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Introduction Methods Results Conclusion Evidence‐based principles in enhanced recovery programs (ERPs) demonstrate substantial improvement in patient outcomes. Determining which latent variables predict composite outcomes could refine ERP pharmacotherapy recommendations.Using R, pharmacotherapy data were modeled from an existing dataset of adult elective colorectal surgery patients. Primary composite outcome was absence of surgical site infection, venous thromboembolism, postoperative nausea and vomiting, and other in‐hospital postoperative complications (POCs). Secondary composite outcome included no postdischarge POCs, hospital length of stay ≤3 days, and no readmission at 7‐ or 30‐days.Variables with greater odds of predicting both positive primary and secondary composite outcomes included prehospital oral iron and oral antibiotic use, postoperative sugammadex and neostigmine use, postoperative morphine milligram equivalents (MME) ≤ 50, and IV fluid stop by postoperative day 2. Preoperative scopolamine patch (OR = 0.29 and CI = −0.19–0.77) and perioperative gabapentin (OR = 0.46 and CI = 0.06–0.83) had lesser odds for both primary and secondary composite outcomes. Ketamine nonanesthetic bolus, ondansetron IV use, and in‐hospital enoxaparin use had paradoxical lesser primary but greater odds for secondary composite outcomes. Prehospital oral laxative use (OR = 0.61 and CI = 0.18–1.04) and postoperative dual IV antibiotics (OR = 0.52 and CI = 0.10–0.94) had lesser odds for primary, but not secondary, outcome.To improve the odds for positive composite outcomes, oral iron and antibiotics, sugammadex and neostigmine, lower MME, and early IV fluid cessation could be considered essential core items, whereas postoperative dual IV antibiotics and epidural anesthesia might be avoided. Additional research needs to clarify the impacts of in‐hospital enoxaparin, ketamine nonanesthetic bolus, and ondansetron use on composite patient outcomes. [ABSTRACT FROM AUTHOR]

Background Method Results Conclusion Clinical Relevance Postoperative nausea and vomiting (PONV) is a common adverse event after general surgery. This study aimed to examine the effectiveness and safety of transcutaneous electrical acupoint stimulation (TEAS) for the prevention of nausea and vomiting after laparoscopic surgery.The Cochrane Library, Pubmed, Embase, and Web of Science databases were accessed from inception to 23 January 2024. The incidence of PONV was the primary outcome measure. The required information size (RIS) of each outcome was estimated by Trial sequential analysis (TSA). The RoB 2.0 tool was used to assess the risk of bias and GRADE to assess the quality of evidence.Seventeen RCTs including 3698 participants were included. In comparison to the control group, TEAS reduced the incidence of PONV (13 trials, n = 3310; RR, 0.56; 95% CI, 0.46–0.67; I2 = 64%; p < 0.01; RIS = 1100), with the level of evidence graded as low. TEAS reduced the incidence of PON (9 trials, n = 2762; RR, 0.64; 95% CI, 0.52–0.79; I2 = 57%, p < 0.01; RIS = 1595), and was also associated with a lower incidence of POV (9 trials, n = 2797; RR, 0.53; 95% CI, 0.45–0.63; I2 = 0%, p < 0.01; RIS = 773).The current meta‐analysis and TSA provide reliable evidence that TEAS is an effective and safe method to prevent PONV. It may reduce the workload of nursing professionals, alleviate emotional stress, and decrease exposure risk. Adverse events related to TEAS were mild.Nurses can incorporate TEAS into the rehabilitation nursing of patients experiencing PONV. [ABSTRACT FROM AUTHOR]

Background: Ketorolac is widely utilized for postoperative pain management, including back pain after lumbar spinal surgery. Several trials have assessed the efficacy of Ketorolac alone and in combination with other analgesics such as bupivacaine, morphine, epinephrine, paracetamol, and pregabalin. However, the effects and safety profile of ketorolac in these contexts remain controversial. Objective: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of Ketorolac administration, both as a monotherapy and in combination with other analgesics, for managing postoperative pain in adults undergoing lumbar spinal surgery. Methods: We searched PubMed, EMbase, Web of Science, EBSCO, CNKI, WanFang, VIP, and Cochrane library databases through July 2024 for randomized controlled trials (RCTs) assessing the analgesic efficacy of Ketorolac administration for postoperative pain of lumbar surgery. The meta-analysis was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statements. Data were extracted and analyzed using open-source meta-analysis software OpenMeta-Analyst, focusing on outcomes such as VAS pain scores, postoperative morphine requirements (PMR), length of hospital stay (LOS), and adverse effects, such as nausea, vomiting, pruritus, and constipation. The quality of evidence was assessed using the Jada scale. Results: Thirteen RCTs comprising a total of 938 patients were included. The methodological quality of the studies was high, with three studies scoring 5, six studies scoring 4, and four studies scoring 3 on the Jadad scale. Ketorolac significantly reduced pain compared to controls at 0–6 h, with a mean difference (MD) of − 1.42 (95% CI: − 2.03 to − 0.80; P < 0.0001), exceeding the Minimal Clinically Important Difference (MCID) of 1.2 to 2.0 points on the Visual Analog Scale (VAS), indicating clinically meaningful pain relief. During the 6–12-h period, the pain reduction was significant (MD = − 0.58; 95% CI: − 0.80 to − 0.35; P < 0.0001), though below the MCID threshold. In the 12–24-h period, Ketorolac continued to show significant pain reduction (MD = − 0.48; 95% CI: − 0.68 to − 0.28; P < 0.0001), but this reduction was also below the MCID. Heterogeneity was low in the 12–24-h period (I2 = 13%), indicating consistent results across studies. There was a significant reduction in PMR (SMD = − 1.83; 95% CI = − 3.42 to − 0.23; P < 0.0001), although with considerable heterogeneity among the studies (I2 = 93%, heterogeneity P < 0.01). Ketorolac administration also significantly reduced the LOS compared to controls (MD = − 0.45 days; 95% CI = − 0.74 to − 0.16; P = 0.0001), though this reduction, which is less than a full day (0.45 days), may have limited clinical significance. The findings suggest that Ketorolac effectively reduces pain and opioid use postoperatively, supporting its role in multimodal analgesia for lumbar spinal surgery. The significant reduction in PMR indicates a beneficial opioid-sparing effect, crucial in the context of reducing opioid-related complications. The observed reduction in LOS, while statistically significant, may not translate into substantial clinical benefit due to its limited magnitude. No significant increase in common adverse effects was noted, indicating Ketorolac's safety profile. Conclusion: Ketorolac administration, either alone or in combination with other analgesics, effectively reduces postoperative pain and opioid consumption in adults following lumbar spinal surgery. And Ketorolac did not significantly increase the incidence of postoperative nausea and vomiting relative to other analgesics or placebos. While it also decreases LOS, the clinical relevance of this reduction is modest. However, the variability in study designs, dosages, and combination therapies contribute to significant heterogeneity in outcomes. Future research should focus on standardizing protocols and exploring optimal dosing strategies. Additionally, long-term safety and effectiveness studies are needed to better understand Ketorolac's role in postoperative pain management. [ABSTRACT FROM AUTHOR]

Objectives: Enhanced recovery after surgery (ERAS) protocols are multimodal evidence‐based care plans that have been adopted for multiple surgical procedures to promote faster and better patient recovery and shorter hospitalization. This study aimed to explore whether worldwide fetal therapy centers offering prenatal myelomeningocele repair implement the ERAS principles and to provide recommendations for improved perioperative management of patients. Methods: In this survey study, a total of 53 fetal therapy centers offering prenatal surgery for open spina bifida were identified and invited to complete a digital questionnaire covering their pre‐, intra‐ and postoperative management. An overall score was calculated per center based on compliance with 20 key ERAS principles, extrapolated from ERAS guidelines for Cesarean section, gynecological oncology and colorectal surgery. Each item was awarded a score of 1 or 0, depending, respectively, on whether the center did or did not comply with that principle, with a maximum score of 20. Results: The questionnaire was completed by 46 centers in 17 countries (response rate, 87%). In total, 22 (48%) centers performed exclusively open fetal surgery (laparotomy and hysterotomy), whereas 14 (30%) offered both open and fetoscopic procedures and 10 (22%) used only fetoscopy. The perioperative management of patients undergoing fetoscopic and open surgery was very similar. The median ERAS score was 12 (range, 8–17), with a mean ± SD of 12.5 ± 2.4. Center compliance was the highest for the use of regional anesthesia (98%), avoidance of bowel preparation (96%) and thromboprophylaxis (96%), while the lowest compliance was observed for preoperative carbohydrate loading (15%), a 2‐h fasting period for clear fluids (20%), postoperative nausea and vomiting prevention (33%) and early feeding (35%). ERAS scores were similar in centers with a short (2–5 days), medium (6–10 days) and long (≥ 11 days) hospital stay (mean ± SD, 12.9 ± 2.4, 12.1 ± 2.0 and 10.3 ± 3.2, respectively, P = 0.15). Furthermore, there was no significant association between ERAS score and surgical technique or case volume. Conclusions: The perioperative management of fetal spina bifida surgery is highly variable across fetal therapy centers worldwide. Standardized protocols integrating ERAS principles may improve patient recovery, reduce maternal morbidity and shorten the hospital stay after fetal spina bifida surgery. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Introduction: Minimally invasive surgery is considered the gold standard for the treatment of gynecological diseases. Our study aims to assess the effectiveness of the new concept of ultra-low-impact laparoscopy as a combination of low-impact laparoscopy, consisting in the use of miniaturized instruments through 3–5mm ports and low-pressure pneumoperitoneum, with regional anesthesia to evaluate the perioperative outcomes. Methods: A cross-sectional study was performed from May 2023 to December 2023, to enroll 26 women affected by benign gynecological disease and threated by mini-invasive surgical approach. The surgical procedures were performed following the low-impact laparoscopy protocol and the regional anesthesia protocol. The postoperative pain, nausea, and vomiting and the antiemetic/analgesic intake were evaluated. Postoperative surgical and anesthesiological variables were analyzed. Results: Operative time was within 90 min (41.1 ± 17.1 mean ± standard deviation (SD)) and no conversion to laparotomy or general anesthesia was required. According to VAS score, the postoperative pain during the whole observation time was less than 3 (mean). Faster resumption of bowel motility (6.5 ± 2.1 mean ± SD) and women's mobilization (3.1 ± 0.7 mean ± SD) were observed as well as low incidence of post-operative nausea and vomit. Early discharge and patient's approval were recorded. Intraoperatively pain score was assessed on Likert scale during all stages. Conclusion: Ultra-low-impact laparoscopy showed to provide a satisfying recovery experience for patients in terms of short hospital stays, cosmetic result, and pain relief, without compromising surgical outcomes. The encouraging results lead us to recruit a greater number of patients to validate our technique as a future well-established produce. [ABSTRACT FROM AUTHOR]

