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Li P, Zhu M, Gao A, Guo H, Fu A, Zhao A, Guo D. A case-control study on the clinical characteristics of granisetron-related arrhythmias and the development of a predictive nomogram. Int J Clin Pharm 2024; 46:684-693. [PMID: 38416350 DOI: 10.1007/s11096-024-01703-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/14/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Automatic monitoring and assessment are increasingly employed in drug safety evaluations using hospital information system data. The increasing concern about granisetron-related arrhythmias requires real-world studies to improve our understanding of its safety. AIM This study aimed to analyze the incidence, clinical characteristics, and risk factors of granisetron-related arrhythmias in hospitalized patients using real-world data obtained from the Adverse Drug Event Active Surveillance and Assessment System-II (ADE-ASAS-II) and concurrently aimed to develop and validate a nomogram to predict the occurrence of arrhythmias. METHOD Retrospective automatic monitoring of inpatients using granisetron was conducted in a Chinese hospital from January 1, 2017, to December 31, 2021, to determine the incidence of arrhythmias using ADE-ASAS- II. Propensity score matching was used to balance confounders and analyze clinical characteristics. Based on risk factors identified through logistic regression analysis, a prediction nomogram was established and internally validated using the Bootstrap method. RESULTS Arrhythmias occurred in 178 of 72,508 cases taking granisetron with an incidence of 0.3%. Independent risk factors for granisetron-related arrhythmias included medication duration, comorbid cardiovascular disease, concomitant use of other 5-hydroxytryptamine 3 receptor antagonists, alanine aminotransferase > 40 U/L, and blood urea nitrogen > 7.5 mmol/L. The nomogram demonstrated good differentiation and calibration, with enhanced clinical benefit observed when the risk threshold ranged from 0.10 to 0.82. CONCLUSION The nomogram, based on the five identified independent risk factors, may be valuable in predicting the risk of granisetron-related arrhythmias in the administered population, offering significant clinical applications.
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Affiliation(s)
- Peng Li
- Chinese People's Liberation Army Medical School, Beijing, 100853, China
- Department of Pharmacy, Medical Supplies Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Man Zhu
- Department of Pharmacy, Medical Supplies Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Ao Gao
- Department of Pharmacy, Medical Supplies Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Haili Guo
- Chinese People's Liberation Army Medical School, Beijing, 100853, China
- Department of Pharmacy, Medical Supplies Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - An Fu
- Chinese People's Liberation Army Medical School, Beijing, 100853, China
- Department of Pharmacy, Medical Supplies Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Anqi Zhao
- Chinese People's Liberation Army Medical School, Beijing, 100853, China
- Department of Pharmacy, Medical Supplies Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Daihong Guo
- Department of Pharmacy, Medical Supplies Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
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Aguilar-Nascimento JED, Ribeiro Junior U, Portari-Filho PE, Salomão AB, Caporossi C, Colleoni Neto R, Waitzberg DL, Campos ACL. PERIOPERATIVE CARE IN DIGESTIVE SURGERY: THE ERAS AND ACERTO PROTOCOLS - BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1794. [PMID: 38716919 PMCID: PMC11072254 DOI: 10.1590/0102-672020240001e1794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/17/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The concept introduced by protocols of enhanced recovery after surgery modifies perioperative traditional care in digestive surgery. The integration of these modern recommendations components during the perioperative period is of great importance to ensure fewer postoperative complications, reduced length of hospital stay, and decreased surgical costs. AIMS To emphasize the most important points of a multimodal perioperative care protocol. METHODS Careful analysis of each recommendation of both ERAS and ACERTO protocols, justifying their inclusion in the multimodal care recommended for digestive surgery patients. RESULTS Enhanced recovery programs (ERPs) such as ERAS and ACERTO protocols are a cornerstone in modern perioperative care. Nutritional therapy is fundamental in digestive surgery, and thus, both preoperative and postoperative nutrition care are key to ensuring fewer postoperative complications and reducing the length of hospital stay. The concept of prehabilitation is another key element in ERPs. The handling of crystalloid fluids in a perfect balance is vital. Fluid overload can delay the recovery of patients and increase postoperative complications. Abbreviation of preoperative fasting for two hours before anesthesia is now accepted by various guidelines of both surgical and anesthesiology societies. Combined with early postoperative refeeding, these prescriptions are not only safe but can also enhance the recovery of patients undergoing digestive procedures. CONCLUSIONS This position paper from the Brazilian College of Digestive Surgery strongly emphasizes that the implementation of ERPs in digestive surgery represents a paradigm shift in perioperative care, transcending traditional practices and embracing an intelligent approach to patient well-being.
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Affiliation(s)
| | - Ulysses Ribeiro Junior
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | | | - Alberto Bicudo Salomão
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery - São Paulo (SP), Brazil
| | - Cervantes Caporossi
- Centro Universitário de Varzea Grande, Department of Surgery - Varzea Grande (MT), Brazil
| | - Ramiro Colleoni Neto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery - São Paulo (SP), Brazil
| | - Dan Linetzky Waitzberg
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
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Fan N, Yan L, Li M, Li S. Comparative efficacies of 13 surgical interventions for primary congenital glaucoma in children: a network meta-analysis of randomized clinical trials. Int J Surg 2024; 110:3081-3082. [PMID: 38748501 PMCID: PMC11093482 DOI: 10.1097/js9.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 05/19/2024]
Affiliation(s)
- Ningning Fan
- Department of Ophthalmology, Air Force Hospital of Eastern Theater Command, Nan Jing City, Jiang Su Province
| | - Liqiang Yan
- Department of Neuro-Ophthalmology, Weifang Eye Hospital, Zheng Da Guang Ming Eye Group, Wei Fang City, Shan Dong Province, People’s Republic of China
| | - Mengxue Li
- Department of Neuro-Ophthalmology, Weifang Eye Hospital, Zheng Da Guang Ming Eye Group, Wei Fang City, Shan Dong Province, People’s Republic of China
| | - Shouqing Li
- Department of Neuro-Ophthalmology, Weifang Eye Hospital, Zheng Da Guang Ming Eye Group, Wei Fang City, Shan Dong Province, People’s Republic of China
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Dang C, Wang Q, Li Q, Xiong Y, Lu Y. Chinese herbal medicines for the treatment of depression: a systematic review and network meta-analysis. Front Pharmacol 2024; 15:1295564. [PMID: 38633609 PMCID: PMC11021639 DOI: 10.3389/fphar.2024.1295564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Objectives: Amidst rising global burden of depression and the associated challenges with conventional antidepressant therapies, there is a growing interest in exploring the efficacy and safety of alternative treatments. This study uses a Bayesian network meta-analysis to rigorously evaluate the therapeutic potential of Chinese herbal medicines in the treatment of depression, focusing on their comparative efficacy and safety against standard pharmacological interventions. Methods: Five databases (PubMed, Wanfang Data, EMBASE, CNKI, and the Cochrane Library) and grey literature were searched from inception to end of July 2023 to identify studies that assessed the efficacy and safety of Chinese herbal medicines in treating depression. The response rate, Hamilton Depression Scale (HAMD) scores, and rates of adverse events were assessed through both direct and indirect comparisons. Data extraction and risk of bias assessment were meticulously performed. Statistical analysis used Markov chain Monte Carlo methods, with effect size estimates provided as odd ratios and their 95% confidence intervals. Results: A total of 198 RCTs involving 8,923 patients were analyzed, assessing 17 Chinese herbal medicines. Surface Under the Cumulative Ranking results indicated that the top three treatments with the best response rate were possibly Guipiwan, Ease Pill, and Chaihu Jia Longgu Muli Decoction; the top three treatments on the reduction of HAMD scores were Chai Hu Shu Gan San, Xingnao Jieyu Decoction, and Xiaoyao Powder; and the top three treatments with the lowest adverse effects rates were Xiaoyao Powder, Alprazolam, and Xingnao Jieyu Decoction. Interestingly, commonly used synthetic drugs such as Fluoxetine, Escitalopram, Amitriptyline, Sertraline, Flupentixol and Melitracen, and Venlafaxine, not only appeared to be less effective than specific Chinese herbal medicines (Gan Mai Da Zao Decoction, Chaihu Jia Longgu Muli Decoction, Chai Hu Shu Gan San, Danzhi-Xiaoyao-San, and Xingnao Jieyu Decoction), but they were also related to substantially higher risk of adverse events. Conclusion: Our findings elucidate the promising therapeutic potential of Chinese herbal medicines as viable alternatives in the treatment of depression, with certain herbs demonstrating enhanced efficacy and safety profiles. The outcomes of this study advocate for the integration of these alternative modalities into contemporary depression management paradigms. However, it underscores the necessity for larger, methodologically robust trials to further validate and refine these preliminary findings. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023452109.
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Affiliation(s)
- Chun Dang
- Department of Periodical Press, West China Hospital, Sichuan University, Chengdu, China
| | - Qinxuan Wang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Qian Li
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ying Xiong
- Department of Periodical Press, West China Hospital, Sichuan University, Chengdu, China
| | - Yaoheng Lu
- Department of General Surgery, Chengdu Integrated Traditional Chinese Medicine and Western Medicine Hospital, Chengdu, China
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Kim HI, Kim KJ, Kim S, Kim HD, Kim SH. Association between preoperative lumbar skeletal muscle index and postoperative nausea and vomiting in patients undergoing pylorus-preserving pancreatoduodenectomy: a retrospective study. Anesth Pain Med (Seoul) 2024; 19:161-168. [PMID: 38725172 PMCID: PMC11089290 DOI: 10.17085/apm.23142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Sarcopenia is associated with postoperative complications; however, its impact on the quality of postoperative recovery, such as postoperative nausea and vomiting (PONV) and pain, remains unclear. We investigated the association of preoperative lumbar skeletal muscle mass index (LSMI) with PONV, postoperative pain, and complications. METHODS Medical records of 756 patients who underwent pylorus-preserving pancreatoduodenectomy (PPPD) were retrospectively reviewed. The skeletal muscle areas were measured on abdominal computed tomography (CT) images. LSMI was calculated by dividing the skeletal muscle area by the square of the patient's height. We analyzed the correlations between preoperative LSMI calibrated with confounding variables and PONV scores, PONV occurrence, pain scores, rescue analgesic administration, postoperative complications, and length of hospital stay. RESULTS The median (1Q, 3Q) LSMI was 47.72 (40.74, 53.41) cm2/m2. The incidence rates of PONV according to time period were as follows: post-anesthesia care unit, 42/756 (5.6%); 0-6 h, 54/756 (7.1%); 6-24 h, 120/756 (15.9%); 24-48 h, 46/756 (6.1%); and overall, 234/756 (31.0%). The incidence of PONV was inversely correlated with LSMI 24-48 h post-surgery and overall. LSMI and PONV scores were negatively associated 6-24 h and 24-48 h post-surgery. There was no association between LSMI and postoperative pain scores, rescue analgesic administration, complications, or length of hospital stay. CONCLUSIONS Preoperative LSMI was associated with PONV in patients undergoing PPPD. Therefore, LSMI measured on preoperative abdominal CT can be a predictive indicator of PONV. Appropriate PONV prophylaxis is necessary in patients with low LSMI before PPPD.
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Affiliation(s)
- Hyun Il Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Jun Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sangil Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hae Dong Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyun Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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González-Santos S, Mugabure B, Granell M, Aguinagalde B, López IJ, Aginaga A, Zubelzu I, Iraeta H, Zabaleta J, Izquierdo JM, González-Jorrín N, Sarasqueta C, Herreros-Pomares A. Analgesic Efficacy and Safety of Intrathecal Morphine or Intercostal Levobupivacaine in Lung Cancer Patients after Major Lung Resection Surgery by Videothoracoscopy: A Prospective Randomized Controlled Trial. J Clin Med 2024; 13:1972. [PMID: 38610735 PMCID: PMC11012894 DOI: 10.3390/jcm13071972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Lung resection using video-assisted thoracoscopic surgery (VATS) improves surgical accuracy and postoperative recovery. Unfortunately, moderate-to-severe acute postoperative pain is still inherent to the procedure, and a technique of choice has not been established for the appropriate control of pain. In this study, we aimed to compare the efficacy and safety of intrathecal morphine (ITM) with that of intercostal levobupivacaine (ICL). Methods: We conducted a single-center, prospective, randomized, observer-blinded, controlled trial among 181 adult patients undergoing VATS (ISRCTN12771155). Participants were randomized to receive ITM or ICL. Primary outcomes were the intensity of pain, assessed by a numeric rating scale (NRS) over the first 48 h after surgery, and the amount of intravenous morphine used. Secondary outcomes included the incidence of adverse effects, length of hospital stay, mortality, and chronic post-surgical pain at 6 and 12 months after surgery. Results: There are no statistically significant differences between ITM and ICL groups in pain intensity and evolution at rest. In cough-related pain, differences in pain trajectories over time are observed. Upon admission to the PACU, cough-related pain was higher in the ITM group, but the trend reversed after 6 h. There are no significant differences in adverse effects. The rate of chronic pain was low and did not differ significantly between groups. Conclusions: ITM can be considered an adequate and satisfactory regional technique for the control of acute postoperative pain in VATS, compatible with the multimodal rehabilitation and early discharge protocols used in these types of surgeries.
