AANA journal
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Randomized Controlled Trial Comparative Study
Comparison of inhalation of isopropyl alcohol vs promethazine in the treatment of postoperative nausea and vomiting (PONV) in patients identified as at high risk for developing PONV.
Frequently, patients identified as high risk for postoperative nausea and vomiting (PONV) are treated prophylactically with intravenous (IV) ondansetron and postoperatively with IV promethazine. The purpose of this study was to determine if using an aromatic therapy of 70% isopropyl alcohol (IPA) would be more effective than promethazine in resolution of breakthrough PONV symptoms in groups of high-risk patients administered prophylactic ondansetron. All subjects enrolled were identified as high risk for PONV, administered general anesthesia and a prophylactic antiemetic of 4 mg of IV ondansetron, and randomized to receive IPA or promethazine for treatment of breakthrough PONV Demographics, verbal numeric rating scale (VNRS) scores for nausea, time to 50% reduction in VNRS scores, and overall antiemetic and incidence of PONV were measured. ⋯ The IPA group reported a faster time to 50% reduction in VNRS scores and decreased overall antiemetic requirements. A similar incidence in PONV was noted between groups. Based on these findings, we recommend that inhalation of 70% IPA is an option for treatment of PONV in high-risk patients who have received prophylactic ondansetron.
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The use of propofol presents chemical and clinical concerns, including pain on injection, allergy risks, possible bacteria growth, and hyperlipidemia. These concerns have encouraged the search for alternative propofol formulations. Elimination of the soybean oil and lecithin carrier agents is difficult because the highly lipophilic diisopropyl phenol molecule does not dissolve in water. ⋯ Fospropofol is an aqueous solution of a propofol prodrug intended for injection. The discovery and development of this drug may address the concerns with the current propofol emulsion formulations while offering altered pharmacokinetics and pharmacodynamics for sedation. The structure, pharmacokinetics, pharmacodynamics, clinical studies, clinical applications, and implications are discussed.
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Review Case Reports
Fire in the operating room during open heart surgery: a case report.
A patient had a fire in his chest cavity during dissection of the left internal mammary artery before coronary artery bypass graft. The electrosurgical unit indirectly ignited gauze, resulting in a fire. It was determined that oxygen was being entrained into the surgical field through open pulmonary blebs. This case identifies the need for continued fire training and prevention strategies, persistent vigilance, and quick intervention to prevent injury whenever electrosurgical units are used in an oxygen-enriched environment.
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Surgical excision of cancerous tumors and the human stress response can lead to metastasis of tumor cells. Furthermore, the medications used during the perioperative period (eg, opioids and anesthetic agents) have been shown to inhibit or suppress natural killer (NK) cell activity, one of the body's main defenses against spread of cancer. ⋯ However, there may be anesthetic techniques that attenuate surgical suppression of NK cell activity. This article reviews the effects of various anesthetics and analgesics on NK cell activity and suggests techniques to attenuate the suppressive effects of these compounds.
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Near-infrared spectroscopy (NIRS) assesses cerebral oxygen saturation (Sco2) as a balance between cerebral oxygen delivery and consumption. In 71 patients, we evaluated whether marked reduction in mean arterial pressure (MAP) during propofol-fentanyl anesthesia induction affects frontal lobe Sco2. The NIRS-determined arm muscle oxygenation (Smo2), heart rate (HR), and cardiac output (CO) were monitored, endtidal carbon dioxide tension was controlled at 3.5 to 4.5 kPa, and central blood volume was maintained. ⋯ When blood pressure decreased, the median (range) NIRS-determined Smo2 also decreased (73% [54%-94%] to 71% [52%-87%]), whereas Sco2 increased from 67% (46%-93%) to 74% (48%-95%) (P < .05), independent of age and gender. After anesthesia induction, variables recovered and remained at preanesthetic levels during surgery. The findings implicate that even an approximately 30% drop in MAP at the induction of anesthesia does not typically affect cerebral oxygenation.