Introduction: This quality improvement initiative is a continued pursuit to optimize outcomes by iteratively improving our opioid sparing anesthesia protocol for tonsillectomy with or without adenoidectomy at our pediatric ambulatory surgical center through data driven Plan‐Do‐Study‐Act cycles. Methods: From 1/2015 through 12/2023, our standardized tonsillectomy protocol underwent nine procedure‐specific perioperative Plan‐Do‐Study‐Act cycles, three procedure‐specific postoperative prescription Plan‐Do‐Study‐Act cycles, and four general ambulatory surgical center enhanced recovery Plan‐Do‐Study‐Act cycles. We analyzed data from the medical record using statistical process control charts. The primary outcome measure was the percent of patients requiring intravenous opioid in the post anesthesia care unit. Secondary outcomes included maximum post anesthesia care unit pain score, the percent of patients requiring treatment for nausea and/or vomiting in the post anesthesia care unit, and the number of postoperative opioid prescription dosages. Balancing measures were average post anesthesia care unit length of stay, percent of patients with prolonged Post Anesthesia Care Unit length of stay (>120 min), and 30‐day reoperation rate. Results: A total of 5654 tonsillectomy with or without adenoidectomy cases were performed at our ambulatory surgical center from 2015 to 2023. The incidence of intravenous opioid administered in the post anesthesia care unit initially rose with opioid free anesthesia launch, but subsequently decreased below the target of 10%. Maximum post anesthesia care unit pain scores rose from mean 3.6 to 4.5, but subsequently returned to the baseline of 3.5, while the incidence of postoperative nausea and/or vomiting improved. The average post anesthesia care unit length of stay increased by 10 min with opioid free anesthesia; however, prolonged post anesthesia care unit stay and 30‐day reoperation rates were unchanged. Conclusions: The continued refinement of our opioid sparing anesthesia protocol has led to reduced perioperative and home opioid use, stable maximum post anesthesia care unit pain scores, and improved postoperative nausea and vomiting rates, with only a slight increase in mean post anesthesia care unit length of stay. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine whether implementing ERAS (Enhanced Recovery After Surgery) elements/protocols improves outcomes in orthognathic surgery (OGS) compared to conventional care. To achieve this, ERAS-specific perioperative elements were identified and literature on ERAS for OGS was systematically reviewed. Using PRISMA methodology and GRADE approach, 44 studies with 49 perioperative care elements (13 pre-, 15 intra-, 21 postoperative) were analyzed. While 39 studies focused on single elements, only five presented multimodal protocols, with three related to ERAS. Preoperative elements included antimicrobial and steroid prophylaxis and prevention of postoperative nausea and vomiting. Intraoperative aspects, especially anesthesiological, showed high evidence. Outcome parameters were heterogeneous: complications and postoperative pain were well-investigated with high evidence, while length of stay (LOS) and patient satisfaction received low to medium evidence. ICU LOS, healthcare costs, and readmission rates were underreported. The meta-analysis revealed significant results for pain reduction and trends towards fewer complications and shorter LOS in the ERAS group. Overall, ERAS protocols are not established in OMFS, particularly OGS. Further research is needed in pre- and postoperative care and standardized multimodal analgesia. The next step should be developing a comprehensive OGS protocol through a consensus conference and implementing it in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion This study aims to establish, execute, and assess the effectiveness of a perioperative enhanced recovery after surgery (ERAS) clinical care pathway in breast reconstruction patients with LD flap breast cancer treatment. The goal is to improve early recovery outcomes, reduce hospitalization time, and enhance patient satisfaction by implementing a standardized approach to postoperative care.This study was conducted at the University of Malaya Medical Center. The outcomes of 21 breast cancer patients who underwent autologous reconstructive breast surgery with the latissimus dorsi (LD) flap within six months before the implementation of the ERAS pathway (pre‐ERAS) were compared with 26 patients who underwent the same surgery with the ultrasound‐guided erector spinae plane (ESP) block for the (ERAS protocol implementation) cohort. The study was conducted from November 2019 to October 2020. The length of hospital stay, amount of analgesic usage, and incidence of postoperative nausea vomiting (PONV) were recorded.The implementation of the ERAS clinical care pathway resulted in shorter hospital stays compared with the preceding care. On average, ERAS patients were mostly discharged on Day 2 post‐surgery, whereas pre‐ERAS patients were mostly discharged on Day 7. ERAS patients had a lower incidence of PONV from Days 1 to 5, starting with 88.5% not experiencing the condition on Days 1 and 2 and increasing to 100% on Day 5. All pre‐ERAS patients experienced PONV in the first 5 days post‐surgery. Fewer ERAS patients required antiemetics post‐surgery (88.5%) compared with pre‐ERAS patients (42.9%).The implementation of the ERAS protocol as part of clinical care in autologous reconstructive breast surgery with the LD flap can improve recovery by shortening hospital stay, decreasing the use of analgesia, and alleviating PONV. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to assess the cost-effectiveness of prophylactic use of ramosetron compared to no antiemetic medications for the prevention of postoperative nausea and vomiting (PONV) from the healthcare payer and societal perspectives in South Korea. Method: A decision analytic model was constructed to assess the cost-effectiveness of prophylactic ramosetron use versus no antiemetic therapy at 24-hour and 48-hour periods post-surgery over a 5-day duration. The model was populated using costs and utility parameters from published studies as well as from surveys of an expert panel of physicians using structured questionnaires. The cost parameters included the costs of drugs, treatment, patient time, productivity loss, and transportation. Effectiveness was measured using quality adjusted life years (QALYs). The study outcome was the incremental cost-effectiveness ratio (ICER). The parameter uncertainties were addressed using deterministic and probabilistic scenario analyses. Results: The base-case analysis showed that, on average, patients treated with prophylactic ramosetron had lower costs from both the healthcare payer (US$16.88 vs US$17.33) and societal (US$16.89 vs US$18.72) perspectives and higher QALYs (0.0121 vs 0.0114) over the 5-day study duration compared to patients without any antiemetic medications. Deterministic and probabilistic sensitivity analyses were conducted to examine the robustness of results for the parameters included in the model. The acceptability curve probability showed that treating patients with ramosetron compared to no antiemetic medications was more than 99% cost-effective at a willingness-to pay threshold of US$5,000/QALY from both payer and societal perspectives. Conclusion: The results demonstrated that prophylactic use of ramosetron compared to no antiemetic therapy is highly cost-effective to prevent PONV for patients undergoing surgery from both healthcare payer and societal perspectives. The cost effectiveness is the result of the decrease in the incidence of PONV and the direct treatment costs of severe PONV with improved patient quality of life. [ABSTRACT FROM AUTHOR]

Background: Music-based intervention has been advocated as a nonpharmacologic approach for the perioperative control of pain and anxiety in surgical patients. However, its impact on patients with preoperative anxiety has not been clearly established. Our study aimed to examine the impact of music-based intervention administered before, during, and after surgery on postoperative opioid consumption and pain levels, as well as preoperative anxiety, depression, and pain catastrophizing. We hypothesized that, compared to a control group, music-based intervention would be effective in reducing opioid requirements and mood disorders. Methods: This study was a single-center, prospective, single-blinded, randomized controlled trial. Inclusion criteria isame-day or observation surgery. Exclusion criteria included American Society of Anesthesiologists physical status IV, use of spinal anesthesia, PROMIS Anxiety T-scores ≤ 57.4 and ≥74.1, preoperative chronic opioid use, transgender surgery, and history of drug or alcohol abuse. Music-based intervention was developed by a certified music therapist. Each patient was randomized to receive standard of care (SC) or SC plus music-based intervention before, during, and after surgery. The primary end point was postoperative oral morphine equivalents (OMEs) over 5 days following surgery using the area under the curve (AUC)Secondary end points were PROMIS Anxiety, PROMIS Depression scores Pain Catastrophizing Scale scores, postoperative nausea and vomiting, time of hospital discharge, and patient satisfaction (0 = totally unsatisfied to 10 = completely satisfied). Results: A total of 75 patients were randomized to a music-based intervention (n = 33) or control (n = 42) group. Patients in the music-based intervention group consumed 56.7% less opioids than those in the control group (AUC was 2.8 in the music-based intervention group vs. 6.4 in the control group, absolute standardized mean difference (aSMD) = 0.34 (−0.17, 0.85)). No difference in pain scores was recorded between groups. Music-based intervention also reduced anxiety on postoperative day (POD)2 (aSMD = 0.38 (−0.16, 0.91)), depression on POD2 (aSMD = 0.31 (−0.23, 0.84)) and POD4 (aSMD = 0.24 (−0.29, 0.77)), and pain catastrophizing on POD1 (aSMD = 0.24 (−0.3, 0.77)). Conclusions: Our data support the use of music-based intervention to reduce postoperative opioid requirements. Music-based intervention may also reduce anxiety, depression, and pain catastrophizing. [ABSTRACT FROM AUTHOR]

The document contains abstracts from the 2024 Scandinavian Society of Anaesthesia and Intensive Care Congress in Oulu, Finland, covering various studies on topics such as postpartum depression risk, propofol dose requirements, inappropriate prescribing patterns, and care for children with neurodevelopmental disorders. The studies aim to provide insights into mortality rates, patient outcomes, and quality of life in different medical contexts, emphasizing the need for tailored approaches and standardized practices to improve patient outcomes. The document also discusses studies related to critical care in patients with acute brain injury, traumatic brain injury, cardiac arrest, sepsis, and aneurysmal subarachnoid hemorrhage, highlighting potential benefits of interventions in improving survival rates and patient outcomes. Additionally, the text presents findings from research studies in the field of anesthesiology and pain management, exploring topics such as postoperative delirium prediction, pain catastrophizing, pain management protocols, and the feasibility of different pain relief methods. The studies underscore the importance of tailored care, multidisciplinary approaches, and standardized guidelines in improving patient outcomes and quality of care in anesthesia and critical care settings. [Extracted from the article]

