Articles: general-anesthesia.
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Postoperative nausea and vomiting (PONV) is a common complaint in patients following general anesthesia. Various antiemetics, including 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, are effective but still have limited efficacy. Therefore, combination therapy is preferable to using a single drug alone in high-risk patients. We performed a comparative study on the antiemetic effect of palonosetron, a 5-HT3 receptor antagonist, monotherapy vs palonosetron-midazolam combination therapy for the prevention of PONV. ⋯ The combination therapy of palonosetron with midazolam did not lead to a greater reduction in the incidence of PONV than monotherapy in patients undergoing breast surgery and receiving IV-PCA containing fentanyl.
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Review Meta Analysis
Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: an abridged Cochrane network meta-analysis‡§.
Aprepitant (NK1), ramosetron (5HT3), granisetron (5HT3), ondanestron (5HT3) & dexamethasone (steroid) all significantly reduce postoperative nausea & vomiting when used as prophylaxis with a high evidence certainty.
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Anesthesia and analgesia · Jul 2021
Observational StudyAssociation Between Lower Preoperative Cognition With Intraoperative Electroencephalographic Features Consistent With Deep States of Anesthesia in Older Patients: An Observational Cohort Study.
Older patients with low pre-operative cognitive performance may inadvertently be receiving a relative overdose during volatile general anaesthesia.
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Anesthesia and analgesia · Jul 2021
Randomized Controlled TrialThe Effect of High-Flow Nasal Oxygen on Carbon Dioxide Accumulation in Apneic or Spontaneously Breathing Adults During Airway Surgery: A Randomized-Controlled Trial.
Significant CO2 accumulation occurs during apneic oxygenation with high-flow nasal oxygen, potentially limiting safety during prolonged apnea.
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Dexmedetomidine can be used for sedation and analgesia and has been approved for this use by the European Medicines Agency since 2017. It causes an arousable state of sedation, which is beneficial during neurosurgical procedures that require the patient to cooperate with neurological tests (i.e. tumor surgery or implantation of deep brain stimulators). ⋯ The use of dexmedetomidine has also been associated with neuroprotective effects and a decreased incidence of delirium, but studies confirming these effects in the peri-operative (neuro-)surgical setting are lacking. Although dexmedetomidine does not cause respiratory depression, its hemodynamic effects are complex and careful patient selection, choice of dose, and monitoring must be performed.