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Affiliation(s)
- Silvia González-Santos
- Department of Anesthesiology, Postoperative Care and Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain; (S.G.-S.); (B.M.); (A.A.); (I.Z.); (H.I.); (N.G.-J.)
| | - Borja Mugabure
- Department of Anesthesiology, Postoperative Care and Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain; (S.G.-S.); (B.M.); (A.A.); (I.Z.); (H.I.); (N.G.-J.)
| | - Manuel Granell
- Department of Anesthesiology, Postoperative Care and Pain Management, Hospital General Universitario de València, 46014 Valencia, Spain
- Department of Surgery, Universitat de València, 46010 Valencia, Spain
| | - Borja Aguinagalde
- Department of Thoracic Surgery, Donostia University Hospital, 20014 San Sebastián, Spain; (B.A.); (I.J.L.); (J.Z.); (J.M.I.)
| | - Iker J. López
- Department of Thoracic Surgery, Donostia University Hospital, 20014 San Sebastián, Spain; (B.A.); (I.J.L.); (J.Z.); (J.M.I.)
| | - Ainhoa Aginaga
- Department of Anesthesiology, Postoperative Care and Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain; (S.G.-S.); (B.M.); (A.A.); (I.Z.); (H.I.); (N.G.-J.)
| | - Inmaculada Zubelzu
- Department of Anesthesiology, Postoperative Care and Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain; (S.G.-S.); (B.M.); (A.A.); (I.Z.); (H.I.); (N.G.-J.)
| | - Haritz Iraeta
- Department of Anesthesiology, Postoperative Care and Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain; (S.G.-S.); (B.M.); (A.A.); (I.Z.); (H.I.); (N.G.-J.)
| | - Jon Zabaleta
- Department of Thoracic Surgery, Donostia University Hospital, 20014 San Sebastián, Spain; (B.A.); (I.J.L.); (J.Z.); (J.M.I.)
| | - Jose Miguel Izquierdo
- Department of Thoracic Surgery, Donostia University Hospital, 20014 San Sebastián, Spain; (B.A.); (I.J.L.); (J.Z.); (J.M.I.)
| | - Nuria González-Jorrín
- Department of Anesthesiology, Postoperative Care and Pain Management, Donostia University Hospital, 20014 San Sebastián, Spain; (S.G.-S.); (B.M.); (A.A.); (I.Z.); (H.I.); (N.G.-J.)
| | - Cristina Sarasqueta
- Department of Clinical Epidemiology, Donostia University Hospital, ISS Bioguipuzcoa, 20014 San Sebastián, Spain;
| | - Alejandro Herreros-Pomares
- Department of Biotechnology, Universitat Politècnica de València, 46022 Valencia, Spain;
- Centro de Investigación Biomédica en Red Cáncer, CIBERONC, 28029 Madrid, Spain
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Wang J, Chen C, Li D, Yang Y, Xu J, Zhang L, Huo F, Guo W, Tang X. Enhanced recovery after surgery (ERAS) in sacral tumour surgery and comprehensive description of a multidisciplinary program: a prospective study in a specialized hospital in China. INTERNATIONAL ORTHOPAEDICS 2024; 48:581-601. [PMID: 37966532 DOI: 10.1007/s00264-023-06016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE There were fewer data to guide the application of enhanced recovery after surgery (ERAS) theory into sacral tumour surgery. In the present study, we were aiming to describe a multidisciplinary program of ERAS and evaluate the availability in sacral tumour surgery. METHODS This was a prospective study of patients with sacral tumour between March 2021 and September 2021 at a single centre. We proposed a multidisciplinary program of ERAS for pre-admission, preoperative, intraoperative, postoperative, and post-discharge clinical care which positively influenced outcomes of patients with sacral tumour. All patients were prospectively assigned into two groups, ERAS group in which patients received ERAS protocols (n = 63), No-ERAS group in which patients had conventional clinical pathways (n = 62). Patient data were collected which included demographics, preoperative preparation, detailed information of surgical procedure, 60-day reoperation rate, 60-day readmission, postoperative length of stay (PLOS), time to first ambulation and flatus after surgery, time to removal of last drainage tube, and visual analogue scale (VAS) score at first ambulation and discharge. Complications referred to ones that occurred within 60 days after surgery. The above parameters were compared between ERAS group and No-ERAS group. RESULTS Time to first ambulation after surgery in ERAS group (mean 20.9 h) was significantly shorter than that in No-ERAS group (mean 104.3 ho). Meanwhile, time to first flatus after surgery in ERAS group (mean 26.7 h) was also significantly shorter than that in No-ERAS group (mean 37.3 h). Patients in ERAS group had statistically shorter PLOS (10.7 days) as compared to that in No-ERAS group (13.8 days). In ERAS group, 19 of 63 patients (30.2%) were discharged within seven days after surgery as compared to seven of 62 patients (11.3%) in No-ERAS group. VAS score at first ambulation in ERAS group was not obviously higher than that in No-ERAS group though the time of first ambulation in ERAS group was statistically earlier than one in No-ERAS group. Furthermore, VAS score at discharge in ERAS group was significantly lower than that in No-ERAS group. The rate of postoperative incision necrosis was 6.3% (4/63) in ERAS group and 8.1% (5/62) in No-ERAS group and all of these nine patients underwent reoperation before discharge. The difference was not statistically significant in the wound complication of incision necrosis and 60-day reoperation rate. Only one readmission occurred in No-ERAS group due to the surgical site infection and also there was no significant difference of 60-day readmission rate between these two groups. Furthermore, there was no statistical difference of complications of femoral artery thrombosis and rectal rupture between ERAS group and No-ERAS group. CONCLUSIONS Our proposed ERAS pathway for sacral tumour surgery and early walking facilitate safe and prompt discharge. ERAS protocols of sacral tumour surgery could decrease PLOS without significantly increasing postoperative complications, 60-day readmission rate and 60-day reoperation rate. The application of ERAS pathway in the field of sacral tumour surgery should have personalized feature with regard to resection type.
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Affiliation(s)
- Jun Wang
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, Beijing, 100044, China.
| | - Chen Chen
- Department of Radiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China.
| | - Dasen Li
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Yi Yang
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Junjun Xu
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Lei Zhang
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Fei Huo
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Wei Guo
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, Beijing, 100044, China.
| | - Xiaodong Tang
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, Beijing, 100044, China.
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Xiao M, Yao D, Fields KG, Sarin P, Macias AA, Eappen S, Juang J. Postoperative and postdischarge nausea and vomiting following ambulatory eye, head, and neck surgeries: a retrospective cohort study comparing incidence and associated factors. Perioper Med (Lond) 2024; 13:3. [PMID: 38245800 PMCID: PMC10800056 DOI: 10.1186/s13741-024-00360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 01/02/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Ambulatory surgery is often followed by the development of nausea and/or vomiting (N/V). Although risk factors for postoperative nausea and vomiting (PONV) are frequently discussed, the distinction between PONV and postdischarge nausea and vomiting (PDNV) is unclear. This is especially troublesome given the potential consequences of postdischarge nausea and vomiting (PDNV), which include major discomfort and hospital readmission. METHODS In this retrospective cohort study, data from 10,231 adult patients undergoing ambulatory ophthalmology or otolaryngology procedures with general anesthesia were collected and analyzed. Binary and multinomial logistic regression was used to assess the association between patient and anesthetic characteristics (including age, body mass index (BMI), American Society of Anesthesiologists Physical Status (ASA P/S) classification, current smoker status, and intra- and postoperative opioid usage) and the odds ratios of experiencing only PDNV, only PONV, or both PONV and PDNV, as compared to not experiencing N/V at all. RESULTS We found that 17.8% of all patients developed N/V (PONV and/or PDNV). Patients who experienced PONV had a 2.79 (95% confidence interval 2.24-3.46) times greater risk of reporting PDNV. Binary logistic regression found that younger age, opioid use, and female sex were associated with an increased likelihood of experiencing any N/V. Increased use of nitrous oxide and a higher ASA P/S class was associated with elevated likelihood of PONV, but not PDNV or PONV plus PDNV. CONCLUSIONS Patients experiencing N/V in the PACU are observed to develop PDNV disproportionately by a factor of 2.79. The patients have distinct predictors, indicating important opportunities for care improvements beyond current guidelines.
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Affiliation(s)
- Mark Xiao
- Department of Anesthesiology, Massachusetts Eye and Ear (MEE), 243 Charles St., Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Dongdong Yao
- Department of Anesthesiology, Massachusetts Eye and Ear (MEE), 243 Charles St., Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Brigham and Women's Hospital (BWH), 75 Francis St., Boston, MA, 02115, USA
| | - Kara G Fields
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Brigham and Women's Hospital (BWH), 75 Francis St., Boston, MA, 02115, USA
| | - Pankaj Sarin
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Brigham and Women's Hospital (BWH), 75 Francis St., Boston, MA, 02115, USA
| | - Alvaro Andres Macias
- Department of Anesthesiology, Massachusetts Eye and Ear (MEE), 243 Charles St., Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Brigham and Women's Hospital (BWH), 75 Francis St., Boston, MA, 02115, USA
| | - Sunil Eappen
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Brigham and Women's Hospital (BWH), 75 Francis St., Boston, MA, 02115, USA
| | - Jeremy Juang
- Department of Anesthesiology, Massachusetts Eye and Ear (MEE), 243 Charles St., Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA.
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Bansal T, Singhal S, Taxak S, Bajwa SJS. Dexamethasone in anesthesia practice: A narrative review. J Anaesthesiol Clin Pharmacol 2024; 40:3-8. [PMID: 38666172 PMCID: PMC11042091 DOI: 10.4103/joacp.joacp_164_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/16/2022] [Accepted: 11/19/2022] [Indexed: 04/28/2024] Open
Abstract
Dexamethasone is routinely used in anesthesia practice and has been regarded as one of the ideal perioperative agents. It is a synthetic glucocorticoid with potent antiinflammatory action. It reduces postoperative nausea and vomiting, pain, postoperative opioid requirements after general anaesthesia as well as spinal anaesthesia. It has been used via intravenous, epidural and perineural routes. It has been used successfully in fascial blocks. It significantly decreases fatigue, shivering and postoperative sore throat and improves quality of recovery.
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Affiliation(s)
- Teena Bansal
- Department of Anaesthesiology and Critical Care, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Suresh Singhal
- Department of Anaesthesiology and Critical Care, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Susheela Taxak
- Department of Anaesthesiology and Critical Care, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
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Paul D, Agrawal R, Singh S. Alzheimer's disease and clinical trials. J Basic Clin Physiol Pharmacol 2024; 35:31-44. [PMID: 38491747 DOI: 10.1515/jbcpp-2023-0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
Alzheimer's disease (AD) is spreading its root disproportionately among the worldwide population. Many genes have been identified as the hallmarks of AD. Based upon the knowledge, many clinical trials have been designed and conducted. Attempts have been made to alleviate the pathology associated with AD by targeting the molecular products of these genes. Irrespective of the understanding on the genetic component of AD, many clinical trials have failed and imposed greater challenges on the path of drug discovery. Therefore, this review aims to identify research and review articles to pinpoint the limitations of drug candidates (thiethylperazine, CT1812, crenezumab, CNP520, and lecanemab), which are under or withdrawn from clinical trials. Thorough analysis of the cross-talk pathways led to the identification of many confounding factors, which could interfere with the success of clinical trials with drug candidates such as thiethylperazine, CT1812, crenezumab, and CNP520. Though these drug candidates were enrolled in clinical trials, yet literature review shows many limitations. These limitations raise many questions on the rationale behind the enrollments of these drug candidates in clinical trials. A meticulous prior assessment of the outcome of clinical studies may stop risky clinical trials at their inceptions. This may save time, money, and resources.
