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The primary purpose of this study was to evaluate the correlation between the intensity of acute postoperative pain and development of postpartum depression (PPD) after cesarean section (CS). The secondary purpose was to investigate perioperative risk factors for PPD detected in the postoperative period after CS. We retrospectively reviewed 615 women who had undergone CS between January 2017 and October 2019 in our hospital. The incidence of PPD was 22.7% on postoperative day (POD) 5 in the 247 women whose numerical rating scale (NRS) scores on POD3 were available. The severity of acute postoperative pain evaluated by NRS was higher in women with than in those without PPD on POD3 (P < 0.02). The independent risk factors for the onset of PPD on POD5 were being a primipara [adjusted odds ratio (aOR), 2.08; 95% confidence interval (CI), 1.03-4.20, P < 0.05], preoperative presence of chronic pain (OR, 4.44; 95% CI 1.82-10.81, P < 0.001), and NRS [greater than or equal to] 2 on POD3 (aOR, 4.90; 95% CI 1.06-22.61, P < 0.05). Our findings suggest that assessing both acute postoperative pain and presence of PPD can inform the introduction of interventions in the early phase to prevent development of PPD after CS., Author(s): Dandan Shen [sup.1], Maiko Hasegawa-Moriyama [sup.1] [sup.2], Kumiko Ishida [sup.1], Satoshi Fuseya [sup.1] [sup.2], Satoshi Tanaka [sup.1], Mikito Kawamata [sup.1] Author Affiliations: (1) grid.263518.b, 0000 0001 1507 4692, Department [...]

Purpose Patients undergoing gynecological surgery are considered to be a high-risk cohort for postoperative nausea and vomiting (PONV). The purpose of this study was to assess the association of intraoperative end-tidal carbon dioxide (EtCO.sub.2) with risk of PONV in patients underwent gynecological open surgery. Methods In this single-center retrospective observational study, we included patients aged 20-60 years who underwent elective gynecological open surgery. We obtained data for the incidence of PONV within 24 h after operation. We collected EtCO.sub.2 every minute during the operation, and determined the lowest value of EtCO.sub.2. We compared the lowest EtCO.sub.2 between patients with and without PONV. Multivariate logistic regression analysis was performed to assess the independent association of EtCO.sub.2 with the risk of PONV. Results A total of 146 patients were included in the current study. There were 81 patients with PONV within 24 h after the operation. The median lowest value of EtCO.sub.2 in patients with PONV was significantly lower than that in patients without PONV (31 vs 33 mmHg, p = 0.02). In the multivariate logistic regression model, we found that lowest EtCO.sub.2 [less than or equal to] 31 mmHg was independently associated with increase in the risk of PONV (adjusted odds ratio = 3.37, p = 0.02). Conclusion In this retrospective observational study, low intraoperative EtCO.sub.2 was shown to be independently associated with increased risk of PONV. However, this result may be skewed by uncollected information including previous PONV, motion sickness or other unknown bias, so future studies should be conducted to refute or confirm our findings., Author(s): Daichi Fujimoto [sup.1], Moritoki Egi [sup.1], Shohei Makino [sup.1], Satoshi Mizobuchi [sup.1] Author Affiliations: (1) grid.411102.7, 0000 0004 0596 6533, Department of Anesthesiology, Kobe University Hospital, , 7-5-2 Kusunoki-cho, [...]

Byline: Bincy. Thomas, Isaac. Babu, Sachin. George, Anu. Janardhanan Introduction Long QT syndrome (LQTS) is identified by QT interval prolongation on electrocardiogram (ECG) with a predilection to ventricular tachyarrhythmias. It [...]

The rise in synthetic cathinone and cannabinoid use has been linked to a wide range of unpredictable effects, including agitation, psychosis, and delirium. (1) Managing and stabilizing the complex toxic [...]