Background: A systematic review and network meta-analysis (NMA) to compare the safety and efficacy of pericapsular nerve group block (PENGB) with other regional analgesia techniques in patients undergoing total hip arthroplasty (THA). Methods: We searched PubMed, Embase, Web of Science, and the Cochrane Library for relevant research from inception to May, 2024. Randomized controlled trials (RCTs) comparing PENGB with other regional analgesia techniques in patients undergoing THA were included. The primary outcome was resting pain scores at 6 h after surgery. The NMA was made by using Stata 15.1 software. Potential risk of bias was assessed by using CINeMA. Sensitivity and subgroup analyses were performed on the primary outcome. Results: A total of 11 RCTs including 766 patients were eligible for inclusion. For postoperative resting and movement pain scores within 24 h analysis, PENGB + periarticular local anesthetic infiltration (PLAI) was found to be significantly more effective than other treatments and its Surface under the cumulative ranking curve (SUCRA) was the lowest. Moreover, PENGB + PLAI was ranked the best in reducing opioid consumption within 24 h and the length of hospital stay. PENGB was found to have significantly lower incidence of quadriceps motor block and postoperative nausea and vomiting (PONV). Conclusions: PENGB is more likely to reduce the incidence of quadriceps motor block and PONV in patients undergoing THA, but PENGB + PLAI is superior to other regional analgesia techniques (PLAI, PENGB, fascia iliaca compartment block, and quadratus lumborum block) in improving postoperative pain and shortening the length of hospital stay. Trial registration number: CRD42024538421. [ABSTRACT FROM AUTHOR]

Postoperative nausea and vomiting (PONV) is a common complication affecting patients undergoing surgery, with significant implications for recovery and patient satisfaction. This study aimed to investigate the incidence, risk factors, and management strategies for PONV among patients undergoing general anesthesia at SRM Medical College Hospital, Bhawanipatna, Odisha. A retrospective cohort study was conducted involving 130 patients who underwent various surgical procedures. Data on demographic factors, surgical details, anesthetic techniques, and incidence of PONV were collected from medical records. The overall incidence of PONV was found to be 30.8%, with mild, moderate, and severe cases observed in 37.5%, 50.0%, and 12.5% of affected patients, respectively. Significant predictors of PONV included a history of motion sickness (OR 2.5, 95% CI 1.1-5.7, p=0.028), previous PONV episodes (OR 3.2, 95% CI 1.5-6.9, p=0.012), laparoscopic procedures (OR 2.1, 95% CI 1.0-4.4, p=0.041), longer surgery durations (OR 1.8, 95% CI 1.2-2.6, p=0.006), and the use of volatile anesthetics (OR 2.5, 95% CI 1.3-4.8, p=0.007) and opioids (OR 1.9, 95% CI 1.1-3.4, p=0.024). Prophylactic antiemetics were partially effective, with a 25% incidence rate despite widespread use (76.9%). These findings underscore the need for tailored perioperative care strategies to minimize PONV and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Spinal anesthesia is widely used for various surgical procedures, but it can be associated with adverse events. Understanding these adverse events and their frequency can guide clinicians in selecting the most appropriate anesthesia technique for different patient populations. Objective: This study aimed to compare the incidence and types of adverse events associated with different spinal anesthesia techniques used during surgery at SRM Medical College Hospital, Bhawani Patna, Odisha, India. Methods: A prospective, observational study was conducted with a sample size of 180 patients undergoing elective surgeries under spinal anesthesia. Patients were randomly assigned to receive one of three types of spinal anesthesia: bupivacaine, ropivacaine, or levobupivacaine. Adverse events were monitored and recorded intraoperatively and postoperatively for up to 48 hours. Data were analyzed using descriptive statistics, chisquare tests, and logistic regression to identify factors associated with adverse events. Results: The overall incidence of adverse events was 32.8%, with the highest frequency observed in the bupivacaine group (38.3%), followed by ropivacaine (30.0%) and levobupivacaine (27.8%). The most common adverse events were hypotension (15.0%), bradycardia (10.6%), and postoperative nausea and vomiting (PONV) (7.2%). Significant differences were found between the groups regarding the incidence of hypotension (p=0.021) and bradycardia (p=0.034). Multivariate analysis identified age, baseline hypertension, and type of spinal anesthesia as significant predictors of adverse events. Conclusion: This study provides comparative data on the adverse events associated with different spinal anesthesia techniques. The findings suggest that levobupivacaine may be associated with a lower incidence of adverse events compared to bupivacaine and ropivacaine. These insights can aid anesthesiologists in selecting the most appropriate spinal anesthesia technique, enhancing patient safety and outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Preoperative fasting is a standard practice aimed at minimising the risk of pulmonary aspiration during surgery. However, patients often experience prolonged fasting periods beyond the recommended duration due to unanticipated delays in the operating theatre, communication failures between teams, inadequate preoperative planning and other factors. Aim: To investigate the effects of unexpectedly prolonged fasting on intraoperative and postoperative parameters in patients undergoing elective surgery under spinal anaesthesia. Materials and Methods: This prospective observational study was conducted from October 2023 to June 2024 at the Department of Anaesthesiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India. The study included 70 patients undergoing elective surgery under spinal anaesthesia. Patients were divided into two groups: Group A (AM group, n=35), scheduled for surgery between 8:00 AM and 12:00 PM and Group B (PM group, n=35), scheduled for surgery after 12:00 PM or with delayed surgeries. Intraoperative parameters, including Mean Arterial Pressure (MAP), Heart Rate (HR), oxygen saturation (SpO2) and random blood glucose levels, were recorded at specific time points. Postoperative outcomes, such as nausea, vomiting and random blood glucose levels, were also assessed. Continuous and discrete variables were summarised as mean±SD and median, while categorical variables were presented as frequencies and percentages. Associations between categorical variables were tested using Pearson's Chi-square or Fisher's-exact test, with p-values<0.05 considered statistically significant. Results: The PM group exhibited higher preoperative random blood glucose levels (102.3±18.7 mg/dL) compared to the AM group (89.2±12.5 mg/dL). Postoperative nausea and vomiting were observed in 5 (14.3%) patients in the AM group and 11 (31.4%) patients in the PM group. Both groups showed a gradual decrease in MAP and HR from the preoperative period to 30 minutes after spinal anaesthesia administration, with slightly higher values noted in the PM group. No significant differences in SpO2 were observed between the groups. Conclusion: Unexpected prolonged fasting before elective surgery under spinal anaesthesia may contribute to higher preoperative blood glucose levels and an increased risk of postoperative nausea and vomiting. These findings underscore the importance of adhering to preoperative fasting guidelines and exploring potential strategies to minimise prolonged fasting periods, such as carbohydrate loading or allowing clear fluids closer to surgery. [ABSTRACT FROM AUTHOR]

Background & Objectives: Radical cystectomy (RC) is usually performed under general anesthesia, with the management of postoperative pain being a big challenge. Various approaches have been tried, including epidural analgesia, or regional nerve blocks in addition to the intravenous patient-controlled analgesia (IV-PCA). We compared the efficacy and safety of bilateral single-injection erector spinae plane block (ESPB) with IV-PCA administered morphine to manage postoperative pain following RC. Methodology: This prospective randomized controlled clinical study was performed on 60 participants ranging in age from 21 to 65 years, both sexes, BMI 20-40 kg/m², ASA physical status II-III, planned for elective RC. Participants were randomized into two equal groups. Group ESPB received ultrasound-guided single shot ESPB at T10 with 20 mL bupivacaine 0.25% bilaterally; IV morphine 3 mg bolus was used as rescue analgesia when the Numeric Rating Scale (NRS) pain score was ≥ 4. Group C (control group) received IV-PCA by morphine 3 mg IV when NRS pain score was ≥ 4 and repeated 1/2 mg if still pain score was recorded ≥ 4 for 15 min. Pain was measured on NRS at 2, 4, 8, and 12 h as well as the postoperative heart rate (HR) and mean arterial blood pressure (MAP). Complications were noted, Results: Time to first analgesic request was substantially prolonged in Group ESPB compared to Group C (P < 0.001). Total postoperative consumption of morphine in 1st 48 h and postoperative nausea and vomiting were substantially reduced in Group ESPB compared to Group C (P < 0.05). NRS pain scores, postoperative HR and MAP measurements were substantially reduced at 2, 4, 8, and 12 h in Group ESPB than Group C (P < 0.05). Bradycardia and hypotension varied insignificantly different between both groups. Respiratory depression and urinary retention did not occur in any patient in both groups. Conclusions: Compared with IV-PCA administered morphine, bilateral single-injection ESPB was associated with better hemodynamics and analgesic properties, as observed by lower pain scores, less postoperative opioid consumption, and longer time to first analgesic request with good safety profile after radical cystectomy. [ABSTRACT FROM AUTHOR]

Background & Objective: Patients suffering from malignancy, often need to undergo computed tomography (CT) for evaluation or for CT-guided bone biopsy. They are shifted to the radio-diagnostic suite and require sedation and analgesia during this procedure. We compared the efficacy and safety of combining dexmedetomidine (DEX) or ketamine with propofol for better sedation among these patients undergoing CT-guided bone biopsy. Methodology: This randomized, double-blind study was done on 60 adult cancer patients undergoing CT-guided bone biopsy. Patients were randomized into two equal groups. Group D received DEX 1 µg/kg (over 10 min) + propofol 2.5 mg/kg intravenous (IV). It was followed by DEX 0.5 µg/kg/h + propofol 2.5 mg/kg/h infusion. Group K received ketamine 1 mg/kg + propofol 2.5 mg/kg IV, followed by ketamine 0.25 mg/kg/h + propofol 2.5 mg/kg/h infusion. Results: The total intra-procedure propofol consumption was significantly decreased in Group D than in Group K (P < 0.05). The visual analog scale score at 15 min and 30 min post-procedure, number of patients requiring morphine and paracetamol within one hour of procedure and the recovery times were significantly decreased in Group D than in Group K (P < 0.05). Mean arterial pressure (MAP) and heart rate (HR) measurements at 10 min, 20 min, end of the procedure, and 15 min, 30 min post-procedure was significantly decreased in Group D than in Group K (P < 0.05). Adverse events, e.g., postoperative nausea and vomiting, hypotension, and bradycardia, were comparable. Conclusion: DEX-propofol combination had superior sedation efficacy as noted through lower pain scores, intraprocedural propofol or postprocedural morphine and paracetamol consumption, and the shorter recovery time during CT-guided bone biopsy compared to ketamine-propofol combination. However, ketamine-propofol combination exhibited superior hemodynamic stability, as shown by more consistent HR and MAP. [ABSTRACT FROM AUTHOR]

