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We investigated whether two doses of dexamethasone are more effective than a single dose in reducing early postoperative nausea and vomiting (PONV) during total knee arthroplasty (TKA). A total of 150 patients between June 2021 and June 2022 were randomized into 3 groups: two doses of normal saline (group A), a single dose of 10 mg dexamethasone before surgery and normal saline after surgery (group B), and two doses of 5 mg dexamethasone during the perioperative period (group C). Primary outcomes were incidences and severity of PONV within 24 hours after surgery, the number and consumption of patients requiring morphine and metoclopramine, and visual analog scale scores for nausea and vomiting at 2, 4, 6, and 24 hours after surgery. Blood glucose levels on days 1, 2, and 3 after operation and incidences of surgical site infection (SSI) as well as gastrointestinal bleeding (GIB) within 45 days after operation were compared. Within 24 hours after operation, the number and consumption of patients requiring morphine and metoclopramide in groups B and C were significantly lower than those in group A. Incidences and severity of PONV in groups B and C were significantly lower than those in group A. And these differences between groups B and C were significant. At 2, 4, 6, and 24 hours after operation, there were significant differences in visual analog scale scores of PONV between groups A and B, A and C, as well as B and C. On postoperative days 1, 2, and 3, there were no significant differences in blood glucose levels among the groups, and there were no incidences of SSI or GIB in any group within 45 days after operation. Dexamethasone significantly reduces PONV within 24 hours after TKA, does not result in significant changes in postoperative blood glucose levels, and does not increase the risk of SSI or GIB, particularly on group C. ChiCTR2400088512. Chinese Clinical Trial Registry (ChiCTR). www.chictr.org.cn. [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]

Postoperative nausea and vomiting (PONV) stands as one of the most prevalent complications within the initial 24 hours following surgery, potentially extending the Length of Stay (LOS) and incurring elevated financial burdens for patients in hospital settings. Aromatherapy emerges as a non-pharmacological approach for alleviating PONV symptoms. This case study aims to evaluate PONV severity and manage symptoms in neurosurgical patients utilizing a nursing process approach. Employing a case study design integrated with a nursing process approach, this study was conducted. The inclusion criteria were respondents aged 18 or older, American Society of Anesthesiologist (ASA) I or II classification, undergoing neurosurgery under general anaesthesia, willing to participate, conscious (GCS: 14-15), with a healthy sense of smell, and PONV scores of 1 or 2. Exclusion criteria comprised discharged or deceased patients, absence of PONV, respiratory issues like asthma/COPD, odor allergies, and severe post-surgical complications. Dropout criteria included sudden emergencies or alternative interventions during PONV assessments. Results showed 4 patients with PONV 1 scores and 6 with PONV 2 scores before aromatherapy. After aromatherapy, 6 patients had PONV 0 scores, 2 had PONV 1 scores, and 2 had PONV 2 scores. Findings underscore alterations in PONV scores pre- and post-aromatherapy administration, highlighting the potential of this evidence-based nursing intervention to enhance patient comfort and mitigate postoperative complications in neurosurgical settings.

The comparative effectiveness of Total Intravenous Anesthesia (TIVA) and inhalational anesthesia has been widely studied, revealing distinct advantages and limitations for each technique. TIVA demonstrates superiority in reducing postoperative nausea and vomiting (PONV), facilitating faster recovery, and improving patient satisfaction. It is particularly beneficial in outpatient settings and high-risk populations, including obese and geriatric patients. Inhalational anesthesia, however, remains a versatile and cost-effective option, especially in resource-limited settings, despite its higher incidence of PONV and potential neurocognitive risks. Both techniques provide comparable hemodynamic stability when managed appropriately. TIVA's minimal environmental footprint offers an added advantage in sustainable healthcare practices. This review highlights the need for personalized anesthetic planning, advanced monitoring, and further research into long-term cognitive outcomes and environmental impacts. These findings can guide anesthesiologists in optimizing patient care while addressing safety, efficacy, and sustainability concerns. [ABSTRACT FROM AUTHOR]