Objective To investigate the effects of 5-hydroxytryptamine 3 receptor antagonists (ondansetron [OND]) versus dopamine receptor antagonists (droperidol [DRO]) in the prevention of postoperative nausea, vomiting (PONV) and headache by pooling data from open published studies. Methods Performed systematic electronic searches of PubMed, Embase, Google scholar and CNKI, to identify open-published prospective randomized controlled trials (RCTs) relevant to the comparison of OND versus DRO for preventing PONV and headache to be included in the present study. The pooled PONV, headache, dizziness and drowsiness were calculated based on the original data of each included study. The pooled data was presented with risk ratio (RR) and 95% confidence interval (95%CI). Results Thirteen prospective randomized clinical trials were included in this meta-analysis. The pooled PONV, post-operative nausea (PON) and positive operative vomiting (POV) were 0.67 (95%CI:0.48-0.93, p0.05) and 0.56 (95%CI:0.39-0.82,p0.05), 0.63 (95%CI:0.21-1.87, p>0.05) and 0.48(0.28-0.81,p

Andrew C Miller,1,2 Abbas M Khan,2 Alberto A Castro Bigalli,3 Kerry A Sewell,4 Alexandra R King,5 Shadi Ghadermarzi,6 Yuxuan Mao,6 Shahriar Zehtabchi7 1Department of Emergency Medicine, Vidant Medical Center, Brody School of Medicine, East Carolina University, Greenville, NC, USA; 2The MORZAK Collaborative, Orlando, FL, USA; 3Brody School of Medicine, East Carolina University, Greenville, NC, USA; 4William E. Laupus Health Sciences Library, East Carolina University, Greenville, NC, USA; 5Division of Emergency Medicine and Toxicology, Department of Pharmacy, Vidant Medical Center, Greenville, NC, USA; 6Department of Internal Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine, Greenville, NC, USA; 7Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA Background: Acute abdominal pain (AAP) comprises up to 10% of all emergency department (ED) visits. Current pain management practice is moving toward multi-modal analgesia regimens that decrease opioid use. Objective: This project sought to determine whether, in patients with AAP (population), does administration of butyrophenone antipsychotics (intervention) compared to placebo, usual care, or opiates alone (comparisons) improve analgesia or decrease opiate consumption (outcomes)? Methods: A structured search was performed in Cochrane CENTRAL, CINAHL, Database of Abstracts of Reviews of Effects, Directory of Open Access Journals, Embase, IEEE-Xplorer, Latin American and Caribbean Health Sciences Literature, Magiran, PubMed, Scientific Information Database, Scopus, TÜBİTAK ULAKBİM, and Web of Science. Clinical trial registries (ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and Australian New Zealand Clinical Trials Registry), relevant bibliographies, and conference proceedings were also searched. Searches were not limited by date, language, or publication status. Studies eligible for inclusion were prospective randomized clinical trials enrolling patients (age ≥18 years) with AAP treated in acute care environments (ED, intensive care unit, postoperative). The butyrophenone must have been administered either intravenously or intramuscularly. Comparison groups included placebo, opiate only, corticosteroids, non-steroidal anti-inflammatory drugs, or acetaminophen. Results: We identified 7,217 references. Six studies met inclusion criteria. One study assessed ED patients with AAP associated with gastroparesis, whereas five studies assessed patients with postoperative AAP: abdominal hysterectomy (n=4), sleeve gastrectomy (n=1). Three of four studies found improvements in pain intensity with butyrophenone use. Three of five studies reported no change in postoperative opiate consumption, while two reported a decrease. One ED study reported no change in patient satisfaction, while one postoperative study reported improved satisfaction scores. Both extrapyramidal side effects (n=3) and sedation (n=3) were reported as unchanged. Conclusion: Based on available evidence, we cannot draw a conclusion on the efficacy or benefit of neuroleptanalgesia in the management of patients with AAP. However, preliminary data suggest that it may improve analgesia and decrease opiate consumption. Keywords: neuroleptanalgesia, butryophenone, abdominal pain, haloperidol, droperidol

After the increasing legalization of cannabis, there has been a rising trend in cannabis consumption, especially among heavy users. Cannabinoid hyperemesis syndrome is a syndrome of cyclic vomiting related to chronic cannabis use. The difficulty of diagnosis and treatment of this syndrome has led to a disproportionately high use of health care resources. Although the exact mechanism of cannabinoid hyperemesis syndrome is still unknown, patients typically progress through prodromal, hyperemetic, and recovery phases. Persistent vomiting in a patient who reports relief with hot showers should trigger the consideration of cannabinoid hyperemesis syndrome as a possible diagnosis. For treatment, antipsychotics such as haloperidol or droperidol have been shown to be more effective than conventional antiemetics for symptom control. Capsaicin should also be considered, given its positive efficacy and low adverse-effect profile. Providers must be aware of cannabinoid hyperemesis syndrome, its diagnosis, and treatment, given the increasing prevalence. Further research is required to elicit the exact mechanism and additional therapies for this syndrome. [ABSTRACT FROM AUTHOR]