This study aimed to assess the effectiveness of diverse postoperative analgesic techniques in laparoscopic colorectal surgery and ascertain whether systemic administration of nalbuphine is a suitable alternative for this type of procedure. Sixty-nine patients suffering from colorectal cancer and undergoing laparoscopic surgery were randomly divided into three groups (n = 23, per group). Group R received patient-controlled epidural analgesia (PCEA) with ropivacaine. Group M received patient-controlled intravenous analgesia (PCIA) with morphine. Group N received PCIA with nalbuphine. Pain at rest (PAR), movement-evoked pain (MEP), stress hormone and any complications during the 72 hours after surgery were recorded. Additionally, chronic post-surgical pain (CPSP) at 3 months and 6 months were also recorded. There was no significant difference in PAR among the 3 groups. However, patients in Group N had a higher intensity of MEP compared to those in Group R after surgery (p < 0.05). There was no significant difference in CPSP at 6 months among the 3 groups (p > 0.05), but the incidence of CPSP at 3 months was higher in Group N (p = 0.01, as compared to Group R). The occurrences of pruritus and postoperative nausea and vomiting (PONV) were observed to be considerably greater in Group M as compared to the other two groups (p < 0.05). In conclusion, PCEA is more effective than PCIA with nalbuphine in reducing postoperative MEP and CPSP at 3 months after laparoscopic colorectal surgery. However, there was no significant difference between PCEA and PCIA with nalbuphine in reducing CPSP at 6 months. Although morphine and nalbuphine have the similar analgesic effects, morphine is associated with more side effects. Therefore, PCIA with nalbuphine might be a good option for patients who are not suitable for PCEA or have a high risk for PONV or pruritus. [ABSTRACT FROM AUTHOR]

Background: For high‑risk patients, adding a third antiemetic drug to dual postoperative nausea and vomiting (PONV) prophylaxis is controversial. Given the established antiemetic properties of midazolam, this study compared the combination of low‑dose dexamethasone‑ondansetron and midazolam with high‑dose dexamethasone‑ondansetron. Methods: A total of 300 female patients scheduled for breast surgery were recruited and randomly assigned to two groups. The DO group received dexamethasone 8 mg and ondansetron 4 mg, whereas the DOM group received dexamethasone 4 mg, ondansetron 4 mg, and midazolam 0.04 mg/kg. The primary outcome was the incidence of PONV within 24 h. Secondary outcomes were PONV severity, antiemetic requirement, blood glucose levels, satisfaction and sedation scores, time to eye opening and extubation, pain outcome, and sore throat. Results: Primary outcome analysis included 298 patients. Incidence of PONV within the first 24 h after surgery occurred in 52 of 150 (35%) patients in the DO group and 33 of 148 (22%) patients in the DOM group (adjusted risk ratio, 0.63; 95% confidence interval, 0.45–0.88; P = 0.007). The antiemetic requirement was significantly greater in the DO group compared with the DOM group (P = 0.034). However, a significantly higher sedation level and longer time for eye‑opening and extubation were observed in the DOM group (P < 0.05). Conclusion: Compared to high‑dose dexamethasone and ondansetron alone, midazolam combined with low‑dose dexamethasone and ondansetron decreased the incidence of PONV in patients undergoing breast surgery; however, it increased the sedation level in the early postoperative period. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine whether continuous wound infiltration (CWI) can replace intravenous patient-controlled analgesia (IV PCA) and to investigate effective pain control strategies after a single-port access (SPA) laparoscopy for adnexal disease. Methods: A total of 470 patients (the CWI group [n = 109], the IV PCA group [n = 198], and the combined group [n = 163]) who underwent an SPA adnexal laparoscopy and who received CWI or IV PCA for postoperative pain management were retrospectively reviewed. The numeric rating scale (NRS) pain score at 6, 12, 24, and 48 h (h) after surgery and the total amount of fentanyl administered via IV PCA were collected. The incidence of postoperative nausea and vomiting (PONV) and the total amount of rescue antiemetic drugs administered were also evaluated. Results: The mean NRS pain scores at 6 h (combined vs. PCA vs. CWI, 3.08 vs. 3.44 vs. 3.96, p < 0.001), 12 h (2.10 vs. 2.65 vs. 2.82, p < 0.001), and 24 h (1.71 vs. 2.01 vs. 2.12, p < 0.001) after surgery were significantly lower in the combined group. CWI showed a similar pain-reduction effect after surgery compared to IV PCA, except for the acute phase (within 6 h after surgery). The incidence of PONV during the entire hospitalization period was significantly lower in the CWI group compared to the groups using IV PCA (p < 0.05). The combined group had a significantly lower incidence of PONV and use of rescue antiemetics than the IV PCA group (p < 0.05). The combined group required significantly less total PCA fentanyl compared to the IV PCA group (combined vs. PCA, 622.1 μg vs. 703.1 μg, p < 0.001). Conclusions: CWI is an effective alternative to IV PCA and has fewer side effects. Combined use of CWI and IV PCA may be an ideal pain management strategy, offering a strong pain-reduction effect and only moderate side effects. [ABSTRACT FROM AUTHOR]

Intrathecal morphine provides effective analgesia for a range of operations. However, widespread implementation into clinical practice is hampered by concerns for potential side-effects. We undertook a systematic review, meta-analysis, and meta-regression with the primary objective of determining whether a threshold dose for non-pulmonary complications could be defined and whether an association could be established between dose and complication rates when intrathecal morphine is administered for perioperative or obstetric analgesia. We systematically searched the literature for randomised controlled trials comparing intrathecal morphine vs control in patients undergoing any type of surgery under general or spinal anaesthesia, or women in labour. Primary outcomes were rates of postoperative nausea and vomiting, pruritus, and urinary retention within the first 24 postoperative hours, analysed according to doses (1–100 μg; 101–200 μg; 201–500 μg; >500 μg), type of surgery, and anaesthetic strategy. Trials were excluded if doses were not specified. Our analysis included 168 trials with 9917 patients. The rates of postoperative nausea and vomiting, pruritus, and urinary retention were significantly increased in the intrathecal morphine group, with an odds ratio (95% confidence interval) of 1.52 (1.29–1.79), P <0.0001; 6.11 (5.25–7.10), P <0.0001; and 1.73 (1.17–2.56), P =0.005, respectively. Meta-regression could not establish an association between dose and rates of non-pulmonary complications. There was no subgroup difference according to surgery for any outcome. The quality of evidence was low (Grading of Recommendations Assessment, Development, and Evaluation [GRADE] system). Intrathecal morphine significantly increased postoperative nausea and vomiting, pruritus, and urinary retention after surgery or labour in a dose-independent manner. PROSPERO (CRD42023387838). [ABSTRACT FROM AUTHOR]

Summary: Background: Postoperative nausea and vomiting occur frequently following thyroid and parathyroid surgery and are associated with worse patient outcomes. We hypothesised that opioid‐free propofol anaesthesia would reduce the incidence of postoperative nausea and vomiting compared with opioid‐inclusive propofol anaesthesia in patients undergoing these procedures. Methods: We conducted a randomised, double‐blinded controlled trial in adult patients scheduled to undergo thyroid and parathyroid surgery at two medical centres in mainland China. Patients were allocated randomly (1:1, stratified by sex and trial site) to an opioid‐free anaesthesia group (esketamine, lidocaine, dexmedetomidine and propofol) or an opioid‐inclusive group (sufentanil and propofol). Propofol infusions were titrated to bispectral index 45–55. Patients received prophylaxis for nausea and vomiting using dexamethasone and ondansetron and multimodal analgesia with paracetamol and flurbiprofen axetil. The primary outcome was the incidence of postoperative nausea and vomiting in the first 48 h after surgery. Results: We assessed 557 patients for eligibility and 394 completed this trial. The incidence of postoperative nausea and vomiting in the first postoperative 48 h was lower in the opioid‐free anaesthesia group (10/197, 5%) compared with opioid‐inclusive group (47/197, 24%) (OR (95%CI) 0.17 (0.08–0.35), p < 0.001), yielding a number needed to treat of 5.3. Additionally, opioid‐free propofol anaesthesia was associated with a reduced need for rescue anti‐emetics, lower rates of hypotension and desaturation after tracheal extubation, and higher patient satisfaction. Time to tracheal extubation was prolonged slightly in the opioid‐free group. The two groups had similar postoperative pain scores and 30‐day outcomes. Discussion: Opioid‐free propofol anaesthesia reduced postoperative nausea and vomiting in patients undergoing thyroid and parathyroid surgery. An opioid‐free anaesthetic regimen can optimise anaesthetic care during thyroid and parathyroid surgery. [ABSTRACT FROM AUTHOR]

Summary: Background: Intrathecal diamorphine is believed to provide postoperative analgesia but is associated with adverse effects such as nausea and vomiting. There is little evidence of synthesis regarding intrathecal diamorphine in the contemporary literature. We performed a systematic review, meta‐analysis with meta‐regression and trial sequential analysis to determine the magnitude of intrathecal diamorphine efficacy and safety. Methods: We systematically searched the literature for trials comparing intrathecal diamorphine with a control group in patients undergoing all types of surgery. The primary efficacy and safety outcomes were intravenous morphine consumption and incidence of postoperative nausea and vomiting at 24 h following surgery, respectively. Results: Twelve trials were identified, which included data for 712 patients. Intrathecal doses of diamorphine ranged from 100 μg to 2500 μg. Intravenous morphine consumption at 24 h postoperatively was significantly reduced in the intrathecal diamorphine group, with a mean difference (95%CI) of ‐8 mg (‐11 to ‐6), I2 = 93%, p < 0.001. There was a significant difference between three intrathecal diamorphine dosing subgroups but without correlation: mean differences (95%CI) ‐1 mg (‐3–0), ‐26 mg (‐40 to ‐11) and ‐6 mg (‐15–4) in patients receiving doses of 0–200 μg, 201–400 μg and > 400 μg, respectively (p = 0.003). Intrathecal diamorphine increased postoperative nausea and vomiting with a risk ratio (95%CI) of 1.37 (1.19–1.58), I2 = 7%, p < 0.001. There were no differences in postoperative nausea and vomiting between the three intrathecal diamorphine dosing subgroups. There was no correlation observed with meta‐regression of the primary efficacy and safety outcomes. The quality of evidence for all outcomes was very low. Conclusion: There is very low level of evidence that intrathecal diamorphine provides effective analgesia after surgery, while increasing postoperative nausea and vomiting with doses > 200 μg. [ABSTRACT FROM AUTHOR]

