Adequacy of Anesthesia Guidance for Colonoscopy Procedures

In patients undergoing colonoscopy procedures (CPs), inadequate dosing of hypnotic drugs (HD) and opioid analgesics (OA) during intravenous sedoanalgesia (ISA) may lead to intraprocedural awareness with recall (IAwR), intraprocedural (IPP) and postprocedural pain (PPP), as well as postoperative nausea and vomiting (PONV). The aim of this study was to evaluate whether the titration of HD and OA based on the observance of changing values of state entropy (SE) and surgical pleth index (SPI) (adequacy of anesthesia—AoA), state entropy alone, or standard practice may reduce the number of adverse events. One hundred and fifty-eight patients were included in the final analysis. The rate of IAwR and IPP was statistically more frequent in patients from the C group in comparison with the AoA and SE groups (p < 0.01 and p < 0.05, respectively). In turn, the rate of PPP, PONV, and patients’ and operators’ satisfaction with ISA between groups was not statistically significant (p > 0.05). Changes in hemodynamic parameters, demand for HD, and OA were statistically significant, but of no clinical value. In patients undergoing CPs under ISA using propofol and FNT, as compared to standard practice, intraprocedural SE monitoring reduced the rate of IAwR and IPP, with no influence on the rate of PPP, PONV, or patients’ and endoscopists’ satisfaction. AoA guidance on propofol and FNT titration, as compared to SE monitoring only, did not reduce the occurrence of the aforementioned studied parameters, imposing an unnecessary extra cost.

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Opioid-Free General Anesthesia with Dexmedetomidine-Esketamine-Lidocaine Versus Opioid-Based General Anesthesia with Sufentanil-Remifentanil for Breast Benign Patients Undergoing Lumpectomy

10.21203/rs.3.rs-900446/v1 ◽

2021 ◽

Author(s):

Xiali Qian ◽

Hongmei Yuan ◽

Lin Zhao ◽

Shanwu Feng ◽

Yajie Chen ◽

...

Keyword(s):

Adverse Events ◽

General Anesthesia ◽

Postoperative Nausea ◽

Recovery Time ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Hemodynamic Parameters ◽

Rescue Analgesia ◽

Surgical Incision ◽

Significant Difference

Abstract Background: Opioid-free anesthesia (OFA) is being implemented in breast benign lumpectomy due to increased awareness of opioid adverse effects and the national opioid crisis. The objective of this study was to examine the effect of Dexmedetomidine-Esketamine-Lidocaine OFA technique in breast benign lumpectomy and assess its impact on subjective pain, intraoperative hemodynamic parameters, adverse events versus standard opioid-based technique (OA).Methods: In this prospective, randomized study, sixty breast benign patients, aging from 20 to 60 years with American Society of Anesthesiologists physical status I or II, were scheduled to undergo lumpectomy. The patients were randomized to receive either OFA (OFA group) or opioid-based (OA group) anesthesia. Dexmedetomidine-Esketamine-Lidocaine or Sufentanil-Remifentanil was administered for induction and maintenance in OFA group or OA group, respectively. Intravenous flurbiprofen axate 50 mg was administered 10 minutes before the end of surgery, and dezocine 5 mg was given to patient showing visual analog scale (VAS) pain score≥4 at any point of time for postoperative rescue analgesia in both groups. Intraoperative hemodynamic parameters at the time points of entering operating room (T0), immediately after induction of anesthesia (T1), immediately after intubation (T2), 1 minute after surgical incision (T3), 5 minutes after surgical incision (T4), and 10 minutes after surgical incision (T5), number of vasoactive drugs required, awakening time and recovery time of orientation, postoperative pain VAS at 2 h, 12 h, and 24 h after recovery, number of postoperative rescue dezocine analgesia required, and incidence of adverse events were recorded.Results: The mean arterial pressure and heart rate at T1, T2, T3, T4, T5 were significantly lower in OA group than OFA group. The incidences of application of rescue ephedrine (1 of 30 [3.3%] versus 12 of 30 [40%], P=0.001) and rescue atropine (2 of 30 [6.7%] versus 6 of 30 [20%], P=0.038) were significantly lower in OFA group compared with OA group. The pain VAS scores at 2 h, 12 h, and 24 h after surgery and number of rescuing dezocine analgesia required (0 of 30 [0%] versus 0 of 30 [0%]) had no statistically significant difference between the two groups. Postoperative nausea and vomiting (3 of 30 [10%] versus 16 of 30 [53%], P=0.001) and application of rescue ondansetron (1 of 30 [3.3%] versus 10 of 30 [33%], P=0.003) were both less in the OFA group compared to those in OA group. However, compared with OA group, patients in OFA group had more delayed awakening time ([7.27±2.85] min versus [4.47±1.11] min, P=0.000) and prolonged recovery time of orientation. ([11.97±3.19] min versus [6.93±1.17] min, P=0.000).Conclusions: The combination of Dexmedetomidine-Esketamine-Lidocaine OFA technique may be an alternative anesthesia for breast benign lumpectomy as better hemodynamic stability, lower incidence of postoperative nausea and vomiting, and adequate postoperative analgesia compared with OA, although longer awakening time and longer recovery time of orientation.Trial registration number: ChiCTR2100044230 (http://www.chictr.org.cn/)