Low-dose droperidol has been widely used as an antiemetic during and after surgery. Although high-dose droperidol affects motor-evoked potential, the effects of low-dose droperidol on motor-evoked potential amplitude are unclear. The aim of this study was to investigate whether low-dose droperidol affects motor-evoked potential amplitude. We retrospectively reviewed the data of patients who underwent spine surgery under general anesthesia with motor-evoked potential monitoring from February 2016 to 2017. The outcome was the motor-evoked potential amplitude of the bilateral abductor pollicis brevis muscle, tibialis anterior muscle, and abductor hallucis muscle within 1 and 1-2 h after droperidol administration, compared with the baseline motor-evoked potential value. Thirty-four patients were analyzed. The median dose of droperidol was 21 µg/kg. The motor-evoked potential amplitudes of all muscles were significantly reduced after droperidol administration and recovered to baseline values within 2 h. The reduction of all motor-evoked potential amplitudes after droperidol administration was 37-45% of baseline values. There were no significant differences in other drugs administered. There were no serious adverse effects of droperidol administration. Motor-evoked potential amplitude was suppressed by low-dose droperidol. During intraoperative motor-evoked potential monitoring in spine surgery, anesthesiologists should pay careful attention to the timing of administration of droperidol, even at low doses. Based on the results of this study, we are conducting a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Acute disturbance is a broad term referring to escalating behaviors secondary to a change in mental state, such as agitation, aggression, and violence. Available management options include de-escalation techniques and rapid tranquilization, mostly via parenteral formulations of medication. While the intramuscular route has been extensively studied in a range of clinical settings, the same cannot be said for intravenous (IV); this is despite potential benefits, including rapid absorption and complete bioavailability. This systematic review analyzed existing evidence for effectiveness and safety of IV medication for management of acute disturbances. It followed a preregistered protocol (PROSPERO identification CRD42020216456) and is reported following the guidelines set by Preferred Reporting Items for Systematic Review and Meta-Analysis. APA PsycINFO, MEDLINE, and EMBASE databases were searched for eligible interventional studies up until May 30th, 2023. Data analysis was limited to narrative synthesis since primary outcome measures varied significantly. Results showed mixed but positive results for the effectiveness of IV dexmedetomidine, lorazepam, droperidol, and olanzapine. Evidence was more limited for IV haloperidol, ketamine, midazolam, chlorpromazine, and valproate. There was no eligible data on the use of IV clonazepam, clonidine, diazepam, diphenhydramine, propranolol, ziprasidone, fluphenazine, carbamazepine, or promethazine. Most studies reported favorable adverse event profiles, though they are unlikely to have been sufficiently powered to pick up rare serious events. In most cases, evidence was of low or mixed quality, accentuating the need for further standardized, large-scale, multi-arm randomized controlled trials with homogeneous outcome measures. Overall, this review suggests that IV medications may offer an effective alternative parenteral route of administration in acute disturbance, particularly in general hospital settings., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Droperidol is a short-acting, potent dopamine D2 antagonist that can pass through the blood–brain barrier. A black box warning was issued for droperidol by the United States Food and Drug Administration in 2001 because of a risk of development of torsades de pointes induced by QT prolongation. Many experts feel that the incidence of arrhythmia is overestimated, and low-dose droperidol is almost always used by anesthesiologists for postoperative nausea and vomiting. In this review, we used evidence-based analysis to appraise high-quality studies with a low risk of bias published after 2001 on the use of droperidol in the emergency department (ED). Droperidol appears not only efficacious but also safe to treat patients with nausea/vomiting, acute psychosis, and migraine in the ED. For these conditions, droperidol may be an option for shared decision-making.