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Affiliation(s)
- Deepraj Paul
- Department of Pharmacology, 621320 College of Pharmacy JSS Academy of Technical Education , Noida, Uttar Pradesh, India
| | - Rohini Agrawal
- Department of Pharmacology, 621320 College of Pharmacy JSS Academy of Technical Education , Noida, Uttar Pradesh, India
| | - Swati Singh
- Department of Pharmacology, 621320 College of Pharmacy JSS Academy of Technical Education , Noida, Uttar Pradesh, India
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11
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Clark RC, Alving-Trinh A, Becker M, Leach GA, Gosman A, Reid CM. Moving the needle: a narrative review of enhanced recovery protocols in breast reconstruction. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:414. [PMID: 38213812 PMCID: PMC10777219 DOI: 10.21037/atm-23-1509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/07/2023] [Indexed: 01/13/2024]
Abstract
Background and Objective After a relatively late introduction to the literature in 2015, enhanced recovery protocols for breast reconstruction have flourished into a wealth of reports. Many have since described unique methodologies making improved offerings with superior outcomes attainable. This is a particularly interesting procedure for the study of enhanced recovery as it encompasses two dissident approaches. Compared to implant-based reconstruction, autologous free-flap reconstruction has demonstrated superiority in a range of long-term metrics at the expense of historically increased peri-operative morbidity. This narrative review collates reports of recovery protocols for both approaches and examines methodologies surrounding the key pieces of a comprehensive pathway. Methods All primary clinical reports specifically describing enhanced recovery protocols for implant-based and autologous breast reconstruction through 2022 were identified by systematic review of PubMed and Embase libraries. Twenty-five reports meeting criteria were identified, with ten additional reports included for narrative purpose. Included studies were examined for facets of innovation from the pre-hospital setting through outpatient follow-up. Notable findings were described in the context of a comprehensive framework with attention paid to clinical and basic scientific background. Considerations for implementation were additionally discussed. Key Content and Findings Of 35 included studies, 29 regarded autologous reconstruction with majority focus on reduction of peri-operative opioid requirements and length of stay. Six regarded implant-based reconstruction with most discussing pathways towards ambulatory procedures. Eighty percent of included studies were published after the 2017 consensus guidelines with many described innovations to this baseline. Pathways included considerations for pre-hospital, pre-operative, intra-operative, inpatient, and outpatient settings. Implant-based studies demonstrated that safe ambulatory care is accessible. Autologous studies demonstrated a trend towards discharge before post-operative day three and peri-operative opioid requirements equivalent to those of implant-based reconstructions. Conclusions Study of enhanced recovery after breast reconstruction has inspired paradigm shift and pushed limits previously not thought to be attainable. These protocols should encompass a longitudinal care pathway with optimization through patient-centered approaches and multidisciplinary collaboration. This framework should represent standard of care and will serve to expand availability of all methods of breast reconstruction.
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Affiliation(s)
- Robert Craig Clark
- Division of Plastic Surgery, UC San Diego School of Medicine, La Jolla, CA, USA
| | | | - Miriam Becker
- Division of Plastic Surgery, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Garrison A Leach
- Division of Plastic Surgery, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Amanda Gosman
- Division of Plastic Surgery, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Chris M Reid
- Division of Plastic Surgery, UC San Diego School of Medicine, La Jolla, CA, USA
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12
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Okutomi Y, Konishi Y, Kakinuma A, Sawamura S. Preoperative Femoral Nerve Block and Postoperative Sciatic Nerve Block at the Subgluteal Space After Total Knee Arthroplasty: A Retrospective Cohort Study. Cureus 2023; 15:e50882. [PMID: 38249241 PMCID: PMC10799308 DOI: 10.7759/cureus.50882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Background A preoperative sciatic nerve block (SNB) before total knee arthroplasty (TKA) frequently causes postoperative drop foot; however, this can also occur as an unintended result of surgical invasion. This study assessed the benefits of a postoperative SNB at the subgluteal space for patients who underwent TKA. Methodology This was a single-center, retrospective cohort study. Patients who underwent TKA under general anesthesia between May 2018 and June 2019 at the Teikyo University School of Medicine were screened for inclusion. They received either a preoperative femoral nerve block alone (control group; n = 87) or a preoperative femoral nerve block and postoperative SNB at the subgluteal space (post-SNB group; n = 40). The primary outcome was the pain-related Numerical Rating Scale (NRS) scores. The secondary outcomes were postoperative nausea and vomiting (PONV), intravenous patient-controlled analgesia (iv-PCA) suspension, and postoperative complications. Results No significant differences were observed in the characteristics, NRS scores, time to first drug use for pain, and iv-PCA suspension between groups. However, the incidence of PONV was significantly lower in the post-SNB group (p = 0.03). Logistic regression analysis revealed that droperidol doses of iv-PCA and the presence of postoperative SNB were independently associated with PONV occurrence [A1] {(p = 0.008, 95% confidence intervals (CI) [0.46, 0.89] and (p = 0.02, 95% CI [0.25, 0.88])}. Conclusions A postoperative SNB at the subgluteal space following TKA does not improve postoperative pain control; however, it may have contributed to reduced PONV.
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Affiliation(s)
- Yuki Okutomi
- Department of Anesthesia and Critical Care, Teikyo University School of Medicine, Tokyo, JPN
| | - Yasutaka Konishi
- Department of Anesthesia and Critical Care, Teikyo University School of Medicine, Tokyo, JPN
| | - Akihito Kakinuma
- Department of Anesthesia and Critical Care, Teikyo University School of Medicine, Tokyo, JPN
| | - Shigehito Sawamura
- Department of Anesthesia and Critical Care, Teikyo University School of Medicine, Tokyo, JPN
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13
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Andrews PLR, Golding JF, Sanger GJ. An assessment of the effects of neurokinin 1 receptor antagonism against nausea and vomiting: Relative efficacy, sites of action and lessons for future drug development. Br J Clin Pharmacol 2023; 89:3468-3490. [PMID: 37452618 DOI: 10.1111/bcp.15852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
A broad-spectrum anti-vomiting effect of neurokinin1 receptor antagonists (NK1 RA), shown in pre-clinical animal studies, has been supported by a more limited range of clinical studies in different indications. However, this review suggests that compared with vomiting, the self-reported sensation of nausea is less affected or possibly unaffected (depending on the stimulus) by NK1 receptor antagonism, a common finding for anti-emetics. The stimulus-independent effects of NK1 RAs against vomiting are explicable by actions within the central pattern generator (ventral brainstem) and the nucleus tractus solitarius (NTS; dorsal brainstem), with additional effects on vagal afferent activity for certain stimuli (e.g., highly emetogenic chemotherapy). The central pattern generator and NTS neurones are multifunctional so the notable lack of obvious effects of NK1 RAs on other reflexes mediated by the same neurones suggests that their anti-vomiting action is dependent on the activation state of the pathway leading to vomiting. Nausea requires activation of cerebral pathways by projection of information from the NTS. Although NK1 receptors are present in cerebral nuclei implicated in nausea, and imaging studies show very high receptor occupancy at clinically used doses, the variable or limited ability of NK1 RAs to inhibit nausea emphasizes: (i) our inadequate understanding of the mechanisms of nausea; and (ii) that classification of a drug as an anti-emetic may give a false impression of efficacy against nausea vs. vomiting. We discuss the potential mechanisms for the differential efficacy of NK1 RA and the implications for future development of drugs that can effectively treat nausea, an area of unmet clinical need.
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Affiliation(s)
- Paul L R Andrews
- Division of Biomedical Sciences, St George's University of London, London, UK
| | | | - Gareth J Sanger
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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14
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Kim JH, Kim JS, Jeon YG, Bae J, Shin K, Hwang B. Effect of dexamethasone and ramosetron on the prevention of postoperative nausea and vomiting in low-risk patients: a randomized, double-blind, placebo-controlled, multicenter trial. BMC Anesthesiol 2023; 23:363. [PMID: 37936053 PMCID: PMC10629132 DOI: 10.1186/s12871-023-02334-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Several studies have investigated the effect of antiemetics on postoperative nausea and vomiting (PONV) in high-risk groups. However, few studies have investigated the effect of antiemetics in patients at low risk of developing PONV. METHODS In this prospective, randomized, double-blinded trial, 177 patients undergoing surgery under general anesthesia were randomly allocated to three groups. Patients allocated to group C (control group) received 2 mL of intravenous 0.9% saline, those allocated to group R (ramosetron group) received 0.3 mg of intravenous ramosetron, and those allocated to group DR (ramosetron plus dexamethasone group) received 5 mg of intravenous dexamethasone and 0.3 mg of intravenous ramosetron. RESULTS Finally, 174 patients completed the study, and the types of surgeries were orthopedic (n = 80), rhinologic (n = 47), urologic (n = 29), and others (n = 18). The incidence of PONV up to 48 h postoperatively was significantly lower in group DR than in group C. The incidence of PONV up to 0-1 h postoperatively was significantly lower in groups R and DR than in group C. The usage pattern of rescue antiemetics was consistent with the incidence of PONV. The percentage of patients requiring rescue analgesics 0-1 h postoperatively was significantly lower in groups R and DR than in group C. CONCLUSIONS The combination of dexamethasone and ramosetron demonstrated a superior effect in preventing PONV for 48 h after surgery under general anesthesia than saline in patients at low risk of developing PONV. Compared with saline injections, ramosetron injections yielded better outcomes for the incidence of PONV and the use of rescue antiemetics and rescue analgesics 0-1 h postoperatively. TRIAL REGISTRATION Clinical trial registration number: criskorea@korea.kr, KCT0006749.
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Affiliation(s)
- Jong-Ho Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University Medical Center, 77 Sakju-ro, Chuncheon, 24253, Republic of Korea
| | - Jin-Sun Kim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangwon, Republic of Korea
| | - Yeong-Gwan Jeon
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University Hospital, Wonju, Republic of Korea
| | - Jangho Bae
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, 24341, Gangwon-do, Republic of Korea
| | - Kiyoung Shin
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, 24341, Gangwon-do, Republic of Korea
| | - Byeongmun Hwang
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, 24341, Gangwon-do, Republic of Korea.
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15
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Elias M, Gombert A, Siddiqui S, Yu S, Jin Z, Bergese S. Perioperative utility of amisulpride and dopamine receptor antagonist antiemetics-a narrative review. Front Pharmacol 2023; 14:1274214. [PMID: 38026950 PMCID: PMC10644345 DOI: 10.3389/fphar.2023.1274214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Despite advances in antiemetics and protocolized postoperative nausea vomiting (PONV) management, it remains one of the most common postoperative adverse events. In patients who developed PONV despite antiemetic prophylaxis, giving a rescue treatment from the same class of medication is known to be of limited efficacy. Given the widespread use of 5-HT3 antagonists as PONV prophylaxis, another class of effective intravenous rescue antiemetic is in dire need, especially when prophylaxis fails, and rescue medication is utilized. Dopamine antagonists were widely used for the treatment of PONV but have fallen out of favor due to some of their side effect profiles. Amisulpride was first designed as an antipsychotic medication but was found to have antiemetic properties. Here we will review the historical perspective on the use of dopamine receptor antagonist antiemetics, as well as the evidence on the efficacy and safety of amisulpride.
