Anesthesiology
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Comparative Study
Prolongation of QTc interval after postoperative nausea and vomiting treatment by droperidol or ondansetron.
At dosages above 0.1 mg/kg, droperidol induces a dose-dependent QTc interval prolongation. Although subject to controversy, low-dose droperidol has recently been suspected to induce cardiac arrhythmias. Hence, 5-hydroxytryptamine type 3 antagonists have become the first-line drug for management of postoperative nausea and vomiting. These drugs are also known to prolong the QTc interval at high dosages. This study describes QTc interval changes associated with postoperative nausea and vomiting treatment by droperidol or ondansetron at low doses. ⋯ Droperidol and ondansetron induced similar clinically relevant QTc interval prolongations. When used in treatment of postoperative nausea and vomiting, a situation where prolongation of the QTc interval seems to occur, the safety of 5-hydroxytryptamine type 3 antagonists may not be superior to that of low-dose droperidol.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of low-dose droperidol on the QT interval during and after general anesthesia: a placebo-controlled study.
Since the effects of antiemetic doses of droperidol on the QT interval have not been previously studied, the authors designed a randomized, double-blind, placebo-controlled study to evaluate the intraoperative and postoperative effects of small-dose droperidol (0.625 and 1.25 mg intravenous) on the QT interval when used for antiemetic prophylaxis during general anesthesia. ⋯ Use of a small dose of droperidol (0.625-1.25 mg intravenous) for antiemetic prophylaxis during general anesthesia was not associated with a statistically significant increase in the QTc interval compared with saline. More importantly, there was no evidence of any droperidol-induced QTc prolongation immediately after surgery.
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Comparative Study
Severe pulmonary hypertension during pregnancy: mode of delivery and anesthetic management of 15 consecutive cases.
Available literature on pregnant women with severe pulmonary hypertension (PH) relies mainly on anecdotal case reports and two series only. ⋯ Despite the most modern treatment efforts, the maternal mortality was 36%. Scheduled cesarean delivery during combined spinal-epidural anesthesia seemed to be an attractive approach, but there was no evidence of actual benefit. Therefore, pregnancy must still be discouraged in patients with severe PH.
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Comparative Study
Heart rate variability predicts severe hypotension after spinal anesthesia for elective cesarean delivery.
Hypotension due to vasodilation during subarachnoid block (SAB) for elective cesarean delivery may be harmful. Heart rate variability (HRV), reflecting autonomic control, may identify patients at risk of hypotension. ⋯ Retrospectively analyzed HRV of patients scheduled to undergo elective cesarean delivery during SAB showed significant differences depending on the severity of hypotension after SAB. Preliminary findings were prospectively confirmed. High LF/HF before SAB predicted severe hypotension. Preoperative HRV analysis may detect patients at risk of hypotension after SAB.
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Prolonged turnover times cause frustration and can thereby reduce professional satisfaction and the workload surgeons bring to a hospital. ⋯ Benchmarking sample mean turnover times among hospitals, without the use of confidence intervals, can be valid and useful. The authors successfully developed and validated a statistical method to estimate the percentage of turnover times at a surgical suite that are prolonged and occur at specified times of the day. Managers can target their quality improvement efforts on times of the day with the largest percentages of prolonged turnovers.