Background: In modern era of medical science, patients' post-anaesthesia recovery has improved mainly because of better monitoring, measures taken intra-operatively to avoid post-operative complications, and better immediate post-anaesthesia care. The present study aimed to know the incidence of postoperative nausea and vomiting, hypothermia and worst pain score in post-surgical patients in recovery room. Materials and Methods: This study was carried out after approval from institutional review board. This is a prospective observational study, conducted on the post-operative patients in the post anaesthesia recovery room in Tata Memorial Hospital, Mumbai for a period of two months. Data was collected from 1,007 patients out of 1,191 elective surgical procedures carried out. Incidence of postoperative nausea and vomiting (PONV), postoperative pain and hypothermia were assessed in the postoperative recovery room. Result: With the cut off value of 35°C, the incidence of hypothermia at ICU admission was 31.4%. There was significant correlation between duration of anaesthesia and hypothermia (p=0.04). Incidence of hypothermia in surface surgeries i.e. breast, head and neck, bone and soft tissue services was 26.3% (162/617) and in cavity surgeries i.e. gastrointestinal, genitourinary, gynaecology and thoracic surgeries was 39.5% (154/390) and in children <12 years was 35.5% (11/31). 6.6% of patients (66/1007) had nausea and 2% (20/1007) had vomiting on ICU admission. There is also no correlation between severe nausea and vomiting with the use of intraoperative antiemetic, duration of anaesthesia. 9.8% (99/1007) had moderate to severe pain on admission to ICU, 12.1% (122/1007) after one hour of admission and 2% had severe pain during ICU stay. There was no significant correlation between intra- operative analgesia and post-operative pain score. The study didn't find any correlation with hypothermia, PONV and worst pain increasing the duration of ICU or hospital stay or affecting the outcome as the p value was >0.05. Conclusion: Incidence of hypothermia in ours study is similar as compared to previous studies. The incidence of severe pain is similar in cancer patients but lower than the patients undergoing general surgical procedures. Rate of re-admission and PONV in a post-surgical patient is very low in our ICU compared to other studies. We need to take further steps in improving the temperature monitoring, to control severe postoperative pain and PONV. Despite of pharmacological advances and known risk factors the incidences of postoperative complications is still higher. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the incidence of early (up to 2 h) and late (2–24 h) postoperative nausea and vomiting (PONV) and hypotension in patients who underwent general anesthesia for orthognathic surgery using propofol or remimazolam along with remifentanil. This retrospective chart review included healthy adult patients under the age of 60 who underwent orthognathic surgery using propofol (P group) or remimazolam (R group) from January 2021 to March 2022. Records were reviewed to gather PONV and intraoperative hypotension data as well as patient characteristics and other variables. Early PONV was significantly lower in the P group vs the R group (9.5% vs 34.1%, respectively; P =.002), although the difference in late PONV was insignificant (36.9% vs 51.2%, respectively; P =.13). A higher incidence of intraoperative hypotension was noted in the P group (22.6%) vs the R group (2.4%; P =.004); however, there were no differences in average intraoperative systolic blood pressure or vasopressor administration. These results suggest that propofol is associated with a lower incidence of early PONV as compared to remimazolam; however, antiemetics are still recommended given the frequency of late PONV in both groups. Propofol also caused more episodes of intraoperative hypotension vs remimazolam, but the increase in transient hypotension is likely to be irrelevant during orthognathic surgery in healthy adults under the age of 60. [ABSTRACT FROM AUTHOR]

Background: End-stage renal diseases patients have a high risk of postoperative nausea and vomiting (PONV), which is multifactorial and need acute attention after renal transplantation for a successful outcome in term of an uneventful postoperative period. The study was done to compare the efficacy of palonosetron and ondansetron in preventing early and late-onset PONV in live donor renal transplantation recipients (LDRT). Methods: The prospective randomized double-blinded study was done on 112 consecutive patients planned for live donor renal transplantation. Patients of both sexes in the age group of 18...60 years were randomly divided into two groups: Group O (Ondansetron) and Group P (Palonosetron) with 56 patients in each group by computer-generated randomization. The study drug was administered intravenously (IV) slowly over 30.ßseconds, one hour before extubation. Postoperatively, the patients were accessed for PONV at 6, 24, and 72.ßhours using the Visual Analogue Scale (VAS) nausea score and PONV intensity scale. Results: The incidence of PONV in the study was found to be 30.35%. There was significant difference in incidence of PONV between Group P and Group O at 6.ßhours (12.5% vs. 32.1%, p.ß=.ß0.013) and 72.ßhours (1.8% vs. 33.9%, p.ß