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Prevention of Postoperative Nausea and Vomiting

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0028 ◽

2018 ◽

pp. 147-152

Keyword(s):

Risk Factors ◽

Nitrous Oxide ◽

Relative Risk ◽

Adverse Events ◽

Postoperative Nausea ◽

Volatile Anesthetic ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Baseline Risk ◽

Maximum Reduction

This case focuses on the prevention of postoperative nausea and vomiting (PONV) by asking the question: What is the efficacy of six well-established prophylactic antiemetic strategies individually and in combination for the prevention of postoperative nausea and vomiting? Each of the three antiemetics in this study (ondansetron, dexamethasone, and droperidol) reduced the risk for PONV by approximately 26%; substituting propofol for volatile anesthetic reduced the risk by 19%; and substituting nitrogen (air) for nitrous oxide reduced the risk by 12%. A maximum reduction of 70% in the relative risk for PONV can be expected when total intravenous anesthesia is used with three antiemetics. The appropriate approach to the management of PONV depends on the patient’s baseline risk factors as well as the likelihood of adverse events and costs from the antiemetic medications.

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Efficacy of Three Different Prophylactic Treatments for Postoperative Nausea and Vomiting after Vitrectomy: A Randomized Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm8030391 ◽

2019 ◽

Vol 8 (3) ◽

pp. 391 ◽

Cited By ~ 5

Author(s):

Michele Reibaldi ◽

Matteo Fallico ◽

Antonio Longo ◽

Teresio Avitabile ◽

Marinella Astuto ◽

...

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Adverse Events ◽

Local Anesthesia ◽

Postoperative Nausea ◽

Therapy Group ◽

Combined Therapy ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Combination Group

Postoperative nausea and vomiting (PONV) after vitreoretinal surgery may potentially be associated with severe complications, such as suprachoroidal hemorrhage. The purpose of the present multicenter clinical trial (NCT02386059) was to assess the efficacy of three different prophylactic treatments for PONV after vitrectomy under local anesthesia. Patients undergoing primary vitrectomy were randomized to the control arm or to one of the treatment arms (4 mg ondansetron, 4 mg dexamethasone, combination of the two drugs). The primary outcome measure was the proportion of complete response (no nausea, no vomiting, no retching, and no use of antiemetic rescue medication) during 24 h after vitrectomy. Secondary outcomes included the severity standardized score of PONV, postoperative pain standardized score, and rate of ocular and non-ocular adverse events. Baseline demographics of the 1287 patients were comparable between the four arms. The combined therapy group showed a statistically significant lower incidence of PONV compared to the placebo and monotherapy (p < 0.001). PONV severity was also reduced in the combination group compared to the others (p < 0.001). Postoperative pain scores and adverse events were comparable among the four groups. Combined therapy with dexamethasone and ondansetron was the most effective treatment for reducing the incidence and severity of PONV in patients undergoing vitrectomy under local anesthesia.

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Balanced Opioid-free Anesthesia with Dexmedetomidine versus Balanced Anesthesia with Remifentanil for Major or Intermediate Noncardiac Surgery

Anesthesiology ◽

10.1097/aln.0000000000003725 ◽

2021 ◽

Author(s):

Helene Beloeil ◽

Matthias Garot ◽

Gilles Lebuffe ◽

Alexandre Gerbaud ◽

Julien Bila ◽

...

Keyword(s):

Relative Risk ◽

Adverse Events ◽

Cognitive Dysfunction ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Opioid Consumption ◽

Nausea And Vomiting ◽

Postanesthesia Care Unit ◽

Balanced Anesthesia ◽

Remifentanil Group

Background It is speculated that opioid-free anesthesia may provide adequate pain control while reducing postoperative opioid consumption. However, there is currently no evidence to support the speculation. The authors hypothesized that opioid-free balanced anesthetic with dexmedetomidine reduces postoperative opioid-related adverse events compared with balanced anesthetic with remifentanil. Methods Patients were randomized to receive a standard balanced anesthetic with either intraoperative remifentanil plus morphine (remifentanil group) or dexmedetomidine (opioid-free group). All patients received intraoperative propofol, desflurane, dexamethasone, lidocaine infusion, ketamine infusion, neuromuscular blockade, and postoperative lidocaine infusion, paracetamol, nefopam, and patient-controlled morphine. The primary outcome was a composite of postoperative opioid-related adverse events (hypoxemia, ileus, or cognitive dysfunction) within the first 48 h after extubation. The main secondary outcomes were episodes of postoperative pain, opioid consumption, and postoperative nausea and vomiting. Results The study was stopped prematurely because of five cases of severe bradycardia in the dexmedetomidine group. The primary composite outcome occurred in 122 of 156 (78%) dexmedetomidine group patients compared with 105 of 156 (67%) in the remifentanil group (relative risk, 1.16; 95% CI, 1.01 to 1.33; P = 0.031). Hypoxemia occurred 110 of 152 (72%) of dexmedetomidine group and 94 of 155 (61%) of remifentanil group patients (relative risk, 1.19; 95% CI, 1.02 to 1.40; P = 0.030). There were no differences in ileus or cognitive dysfunction. Cumulative 0 to 48 h postoperative morphine consumption (11 mg [5 to 21] versus 6 mg [0 to 17]) and postoperative nausea and vomiting (58 of 157 [37%] versus 37 of 157 [24%]; relative risk, 0.64; 95% CI, 0.45 to 0.90) were both less in the dexmedetomidine group, whereas measures of analgesia were similar in both groups. Dexmedetomidine patients had more delayed extubation and prolonged postanesthesia care unit stay. Conclusions This trial refuted the hypothesis that balanced opioid-free anesthesia with dexmedetomidine, compared with remifentanil, would result in fewer postoperative opioid-related adverse events. Conversely, it did result in a greater incidence of serious adverse events, especially hypoxemia and bradycardia. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Addition of haloperidol to ondansetron and dexamethasone to prevent postoperative nausea and vomiting in female smoking patients following laparoscopic surgery: A prospective, randomized, double-blind study