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Affiliation(s)
- Murad Elias
- Department of Anesthesiology, Stony Brook University Health Sciences Center, Stony Brook, NY, United States
| | - Alexa Gombert
- Department of Anesthesiology, Stony Brook University Health Sciences Center, Stony Brook, NY, United States
| | - Sulaimaan Siddiqui
- Department of Anesthesiology, Stony Brook University Health Sciences Center, Stony Brook, NY, United States
| | - Sun Yu
- Department of Surgery, Stony Brook University Health Sciences Center, Stony Brook, NY, United States
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Sciences Center, Stony Brook, NY, United States
| | - Sergio Bergese
- Department of Anesthesiology, Stony Brook University Health Sciences Center, Stony Brook, NY, United States
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16
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Tan JQ, Wu HL, Wang YC, Cata JP, Chen JT, Cherng YG, Tai YH. Antiemetic prophylaxis with droperidol in morphine-based intravenous patient-controlled analgesia: a propensity score matched cohort study. BMC Anesthesiol 2023; 23:351. [PMID: 37898746 PMCID: PMC10612161 DOI: 10.1186/s12871-023-02319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND There are limited real-world data regarding the use of droperidol for antiemetic prophylaxis in intravenous patient-controlled analgesia (IV-PCA). This study aimed to evaluate the antiemetic benefits and sedation effects of droperidol in morphine-based IV-PCA. METHODS Patients who underwent major surgery and used morphine-based IV-PCA at a medical center from January 2020 to November 2022 were retrospectively analyzed. The primary outcome was the rate of any postoperative nausea and/or vomiting (PONV) within 72 h after surgery. Propensity score matching was used to match patients with and without the addition of droperidol to IV-PCA infusate in a 1:1 ratio. Multivariable conditional logistic regression models were used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS After matching, 1,104 subjects were included for analysis. The addition of droperidol to IV-PCA reduced the risk of PONV (aOR: 0.49, 95% CI: 0.35-0.67, p < 0.0001). The antiemetic effect of droperidol was significant within 36 h after surgery and attenuated thereafter. Droperidol was significantly associated with a lower risk of antiemetic uses (aOR: 0.58, 95% CI: 0.41-0.80, p = 0.0011). The rate of unintentional sedation was comparable between the patients with (9.1%) and without (7.8%; p = 0.4481) the addition of droperidol. Postoperative opioid consumption and numeric rating scale acute pain scores were similar between groups. CONCLUSIONS The addition of droperidol to IV-PCA reduced the risk of PONV without increasing opiate consumption or influencing the level of sedation. However, additional prophylactic therapies are needed to prevent late-onset PONV.
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Affiliation(s)
- Jia Qi Tan
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, 23561, New Taipei City, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, 11031, Taipei, Taiwan
| | - Hsiang-Ling Wu
- Department of Anesthesiology, Taipei Veterans General Hospital, 11217, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, 11221, Taipei, Taiwan
| | - Yi-Chien Wang
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, 23561, New Taipei City, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, 11031, Taipei, Taiwan
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 409, 77030, Houston, TX, USA
| | - Jui-Tai Chen
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, 23561, New Taipei City, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, 11031, Taipei, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, 23561, New Taipei City, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, 11031, Taipei, Taiwan
| | - Ying-Hsuan Tai
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, 23561, New Taipei City, Taiwan.
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, 11031, Taipei, Taiwan.
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Tsan SEH, Dinsmore J. Dexamethasone Use in Perioperative Neuroscience: Boon or Bane, or Both? J Neurosurg Anesthesiol 2023; 35:351-353. [PMID: 37488714 DOI: 10.1097/ana.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023]
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18
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Kim Y, Yoo S, Kim SH, Kim H, Bae J, Park SK, Kim JT, Lim YJ. Comparison between low-volume local anesthetic with intravenous dexamethasone and conventional volume without dexamethasone for superior trunk block after arthroscopic shoulder surgery: a randomized controlled non-inferiority trial. Reg Anesth Pain Med 2023:rapm-2023-104520. [PMID: 37775273 DOI: 10.1136/rapm-2023-104520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION This study aimed to investigate whether low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while maintaining the analgesic duration compared with conventional volume of local anesthetic without intravenous dexamethasone when performing ultrasound-guided superior trunk block in patients undergoing arthroscopic shoulder surgery. METHODS Eighty-four adult patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to receive ultrasound-guided superior trunk block using 7 mL of 0.5% ropivacaine with 0.15 mg/kg of intravenous dexamethasone (treatment group), or 15 mL of 0.5% ropivacaine with intravenous normal saline (control group). The co-primary outcomes were (1) the duration of analgesia (time between block completion and onset of surgical pain with a Numeric Rating Scale pain score of 4 or higher), which was compared against a non-inferiority margin of 3 hours, and (2) the incidence of diaphragmatic paresis evaluated using M-mode ultrasonography in the post-anesthesia care unit. RESULTS The mean duration of analgesia was 12.4 (6.8) and 11.2 (4.6) hours in the treatment and control groups, respectively (mean difference: -1.2 hours; 95% CI -3.8 to 1.3]; p for non-inferiority<0.001), meeting the non-inferiority criteria. The incidence of diaphragmatic paresis was 45.2% and 85.4% in the treatment and control groups, respectively (relative risk: 0.53; 97.5% CI 0.35 to 0.80; p<0.001). CONCLUSIONS Superior trunk block using low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while providing non-inferior analgesic duration compared with the conventional volume of local anesthetic in patients undergoing arthroscopic shoulder surgery. TRIAL REGISTRATION NUMBER Clinical Research Information Service of Republic of Korea Registry (KCT0005998).
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Affiliation(s)
- Youngwon Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seokha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hansol Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jinyoung Bae
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Sun-Kyung Park
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Jin Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Freeman SC, Saeedi E, Ordóñez-Mena JM, Nevill CR, Hartmann-Boyce J, Caldwell DM, Welton NJ, Cooper NJ, Sutton AJ. Data visualisation approaches for component network meta-analysis: visualising the data structure. BMC Med Res Methodol 2023; 23:208. [PMID: 37715126 PMCID: PMC10502971 DOI: 10.1186/s12874-023-02026-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Health and social care interventions are often complex and can be decomposed into multiple components. Multicomponent interventions are often evaluated in randomised controlled trials. Across trials, interventions often have components in common which are given alongside other components which differ across trials. Multicomponent interventions can be synthesised using component NMA (CNMA). CNMA is limited by the structure of the available evidence, but it is not always straightforward to visualise such complex evidence networks. The aim of this paper is to develop tools to visualise the structure of complex evidence networks to support CNMA. METHODS We performed a citation review of two key CNMA methods papers to identify existing published CNMA analyses and reviewed how they graphically represent intervention complexity and comparisons across trials. Building on identified shortcomings of existing visualisation approaches, we propose three approaches to standardise visualising the data structure and/or availability of data: CNMA-UpSet plot, CNMA heat map, CNMA-circle plot. We use a motivating example to illustrate these plots. RESULTS We identified 34 articles reporting CNMAs. A network diagram was the most common plot type used to visualise the data structure for CNMA (26/34 papers), but was unable to express the complex data structures and large number of components and potential combinations of components associated with CNMA. Therefore, we focused visualisation development around representing the data structure of a CNMA more completely. The CNMA-UpSet plot presents arm-level data and is suitable for networks with large numbers of components or combinations of components. Heat maps can be utilised to inform decisions about which pairwise interactions to consider for inclusion in a CNMA model. The CNMA-circle plot visualises the combinations of components which differ between trial arms and offers flexibility in presenting additional information such as the number of patients experiencing the outcome of interest in each arm. CONCLUSIONS As CNMA becomes more widely used for the evaluation of multicomponent interventions, the novel CNMA-specific visualisations presented in this paper, which improve on the limitations of existing visualisations, will be important to aid understanding of the complex data structure and facilitate interpretation of the CNMA results.
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Affiliation(s)
- Suzanne C Freeman
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK.
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK.
| | - Elnaz Saeedi
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clareece R Nevill
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicola J Cooper
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
| | - Alex J Sutton
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Complex Reviews Support Unit, University of Leicester and University of Glasgow, Leicester, UK
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20
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Meyer TA, Habib AS, Wagner D, Gan TJ. Neurokinin-1 receptor antagonists for the prevention of postoperative nausea and vomiting. Pharmacotherapy 2023; 43:922-934. [PMID: 37166582 DOI: 10.1002/phar.2814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/12/2023]
Abstract
Despite the availability of several classes of antiemetics, postoperative nausea and vomiting (PONV) remains a substantial burden for patients following surgery, resulting in patient dissatisfaction and prolonged stays in post-anesthesia care units and ultimately increasing the cost of care. Enhanced recovery protocols and PONV management guidelines are now centered on the assessment of the individual patient's risk for developing PONV, as well as multimodal prophylaxis using antiemetics targeting different mechanisms of action. Over the last two decades, the neurokinin-1 receptor (NK1R) has emerged as a therapeutic target for the management of PONV. This review of the literature explains the role of the NK1R and its ligand-substance P-in vomiting, describes the pharmacologic and pharmacokinetic properties of NK1R antagonists (NK1RAs) and summarizes the clinical evidence supporting NK1RAs for PONV prophylaxis in patients undergoing surgery. In particular, we discuss the therapeutic application of NK1RA in PONV prophylaxis protocols owing to their advantages over other antiemetic classes in efficacy, duration of efficacy, safety, pharmacology, and ease of administration. Future studies will be aimed at further investigating the efficacy and safety of NK1RA-based multimodal combinations, particularly among vulnerable populations (e.g., children and elderly).
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Affiliation(s)
- Tricia A Meyer
- Department of Anesthesiology, Texas A&M College of Medicine, Temple, Texas, USA
| | - Ashraf S Habib
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Deborah Wagner
- Department of Anesthesiology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Tong J Gan
- Division of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Lee SY, Tamale JR. Isopropyl alcohol inhalation for the treatment of nausea in adult emergency department patients: a systematic review and meta-analysis. Emerg Med J 2023; 40:660-665. [PMID: 37076258 DOI: 10.1136/emermed-2022-212871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/29/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Nausea and vomiting is a common ED chief complaint. However, randomised trials comparing antiemetic agents to placebo have not demonstrated superiority. This systematic review investigates the efficacy of inhaled isopropyl alcohol (IPA) compared with usual care or placebo in adults presenting to the ED with nausea and vomiting. METHODS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, other relevant trial registries, journals, and conference proceedings up to September 2022. Randomised controlled trials using IPA to treat adult ED patients with nausea and vomiting were included. The primary outcome was change in severity of nausea, measured by a validated scale. A secondary outcome was vomiting during the ED stay. We used a random-effects model for the meta-analysis, and assessed certainty of evidence using the Grades of Recommendation, Assessment, Development and Evaluation system. RESULTS Two trials comparing inhaled IPA to saline placebo and including a total of 195 patients were pooled for meta-analysis of the primary outcome. A third study comparing a group receiving inhaled IPA and oral ondansetron to another group receiving inhaled saline placebo and oral ondansetron did not qualify for the original registered protocol, but was included in a secondary analysis. All studies were judged to be at low or unclear risk of bias. The pooled mean difference for the primary analysis was a reduction in reported nausea of 2.18 on a 0-10 scale (95% confidence interval (CI) 1.60 to 2.76), favouring IPA over placebo, where the minimum clinically significant difference was defined as 1.5. The evidence level was graded as moderate, due to imprecision from low patient numbers. Only the study included in the secondary analysis assessed the secondary outcome of vomiting, and did not find a difference between intervention and control. CONCLUSION This review suggests that IPA likely has a modest effect in reducing nausea in adult ED patients, compared with placebo. Larger multicentre trials are needed, as the evidence is limited by few trials and patients. PROSPERO REGISTRATION NUMBER CRD42022299815.
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Affiliation(s)
- Stefanie Y Lee
- Department of Radiology, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - John R Tamale
- Department of Family Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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Singh K, Jain A, Panchal I, Madan H, Gupta A, Sharma A, Gupta S, Kostojchin A, Singh A, Sandhu IS, Mittal J, Bhogal L, Kolli ST, Bejugam VR, Chaturvedi S, Bhalla A, Piplani S. Ondansetron-induced QT prolongation among various age groups: a systematic review and meta-analysis. Egypt Heart J 2023; 75:56. [PMID: 37395900 DOI: 10.1186/s43044-023-00385-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/29/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Ondansetron is a selective 5-hydroxytryptamine type 3 serotonin-receptor antagonist with antiemetic properties used inadvertently in the emergency department for controlling nausea. However, ondansetron is linked with a number of adverse effects, including prolongation of the QT interval. Therefore, the purpose of this meta-analysis was to assess the occurrence of QT prolongation in pediatric, adult, and elderly patients receiving oral or intravenously administered ondansetron. METHODS A thorough electronic search was conducted on PubMed (Medline) and Cochrane Library from the databases' inception to August 10, 2022. Only those studies were considered in which ondansetron was administered orally or intravenously to participants for the treatment of nausea and vomiting. The prevalence of QT prolongation in multiple predefined age groups was the outcome variable. Analyses were conducted using Review manager 5.4 (Cochrane collaboration, 2020). RESULTS A total of 10 studies involving 687 ondansetron group participants were statistically analyzed. The administration of ondansetron was associated with a statistically significant prevalence of QT prolongation in all age groups. An age-wise subgroup analysis was conducted which revealed that the prevalence of QT prolongation among participants younger than 18 years was not statistically significant, whereas it was statistically significant among participants aged 18-50 years and among patients older than 50 years. CONCLUSIONS The present meta-analysis provides further evidence that oral or intravenous administration of Ondansetron may lead to QT prolongation, particularly among patients older than 18 years of age.