Introduction: The objective of the present study was to evaluate morphine consumption and pain scores 24 h postoperatively to compare the effects of a bilateral External Oblique Intercostal (EOI) block with those of a Modified Thoracoabdominal Nerve Block Trough Perichondrial Approach (M-TAPA) block in laparoscopic sleeve gastrectomy (LSG). Methods: Fifty-eight patients aged between 18 and 65 years of with American Society of Anesthesiologists class II–III were included in this randomized, double-blinded study. Patients were assigned into two groups either EOI block or M-TAPA block. The primary outcome was cumulative morphine consumption within the first postoperative 24 h. Secondary outcomes were numerical rating scale (NRS) scores at rest and during activity, QoR-15 Patient Questionnaire scores, incidence of postoperative nausea and vomiting (PONV), number of patients requiring rescue analgesic and antiemetics drugs, and complications. Results: There was no statistically significant difference between the groups in terms of morphine consumption in the first 24 h (EOI block; 10.74 ± 3.94 mg vs. M-TAPA block; 11.67 ± 4.66 mg, respectively). In addition, no significant difference between the two groups in the NRS and PONV scores, total QoR-15 scores, and the number of patients requiring rescue analgesics and antiemetics. Conclusions: EOI block and M-TAPA block showed similar effectiveness for morphine consumption within 24 h postoperatively and in pain scores in LSG. [ABSTRACT FROM AUTHOR]

Background: Remimazolam is a novel ultra-short-acting benzodiazepine that has been recently introduced as an alternative to propofol for general anesthesia. While both agents have been compared in terms of safety and efficacy, their relative effects on postoperative quality of recovery (QoR) remain unclear. Therefore, this meta-analysis aimed to compare the effects of remimazolam and propofol on subjective QoR in surgical patients who underwent general anesthesia. Methods: Medline, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched from inception to May 28, 2024 to identify randomized controlled trials comparing remimazolam and propofol in terms of postoperative QoR. The Cochrane risk-of-bias tool (RoB 2) was used to assess study quality. QoR score on postoperative day (POD) 1 (primary outcome), QoR scores on PODs 2–3, QoR dimensions, time to loss of consciousness, other recovery characteristics, and rescue analgesia requirement were evaluated using random-effects meta-analyses. Results: This meta-analysis included 13 studies published between 2022 and 2024 involving 1,418 patients. QoR was evaluated using either the QoR-15 (10 studies) or QoR-40 (3 studies) questionnaire. The pooled results indicated no significant difference in the QoR scores on POD 1 (standardized mean difference: 0.02, 95% confidence interval [CI]: − 0.20, 0.23, P = 0.88, I2 = 73%) and PODs 2–3 between remimazolam and propofol. Furthermore, no significant differences were observed in QoR dimensions, length of postanesthesia care unit (PACU) stay, and time to extubation as well as in the risks of agitation and postoperative nausea and vomiting. Patients administered remimazolam exhibited slower anesthetic induction (mean difference (MD): 32.27 s) but faster recovery of consciousness (MD: − 1.60 min) than those administered propofol. Moreover, remimazolam was associated with a lower risk of rescue analgesia requirement in the PACU (risk ratio: 0.62, 95% CI: 0.43, 0.89, P = 0.009, I2 = 0%) but not in the ward. Conclusion: Remimazolam is a potential alternative to propofol for general anesthesia as it offers similar QoR to the latter and has advantages in terms of consciousness recovery and immediate postoperative analgesia requirement. [ABSTRACT FROM AUTHOR]

Background Purpose Classical antiemetics that target the serotonin system may not be effective in treating certain nausea and vomiting conditions like cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS). As a result, there is a need for better therapies to manage the symptoms of these disorders, including nausea, vomiting, and anxiety. Cannabis is often used for its purported antiemetic and anxiolytic effects, given regulation of these processes by the endocannabinoid system (ECS). However, there is considerable evidence that cannabinoids can also produce nausea and vomiting and increase anxiety in certain instances, especially at higher doses. This paradoxical effect of cannabinoids on nausea, vomiting, and anxiety may be due to the dysregulation of the ECS, altering how it maintains these processes and contributing to the pathophysiology of CVS or CHS.The purpose of this review is to highlight the involvement of the ECS in the regulation of stress, nausea, and vomiting. We discuss how prolonged cannabis use, such as in the case of CHS or heightened stress, can dysregulate the ECS and affect its modulation of these functions. The review also examines the evidence for the roles of ECS and stress systems' dysfunction in CVS and CHS to better understand the underlying mechanisms of these conditions. [ABSTRACT FROM AUTHOR]

This article provides information on the emergency care of patients who have undergone metabolic bariatric surgery. It emphasizes that patients may present with few symptoms and little pain, but still be critically unwell. The article discusses common clinical signs of surgical complications and the importance of transferring patients to specialist bariatric centers when necessary. It also provides information on side effects and complications of different bariatric procedures, highlighting the need for prompt diagnosis and appropriate management to minimize morbidity and mortality. The document emphasizes the importance of specialized care in bariatric centers and collaboration with bariatric surgeons for optimal outcomes. [Extracted from the article]

This multicenter study aims to investigate the incidence of chronic postsurgical pain (CPSP) after cardiac surgery, exploring the influence of various factors and their implications on patients' quality of life. The CPSP-Cardiac is a large, multicenter, observational study. The target population of 1176 cardiac surgery patients will be recruited from participating hospital sites. Patients undergoing cardiac surgery with median sternotomy for coronary surgery and all open-heart procedures will be eligible for the study. Patients between the ages of 18–80 years who have an American Society of Anesthesiologists Physical Status score of II–III will be included. The primary outcome of our study is to determine the incidence of chronic postsurgical pain in the third month following cardiac surgery, along with identifying the factors that influence it. Our secondary outcomes include assessing opioid consumption in the first 24 hours postoperatively, NRS scores, incidences of postoperative nausea and vomiting, side effects and complications, extubation time, length of stay in the intensive care unit and hospital, chronic pain status at 3 and 6 months, psychological assessments, quality of life, and postoperative complications at 3 and 6 months. [ABSTRACT FROM AUTHOR]

Awake surgery has been applied for various surgical procedures with positive outcomes; however, in neurosurgery, the technique has traditionally been reserved for cranial surgery. Awake surgery for the spine (ASFS) is an alternative to general anesthesia (GA). As early studies report promising results, ASFS is progressively gaining more interest from spine surgeons. The history defining the range of adverse events facing patients undergoing GA has been well described. Adverse reactions resulting from GA can include postoperative nausea and vomiting, hemodynamic instability and cardiac complications, acute kidney injury or renal insufficiency, atelectasis, pulmonary emboli, postoperative cognitive dysfunction, or malignant hyperthermia and other direct drug reactions. For this reason, many high-risk populations who have typically been poor candidates under classifications for GA could benefit from the many advantages of ASFS. This narrative review will discuss the significant historical components related to ASFS, pertinent mechanisms of action, protocol overview, and the current trajectory of spine surgery with ASFS. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of low intra‐abdominal pressure (IAP) facilitated by deep neuromuscular block (NMB) to standard practice in improving the quality of recovery, preserving immune function, and enhancing parietal perfusion during robot‐assisted radical prostatectomy (RARP). Patients and Methods: In this blinded, randomised controlled trial, 96 patients were randomised to the experimental group with low IAP (8 mmHg) facilitated by deep NMB (post‐tetanic count 1–2) or the control group with standard IAP (14 mmHg) and moderate NMB (train‐of‐four 1–2). Recovery was measured using the 40‐item Quality of Recovery questionnaire and 36‐item Short‐Form Health survey. Immune function was evaluated by plasma damage‐associated molecular patterns, cytokines, and ex vivo lipopolysaccharide‐stimulated cytokine production. Parietal peritoneum perfusion was measured by analysing the recordings of indocyanine‐green injection. Results: Quality of recovery was not superior in the experimental group (n = 46) compared to the control group (n = 50). All clinical outcomes, including pain scores, postoperative nausea and vomiting, and hospital stay were similar. There were no significant differences in postoperative plasma concentrations of damage‐associated molecular patterns, cytokines, and ex vivo cytokine production capacity. The use of low IAP resulted in better parietal peritoneum perfusion. Conclusion: Despite better perfusion of the parietal peritoneum, low IAP facilitated by deep NMB did not improve the quality of recovery or preserve immune function compared to standard practice in patients undergoing RARP. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Postoperative nausea and vomiting (PONV), a common and uncomfortable consequence of anaesthesia and surgery, can lead to dehydration, alkalosis, aspiration, and psychological distress, including a reluctance to undergo future surgical procedures. The aim of the study was to compare the effect of Granisetron and Palonosetron on the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery under general anaesthesia. MATERIALS AND METHODS: In this randomised prospective study, after a full preoperative evaluation and investigation, patients meeting the inclusion criteria were taken for the study. 80 patients were selected and randomly divided into two groups. Group G received 40 mcg/kg of granisetron and group P was administered palonosetron 1 mcg/kg before induction of anesthesia. The patients were monitored in the postoperative period and PONV scores were observed at 0-2, 4-6, 6-12, and 12-24 hours postoperatively. Rescue antiemetic, in the form of Dexamethasone 4 mg IV, was administered with PONV score <1. RESULTS: There were no statistically significant differences between the two groups with respect to the classification of ASA, the sex distribution, age, BMI or the duration of anaesthesia, making the two groups comparable. PONV scores were comparable between the two groups during 0 to 2 hours and 2 to 6 hours postoperatively (p value>0.05). During the 6- to 12-hour interval and the 12- to 24-hour interval, PONV scores were significantly lower in patients in Group P (p-value 0.022). There was no statistically significant difference between the antiemetic rescue requirement between the group G and group P (p-value 0.152). CONCLUSIONS: This study concludes that both granisetron and palonosetron are effective in controlling PONV in the immediate postoperative period, but palonosetron is superior to granisetron in preventing PONV beyond 6 hours. [ABSTRACT FROM AUTHOR]

Postoperative nausea and vomiting (PONV) is a common complication of ambulatory surgery, leading to numerous deleterious effects such as decreased patient satisfaction, prolonged recovery unit stays, and rarely, more serious complications such as aspiration pneumonia or wound dehiscence. In this paper, we present a narrative review of the literature regarding common risk factors for PONV including patient factors, surgical factors, and anesthetic factors. We then will review anesthetic techniques and antiemetic drugs demonstrated to mitigate the risk of PONV. Finally, we discuss the potential economic benefits of PONV prophylaxis in the perioperative ambulatory setting. [ABSTRACT FROM AUTHOR]