10.21203/rs.2.11216/v1 ◽

2019 ◽

Author(s):

Xin-qi Zhuang ◽

Ji Yang ◽

Sen Zhao ◽

Yue-chun Lu ◽

Ke-liang Xie ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Adverse Events ◽

Pain Score ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Anesthesia Induction ◽

Gynecological Surgery ◽

Study Results ◽

Significant Difference

Abstract Background Postoperative nausea and vomiting (PONV) is an unpleasant experience that impacts on patient comfort and satisfaction and may lead to other complications. Some risk factors such as female gender and non-smoking status were used to predict the risk of PONV. Regarding its prevention, the combination of two different types of prophylaxis has been demonstrated to exert an additive effect. The present study aimed to evaluate the efficacy of a triple combination of haloperidol, ondansetron and dexamethasone for the prevention of PONV following laparoscopic gynecological surgery in female smoking patients. Methods A total of 210 eligible consecutive female patients ranked as American Society of Anesthesiology physical status I-II and aged 18-60 years who were undergoing selective laparoscopic gynecological surgery were included in the current study and allocated into three groups: Patients in group O received 4 mg ondansetron, group OD received 4 mg ondansetron and 8 mg dexamethasone, group ODH received 4 mg ondansetron, 8 mg dexamethasone and 2 mg haloperidol intravenously prior to anesthesia induction. The incidence of PONV, the need for rescue antiemetics, pain score, patient-controlled analgesia (PCA) consumption, rescue analgesics and adverse events were recorded 48 h after operation. Results The final analysis consisted of 193 patients who completed the study. Results indicated that the incidence of PONV was significantly decreased in groups OD (20.00%) and ODH (15.63%) compared with in group O (42.19%; P = 0.005). Furthermore, the need for rescue antiemetics was significantly lower in groups OD (13.85%) and ODH (12.50%) than in group O (32.81%; P = 0.005). There was no significant difference in the incidence of PONV or the need for rescue antiemetics between groups OD and ODH (P = 0.516 and 0.821 respectively). No statistically significant differences were detected in pain score, PCA consumption, rescue analgesics or adverse events among the groups (all P > 0.05). Conclusion The addition of haloperidol to a combination of ondansetron and dexamethasone did not decrease PONV frequency below that obtained with the two-drug combination. As for female smokers, prophylaxis comprising ondansetron and dexamethasone, with or without haloperidol, could effectively reduce PONV following laparoscopic surgery.

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Effective Dose of Ramosetron for Prophylaxis of Postoperative Nausea and Vomiting in High-Risk Patients

BioMed Research International ◽

10.1155/2015/951474 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Seongheon Lee ◽

Sinho Jeong ◽

Joungmin Kim ◽

Seongwook Jeong

Keyword(s):

High Risk ◽

Adverse Events ◽

Effective Dose ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Complete Response ◽

Nausea And Vomiting ◽

High Risk Patients ◽

Risk Patients ◽

Group A

Background. Postoperative nausea and vomiting (PONV) are common adverse events with an incidence of up to 80% in high-risk patients. Ramosetron, a selective 5-HT3receptor antagonist, is widely used to prevent PONV. The purpose of this study was to evaluate the effective dose of ramosetron for the prevention of PONV in high-risk patients.Methods. Fifty-one patients were randomly allocated to 3 groups and were administered ramosetron 0.3 mg (group A), 0.45 mg (group B), or 0.6 mg (group C), at the end of their surgery. The episodes of PONV were assessed 1, 6, 24, and 48 hours after the injection and all the adverse events were observed.Results. The complete response rate in the postoperative period 6–24 hours after the anesthesia was higher in group C than in group A: 93% versus 44%. Group C’s experience score of Rhodes index was lower than group A’s: 0.81 ± 2.56 versus 3.94 ± 5.25. No adverse drug reaction could be observed in all groups.Conclusions. The effective dose of ramosetron to be injected for the near-complete prophylaxis of PONV 6 to 24 hours after surgery in high-risk patients is a 0.6 mg bolus injection at the end of the surgery.

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