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Affiliation(s)
- Kamaldeep Singh
- Department of Medicine, KAHER's Jawaharlal Nehru Medical College, Belagavi, Karnataka, 590 010, India
| | - Arpit Jain
- Department of Medicine, KAHER's Jawaharlal Nehru Medical College, Belagavi, Karnataka, 590 010, India
| | - Ishita Panchal
- Department of Medicine, KAHER's Jawaharlal Nehru Medical College, Belagavi, Karnataka, 590 010, India
| | - Hritik Madan
- Department of Medicine, Adesh Medical College and Hospital, Ambala, 136 135, India
| | - Anubhav Gupta
- Department of Medicine, KAHER's Jawaharlal Nehru Medical College, Belagavi, Karnataka, 590 010, India
| | - Aakanksha Sharma
- Department of Internal Medicine, Icahn School of Medicine, Mount Sinai West Hospital, New York, NY, 10019, USA
| | - Surabhi Gupta
- Department of Internal Medicine, Christian Medical College, Ludhiana, Punjab, 141008, India
| | - Anastas Kostojchin
- Department of Medicine, Icahn School of Medicine at Mount Sinai/James J. Peters VA Medical Center, Bronx, NY, 10468, USA
| | - Anmol Singh
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | | | - Jayesh Mittal
- Department of Internal Medicine, St Mary Mercy Hospital Livonia, Trinity Health, Livonia, MI, 48154, USA
| | - Loveleen Bhogal
- Department of Medicine, Medstar Washington Hospital Center, Washington, DC, 20010, USA
| | - Shiny Teja Kolli
- Department of Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, 10467, USA
| | - Vishal Reddy Bejugam
- Department of Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, 10467, USA
| | - Salil Chaturvedi
- Department of Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, 10467, USA
| | - Akhil Bhalla
- Department of Anesthesiology, Adesh Medical College and Hospital, Ambala, 136 135, India
| | - Shobhit Piplani
- Department of Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, 10467, USA.
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23
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Yan S, Xu M, Zou X, Xiong Z, Li H, Yang J, Cao W, Zhu Z, Liu C. Acupuncture combined with ondansetron for prevention of postoperative nausea and vomiting in high-risk patients undergoing laparoscopic gynaecological surgery: A randomised controlled trial. United European Gastroenterol J 2023. [PMID: 37318120 DOI: 10.1002/ueg2.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/17/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Consensus guidelines recommend the use of multiple antiemetics as prophylaxis in patients at high risk of postoperative nausea and vomiting (PONV), but the evidence regarding combining acupuncture and antiemetics as a multimodal approach was of very low quality. OBJECTIVE This study aimed to assess the effect of combinations of acupuncture with ondansetron versus ondansetron alone for PONV prophylaxis in women at a high risk. METHODS This parallel, randomised controlled trial was conducted in a tertiary hospital in China. Patients who had three or four PONV risk factors on the Apfel simplified risk score, undergoing elective laparoscopic gynaecological surgery for benign pathology, were recruited. Patients in the combination group received two sessions of acupuncture treatment and 8 mg intravenous ondansetron, whereas those in the ondansetron group received ondansetron alone. The primary outcome was the incidence of PONV within 24 h postoperatively. Secondary outcomes included the incidence of postoperative nausea, postoperative vomiting, adverse events etc. RESULTS: Between January and July 2021, a total of 212 women were recruited, 91 patients in the combination group and 93 patients in the ondansetron group were included in the modified intention-to-treat analysis. In the first 24 h postoperatively, 44.0% of the patients in the combination group and 60.2% of the patients in the ondansetron group experienced nausea, vomiting, or both (difference, -16.3% [95% CI, -30.5 to -2.0]; risk ratio, 0.73 [95% CI, 0.55-0.97]; p = 0.03). However, the results of the secondary outcomes showed that compared to ondansetron alone, acupuncture together with ondansetron was only effective in reducing nausea but did not have a significant impact on vomiting. The incidence of adverse events was similar between the groups. CONCLUSION Acupuncture combined with ondansetron as a multimodal prophylaxis approach is more effective than ondansetron alone in preventing postoperative nausea in high-risk patients.
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Affiliation(s)
- Shiyan Yan
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Mingjun Xu
- Department of Anaesthesiology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
| | - Xuan Zou
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiyi Xiong
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Hewen Li
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jingwen Yang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Wenchao Cao
- Department of Anaesthesiology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
| | - Ziqiong Zhu
- Department of Anaesthesiology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
| | - Cunzhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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Jin L, Liang Y, Yu Y, Miao P, Huang Y, Xu L, Wang H, Wang C, Huang J, Guo K. Evaluation of the Effect of New Multimodal Analgesia Regimen for Cardiac Surgery: A Prospective, Randomized Controlled, Single-Center Clinical Study. Drug Des Devel Ther 2023; 17:1665-1677. [PMID: 37309414 PMCID: PMC10257907 DOI: 10.2147/dddt.s406929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023] Open
Abstract
Objective To investigate the feasibility of multimodal regimen by paracetamol, gabapentin, ketamine, lidocaine, dexmedetomidine and sufentanil among cardiac surgery patients, and compare the analgesia efficacy with conventional sufentanil-based regimen. Design A single-center, prospective, randomized, controlled clinical trial. Setting One participating center, the cardiovascular center of the major integrated teaching hospital. Participants A total of 115 patients were assessed for eligibility: 108 patients were randomized, 7 cases were excluded. Interventions The control group (group T) received conventional anesthesia management. Interventions in the multimodal group (group M) were as follows in addition to the standard of care: gabapentin and acetaminophen 1 hour before surgery; ketamine for induction and to maintain anesthesia with lidocaine and dexmedetomide. Ketamine, lidocaine, and dexmedetomidine were added to routine sedatives postoperatively in group M. Measurements and Main Results The incidence of moderate-to-severe pain on coughing made no significant difference (68.5% vs 64.8%, P=0.683). Group M had significantly less sufentanil use (135.72µg vs 94.85µg, P=0.000) and lower rescue analgesia rate (31.5% vs 57.4%, P=0.007). There was no significant difference in the incidence of chronic pain, PONV, dizziness, inflammation index, mechanical ventilation time, length of stay, and complications between the two groups. Conclusion Our multimodal regimen in cardiac surgery is feasible, but was not superior to traditional sufentanil-based regimen in the aspects of analgesia effects; however, it did reduce perioperative opioid consumption along with rescue analgesia rate. Moreover, it showed the same length of stay and the incidences of postoperative complications.
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Affiliation(s)
- Lin Jin
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yafen Liang
- Department of Anesthesiology, University of Texas Health Center at Houston, Houston, TX, USA
| | - Ying Yu
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Peng Miao
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yihao Huang
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Liying Xu
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Huilin Wang
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine University of Louisville, Louisville, KY, USA
| | - Kefang Guo
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
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25
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Chen P, Du R, Chang Z, Gao W, Zhao W, Jin L, Zhao Y, Li D, Liu H, Liu X, Dong G. The risk factors of postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy and laparoscopic distal gastrectomy: a propensity score matching analysis. Sci Rep 2023; 13:7866. [PMID: 37188833 DOI: 10.1038/s41598-023-34992-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/11/2023] [Indexed: 05/17/2023] Open
Abstract
Postoperative nausea and vomiting (PONV) is a common side effect after laparoscopic surgery. The aim of the study is to investigate the variables that could predict PONV in patients who underwent laparoscopic gastrectomy. We divided patients who underwent laparoscopic gastrectomy into PONV and No-PONV groups. Propensity score matching (PSM) was applied to adjust confounding factors for further validation, and ordinal logistic regression analysis was used to identify predictors for PONV. In the ordinal logistic regression analysis, the preoperative neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR]: 3.19, 95% confidence interval [CI]: 1.38-7.38; p < 0.01) was identified as an independent risk factor for the presence of PONV and a predictor of the severity of PONV (OR: 3.44, 95% CI: 1.67-5.20; p < 0.01) in 94 PSM patients. Besides, NLR was positively correlated with the PONV score (r = 0.534, p < 0.001). In the receiver-operating characteristic (ROC) curve analysis, an NLR with an optimal cutoff value of 1.59 predicted severe PONV with a sensitivity of 72% and specificity of 81%. The NLR was an independent risk factor for the presence of PONV, and a high NLR tends to be positively associated with the severity of PONV after laparoscopic gastrectomy.
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Affiliation(s)
- Peng Chen
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery and Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Rongrong Du
- Medical School of Chinese PLA, Beijing, China
- School of Medical, Nankai University, Tianjin, 300071, China
| | - Zhengyao Chang
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery and Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Wenxing Gao
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery and Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Wen Zhao
- School of Medical, Nankai University, Tianjin, 300071, China
| | - Lujia Jin
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery and Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Yingjie Zhao
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery and Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Dingchang Li
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery and Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Hao Liu
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery and Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Xianqiang Liu
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery and Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Guanglong Dong
- Department of General Surgery and Institute of General Surgery, The First Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
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Agboola KM, Dietrich M, Karki R, Lodhi F, McGill T, Asirvatham SJ, Deshmukh AJ, DeSimone CV. Single-Dose Intraprocedural Steroid Administration Does Not Impact Early Atrial Fibrillation Recurrence. Cardiovasc Drugs Ther 2023; 37:151-157. [PMID: 34581901 DOI: 10.1007/s10557-021-07271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the effect of single-dose intravenous dexamethasone on atrial fibrillation (AF) recurrence following radiofrequency catheter ablation. METHODS A cohort of 84 adult patients (> 18 years) underwent catheter ablation at Mayo Clinic Rochester from January to March 2019. Only first-time ablation patients were included, with all re-do ablations excluded to minimize heterogeneity. Administration of intraoperative dexamethasone 4 mg or 8 mg was determined by chart review from the procedure. At our institution, intraoperative intravenous steroids are administered for postoperative nausea and vomiting (PONV) prophylaxis at the discretion of the anesthesiologist. AF recurrence was determined by ECG or cardiac monitoring within 3 months or between 3 and 12 months post-ablation with an in-person follow-up visit. RESULTS A total of 31 (36.9%) patients received intravenous dexamethasone compared to 54 (63.1%) who did not (approximating a 2:1 comparison group). The incidence of documented AF or atrial flutter, lasting greater than 30 s, within the first 3 months post-ablation was 29.0% in the dexamethasone group versus 24.5% in the non-dexamethasone group (p value 0.80). AF or atrial flutter recurrence at 3-12 months post-ablation was 3.2% in the dexamethasone group compared to 9.4% in the non-dexamethasone group (p value 0.41). CONCLUSION These data suggest that intraoperative intravenous dexamethasone administered during AF ablation for postoperative nausea and vomiting prophylaxis may not have a significant effect on AF recurrence rates.
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Affiliation(s)
- Kolade M Agboola
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael Dietrich
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Roshan Karki
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Fahad Lodhi
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Trevon McGill
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Samuel J Asirvatham
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Abhishek J Deshmukh
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Christopher V DeSimone
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Song Y, Zhu J, Dong Z, Wang C, Xiao J, Yang W. Incidence and risk factors of postoperative nausea and vomiting following laparoscopic sleeve gastrectomy and its relationship with Helicobacter pylori: A propensity score matching analysis. Front Endocrinol (Lausanne) 2023; 14:1102017. [PMID: 36909334 PMCID: PMC9992875 DOI: 10.3389/fendo.2023.1102017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) are common after laparoscopic sleeve gastrectomy (LSG), affecting patient satisfaction and postoperative recovery. The purpose of this study was to investigate the incidence and severity of PONV after LSG and the relationship between Helicobacter pylori (HP) and PONV. METHODS Patients undergoing LSG in our center from June 1, 2018, to May 31, 2022, were divided into HP-positive and HP-negative groups for retrospective analysis. The independent risk factors of PONV were determined by univariate and binary logistic regression analysis using a 1:1 propensity score matching (PSM) method. RESULTS A total of 656 patients was enrolled, and 193 pairs of HP-positive and negative groups were matched after PSM. Both groups of patients had similar clinical features and surgical procedures. PONV occurred in 232 patients (60.1%) after LSG, and the incidence of PONV in HP-positive patients was 61.10%. The incidence and severity of PONV were statistically similar in both groups (P=0.815). Multivariate analysis showed that the female sex (OR=1.644, P=0.042), postoperative pain (OR=2.203, P=0.001) and use of postoperative opioid (OR=2.229, P=0.000) were independent risk factors for PONV after LSG, whereas T2DM (OR=0.510, P=0.009) and OSAS (OR=0.545, P=0.008) independently reduced the incidence rate of PONV. There was no difference either in smoking (P=0.255) or alcohol drinking (P=0.801). HP infection did not affect PONV (P=0.678). CONCLUSIONS The incidence of PONV following LSG was relatively high. Female sex, postoperative pain and use of postoperative opioid predicted a higher incidence of PONV. Patients with T2DM and OSAS were less likely to have PONV. There was no clear association between HP infection and PONV after LSG.