Purpose After a long period of low utilization, droperidol has become easier to obtain in the US market. This comprehensive review discusses the safety, indications, clinical efficacy, and dosing of droperidol for use in the emergency department (ED) setting. Summary In 2001 the US Food and Drug Administration (FDA) mandated a boxed warning in the labeling of droperidol after reports of QT interval prolongation associated with droperidol use. Since that time, it has been difficult to access droperidol in the United States; as a result, many practicing clinicians lack experience in its clinical use. Multiple studies have been conducted to assess the clinical efficacy and safety of droperidol use in ED patients. Results consistently show the safety of droperidol and its clinical efficacy when used as an analgesic, antiemetic, and sedative. Now that droperidol is more widely available for use in the US market, pharmacists and prescribers need to reliably translate safety and efficacy data compiled since 2001 to help ensure appropriate and effective use of the medication. Conclusion Droperidol is an effective and safe option for the treatment of acute agitation, migraine, nausea, and pain for patients in the ED setting. Healthcare professionals can adopt droperidol for use in clinical practice, and they should become familiar with how to dose and monitor droperidol for safe and effective use. [ABSTRACT FROM AUTHOR]

Background: Droperidol is a dopamine receptor antagonist that functions as an analgesic, sedative, and antiemetic. In 2001, the U.S. Food and Drug Administration required a black box warning in response to case reports of QT prolongation and potential fatal arrhythmias. The aim of this study was to evaluate the effectiveness and safety of droperidol in patients presenting to a United States Emergency Department (ED).Methods: Observational cohort study of all droperidol administrations from 1/1/2012 through 4/19/2018 at an academic ED. The primary endpoint was mortality within 24 h of droperidol administration. Secondary endpoint included use of rescue analgesics.Results: A total of 6,881 visits by 5,784 patients received droperidol of whom 6,353 visits authorized use of their records for research, including 5.4% administrations in children and 8.2% in older adults (≥65). Droperidol was used as an analgesic for pain (N = 1,387, 21.8%) and headache (N = 3,622, 57.0%), as a sedative (N = 550, 8.7%), and as an antiemetic (N = 794, 12.5%). No deaths secondary to droperidol administration were recorded within 24 h. Need for rescue analgesia occurred in 5.2% of patients with headache (N = 188) and 7.4% of patients with pain (N = 102); 1.1% of patients with headache received rescue opioids (N = 38) after droperidol, as did 5.4% of patients with pain other than headache (N = 75). No patients had fatal arrhythmias. Akathisia occurred in 2.9%.Conclusion: No fatalities were seen among this large cohort of patients who received droperidol in the ED. Our findings suggest droperidol's effectiveness and safety when used as an analgesic, antiemetic and/or sedative. [ABSTRACT FROM AUTHOR]

Byline: Abhijit. Nair, Suresh. Seelam Sir, Postoperative nausea and vomiting (PONV) is a common phenomenon after receiving an anaesthetic for surgery. Currently, the prevalence of PONV has been estimated to [...]

BackgroundDroperidol (DHB) reportedly reduces the dose of propofol needed to achieve hypnosis when anesthesia is induced and decreases the bispectral index (BIS) in propofol-sedated patients during spinal anesthesia. We reported previously that supplemental DHB decreased the BIS after the administration of sevoflurane and remifentanil. This study investigated the effect of DHB on desflurane (DES) consumption in a clinical setting.MethodsWe conducted a prospective, randomized double-blinded study of 35 women with American Society of Anesthesiologist physical status I or II who underwent a mastectomy. Either DHB (20 µg/kg) or a saline placebo was administered to patients 30 min after the induction of anesthesia. A blinded anesthesiologist maintained a BIS value of 50 during anesthesia by modulating inhaled DES concentrations that changed 0.5% at 2.5 min intervals and maintained analgesia via the constant administration of remifentanil by referring to vital signs. The primary endpoint was the effect of DHB on DES consumption. The secondary endpoints included blood circulatory parameters, the time from the end of surgery to extubation, and discharge time between the groups.ResultsThe characteristics of the patients did not differ between the groups. The DHB group used a mean of 27.2 ± 6.0 ml of DES compared with 41.4 ± 9.5 ml by the placebo group (P < 0.05).ConclusionsA small dose of DHB reduced the DES concentration needed to maintain a BIS of 50. Our results show that DHB reduced the consumption of DES without adverse effects.