Background: Post operative nausea and vomiting is one of the commonest and unpleasant complications encountered and often cause delay in the discharge of patients. It is often associated with complications like dehydration, haematoma formation, wound dehiscence resulting in prolonged hospital stay. This study aimed to compare the effect of aprepitant and ramosetron, for prevention of postoperative nausea and vomiting in patients after intra-abdominal surgeries. Materials and methods: This randomised double blinded study included patients who underwent intraabdominal surgeries under general anaesthesia. Patients were divided into two groups, group A and B(22 patients in each group) receiving oral aprepitant(80mg) and single dose of intravenous ramosetron(0.3mg) respectively. Incidence and extent of nausea and vomiting, use of rescue antiemetics and number of post operative nausea and vomiting episodes in both the drug groups were assessed at 12,24 and 48 hours after the operation. Results: In patients receiving aprepitant(Group A) incidence and severity of post operative nausea and vomiting were found to be comparable to the same in the patients receiving ramosetron(Group B) in 12th, 24th and 48th post operative hours. Conclusion: It was found that Aprepitant and Ramosetron had comparable efficacy in preventing PONV upto 48 hrs post operatively in patients having abdominal surgeries under general anaesthesia, as well as in aspects of causing adverse effects. Number of patients who experienced nausea and vomiting postoperatively were less in the Group A population(Aprepitant group) compared to the patients in Group B(Ramosetron group). [ABSTRACT FROM AUTHOR]

Postoperative Nausea and vomiting (PONV) are the most complications after laparoscopic surgeries, especially laparoscopic bariatric surgeries. The incidence of PONV has been estimated in over twothirds of patients undergoing laparoscopic bariatric surgeries. Prophylactic combined antiemetic therapy is recommended for patients undergoing these surgeries. This is a double-blinded randomized clinical trial. Eighty-three patients of ASA physical status I and II undergoing elective bariatric laparoscopic surgery were enrolled in this clinical trial and divided into two equal groups through simple randomization using a random number table. One group (group A) received a combination of ondansetron, dexamethasone, and haloperidol (ODH); and the other group (group B) received a combination of ondansetron, dexamethasone, and promethazine (ODP). The ODP group received promethazine 25 mg IM 30 minutes before extubation and ODH group received haloperidol 2 mg IM at the beginning of the surgery. Nausea and vomiting were assessed in terms of severity and frequency in the recovery room, 6, and 24 hours postoperatively in both groups using the Numeric Verbal Rating Scale (NVRS). The frequency of PONV was significantly lower in the ODH group compared to the ODP group in the recovery room (20% versus 40%). PONV severity was lower in the ODH group compared to the ODP group. The time to first rescue antiemetic prescription in the ODP group was more than in the ODH group (7.2 h versus 2.6 h). In morbidly obese patients undergoing laparoscopic bariatric surgery, both antiemetic combinations decreased the incidence of PONV, but the combination of haloperidol, dexamethasone, and ondansetron was more effective than promethazine, dexamethasone, and ondansetron. [ABSTRACT FROM AUTHOR]