Purpose: Anesthesia for metabolic–bariatric surgery is challenging due to the increased risk of opioid-related adverse events. The purpose of the investigation was to assess the feasibility and efficacy of multimodal opioid-free general anesthesia with transversus abdominis plane (TAP) block for laparoscopic sleeve gastrectomy in contrast with conventional opioid-based general anesthesia. Patients and Methods: Eighty patients who underwent laparoscopic sleeve gastrectomy and eventually 71 patients included in the analysis. They were randomly divided into an opioid-based anesthesia group (control group) with sufentanil or opioid-free anesthesia (OFA) group. Esketamine, dexmedetomidine, and TAP were as part of the OFA. Sevoflurane, dexamethasone, and muscle relaxants were administered intraoperatively to all patients. The primary outcome was antiemetic rescue within 24 hours after surgery. The secondary outcomes included pain scores, analgesic needs, extubation time, complications, the hemodynamic changes, and duration of hospital stay. Results: In contrast with the control group, the need for antiemetic rescue was significantly reduced (p= 0.035). Furthermore, the visual Analog Scale (VAS) for postoperative pain was considerably lower in the OFA group (p < 0.01) than it was in the control group. There was no significant difference in the need for analgesic rescue in both groups (p= 0.155). Extubation time and post-anesthesia care unit (PACU) stay duration were equal between the two groups (p =0.328 and p =0.54). At the end of the surgery and after extubation, hemodynamic changes was more pronounced in the OFA group (p =0.027) than the control group. The length of the hospital stay was significantly shorter compared with the control group (p =0.002). Conclusion: OFA with TAP results in a significant decrease in the need for antiemetic rescue, a lower level of pain after the surgery, and a shorter hospital stay in contrast with anesthesia based on opioids. [ABSTRACT FROM AUTHOR]

Purpose: Postoperative nausea and vomiting (PONV) is a frequently reported adverse event following orthognathic surgery. The aim of this work is to conduct a systematic review of the literature on the subject, and to discuss the role of maxillofacial surgeons and the steps that can be taken to prevent or control PONV in orthognathic surgery. Methods: A systematic review was conducted according to the PRISMA guidelines, using the search strategy: (orthognathic AND (nausea OR vomiting)). The authors searched PubMed, Embase, Dimensions, Web of Science and Google Scholar databases, without any language restrictions. RevMan 5.4 was used to create a risk of bias graph and a forest plot. Results: The included articles were classified as having a low risk of bias, despite the limited literature on the subject. Various measures have been reported to be beneficial in preventing or managing PONV, such as the use of dexamethasone, antiemetic drugs, gastric aspiration, and anesthetic blocks. Effective bleeding control and faster surgeries can also be helpful. Conclusions: Throat packs have not been found to be effective in preventing PONV. Although no definitive protocol has been established in the literature, the Enhanced Recovery After Surgery (ERAS) protocol could be a useful approach. Overall, a multimodal approach may be taken to prevent PONV, and further research is needed to establish definitive protocols. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of omentum reduction in laparoscopic sleeve gastrectomy (LSG) on the improvement of postoperative nausea and vomiting and gastroesophageal reflux symptoms. Methods: A retrospective study was performed on the case data of 198 obese patients who underwent LSG in the Department of Obesity and Metabolic Diseases of Xiaolan People's Hospital of Zhongshan from March 2021 to March 2022 and were divided into omentum reduction group and control group, with 99 cases in each group, and the preoperative body mass index (BMI) of the patients was recorded. Age, gender, comorbidities, and comparative analysis of operation time, blood loss, length of hospital stay, postoperative nausea and vomiting score, gastroesophageal reflux GerdQ score, postoperative pain score, weight, and postoperative complications were analyzed. Results: There were no significant differences in preoperative BMI, age, gender and comorbidities between the two groups (P > 0.05), but there were significant differences in intraoperative blood loss and operation time (P < 0.05). There were differences in postoperative nausea and vomiting scores and VAS pain scores between the two groups (P < 0.05). The GerdQ scores of the omental reduction group were 8.11 ± 2.84 points at 1 year, and those in the control group were 7.56 ± 2.67 points, which were 3.97 ± 4.09 points higher than those in the preoperative omentum reduction group and 3.42 ± 3.41 in the control group, with no significant difference (P > 0.05). There was no significant difference in the postoperative excess weight loss rate %EWL and postoperative complications (p > 0.05). Conclusion: Omentum reduction can improve short-term nausea and vomiting after LSG, but it cannot significantly improve long-term reflux symptoms. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this systematic review and network meta-analysis was to evaluate the efficacy and safety of different preemptive analgesia measures given before laparoscopic cholecystectomy (LC) for postoperative pain in patients. Methods: We conducted a comprehensive search in databases including PubMed, Web of Science, Embase, and the Cochrane Library up to March 2024, and collected relevant research data on the 26 preemptive analgesia measures defined in this article in LC surgery. Outcomes included postoperative Visual Analogue Scores (VAS) at different times (2, 6, 12, and 24 h), opioid consumption within 24 h post-operation, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and incidence of postoperative headache or dizziness. Results: Forty-nine articles involving 5987 patients were included. The network meta-analysis revealed that multimodal analgesia, nerve blocks, pregabalin, and gabapentin significantly reduced postoperative pain scores at all postoperative time points and postoperative opioid consumption compared to placebo. Tramadol, pregabalin, and gabapentin significantly extended the time to first rescue analgesia. Ibuprofen was the best intervention for reducing PONV incidence. Tramadol significantly reduced the incidence of postoperative headache or dizziness. Subgroup analysis of different doses of pregabalin and gabapentin showed that compared to placebo, pregabalin (300 mg, 150 mg) and gabapentin (600 mg, 300 mg, and 20 mg/kg) were all more effective without significant differences in efficacy between these doses. Higher doses increased the incidence of PONV and postoperative headache and dizziness, with gabapentin 300 mg having a lower adverse drug reaction (ADR) incidence. Conclusions: Preemptive analgesia significantly reduced postoperative pain intensity, opioid consumption, extended the time to first rescue analgesia, and decreased the incidence of PONV and postoperative headache and dizziness. Multimodal analgesia, nerve blocks, pregabalin, and gabapentin all showed good efficacy. Gabapentin 300 mg given preoperatively significantly reduced postoperative pain and ADR incidence, recommended for preemptive analgesia in LC. Trial Registration: PROSPERO CRD42024522185. [ABSTRACT FROM AUTHOR]

The article discusses a study comparing rectus sheath block and erector spinae plane (ESP) block for postoperative pain management in patients undergoing midline abdominal surgery in Ethiopia. The study found a significant decrease in analgesic consumption with the ESP block. However, the article highlights challenges in research surrounding regional techniques, including lack of robust evidence, publication bias, and difficulty in interpreting results due to complex nomenclature. The controversy surrounding the ESP block's efficacy, mechanism of action, and potential adverse events is also discussed, emphasizing the need for further research and standardization in regional anaesthesia. [Extracted from the article]

Purpose: Perioperative bleeding is a serious concern during orthognathic surgery. Tranexamic acid (TXA), a synthetic lysine analog with antifibrinolytic properties, reduces blood loss across various surgical fields. This study aimed to investigate the effectiveness of preoperative TXA administration in reducing intraoperative and postoperative blood loss following combined Le Fort I and sagittal split ramus osteotomies at our hospital. Methods: This single-center, retrospective cohort study included patients who underwent combined Le Fort I and sagittal split ramus osteotomies between November 2017 and October 2022. The primary outcome was the volume of intraoperative blood loss. Results: Among 1,329 eligible patients, 87 were included in the analysis (32 in the TXA group and 55 in the control group, where no TXA was administered). The median (interquartile range) intraoperative blood loss was 200.0 (157.5–237.5) mL in the TXA group and 260.0 (180.0–350.0) mL in the control group, showing a significant difference between the groups (p = 0.0365). However, postoperative blood drainage within 24 h and 24–48 h did not differ significantly between the two groups. Conclusion: A single intravenous administration of TXA was associated with a decrease in intraoperative bleeding without severe adverse events during combined Le Fort I and sagittal split ramus osteotomies. However, postoperative blood loss, nausea, vomiting, and autologous blood transfusion were not significantly associated with this administration. [ABSTRACT FROM AUTHOR]

Background: Postoperative nausea and vomiting are common complications after surgery, and female patients are more likely to experience these adverse events. The goal of this study was to explore the relationship between the CHRM3 rs2165870 polymorphism and postoperative vomiting incidence in female patients who underwent laparoscopic surgery. Methods: Two hundred female patients who underwent elective laparoscopic surgery with subsequent patient-controlled intravenous analgesia using dexmedetomidine and sufentanil were prospectively enrolled. The CHRM3 rs2165870 and KCNB2 rs349358 polymorphisms were genotyped using MassARRAY SNP typing technology. Demographic data and preoperative laboratory results of all patients were recorded. Postoperative analgesia-related information, incidence of postoperative nausea and vomiting, and other adverse events were followed up and recorded for analysis. Results: No significant differences were observed in any of the demographic characteristics of these patients among the different genotype carriers (P>0.05). The percentages of patients with each genotype of CHRM3 were 67% (GG), 28.5% (GA) and 4.5% (AA). We found that the AA or A allele of the CHRM3 rs2165870 polymorphism elevated the risk of postoperative vomiting (AA versus GG; OR, 6.94; 95% CI, 1.49–32.46; P = 0.014; A versus G; OR, 2.52; 95% CI, 1.22–5.19; P = 0.012). The percentages of patients with each genotype of KCNB2 were 84.5% (TT), 15.5% (CT) and 0% (CC). There were no significant differences in the postoperative nausea or vomiting rate across the KCNB2 rs349358 polymorphisms (P>0.05). Conclusion: The CHRM3 rs2165870 polymorphism is associated with the occurrence of postoperative vomiting in female patients who have undergone laparoscopic surgery. The AA genotype or A allele of the CHRM3 rs2165870 polymorphism elevates the risk of postoperative vomiting. Trial registration: www.chictr.org.cn, registration number: ChiCTR2200062425. [ABSTRACT FROM AUTHOR]

