ◽  
Therapeutic Procedures ◽  
Sedative Drugs

Preterm and former preterm infants present unique challenges for sedation providers. These children represent a heterogeneous high-risk population who frequently require sedation or anesthesia for diagnostic and therapeutic procedures. They have limited physiologic reserve and immature metabolic functions. Prematurity is associated with an increased risk for sedation adverse events, including death. Understanding the anatomic and physiologic differences between preterm and term children is necessary for the development of a sedation plan. One of the most important differences pertains to the airway and respiratory system, so airway management is a critical component of the sedation plan. Preterm neonates have altered pharmacokinetics and pharmacodynamics, so titration of sedative drugs is recommended.

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