Anaesthesia
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Randomized Controlled Trial Multicenter Study Clinical Trial
Single oral dose ondansetron in the prevention of postoperative nausea and emesis. The European and US Study Groups.
In two placebo-controlled, double-blind, multicentre studies, the efficacy and safety of single oral doses of ondansetron 4 mg, 8 mg and 16 mg were evaluated for the prevention of postoperative nausea and vomiting in female inpatients. For the total study populations, 26% (European study) and 32% (US study) of placebo-treated patients experienced no emesis compared with 54% (European study) and 52% (US study) of patients treated with ondansetron 16 mg, the most effective dose. Similarly, 22% (European study) and 19% (US study) of placebo-treated patients experienced no nausea compared with 42% (European study) and 34% (US study) of ondansetron 16 mg-treated patients. ⋯ In the US study, a slightly greater percentage of patients undergoing non-gynaecological surgery had no nausea and no emesis compared with patients undergoing gynaecological surgery in both the placebo and ondansetron treatment groups. Again, ondansetron 16 mg was the most effective dose in both surgery types. Ondansetron was well tolerated, with only headache being reported as a significant problem in both studies.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Analgesia after laparoscopic sterilisation. Effect of 2% lignocaine gel applied to Filshie clips.
We performed a randomised controlled study in patients undergoing day case laparoscopic sterilisation to assess whether coating Filshie clips with 2% lignocaine gel prior to application to the Fallopian tubes would reduce postoperative pain. Sixty-two patients were studied, in 33 of whom the Filshie clips were coated in sterile 2% lignocaine gel. Pain scores in the lignocaine gel group were significantly lower than in the control group at 1 h after return to the ward, but no differences were found immediately on return to the ward, or at discharge or at 24 h. There were no significant differences between the two groups in postoperative analgesic requirements or in side effects.
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Although the aetiology of postoperative nausea and vomiting is not completely clear, a number of key contributing factors increase the risk for an individual patient. The inhalational agents are variably associated with postoperative nausea and vomiting, and nitrous oxide is particularly emetogenic. Older inhalational anaesthetics, such as cyclopropane, are associated with a high incidence, while the currently used agents, isoflurane, enflurane and halothane, cause less, but still significant postoperative nausea and vomiting. ⋯ Furthermore, a previous history of postoperative nausea and vomiting or motion sickness is a known risk factor. Superimposed on this is the type of surgery--abdominal and gynaecological surgery are particularly emetogenic, and the incidence of postoperative nausea and vomiting following strabismus surgery is high. Increased quality of healthcare, and a growing awareness of the importance of patient satisfaction, are providing new incentives to ensure that postoperative nausea and vomiting is dealt with adequately.
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Comment Letter Case Reports
Cardiopulmonary arrest and combined spinal/epidural anaesthesia for caesarean section.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Single dose intravenous ondansetron in the prevention of postoperative nausea and vomiting.
Postoperative nausea and vomiting continues to pose problems for surgical patients. Three studies were undertaken to evaluate the efficacy and safety of prophylactic intravenous ondansetron in male and female patients undergoing outpatient surgery. Studies 1 and 2 included a total of 1169 female patients scheduled to undergo surgery on a day case basis. ⋯ In study 3, ondansetron 4 mg was significantly (p < or = 0.001) more effective than placebo in preventing emesis in males. There were no differences between treatment groups with respect to vital signs, laboratory values, or adverse events. Intravenous ondansetron is safe and effective at preventing postoperative nausea and vomiting in male and female patients undergoing day case surgery.