Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · May 2006
Review[Risk assessment, prophylaxis and treatment for postoperative nausea and vomiting].
The incidence of postoperative nausea and vomiting in the general population has been estimated to have remained constant at around 20% to 30% in recent years, but it can reach 80% in high-risk patients. A wide range of risk factors related to patient variables, anesthetic technique, or surgery have been described. However, risk can be classified by taking only 4 factors into consideration: female gender, nonsmoker, a history of motion sickness or postoperative vomiting, and use of opioids for postoperative analgesia. ⋯ For patients at high risk (3 or 4 risk factors), prophylaxis should be provided with 4 mg of intravenous ondansetron 30 minutes before ending surgery, 4 mg of intravenous dexamethasone at anesthetic induction, or both. Besides medical prophylaxis, strategies for lowering underlying risk are recommended: use regional anesthesia whenever possible, use total intravenous anesthesia with propofol if regional anesthesia is impossible, keep opioid and neostigmine use to a minimum, and try to maintain adequate hydration during surgery. Once preventive measures are taken, therapeutic options are limited and the management of postoperative nausea and vomiting, once established, is difficult.
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Rev Esp Anestesiol Reanim · May 2006
Comparative Study[Pharmacodynamics of propofol in children and adults: comparison based on the auditory evoked potentials index].
The clinically useful concentrations of propofol to provide loss of consciousness in children have not been determined. Therefore, target-controlled infusion systems are used with parameters taken from results for adults. As a result, hypnosis can be inadequate in the pediatric population. We studied the dose-response relationship by comparing the predicted effect-site concentration (Ce) and the level of hypnosis measured by a monitor of depth of anesthesia based on auditory evoked potentials. ⋯ Children seem to be more sensitive to propofol than adults, suggesting that the higher dose requirements described for children would be attributable to pharmacokinetic differences between the 2 populations.
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To compare the clinical effect of mivacurium in morbidly obese and normal-weight patients. ⋯ We found no differences in the clinical effect of mivacurium between morbidly obese and normal-weight patients when doses were based on real weight.
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Rev Esp Anestesiol Reanim · May 2006
Randomized Controlled Trial[Hemodynamic, immunologic and systemic stress response during surgery under total intravenous anesthesia with midazolam-ketamine-fentanyl or remifentanil-midazolam: a randomized clinical trial].
To assess the effect of stress from surgery on hemodynamics, white cell count, and systemic markers during cholecystectomies performed under 2 intravenous anesthetic techniques. ⋯ The 2 intravenous anesthesia regimens compared differ slightly with regard to their effects on surgical stress. Anesthesia with remifentanil and midazolam contributes to reducing the inflammatory response through modulation of the neurohumoral response to stress.