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Affiliation(s)
- Yali Song
- Department of Metabolic and Bariatric Surgery, Clinical Research Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Institute of Obesity and Metabolic Disorders, Jinan University, Guangzhou, China
| | - Jie Zhu
- Department of Metabolic and Bariatric Surgery, Clinical Research Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Institute of Obesity and Metabolic Disorders, Jinan University, Guangzhou, China
| | - Zhiyong Dong
- Department of Metabolic and Bariatric Surgery, Clinical Research Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Institute of Obesity and Metabolic Disorders, Jinan University, Guangzhou, China
- Laboratory of Metabolic and Molecular Medicine, Guangdong-Hong Kong-Macao Joint University, Guangzhou, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, Clinical Research Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Institute of Obesity and Metabolic Disorders, Jinan University, Guangzhou, China
- Laboratory of Metabolic and Molecular Medicine, Guangdong-Hong Kong-Macao Joint University, Guangzhou, China
| | - Jia Xiao
- Department of Metabolic and Bariatric Surgery, Clinical Research Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Institute of Obesity and Metabolic Disorders, Jinan University, Guangzhou, China
- Laboratory of Metabolic and Molecular Medicine, Guangdong-Hong Kong-Macao Joint University, Guangzhou, China
- *Correspondence: Jia Xiao, ; Wah Yang,
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, Clinical Research Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Institute of Obesity and Metabolic Disorders, Jinan University, Guangzhou, China
- Laboratory of Metabolic and Molecular Medicine, Guangdong-Hong Kong-Macao Joint University, Guangzhou, China
- *Correspondence: Jia Xiao, ; Wah Yang,
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Cho HB, Park SY, Kim N, Choi SJ, Song S, Yoo JH, Kim MG, Chung JW. Effect of anesthetics on postoperative nausea and vomiting after peripheral vascular surgery in end-stage renal disease patients: A retrospective observational study. Front Surg 2022; 9:1054670. [PMID: 36504578 PMCID: PMC9727076 DOI: 10.3389/fsurg.2022.1054670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Propofol-based total intravenous anesthesia (TIVA) is considered a prophylactic approach to decrease postoperative nausea and vomiting (PONV). Despite general anesthesia commonly being performed in end-stage renal disease (ESRD) patients, PONV in ESRD patients has not been well-described. We investigated PONV in peripheral vascular surgery under general anesthesia in ESRD patients. Methods To compare PONV between propofol-based TIVA and anesthesia with volatile anesthetics, we collected retrospective data from patients who underwent peripheral vascular surgery under general anesthesia from July 2018 to April 2020. We performed univariable and multivariable analyses, including factors that could be associated with PONV and those previously shown to affect PONV. Result A total of 1,699 peripheral vascular surgeries under general anesthesia in ESRD patients were eligible for analysis. Based on the multivariable analysis, TIVA (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.35-0.60; P < 0.001) significantly decreased PONV. Female sex (OR, 1.85; 95% CI, 1.44-2.38; P < 0.001) and anesthetic duration (OR, 1.01; 95% CI, 1.00-1.01; P < 0.001) were associated with increased PONV. Conclusion Propofol-based TIVA is the most influential factor decreasing PONV after peripheral vascular surgery in ESRD patients. Anesthesiologists can apply propofol-based TIVA as an alternative to anesthesia with volatile anesthetics.
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29
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Effects of Systemic Lidocaine Versus Dexmedetomidine on the Recovery Quality and Analgesia After Thyroid Cancer Surgery: A Randomized Controlled Trial. Pain Ther 2022; 11:1403-1414. [PMID: 36203077 PMCID: PMC9633913 DOI: 10.1007/s40122-022-00442-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/20/2022] [Indexed: 10/10/2022] Open
Abstract
INTRODUCTION Surgical management is commonly used for thyroid cancer. We evaluated the effects of systemic lidocaine versus dexmedetomidine on the recovery quality and analgesia after thyroid cancer surgery. METHODS A total of 120 patients with thyroid cancer were randomly allocated to group L (received lidocaine 1.5 mg/kg loading, continuously infused 1.5 mg/kg per hour), group D (received dexmedetomidine 0.5 µg/kg loading, continuously infused 0.5 µg/kg per hour) and group C (received normal saline), with 40 cases in each group. Anaesthesia induction and maintenance were performed using target-controlled infusions (TCIs) of propofol and remifentanil. The primary outcome of the quality of recovery-15 (QoR-15) score was recorded on the day before surgery and postoperative day 1 (POD1). Secondary outcomes included the consumption of remifentanil during surgery, time to first required rescue analgesia, number of patients requiring rescue analgesia, postoperative cumulative consumption of tramadol, visual analogue scale (VAS) pain score, incidence of postoperative nausea or vomiting (PONV) and side effects. RESULTS The total score of the QoR-15 at POD1 (median, IQR) was higher in group L (128.0, 122.0-132.8) and group D (127.5, 122.5-132.5) compared to group C (118.5, 113.0-123.5) (P = 0.000). Compared to group C, systemic lidocaine and dexmedetomidine reduced cumulative consumption of remifentanil and VAS pain score (P = 0.000). The time to first required rescue analgesia (mean, SD) was longer in group L (8.1 h, 1.2 h) and group D (8.5 h, 1.9 h) than group C (5.9 h, 0.9 h) (P = 0.000). The number of patients requiring rescue analgesia was lower in group L (8/40, 20%) and group D (6/40, 15%) than group C (16/40, 40%) (P = 0.029), and cumulative consumption of tramadol (mean, SD) was lower in group L (44.0 mg, 17.1 mg) and group D (51.7 mg, 14.1 mg) than group C (73.9 mg, 18.4 mg) (P = 0.000). The incidence of PONV in group L (7/40, 17.5%) and group D (9/40, 22.5%) was lower than group C (18/40, 45.0%) (P = 0.016). Bradycardia (heart rate less than 50 beats/min or lower) was noted in 25 patients (25/40, 62.5%), which was reversed by intravenous administration of atropine 0.5 mg. CONCLUSION Systemic lidocaine and dexmedetomidine had similar effects on enhancing the quality of recovery, alleviating the intensity of pain and reducing the incidence of PONV after thyroid cancer surgery. However, dexmedetomidine may result in bradycardia. Therefore, lidocaine was superior to dexmedetomidine. TRIAL REGISTRATION ChiCTR.org.cn (ChiCTR2000038442). Registered on September 22, 2020.
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Li C, Cui W, Song P, Liu W, Wang X, Yang Q. Effect of ondansetron for preventing postoperative nausea and vomiting after breast cancer surgery. Am J Transl Res 2022; 14:6689-6695. [PMID: 36247242 PMCID: PMC9556477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To evaluate the preventive effect of preoperative administration of ondansetron on postoperative nausea and vomiting (PONV) in patients receiving breast cancer surgery. METHODS Data from 225 patients who received modified radical mastectomy from January 2019 to December 2020 were retrospectively reviewed. The patients were divided into an ondansetron group and a control group according to whether they received preoperative ondansetron or not. The incidence of PONV, visual analog scale (VAS) score, the rescue analgesics use and rescue antiemetic use, as well as the patient satisfaction degree about their PONV were compared between the two groups. RESULTS The ondansetron group showed lower total incidence of PONV, lower VAS score at 6 h post-operation as well as less rescue antiemetic use than the control group (P<0.05). Patients in the ondansetron group were more satisfied with their PONV condition than those in the control group (P<0.05). CONCLUSION Preoperative administration of ondansetron can prevent PONV and relieve pain 2-24 hours after breast cancer surgery.
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Affiliation(s)
- Chunlei Li
- Department of Anesthesiology, Cangzhou Central HospitalCangzhou 061000, Hebei, China
| | - Wenbin Cui
- Department of Anesthesiology, Cangzhou Central HospitalCangzhou 061000, Hebei, China
| | - Panpan Song
- Department of Anesthesiology, Cangzhou Central HospitalCangzhou 061000, Hebei, China
| | - Wang Liu
- Department of Anesthesiology, Children’s Ward of Cangzhou Central HospitalCangzhou 061000, Hebei, China
| | - Xiaodong Wang
- Department of Anesthesiology, Cangzhou Integrated Traditional Chinese and Western Medicine HospitalCangzhou 061000, Hebei, China
| | - Qiang Yang
- Department of Anesthesiology, Cangzhou Central HospitalCangzhou 061000, Hebei, China
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Hackenbroich S, Kranke P, Meybohm P, Weibel S. Include or not to include conference abstracts in systematic reviews? Lessons learned from a large Cochrane network meta-analysis including 585 trials. Syst Rev 2022; 11:178. [PMID: 36028879 PMCID: PMC9413929 DOI: 10.1186/s13643-022-02048-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/04/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Systematic reviews attempt to gather all available evidence. Controversy exists regarding effort and benefit of including study results presented at conferences only. We recently published a Cochrane network meta-analysis (NMA) including 585 randomized controlled trials comparing drugs for prevention of postoperative nausea and vomiting (PONV). Studies published as conference abstracts only were excluded. This study aimed to include all eligible studies published as abstracts only, assessing their added value regarding reporting quality and effect on the review's interpretation. METHODS Conference abstracts were searched in the review's excluded studies and conference proceedings of anaesthesiologic societies. We assessed their reporting quality regarding review's eligibility criteria, Cochrane 'risk of bias' assessment tool 1.0, and adherence to CONSORT (Consolidated Standards of Reporting Trials) for abstracts. Abstracts were included in sensitivity NMA, and impact on the NMA structure was investigated. RESULTS We identified 90 abstracts. A total of 14% (13/90) were eligible. A total of 86% (77/90) are awaiting classification due to insufficient reporting of review's eligibility criteria. In abstracts awaiting classification, sufficient information was missing on standardization of anaesthesia in 71% (55/77), age of participants in 56% (43/77), and outcome details in 46% (36/77). A total of 73% (66/90) of abstracts lacked sufficient information on 15/25 data extraction items. Reported study characteristics of abstracts were comparable to included studies of the review. A total of 62% (56/90) of abstract trials were assessed as overall high risk of bias due to poor reporting. Median adherence to CONSORT for abstracts was 24% (IQR, 18 to 29%). Six of the 13 eligible abstracts reported relevant outcome data in sufficient detail for NMA on seven outcomes of the Cochrane review. Inclusion of abstracts did not substantially change the network structure, network effect estimates, ranking of treatments, or the conclusion. Certainty of evidence for headache on palonosetron use was upgraded from very low to low. CONCLUSIONS Most conference abstracts on PONV were insufficiently reported regarding review's narrow inclusion criteria and could not be included in NMA. The resource-intensive search and evaluation of abstracts did not substantially extent the full-text evidence base of the review, given the few adequately reported abstracts. Conferences should oblige authors to adhere to CONSORT for abstracts.
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Affiliation(s)
- Samantha Hackenbroich
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, 97080, Wuerzburg, Germany
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, 97080, Wuerzburg, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, 97080, Wuerzburg, Germany
| | - Stephanie Weibel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, 97080, Wuerzburg, Germany.
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Kowa CY, Jin Z, Gan TJ. Framework, component, and implementation of enhanced recovery pathways. J Anesth 2022; 36:648-660. [PMID: 35789291 PMCID: PMC9255474 DOI: 10.1007/s00540-022-03088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 06/15/2022] [Indexed: 12/01/2022]
Abstract
The introduction of enhanced recovery pathways (ERPs) has led to a considerable paradigm shift towards evidence-based, multidisciplinary perioperative care. Such pathways are now widely implemented in a variety of surgical specialties, with largely positive results. In this narrative review, we summarize the principles, components and implementation of ERPs, focusing on recent developments in the field. We also discuss ‘special cases’ in ERPs, including: surgery in frail patients; emergency procedures; and patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2/COVID-19).
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Affiliation(s)
- Chao-Ying Kowa
- Department of Anaesthesia, Whittington Hospital, Magdala Ave, London, N19 5NF, UK
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA.