Yu Cui,1,&ast; Yu Wang,2,&ast; Jing Yang,1,&ast; Longqing Ran,1,&ast; Qianqian Zhang,1 Qinghua Huang,1 Tianqing Gong,1 Rong Cao,1 Xiao Yang3 1Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s & Children’s Central Hospital, Chengdu, People’s Republic of China; 2Department of Anesthesiology, No.363 Hospital, Chengdu, People’s Republic of China; 3Department of Hospital Management, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s & Children’s Central Hospital, Chengdu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiao Yang, Tel/Fax +86 13882288881, Email yczar@126.comStudy Objective: Pain management plays a pivotal role in enhanced recovery after surgery (ERAS). Erector spinae plane block (ESPB) is widely used in many regions to treat perioperative pain, but its benefits are still somewhat controversial. We, therefore, intent to systematically review the available literature on ESPB, to elucidate its effects on opioid-sparing analgesia, and summarize its potential complications.Design: Systematic review of randomized controlled trials (RCTs) with meta-analysis.Setting: Postoperative opioid consumption for various surgeries.Patients: Patients undergoing various surgeries.Intervention: We searched relevant studies in PubMed, EMBASE, Medline, and the Cochrane Library up to May 16, 2021. All prospective and RCTs that compared ESPB and sham block or no block were enrolled.Measurements: The primary outcomes were postoperative opioid consumption during the first 24 hours. The secondary outcomes were the requirement of rescue analgesia, time to first rescue analgesic and ESPB-related adverse events.Results: We included 52 trials that reported postoperative opioid consumption during the first 24 hours. The results presented that compared to control group (ie, no intervention or a sham block), ESPB reduced the accumulated opioid consumption during the first 24 h after surgery [mean difference (MD) of − 12.83 (95% CI: − 17.29 to − 8.38; p < 0.001) mg; I2 = 100%]. Besides, ESPB could prolong time to first rescue analgesia after surgery [SMD = 5.31; 95% CI 4.01– 6.61; p < 0.001; I2 = 97%]. The number of patients who received rescue analgesia after surgery in the ESPB group was less than that in the control group (OR 0.13; 95% CI 0.09, 0.21; p < 0.001; I2 = 54%), and the incidence of PONV was lower in the ESPB group (OR 0.51; 95% CI 0.43, 0.62; p < 0.001; I2 = 19%).Conclusion: ESPB is an effective technique on pain management with few complications.Keywords: erector spinae plane block, ESPB, opioid consumption, postoperative nausea and vomiting, PONV

Postoperative Nausea and vomiting (PONV) are the most complications after laparoscopic surgeries, especially laparoscopic bariatric surgeries. The incidence of PONV has been estimated in over two-thirds of patients undergoing laparoscopic bariatric surgeries. Prophylactic combined antiemetic therapy is recommended for patients undergoing these surgeries. This is a double-blinded randomized clinical trial. Eighty-three patients of ASA physical status I and II undergoing elective bariatric laparoscopic surgery were enrolled in this clinical trial and divided into two equal groups through simple randomization using a random number table. One group (group A) received a combination of ondansetron, dexamethasone, and haloperidol (ODH); and the other group (group B) received a combination of ondansetron, dexamethasone, and promethazine (ODP). The ODP group received promethazine 25 mg IM 30 minutes before extubation and ODH group received haloperidol 2 mg IM at the beginning of the surgery. Nausea and vomiting were assessed in terms of severity and frequency in the recovery room, 6, and 24 hours postoperatively in both groups using the Numeric Verbal Rating Scale (NVRS). The frequency of PONV was significantly lower in the ODH group compared to the ODP group in the recovery room (20% versus 40%). PONV severity was lower in the ODH group compared to the ODP group. The time to first rescue antiemetic prescription in the ODP group was more than in the ODH group (7.2 h versus 2.6 h). In morbidly obese patients undergoing laparoscopic bariatric surgery, both antiemetic combinations decreased the incidence of PONV, but the combination of haloperidol, dexamethasone, and ondansetron was more effective than promethazine, dexamethasone, and ondansetron.

Vitrectomy is one of the most widely performed precise procedures in ophthalmic surgery. Although usually carried out under local anaesthesia, in selected cases general anaesthesia is the only possible alternative to carry out procedure safely and ensure optimal analgesia. Bearing in mind the burden of all negative effects of opioid analgesics administered systemically during general anaesthesia, the concept of preemptive analgesia was developed to reduce intraoperative opioid requirements and diminish their adverse effects. Applying analgesic treatment prior to surgical incision enables maintaining stable intra- and postoperative analgesia and thus results in opioid sparring and improves perioperative outcomes by reducing adverse event rates (such as postoperative nausea and vomiting, occurrence of ocluocardiac reflex, postoperative intolerable pain perception) during vitreoretinal surgery. In this study, several methods of preemptive analgesia and their influence on perioperative outcomes in patients under-going vitrectomy will be discussed. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of combination of dexamethasone and ondansetron in prevention of postoperative nausea and vomiting in laparoscopic cholecystectomy. Study Design: Descriptive Case Series study. Setting: Departments of Surgery, Khyber Teaching Hospital and Hayatabad Medical Complex, Peshawar. Period: 01 Jan 2018 to 31 May 2019. Material & Methods: A total of 231 patients undergoing laparoscopic cholecystectomies were included in the study and subjected to dexamethasone in combination with ondansetron and followed up at 24 hours after surgery to detect nausea and vomiting. Results: The mean age of the study sample was 38.5 + 10.4 years. In our study, we had 62.3% males and 37.7% female patients. On follow up, we observed that PONV was recorded in 39.4% of patients of which grade 1 were 15.2%, grade 2 were 14.7% and grade 3 were 9.5%. In this regards, the effectiveness of dexamethasone and Ondansetron combination was recorded in 60.6% of patients. Conclusion: The combination of dexamethasone and ondansetron is moderately effective in prevention of post operative nausea and vomiting. [ABSTRACT FROM AUTHOR]