Postoperative nausea and vomiting (PONV) is a common adverse effect of anesthesia. Identifying risk factors for PONV is crucial because it is associated with a longer stay in the post-anesthesia care unit, readmissions, and perioperative costs. This retrospective study used artificial intelligence to analyze data of 37,548 adult patients (aged ≥20 years) who underwent surgery under general anesthesia at Tohoku University Hospital from January 1, 2010 to December 31, 2019. To evaluate PONV, patients who experienced nausea and/or vomiting or used antiemetics within 24 hours after surgery were extracted from postoperative medical and nursing records. We create a model that predicts probability of PONV using the gradient tree boosting model, which is a widely used machine learning algorithm in many applications due to its efficiency and accuracy. The model implementation used the LightGBM framework. Data were available for 33,676 patients. Total blood loss was identified as the strongest contributor to PONV, followed by sex, total infusion volume, and patient's age. Other identified risk factors were duration of surgery (60–400 min), no blood transfusion, use of desflurane for maintenance of anesthesia, laparoscopic surgery, lateral positioning during surgery, propofol not used for maintenance of anesthesia, and epidural anesthesia at the lumbar level. The duration of anesthesia and the use of either sevoflurane or fentanyl were not identified as risk factors for PONV. We used artificial intelligence to evaluate the extent to which risk factors for PONV contribute to the development of PONV. Intraoperative total blood loss was identified as the potential risk factor most strongly associated with PONV, although it may correlate with duration of surgery, and insufficient circulating blood volume. The use of sevoflurane and fentanyl and the anesthesia time were not identified as risk factors for PONV in this study. [ABSTRACT FROM AUTHOR]

Background: OFA (Opioid-free anesthesia) has the potential to reduce the occurrence of opioid-related adverse events and enhance postoperative recovery. Our research aimed to investigate whether OFA, combining esketamine and dexmedetomidine, could serve as an alternative protocol to traditional OBA (opioid-based anesthesia) in shoulder arthroscopy, particularly in terms of reducing PONV (postoperative nausea and vomiting). Methods: A total of 60 patients treated with shoulder arthroscopy from September 2021 to September 2022 were recruited. Patients were randomly assigned to the OBA group (n = 30) and OFA group (n = 30), receiving propofol-remifentanil TIVA (total intravenous anesthesia) and esketamine-dexmedetomidine intravenous anesthesia, respectively. Both groups received ultrasound-guided ISBPB(interscalene brachial plexus block)for postoperative analgesia. Results: The incidence of PONV on the first postoperative day in the ward (13.3% vs. 40%, P < 0.05) was significantly lower in the OFA group than in the OBA group. Moreover, the severity of PONV was less severe in the OFA group than in the OBA group in PACU (post-anesthesia care unit) (0 [0, 0] vs. 0 [0, 3], P<0.05) and in the ward 24 h postoperatively (0 [0, 0] vs. 0 [0, 2.25], P<0.05). Additionally, the OFA group experienced a significantly shorter length of stay in the PACU compared to the OBA group (39.4 ± 6.76 min vs. 48.7 ± 7.90 min, P < 0.001). Conclusions: Compared to the OBA with propofol-remifentanil, the OFA with esketamine- dexmedetomidine proved to be feasible for shoulder arthroscopy, resulting in a reduced incidence of PONV and a shorter duration of stay in the PACU. Trial registration: The Chinese Clinical Trial Registry (No: ChiCTR2100047355), 12/06/2021. [ABSTRACT FROM AUTHOR]

Background: Pre-operative prediction of postoperative nausea and vomiting (PONV) is primarily based on the patient's medical history. The predictive value of gastric morphological parameters observed on ultrasonography has not been comprehensively assessed. Methods: A prospective observational study was conducted to evaluate the preoperative ultrasonographic measurement of gastric morphology for predicting PONV. The gastric antrum of the participants was assessed using ultrasound before anesthesia, and the occurrence of PONV in the first 6 hours and during the 6--24 hours after surgery was reported. The main indicators included the thickness of the muscularis propria (TMP) and the cross-sectional area of the inner side of the muscularis propria (CSA-ISMP). These were recorded and analyzed. Logistic regression analysis was applied to identify factors for PONV. Results: A total of 72 patients scheduled for elective gynecological laparoscopic surgery were investigated in the study. The pre-operative CSA-ISMP of patients with PONV in the first 6 hours was significantly greater than that of those without PONV (2.765 ± 0.865 cm² vs 2.349 ± 0.881 cm², P=0.0308), with an area under the curve of 0.648 (95% CI, 0.518 to 0.778, P=0.031). Conversely, the preoperative TMP of patients with PONV during the 6--24 hours was significantly smaller than that of those without PONV (1.530 ± 0.473 mm vs 2.038 ± 0.707 mm, P=0.0021), with an area under the curve of 0.722 (95% CI, 0.602 to 0.842, P=0.003). Logistic regression analysis confirmed that CSA-ISMP was an independent risk factor for PONV in the first 6 hours (OR=2.986, P=0.038), and TMP was an independent protective factor for PONV during the 6--24 hours after surgery (OR=0.115, P=0.006). Conclusion: Patients with a larger pre-operative CSA-ISMP or a thinner TMP are prone to develop PONV in the first 6 hours or during the 6--24 hours after surgery, respectively. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the potential of dexmedetomidine in preventing or reducing postoperative arrhythmias in pediatric patients undergoing direct vision cardiac surgery with extracorporeal circulation (cardiopulmonary bypass (CPB)). Methods: 62 children undergoing elective CPB cardiac surgery in Northwest Women and Children's Hospital, Xian, China between May 2020 and June 2023 were randomly and equally divided into study and control groups. The study group received a loading dose of 1 μg/kg dexmedetomidine followed by continuous intravenous infusion during surgery, while control group received an equivalent volume of saline infusion during surgery. Clinical data, perioperative indices (adverse reactions and intraoperative use of vasoactive drugs), levels of lactic acid, blood urea nitrogen (BUN) glomerular filtration rate (GFR), and postoperative arrhythmias were compared between the two groups at the end of the surgery. Results: The study group showed significantly lower postoperative lactate and BUN levels compared to the control group (p < 0.05). There was no significant difference in incidence of intraoperative hypotension, bradycardia, tachycardia, and vasoactive drug use between the two groups (p > 0.05). The study group showed significantly lower incidences of postoperative nausea and vomiting as well as supraventricular and ventricular arrhythmias compared to control group (p < 0.05). Furthermore, mean arterial pressure (MAP) at T2 and T3 was significantly lower in study group compared to control group (p < 0.05). Conclusion: Dexmedetomidine reduces postoperative lactate, BUN levels, incidence of postoperative supraventricular and ventricular arrhythmias, maintains hemodynamic stability, attenuates stress responses, preserves renal function, and decreases postoperative nausea and vomiting in pediatric CPB cardiac surgery. Large-sample multicenter clinical trials are needed for validation in further studies. [ABSTRACT FROM AUTHOR]

Background: Currently, the prevalence of obesity is on the rise annually. Bariatric surgery stands out as the most efficacious approach for addressing obesity. Obese patients are more prone to experience moderate to severe pain after surgery due to lower pain thresholds. Regional block, as an important component of multimodal analgesia in bariatric surgery, is crucial in reducing opioid consumption and alleviating postoperative pain in patients undergoing bariatric surgery. Transversus abdominis plane block (TAPB) has gained widespread utilization in bariatric surgery; however, its limitation of inadequate reduction of visceral pain in obese patients remains a significant concern. Therefore, it is imperative to explore new and more efficient strategies for analgesia. Quadratus lumborum block (QLB) has emerged as a popular nerve block in recent years, frequently utilized in conjunction with general anesthesia for abdominal surgery. In the cadaver study of QLB, it was confirmed that the dye level could reach up to T6 when using the subcostal anterior quadratus lumborum muscle approach, which could effectively reduce the incision pain and visceral pain of bariatric surgery patients during the perioperative period. However, there is currently a lack of research on the use of subcostal anterior QLB in patients undergoing bariatric surgery. Our study aims to investigate whether subcostal anterior QLB can provide superior perioperative analgesic efficacy for bariatric surgery under general anesthesia compared to TAPB, leading to reduced postoperative opioid consumption and a lower incidence of postoperative nausea and vomiting (PONV). Methods and design: This study is a prospective, randomized controlled trial aiming to recruit 66 patients undergoing bariatric surgery. The participants will be randomly allocated into two groups in a 1:1 ratio: subcostal anterior QLB group (n = 33) and TAPB group (n = 33). The study aims to investigate the efficacy of subcostal anterior QLB and TAPB in obese patients who are scheduled to undergo bariatric surgery. Our primary outcome is to observe the amount of opioids used in the two groups 24 h after operation. The secondary outcomes included VAS of pain during rest/activity after operation, the type and dose of additional analgesics, the occurrence and severity of PONV, the type and dose of additional antiemetic drugs, postoperative anesthesia care unit (PACU) time, time of first postoperative exhaust, time to first out of bed activity, time to first liquid diet and postoperative admission days. Discussion: Opioid analgesics are prone to causing adverse reactions such as nausea, vomiting, and respiratory depression, especially in obese patients. Multimodal analgesia, including nerve block, can effectively reduce the dose of opioids and alleviate their adverse effects. Currently, TAPB is the most prevalent nerve block analgesia method for abdominal surgery. Recent studies have indicated that subcostal anterior QLB offers advantages over TAPB, including a wider block plane, faster onset, and longer maintenance time. It is not clear which of the two nerve block analgesia techniques is better for postoperative analgesia in patients undergoing bariatric surgery. Our objective in this investigation is to elucidate the superior method between TAPB and subcostal anterior QLB for postoperative pain management in bariatric surgery. Trial registration: ChiCTR ChiCTR2300070556. Registered on 17 April 2023. [ABSTRACT FROM AUTHOR]