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Albazee E, Almahmoud L, Al-Rshoud F, Sallam D, Albzea W, Alenezi R, Baradwan S, Abu-Zaid A. Ondansetron versus metoclopramide for managing hyperemesis gravidarum: A systematic review and meta-analysis of randomized controlled trials. Turk J Obstet Gynecol 2022; 19:162-169. [PMID: 35770443 PMCID: PMC9249360 DOI: 10.4274/tjod.galenos.2022.14367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This investigation examined the efficacy of ondansetron (intervention) versus metoclopramide (control) in managing parturient females with hyperemesis gravidarum (HG), by pooling data from randomized controlled trials (RCTs) using a meta-analysis approach. From inception until January 2022, five information sources were screened: Cochrane Central Register of Controlled Trials, Google Scholar, Scopus, PubMed and Web of Science. Quality assessment was done through the Cochrane Risk of Bias (version 2) assessment tool. The mean difference (MD) with 95% confidence interval (CI) was used to summarize the continuous data in a fixed- or random-effects model, depending on the extent of between-study heterogeneity. Five RCTs were included, comprising a total of 695 patients (355 and 340 females were assigned to ondansetron and metoclopramide, respectively). Four RCTs had an overall “low” risk of bias, whereas one RCT had an overall “some concerns” due to lack of sufficient information about randomization. There was no significant difference between both groups regarding the pregnancy-unique quantification of emesis and nausea score [MD=0.23, 95% CI (-0.42, 0.88), p=0.49], length of hospital stay [MD=-0.17 days, 95% CI (-0.35, 0.02), p=0.08], the number of doses of drug received [MD=0.45, 95% CI (-0.08, 0.98), p=0.10], and duration of intravenous fluids [MD=-1.73 hours, 95% CI (-5.79, 2.33), p=0.40]. Among parturient females with HG, there was no substantial difference in efficacy between both agents. Nevertheless, ondansetron is favored over metoclopramide in view of its trending therapeutic efficacy and better safety profile.
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Schwenk W. Optimized perioperative management (fast-track, ERAS) to enhance postoperative recovery in elective colorectal surgery. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc10. [PMID: 35909653 PMCID: PMC9284431 DOI: 10.3205/dgkh000413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim This manuscript provides information on the history, principles, and clinical results of Fast-track or ERAS concepts to optimize perioperative management (OPM). Methods With the focus on elective colorectal surgery description of the OPM concept and its elements for with special attention to the prevention of infectious complications and clinical results compared to traditional care will be given using recent systematic literature reviews. Additionally, clinical results for other major abdominal procedures are given. Results An optimized perioperative management protocol for elective colorectal resections will currently consist of 25 perioperative elements. These elements include the time from before hospital admission (patient education, screening, and treatment of possible risk factors like anemia, malnutrition, cessation of nicotine or alcohol abuse, optimization of concurrent systemic disease, physical prehabilitation, carbohydrate loading, adequate bowel preparation) to the preoperative period (shortened fasting, non-sedative premedication, prophylaxis of PONV and thromboembolic complications), intraoperative measures (systemic antibiotic prophylaxis, standardized anesthesia, normothermia and normovolemia, minimally invasive surgery, avoidance of drains and tubes) as well as postoperative actions (early oral feeding, enforced mobilization, early removal of a urinary catheter, stimulation of intestinal propulsion, control of hyperglycemia). Most of these elements are based on high-level evidence and will also have effects on the incidence of postoperative infectious complications. Conclusion Optimized perioperative management should be mandatory for elective surgery today as it enhances postoperative patient recovery, reduces morbidity and infectious complications.
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Affiliation(s)
- Wolfgang Schwenk
- GOPOM GmbH, Gesellschaft für Optimiertes PeriOperatives Management, Düsseldorf, Germany,*To whom correspondence should be addressed: Wolfgang Schwenk, GOPOM GmbH, Gesellschaft für Optimiertes PeriOperatives Management, Oberlörickerstrasse 390 B, 40547 Düsseldorf, Germany, Phone: +49 175 1839827, E-mail:
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Gottlieb M, Carlson JN, Peksa GD. Prophylactic antiemetics for adults receiving intravenous opioids in the acute care setting. Cochrane Database Syst Rev 2022; 5:CD013860. [PMID: 35588093 PMCID: PMC9119423 DOI: 10.1002/14651858.cd013860.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Physicians often prescribe opioids for pain in the acute care setting. Nausea and vomiting are well-described adverse events, occurring in over one-third of patients. Prophylactic antiemetics may be one option to reduce opioid-associated nausea and vomiting. However, these medications also have their own adverse effects, so it is important to understand their efficacy and safety prior to routine use. This is a review of randomized controlled trials comparing prophylactic antiemetics versus placebo or standard care for preventing opioid-associated nausea and vomiting. OBJECTIVES To assess the effects of prophylactic antiemetics for nausea and vomiting in adults (aged 16 years or older) receiving intravenous opioids in the acute care setting. SEARCH METHODS We searched CENTRAL (the Cochrane Library), MEDLINE (OVID), Embase (OVID) from inception to January 2022, and Google Scholar (17 January 2022). We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and screened reference lists. SELECTION CRITERIA We included randomized controlled trials of prophylactic antiemetics versus placebo or standard care in adults prior to receiving an intravenous opioid. DATA COLLECTION AND ANALYSIS Two review authors (MG, JNC) independently determined the eligibility of each study according to the inclusion criteria. Two review authors (MG, GDP) then independently extracted data, assessed risk of bias, and determined the certainty of evidence using GRADE. Our primary outcomes were the occurrence of nausea, vomiting, and adverse events. Secondary outcomes included nausea severity, number of vomiting episodes, and number of participants requiring antiemetic rescue therapy. We presented outcomes as risk ratios (RR) for dichotomous data (e.g. presence of vomiting, presence of nausea, number of participants requiring rescue medication, adverse events) and mean difference (MD) or standardized mean difference for continuous data (e.g. number of vomiting episodes, nausea severity) with 95% confidence intervals (CI). MAIN RESULTS We included three studies involving 527 participants (187 women and 340 men) with a mean age of 42 years. All studies used intravenous metoclopramide (10 mg) as the intervention and a placebo for the comparator. No studies assessed any other antiemetic or compared the intervention to standard care. Compared to placebo, metoclopramide did not reduce vomiting (RR 1.18, 95% CI 0.26 to 5.32; low-certainty evidence) or nausea (RR 0.55; 95% CI 0.15 to 2.03; low-certainty evidence) and there was no difference in adverse events (RR 2.34, 95% CI 0.47 to 11.61; low-certainty evidence). No data were available regarding the number of vomiting episodes. Metoclopramide did reduce the severity of nausea compared with placebo (MD -0.49, 95% CI -0.75 to -0.23; low-certainty evidence) but did not reduce the need for rescue medication (RR 1.86, 95% CI 0.17 to 20.16; low-certainty evidence). Two studies were at unclear risk of bias for random sequence generation, one for blinding of outcome assessors, one for incomplete outcome data, and two for selective reporting. The studies were at low risk of bias for all remaining components. AUTHORS' CONCLUSIONS There was no evidence that prophylactic metoclopramide affected the risk of vomiting, nausea, or the need for rescue medication when provided prior to intravenous opioids in the acute care setting. There was a clinically insignificant difference in nausea severity when comparing prophylactic metoclopramide with placebo. Overall, the evidence was of low certainty. Future research could better delineate the effects of prophylactic antiemetics on specific populations, and new studies are needed to evaluate the use of other prophylactic antiemetic agents, for which there were no data.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jestin N Carlson
- Emergency Department, Allegheny Health Network, Erie, Pennsylvania, USA
| | - Gary D Peksa
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
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Stasiowski MJ, Pluta A, Lyssek-Boroń A, Król S, Krawczyk L, Niewiadomska E, Żak J, Kawka M, Dobrowolski D, Grabarek BO, Szumera I, Koss MJ, Missir A, Rejdak R, Jałowiecki P. Adverse Events during Vitreoretinal Surgery under Adequacy of Anesthesia Guidance—Risk Factor Analysis. Pharmaceuticals (Basel) 2022; 15:ph15020237. [PMID: 35215349 PMCID: PMC8879673 DOI: 10.3390/ph15020237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/08/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
Vitreoretinal surgeries require the administration of general anesthesia (GA) in selected groups of patients. The administration of intraoperative rescue narcotic analgesia (IRNA) during GA poses the risk of postoperative nausea and vomiting (PONV). The surgical pleth index (SPI), a crucial component of the adequacy of anesthesia (AoA) guidance of GA, optimizes the intraoperative titration of IRNA. The current analysis evaluated the risk factors for the occurrence of PONV and the oculo-cardiac reflex (OCR) in patients undergoing pars plana vitrectomy (PPV) under AoA guidance. In total, 175 patients undergoing PPV were randomly allocated to receive either GA with SPI-guided IRNA administration using fentanyl alone or in addition to different preoperative analgesia techniques. Any incidence of PONV or OCR was recorded. Obesity, overweight, smoking status, motion sickness, postoperative intolerable pain perception, female gender, fluid challenge and arterial hypertension did not correlate with an increased incidence of PONV or OCR under AoA guidance. Diabetes mellitus, regardless of insulin dependence, was found to correlate with the increased incidence of PONV. The AoA regimen including SPI guidance of IRNA presumably created similar conditions for individual subjects, so no risk factors of the occurrence of PONV or OCR were found, except for diabetes mellitus. We recommend using AoA guidance for GA administration to reduce OCR and PONV rates.
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Affiliation(s)
- Michał Jan Stasiowski
- Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-200 Sosnowiec, Poland; (A.P.); (L.K.); (J.Ż.); (I.S.); (P.J.)
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, 41-200 Sosnowiec, Poland; (S.K.); (A.M.)
- Correspondence:
| | - Aleksandra Pluta
- Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-200 Sosnowiec, Poland; (A.P.); (L.K.); (J.Ż.); (I.S.); (P.J.)
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, 41-200 Sosnowiec, Poland; (S.K.); (A.M.)
| | - Anita Lyssek-Boroń
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital, 41-200 Sosnowiec, Poland; (A.L.-B.); (M.K.)
- Department of Ophthalmology, Faculty of Medicine in Zabrze, University of Technology, Academy of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Seweryn Król
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, 41-200 Sosnowiec, Poland; (S.K.); (A.M.)
- Department of General, Colorectal and Polytrauma Surgery, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-555 Katowice, Poland
| | - Lech Krawczyk
- Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-200 Sosnowiec, Poland; (A.P.); (L.K.); (J.Ż.); (I.S.); (P.J.)
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, 41-200 Sosnowiec, Poland; (S.K.); (A.M.)
| | - Ewa Niewiadomska
- Department of Epidemiology and Biostatistics, School of Public Health in Bytom, Medical University of Silesia, 41-902 Bytom, Poland;
| | - Jakub Żak
- Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-200 Sosnowiec, Poland; (A.P.); (L.K.); (J.Ż.); (I.S.); (P.J.)
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, 41-200 Sosnowiec, Poland; (S.K.); (A.M.)
| | - Magdalena Kawka
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital, 41-200 Sosnowiec, Poland; (A.L.-B.); (M.K.)
| | - Dariusz Dobrowolski
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland;
| | - Beniamin Oskar Grabarek
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine in Zabrze, University of Technology, Academy of Silesia in Katowice, 41-800 Zabrze, Poland;
- Department of Gynaecology and Obstetrics, Faculty of Medicine in Zabrze, University of Technology, Academy of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Izabela Szumera
- Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-200 Sosnowiec, Poland; (A.P.); (L.K.); (J.Ż.); (I.S.); (P.J.)
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, 41-200 Sosnowiec, Poland; (S.K.); (A.M.)
| | - Michael Janusz Koss
- Augenzentrum Nymphenburger Höfe, 80335 Munich, Germany;
- Department of Ophthalmology, Augenklinik der Universität Heidelberg, 69120 Heidelberg, Germany
| | - Anna Missir
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, 41-200 Sosnowiec, Poland; (S.K.); (A.M.)
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Przemysław Jałowiecki
- Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-200 Sosnowiec, Poland; (A.P.); (L.K.); (J.Ż.); (I.S.); (P.J.)
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, 41-200 Sosnowiec, Poland; (S.K.); (A.M.)