Sufentanil, a potent opioid, serves as the first option for perioperative analgesia owing to its analgesic effect, long duration and stable hemodynamics, whereas its side effects frequently blunt its application. The intravenous (IV) injection of sufentanil during anesthesia induction has high incidence of choking or bucking reaction, which is defined as sufentanil-induced cough (SIC). Moreover, postoperative nausea and vomiting (PONV) is a common and stressful complication, which is also related to the usage of opioid. High incidence of PONV is reported in the patients with SIC. Hence, we sought to determine whether naloxone, an opioid antagonist, at low dose would decrease the incidences of SIC and PONV. 216 female patients undergoing gynecological laparoscopic operation (

Postoperative nausea and vomiting is one of the most common side effects associated with anesthesia. The aim of this study is to determine the effect of ginger on severity and incidence of nausea and vomiting after lower and upper limb surgery. This was a triple-blinded clinical trial. Sixty eligible patients were randomly assigned to the intervention and control groups. The intervention group received four 250 mg ginger capsules and the control group received four placebo capsules 2 hours before surgery. Incidence and severity of nausea and vomiting immediately after the surgery and 2, 4, 6, and 8 hours after the surgery were evaluated. The results of this study showed that the use of ginger capsules significantly reduces the incidence and severity of postoperative nausea and vomiting at different hours after surgery compared to placebo, P <.05, irrespective of the gender and the age of the patients. Use of ginger is effective in decreasing postoperative nausea and vomiting. However, further studies in comorbid patients are required to verify these outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Postoperative nausea and vomiting (PONV) is one of the most frequent complications following strabismus surgery. Penehyclidine, an anticholinergic agent, is widely used as premedication. This study investigated the effect of preoperative penehyclidine on PONV in patients undergoing strabismus surgery. Methods In this prospective, randomized, double-blind study, patients scheduled for strabismus surgery under general anesthesia were randomly assigned to either penehyclidine (n = 114) or normal saline (n = 104) group. Penehyclidine was administrated immediately after anesthesia induction, and normal saline was substituted as control. PONV was investigated from 0 to 48 h after surgery. Intraoperative oculocardiac reflex (OCR) was also recorded. Results Compared with normal saline, penehyclidine significantly reduced PONV incidence (30.7% vs. 54.8%, P

Background: Postoperative nausea and vomiting (PONV) is common side effect after gastrointestinal surgery. It causses discomfort, increase risk of incision disruption, bleeding and airway blockage. This study aimed to investigate the incidence and severity of PONV and determine whether preoperative reflux or regurgitation symptoms influence PONV in patients undergoing bariatric surgery. Methods: Patients with obesity underwent laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in our center between January 2016 and December 2018 were divided into PONV and NoPONV group and analyzed retrospectively. PONV and postoperative pain visual analogue scale (VAS) were analyzed after surgery. A 1:1 propensity score matching (PSM) method was performed, and multivariable logistic regression analyses were used to identify predictors for PONV. Results: There were 483 patients enrolled, with a mean age of 30.19 ± 9.96 years, and 134 pairs of matched patients were selected from PONV group and NoPONV group after PSM. PONV occurred in 288 (59.6%) patients after bariatric surgery (77.4% after LSG vs 21.5% after LRYGB, p < 0.001). In PONV group, 210 (72.9%) were female, preoperative reflux or regurgitation symptoms were 128 (33.6%). Multivariable analysis found that preoperative reflux or regurgitation symptoms were independent risk factors for PONV after LSG, with an OR of 2.78 (95% CI: 1.12–6.93, p = 0.028). Conclusions: Incidence of PONV after bariatric surgery is high. For the first time, this study valued preoperative reflux or regurgitation symptoms as risk factors that may promote PONV after bariatric surgery. Patients with preoperative symptoms undergoing LSG have a higher risk of PONV, so these patients should be carefully evaluated for the feasibility of LSG before surgery. [ABSTRACT FROM AUTHOR]