Aims: Esketamine may reduce acute postoperative pain in several settings. However, the effects of low‐dose esketamine on postoperative pain after vestibular schwannoma (VS) resection with propofol/remifentanil total intravenous anaesthesia (TIVA) are unclear. The aim of this study is to observe the effects of intraoperative low‐dose esketamine on postoperative pain after vestibular schwannoma resection. Methods: This single‐centre, randomized, placebo‐controlled, double‐blind trial included 90 adults undergoing VS resection via the retrosigmoid approach with TIVA. The patients were randomly allocated to two groups: esketamine or control (n = 45 in each group). Patients received low‐dose esketamine (0.2 mg/kg) or a similar volume of normal saline after dural closure. The primary outcome was the pain score during movement (gentle head movement) at 24 h postoperatively. Secondary outcomes included recovery time, bispectral index (BIS) values and haemodynamic profiles during the first 30 min after esketamine administration, and adverse effects. Results: Low‐dose esketamine did not reduce pain scores at rest (P >.05) or with movement (P >.05) within the first 24 h after surgery. Esketamine moderately increased BIS values for at least 30 min after administration (P <.0001) but did not affect heart rate (P =.992) or mean arterial blood pressure (P =.994). Esketamine prolonged extubation time (P =.042, 95% confidence interval: 0.08 to 4.42) and decreased the effect‐site concentration of remifentanil at extubation (P =.001, 95% confidence interval: −0.53 to −0.15) but did not affect the time to resumption of spatial orientation. Postoperative nausea and vomiting rates did not differ between groups, and no hallucinations or excessive sedation was observed. Conclusion: Intraoperative low‐dose esketamine did not significantly reduce acute pain after VS resection with propofol/remifentanil TIVA. However, BIS values increased for at least 30 min after esketamine administration. [ABSTRACT FROM AUTHOR]

Background: Postoperative nausea and vomiting (PONV) refers to nausea and vomiting that occurs within 24-h after surgery or in the post-anesthesia care unit (PACU). Previous studies have reported that the use of remimazolam, a newer benzodiazepine (BDZ) hypnotic, for anesthesia results in less PONV. In this study, we compared the rate of PONV between sevoflurane and remimazolam after general anesthesia. Methods: In this prospective randomized controlled trial, participants aged 20-80 years who underwent elective laparoscopic cholecystectomy or hemicolectomy were randomized to either the remimazolam or sevoflurane group. The primary outcome was PONV incidence for 24-h after surgery. Secondary outcomes comprised of PONV at 30-min post-surgery, postoperative additional antiemetic use, and Quality of Recovery-15 (QOR- 15) score at 24-h postoperatively. Results: Forty patients were enrolled in the study. The remimazolam group exhibited significantly lower rates of PONV for 24-h after surgery than did the sevoflurane group (remimazolam group vs. sevoflurane group; 5% vs. 45%, P = 0.003, respectively). The use of dexamethasone, a rescue antiemetic administered within 24 h of surgery, was substantially lower in the remimazolam group than in the sevoflurane group (0% in remimazolam vs. 30% in sevoflurane, P = 0.020). The QOR-15 score at 24-h after surgery showed no significant difference between the two groups. Conclusions: Compared to sevoflurane, opting for remimazolam as an intraoperative hypnotic may decrease the incidence of PONV and reduce antiemetic use for 24 h after laparoscopic surgery. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis of randomized controlled trials (RCTs) with trial sequential analysis (TSA) aimed to comprehensively evaluate and compare the efficacy of the prophylactic administration of tropisetron in the prevention of the incidence of post-operative nausea and vomiting (PONV) in patients undergoing surgery under general anesthesia. This study was registered with PROSPERO (CRD42024372692). RCTs comparing the efficacy of the perioperative administration of tropisetron with that of a placebo, other anti-emetic agents, or a combination of anti-emetic injections were retrieved from the databases of Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar. The frequency of rescue anti-emetic use (RA) and the incidence of PON, POV, and PONV (relative risk [RR]: 0.718; 95% confidence interval [CI] 0.652–0.790; I2 = 0.0, RR: 0.587; 95% CI 0.455–0.757; I2 = 63.32, RR: 0.655; 95% CI 0.532–0.806; I2 = 49.09, and RR: 0.622; 95% CI 0.552–0.700; I2 = 0.00, respectively) in the tropisetron group were lower than those in the control group; however, the incidence of complete response (CR) was higher in the tropisetron group (RR: 1.517;95% CI 1.222–1.885; I2 = 44.14). TSA showed the cumulative Z-curve exceeded both the conventional test and trial sequential monitoring boundaries for RA, PON, POV, and PONV between the tropisetron group and the control group. Thus, the prophylactic administration of tropisetron exhibited superior efficacy in the prevention of PON, POV, and PONV. Furthermore, a lower incidence of RA and a higher incidence of CR were observed with its use. [ABSTRACT FROM AUTHOR]

Postoperative nausea and vomiting (PONV) occurs in up to 30% of patients and its pathophysiology and mechanisms have not been completely described. Hypotension and a decrease in cardiac output are suspected to induce nausea. The hypothesis that intraoperative hypotension might influence the incidence of PONV was investigated. The study was conducted as a retrospective large single center cohort study. The incidence of PONV was investigated until discharge from post anesthesia care unit (PACU). Surgical patients with general anesthesia during a 2-year period between 2018 and 2019 at a university hospital in Germany were included. Groups were defined based on the lowest documented mean arterial pressure (MAP) with group H50: MAP <50mmHg; group H60: MAP <60mmHg; group H70: MAP <70mmHg, and group H0: no MAP <70mmHg. Decreases of MAP in the different groups were related to PONV. Propensity-score matching was carried out to control for overlapping risk factors. In the 2-year period 18.674 patients fit the inclusion criteria. The overall incidence of PONV was 11%. Patients with hypotension had a significantly increased incidence of PONV (H0 vs. H50: 11.0% vs.17.4%, Risk Ratio (RR): 1.285 (99%CI: 1.102–1.498), p < 0.001; H0 vs. H60: 10.4% vs. 13.5%, RR: 1.1852 (99%CI: 1.0665–1.3172), p < 0.001; H0 vs. H70: 9.4% vs. 11.2%, RR: 1.1236 (99%CI: 1.013 − 1.2454); p = 0.0027). The study demonstrates an association between intraoperative hypotension and early PONV. A more severe decrease of MAP had a pronounced effect. [ABSTRACT FROM AUTHOR]

Background: Alexander disease is a rare, progressive leukodystrophy, which predisposes patients to complications under general anesthesia due to clinical manifestations including developmental delay, seizures, dysphagia, vomiting, and sleep apnea. However, study of anesthetic outcomes is limited. Aims: Our aim was to describe patient characteristics, anesthetic techniques, and anesthesia‐related complications for Alexander disease patients undergoing magnetic resonance imaging and/or lumbar puncture at a quaternary‐care children's hospital. Methods: We performed a retrospective review of anesthetic outcomes in patients with Alexander disease enrolled in a prospective observational study. Included patients had diagnosed Alexander disease and underwent magnetic resonance imaging and/or lumbar puncture at our institution. We excluded anesthetics for other procedures or at outside institutions. Collected data included patient characteristics, anesthetic techniques, medications, and complications under anesthesia and in the subsequent 24 h. We performed descriptive statistics as appropriate. Results: Forty patients undergoing 64 procedures met inclusion criteria. Fifty‐six procedures (87.5%) required general anesthesia or monitored anesthesia care (MAC) and eight (12.5%) did not. The general anesthesia/MAC group tended to be younger than nonanesthetized patients (median age 6 years [IQR 3.8; 9] vs. 14.5 years [IQR 12.8; 17.5]). In both groups, dysphagia (78.6% vs. 87.5%, respectively), seizures (62.5% vs. 25%), and recurrent vomiting (17.9% vs. 25%) were frequently reported preprocedure symptoms. Inhalational induction was common (N = 48; 85.7%), and two (3.6%) underwent rapid sequence induction. Serious complications were rare, with no aspiration or seizures. Hypotension resolving with ephedrine occurred in eight cases (14.3%). One patient each (1.8%) experienced postprocedure emergence agitation or vomiting. Fifty‐three (94.6%) were ambulatory procedures. No inpatients required escalation in acuity of care. Conclusions: In this single‐center study, patients with Alexander disease did not experience frequent or irreversible complications while undergoing general anesthesia/MAC. Co‐morbid symptoms were not increased postanesthesia. Some patients may not require anesthesia to complete short procedures. [ABSTRACT FROM AUTHOR]

• Erector spinae plane block (ESPB) administration at varying distances from the incision (ES distance) does not significantly affect postoperative pain scores within the Enhanced Recovery After Surgery (ERAS) protocol for lumbar spine surgery. • Postoperative pain management with ESPB shows no significant difference in Numerical Rating Scale (NRS) pain scores between different ES distances immediately after surgery and up to 72 hours postoperatively within the ERAS group. • Patients in the ERAS group reported significantly lower pain scores and reduced morphine consumption compared to the non-ERAS group, indicating the effectiveness of the ERAS protocol. • ERAS protocols facilitated quicker resumption of diet and reduced the incidence of postoperative nausea and vomiting. • The study suggests that lumbar ESPB may be preferable due to difficulties with sonovisualization and to avoid the risk of pleural injury, establishing a safe and effective range for ESPB application. Postoperative pain control following spine surgery can be difficult. The Enhanced Recovery After Surgery (ERAS) programs use multimodal approaches to manage postoperative pain. While an erector spinae plane block (ESPB) is commonly utilized, the ideal distance for injection from the incision, referred to as the ES (ESPB to mid-surgical level) distance, remains undetermined. We evaluated the impact of varying ES distances for ESPB on Numerical Rating Scale (NRS) measures of postoperative pain within the ERAS protocol. Retrospective observational study. Adult patients who underwent elective lumbar spine fusion surgery. Primary outcome measures include the comparative postoperative NRS scores across groups at immediate (T1), 24 (T2), 48 (T3), and 72 (T4) hours postsurgery. For secondary outcomes, a propensity matching analysis compared these outcomes between the ERAS and non-ERAS groups, with opioid-related recovery metrics also assessed. All included patients were assigned to one of three ERAS groups according to the ES distance: Group 1 (G1, ES > 3 segments), Group 2 (G2, ES = 2–3 segments), and Group 3 (G3, ES<2 segments). Each patient underwent a bilateral ultrasound-guided ESPB with 60 mL of diluted ropivacaine or bupivacaine. Patients within the ERAS cohort reported mild pain (NRS < 3), with no significant NRS variation across G1 to G3 at any time. Sixty-five patients were matched across ERAS and non-ERAS groups. The ERAS group exhibited significantly lower NRS scores from T1 to T3 than the non-ERAS group. Total morphine consumption during hospitalization was 26.7 mg for ERAS and 41.5 mg for non-ERAS patients. The ERAS group resumed water and food intake sooner and had less postoperative nausea and vomiting. ESPBs can be effectively administered at or near the mid-surgical level to the low thoracic region for lumbar spine surgeries. Given challenges with sonovisualization, a lumbar ESPB may be preferred to minimize the risk of inadvertent pleural injury. [ABSTRACT FROM AUTHOR]