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Trial registration and selective outcome reporting in 585 clinical trials investigating drugs for prevention of postoperative nausea and vomiting. BMC Anesthesiol 2021; 21:249. [PMID: 34666681 PMCID: PMC8524993 DOI: 10.1186/s12871-021-01464-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/04/2021] [Indexed: 02/08/2023] Open
Abstract
Background Selective outcome reporting in clinical trials introduces bias in the body of evidence distorting clinical decision making. Trial registration aims to prevent this bias and is suggested by the International Committee of Medical Journal Editors (ICMJE) since 2004. Methods The 585 randomized controlled trials (RCTs) published between 1965 and 2017 that were included in a recently published Cochrane review on antiemetic drugs for prevention of postoperative nausea and vomiting were selected. In a retrospective study, we assessed trial registration and selective outcome reporting by comparing study publications with their registered protocols according to the ‘Cochrane Risk of bias’ assessment tool 1.0. Results In the Cochrane review, the first study which referred to a registered trial protocol was published in 2004. Of all 585 trials included in the Cochrane review, 334 RCTs were published in 2004 or later, of which only 22% (75/334) were registered. Among the registered trials, 36% (27/75) were pro- and 64% (48/75) were retrospectively registered. 41% (11/27) of the prospectively registered trials were free of selective outcome reporting bias, 22% (6/27) were incompletely registered and assessed as unclear risk, and 37% (10/27) were assessed as high risk. Major outcome discrepancies between registered and published high risk trials were a change from the registered primary to a published secondary outcome (32%), a new primary outcome (26%), and different outcome assessment times (26%). Among trials with high risk of selective outcome reporting 80% favoured at least one statistically significant result. Registered trials were assessed more often as ‘overall low risk of bias’ compared to non-registered trials (64% vs 28%). Conclusions In 2017, 13 years after the ICMJE declared prospective protocol registration a necessity for reliable clinical studies, the frequency and quality of trial registration in the field of PONV is very poor. Selective outcome reporting reduces trustworthiness in findings of clinical trials. Investigators and clinicians should be aware that only following a properly registered protocol and transparently reporting of predefined outcomes, regardless of the direction and significance of the result, will ultimately strengthen the body of evidence in the field of PONV research in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01464-w.
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Kienbaum P, Schaefer MS, Weibel S, Schlesinger T, Meybohm P, Eberhart LH, Kranke P. [Update on PONV-What is new in prophylaxis and treatment of postoperative nausea and vomiting? : Summary of recent consensus recommendations and Cochrane reviews on prophylaxis and treatment of postoperative nausea and vomiting]. Anaesthesist 2021; 71:123-128. [PMID: 34596699 DOI: 10.1007/s00101-021-01045-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/27/2022]
Abstract
The prophylaxis and treatment of postoperative pain to enhance patient comfort has been a primary goal of anesthesiologists for the last decades; however, avoiding postoperative nausea and vomiting (PONV) is, from a patient's perspective, a highly relevant and equally important goal of anesthesia. Recent consensus-based guidelines suggest the assessment of risk factors including female gender, postoperative opioid administration, non-smoking status, a history of PONV or motion sickness, young patient age, longer duration of anesthesia, volatile anesthetics and the type of surgery and reducing the patient's baseline risk (e.g. through the use of regional anesthesia and administration of non-opioid analgesics as part of a multimodal approach). In general, a liberal PONV prophylaxis is encouraged for adult patients and children, which should also be administered when no risk assessment is made. The basis for every adult patient should be a standard prophylaxis with two antiemetics, such as dexamethasone in combination with a 5-HT3 receptor antagonist. In patients at high risk, this should be supplemented by a third and potentially a fourth antiemetic prophylaxis with a different mechanism of action. A recently published comprehensive Cochrane meta-analysis comparing available antiemetic prophylaxes reported the highest effectiveness to prevent PONV for the NK1 receptor antagonist aprepitant (relative risk, RR 0.26), followed by ramosetron (RR 0.44), granisetron (RR 0.45), dexamethasone (RR 0.51) and ondansetron (RR 0.55), thereby revising the dogma that every antiemetic is equally effective. Adverse events of antiemetics were generally rare and reported in less than half of the included studies, yielding a low quality of evidence for these end points. In general, combinations of different antiemetics were more effective than single prophylaxes. In children above 3 years of age, the same principles should be applied as in adults. For these patients, there is a high degree of evidence for the combination of dexamethasone and 5‑HT3 receptor antagonists. When PONV occurs, the consensus guidelines suggest that antiemetics from a class different than given as prophylaxis should be administered. To decrease the incidence of PONV and increase the quality of care, the importance of the implementation of institutional-level guidelines and protocols as well as assessment of PONV prophylaxis and PONV incidence is highly recommended.
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Affiliation(s)
- Peter Kienbaum
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Maximilian S Schaefer
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland. .,Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, 02215, Boston, MA, USA.
| | - Stephanie Weibel
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Tobias Schlesinger
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Patrick Meybohm
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Leopold H Eberhart
- Klinik für Anästhesie und Operative Intensivmedizin, Universitätsklinikum Marburg, Marburg, Deutschland
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
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A Fast and Validated HPLC Method for the Simultaneous Analysis of Five 5-HT 3 Receptor Antagonists via the Quantitative Analysis of Multicomponents by a Single Marker. Int J Anal Chem 2021; 2021:5533646. [PMID: 34257662 PMCID: PMC8257339 DOI: 10.1155/2021/5533646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/27/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022] Open
Abstract
In this study, a new strategy for the simultaneous quantization of five serotonin 5-hydroxytryptamine receptor antagonists—ondansetron, azasetron, ramosetron, granisetron, and tropisetron—either in infusion samples or in injection dosage form was first established based on high-performance liquid chromatography combined with a quantitative analysis of multiple components by a single marker. The quantitative analysis of multicomponents by a single marker method was conducted with ondansetron as an internal reference substance and performed using relative retention time and ultraviolet spectral similarity as the double indicator. The quantitative analysis of the 5-HT3 receptor antagonists was calculated and investigated based on the relative correction factors. Chromatographic separation was achieved using a C18 column (150 mm × 4.6 mm, 5.0 μm), and the mobile phase was composed of acetonitrile-0.05 mol·L−1 potassium dihydrogen phosphate (pH 4.0) (25 : 75) at a flow rate of 1.0 mL·min−1 and detection wavelengths of 307 nm (ondansetron, azasetron, ramosetron), 302 nm (granisetron), and 285 nm (tropisetron). In addition, the accuracy of the quantitative analysis of multicomponents by a single marker method was compared with an external standard method, and no significant difference was observed between the two methods. The established method is rapid, is easy, and does not require many reference substances, and it can been successfully applied as part of the quality control of the five 5-HT3 receptor antagonists in their injection dosage form and infusion sample drugs in hospitals.
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Lu H, Zheng C, Liang B, Xiong B. Efficacy and safety analysis of dexamethasone-lipiodol emulsion in prevention of post-embolization syndrome after TACE: a retrospective analysis. BMC Gastroenterol 2021; 21:256. [PMID: 34116638 PMCID: PMC8196541 DOI: 10.1186/s12876-021-01839-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023] Open
Abstract
Background To investigate the efficacy and safety of dexamethasone-lipiodol emulsion in the prevention of post-embolization syndrome after TACE. Method The data of 255 patients who underwent TACE in the interventional department from June 2017 to June 2020 were collected. This is a retrospective assessment of patients who were non-randomly treated with dexamethasone in TACE. The patients were divided into two groups: TACE using lipiodol + chemotherapeutic emulsion group (TACE group, N = 133); TACE using lipiodol + dexamethasone + chemotherapeutic emulsion group (TACE + dexamethasone group, N = 122). Primary study endpoint: incidence of abdominal pain, fever, nausea and vomiting 0–72 h after TACE in both groups. Secondary study endpoints: incidence of infection after TACE in both groups. Results Incidence of post-embolization syndrome after TACE (TACE group vs TACE + dexamethasone group): abdominal pain, 55.6% versus 36.1% (P value 0.002); fever, 37.6% versus 13.1% (P value 0.000); nausea, 60.9% versus 41.0% (P value 0.001); vomiting, 48.1% versus 21.3% (P value 0.000). Incidence of infection after TACE (TACE group vs TACE + dexamethasone group): 1.5% versus 2.5% (P value 0.583). Conclusion The lipiodol + dexamethasone emulsion can significantly reduce the incidence rate of post-embolization syndrome after TACE, with exact effect and high safety.
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Affiliation(s)
- Haohao Lu
- Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chuansheng Zheng
- Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Bin Liang
- Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Bin Xiong
- Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
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Jin Z, Daksla N, Gan TJ. Neurokinin-1 Antagonists for Postoperative Nausea and Vomiting. Drugs 2021; 81:1171-1179. [PMID: 34106456 DOI: 10.1007/s40265-021-01532-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/20/2022]
Abstract
Postoperative nausea and vomiting (PONV) are the second most frequent adverse events after surgery second only to postoperative pain. Despite the advances in antiemetics and implementation of multimodal prophylactic interventions, the clinical management of PONV remains problematic. Neurokinin-1 (NK-1) receptor is a tachykinin receptor found throughout the central and peripheral nervous systems, with a particular affinity towards substance P. NK-1 receptors interact with several parts of the neuronal pathway for nausea and vomiting. This includes the chemoreceptor trigger zone, the gastrointestinal tract, and dorsal motor nucleus of the vagus. NK-1 antagonists are thought to prevent nausea and vomiting by downregulating the emetogenic signals at those points. As more head-to-head trials are conducted between the various anti-emetics, there is emerging evidence that NK-1 antagonists may be more effective in preventing PONV than several other antiemetics currently in use. In this review, we will discuss the pharmacology of NK-1 antagonists, their efficacy in clinical practice, and how they could fit into the framework of PONV management.
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Affiliation(s)
- Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, 11794-8480, USA
| | - Neil Daksla
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, 11794-8480, USA
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, 11794-8480, USA.
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Zhong W, Shahbaz O, Teskey G, Beever A, Kachour N, Venketaraman V, Darmani NA. Mechanisms of Nausea and Vomiting: Current Knowledge and Recent Advances in Intracellular Emetic Signaling Systems. Int J Mol Sci 2021; 22:5797. [PMID: 34071460 PMCID: PMC8198651 DOI: 10.3390/ijms22115797] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023] Open
Abstract
Nausea and vomiting are common gastrointestinal complaints that can be triggered by diverse emetic stimuli through central and/or peripheral nervous systems. Both nausea and vomiting are considered as defense mechanisms when threatening toxins/drugs/bacteria/viruses/fungi enter the body either via the enteral (e.g., the gastrointestinal tract) or parenteral routes, including the blood, skin, and respiratory systems. While vomiting is the act of forceful removal of gastrointestinal contents, nausea is believed to be a subjective sensation that is more difficult to study in nonhuman species. In this review, the authors discuss the anatomical structures, neurotransmitters/mediators, and corresponding receptors, as well as intracellular emetic signaling pathways involved in the processes of nausea and vomiting in diverse animal models as well as humans. While blockade of emetic receptors in the prevention of vomiting is fairly well understood, the potential of new classes of antiemetics altering postreceptor signal transduction mechanisms is currently evolving, which is also reviewed. Finally, future directions within the field will be discussed in terms of important questions that remain to be resolved and advances in technology that may help provide potential answers.
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Affiliation(s)
- Weixia Zhong
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766, USA; (W.Z.); (G.T.); (V.V.)
| | - Omar Shahbaz
- School of Medicine, Universidad Iberoamericana, Av. Francia 129, Santo Domingo 10203, Dominican Republic;
| | - Garrett Teskey
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766, USA; (W.Z.); (G.T.); (V.V.)
| | - Abrianna Beever
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA; (A.B.); (N.K.)
| | - Nala Kachour
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA; (A.B.); (N.K.)
| | - Vishwanath Venketaraman
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766, USA; (W.Z.); (G.T.); (V.V.)
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA; (A.B.); (N.K.)
| | - Nissar A. Darmani
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766, USA; (W.Z.); (G.T.); (V.V.)
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43
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Gottlieb M, Carlson JN, Peksa GD. Prophylactic antiemetics for adults receiving intravenous opioids in the acute care setting. Hippokratia 2021. [DOI: 10.1002/14651858.cd013860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine; Rush University Medical Center; Chicago IL USA
| | - Jestin N Carlson
- Emergency Department; Allegheny Health Network; Erie Pennsylvania USA
| | - Gary D Peksa
- Department of Emergency Medicine; Rush University Medical Center; Chicago IL USA
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