Ting-Ting Li,1,* Liu-Lin Xiong,2,* Jin Huang,3 Song Wen,4 Yan-Jun Chen,1 Ting-Hua Wang,1 Fei Liu1 1Department of Anesthesiology, Institute of Neurological Disease, West China Hospital, Sichuan University, Chengdu, 610044, People’s Republic of China; 2School of Pharmacy and Medical Sciences, Faculty of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; 3Laboratory Zoology Department, Institute of Neuroscience, Kunming Medical University, Kunming, People’s Republic of China; 4Department of Pain, Affiliated Hospital of Zunyi Medical University, Guizhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ting-Hua WangInstitute of Neurological Disease, Department of Anesthesiology, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, People’s Republic of ChinaTel +86 871-65939180Fax +86 871-65922935Email Wangth_email@163.comFei LiuDepartment of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, People’s Republic of ChinaTel +86 18980605856Fax +86 871-85423593Email 30333870@qq.comPurpose: To investigate the impact of body mass index (BMI) on the analgesic effects and adverse reactions of patient-controlled intravenous analgesia (PCIA).Methods: From 2017 to 2018, 390 patients undergoing open gastrointestinal surgery were reviewed at West China Hospital, Sichuan University. All used PCIA of sufentanil combined with dexmedetomidine and flurbiprofen axetil. According to their BMIs, they were placed into six groups: group A (BMI < 18.5kg/m2, 29), group B (18.5kg/m2 ≤ BMI< 22kg/m2, 124), group C (22kg/m2 ≤ BMI < 24kg/m2, 99), group D (24kg/m2 ≤ BMI < 26kg/m2, 69), group E (26kg/m2 ≤ BMI < 28kg/m2, 46) and group F (BMI ≥ 28kg/m2, 23). Main data of the perioperative use of analgesics, postoperative visual analogue score (VAS), and adverse reactions were collected.Results: Twenty-four hours (h) after surgery, patients in group A had a higher resting VAS than the other groups, especially B (pA-B = 0.011). VAS of patients during activity in group B was lower than those in group C 48 h after surgery (p = 0.013). Compared with groups B to F, group A had a significantly lower incidence of hypertension (p = 0.012) and a significantly higher incidence of vomiting 24 h after surgery (p = 0.009). Binary logistic analysis found that higher age was a risk factor for vomiting 24 h after surgery (OR 1.158, p = 0.045).Conclusion: Using the same PCIA, patients with BMIs of less than 18.5 kg/m2 had worse analgesia on the first day after surgery and were more likely to vomit. Postoperative analgesia and related experiences in patients with BMIs of less than 18.5 kg/m2 need to be improved.Keywords: postoperative nausea and vomiting, PONV, postoperative pain, sufentanil, dexmedetomidine, flurbiprofen axetil

Abstract Background Infratentorial craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). Enhanced Recovery After Surgery (ERAS) protocols have been shown in multiple surgical disciplines to improve outcomes, including reduced PONV. However, very few studies have described the application of ERAS to infratentorial craniotomy. The aim of this study was to examine whether our ERAS protocol for infratentorial craniotomy could improve PONV. Methods We implemented an evidence-based, multimodal ERAS protocol for patients undergoing infratentorial craniotomy. A total of 105 patients who underwent infratentorial craniotomy were randomized into either the ERAS group (n = 50) or the control group (n = 55). Primary outcomes were the incidence of vomiting, nausea score, and use of rescue antiemetic during the first 72 h after surgery. Secondary outcomes included postoperative anxiety level, sleep quality, and complications. Results Over the entire 72 h post-craniotomy observation period, the cumulative incidence of vomiting was significantly lower in the ERAS group than in the control group. Meanwhile, the incidence of vomiting was significantly lower in the ERAS group on postoperative days (PODs) 2 and 3. Notably, the proportion of patients with mild nausea (VAS 0–4) was higher in the ERAS group as compared to the control group on PODs 2 or 3. Additionally, the postoperative anxiety level and quality of sleep were significantly better in the ERAS group. Conclusion Successful implementation of our ERAS protocol in infratentorial craniotomy patients could attenuate postoperative anxiety, improve sleep quality, and reduce the incidence of PONV, without increasing the rate of postoperative complications. Trial registration ChiCTR-INR-16009662 , 27 Oct 2016, Clinical study on the development and efficacy evaluation of Enhanced Recovery After Surgery (ERAS) in Neurosurgery.

Purpose: Postoperative nausea and vomiting (PONV) is common among females undergoing gynecological surgeries. PONV not only causes patients discomfort but also leads to serious complications, affecting their health outcomes. This study aimed to evaluate the effectiveness of applying auricular acupressure to alleviate PONV and postoperative anxiety and to improve satisfaction with anesthesia care in patients undergoing gynecological laparoscopic surgery (GLS)., Design: A randomized control trial was conducted for this study., Methods: Eighty patients who received general anesthesia for GLS were recruited at a medical center in northern Taiwan and randomly assigned to the control and experimental groups. Both groups had pellets taped onto different auricular points after the surgery: the stomach (CO4), cardia (CO3), liver (CO12), occiput (AT3), shenmen (TF4), and subcortex (AT4) for the experimental group and the knee (AH4) and thoracic vertebrae (AH11) for the control group. The pellets were removed 24 hours after surgery. The severity of PONV was assessed as the primary outcome. Secondary outcomes included levels of anxiety and satisfaction with postanesthesia care., Findings: After 24 hours of follow-up, patients in the experimental group reported significantly less PONV and a higher level of satisfaction with anesthesia care compared to patients in the control group. However, the levels of postoperative anxiety between the control and experimental groups were statistically insignificant., Conclusions: The study demonstrates that the six auricular points, including CO4, CO3, CO12, AT3, TF4, and AT4, can effectively alleviate PONV and improve the quality of anesthesia care after GLS. Auricular acupressure is a nonpharmacologic treatment for PONV that takes cost and patient satisfaction into consideration., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Background: Whether preoperative exposure to glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG) remains unclear., Objectives: To investigate the association between preoperative GLP-1RAs exposure and PONV after LSG., Setting: University Hospital, China., Methods: We reviewed a retrospective cohort of patients underwent LSG between January 1, 2017, and December 30, 2021 at Nanjing Drum Tower Hospital, dividing the patients into 2 groups on the basis of whether they were exposed to GLP-1RAs preoperatively. A 1:1 propensity score matching was performed to balance the characteristics between the groups. Associations between GLP-1RAs exposure and PONV were determined by logistic regressions., Results: A total of 564 eligible patients underwent LSG, 351 (62.2%, 95% CI 58.2-66.1) of whom had PONV. In total cohort, PONV occurred in 72(84.7%) patients exposed to GLP-1RAs preoperatively and 279 (58.2%) patients not exposed to GLP-1RAs (adjusted odds ratio 6.782, 95% confidence interval 3.307-13.907, P < .001). In the 158 matched patients, PONV occurred in 66 (83.5%) patients exposed to GLP-1RAs preoperatively and 48 (60.8%) matched patients not exposed to GLP-1RAs (adjusted odds ratio 3.830, 95% confidence interval 1.461-10.036, P = .006). Subgroup analysis by dosage forms and doses revealed a positive association between greater doses and an increased risk of PONV after LSG for both once-daily and once-weekly formulations., Conclusions: Preoperative exposure to GLP-1RAs is associated with an increased risk of PONV in patients undergoing LSG, particularly at higher doses of exposure., Competing Interests: Disclosures The authors have no commercial associations that might be a conflict of interest in relation to this article., (Copyright © 2024 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Mastectomy with immediate reconstruction is a high-risk cohort for postoperative nausea and vomiting (PONV). Known risk factors for PONV include female gender, prior PONV history, nonsmoker, age < 50, and postoperative opioid exposure. The objective of this observational, cohort analysis was to determine whether a standardized preoperative protocol with nonopioid and anti-nausea multimodal medications would reduce the odds of PONV. After IRB approval, retrospective data were collected for patients undergoing mastectomy with or without a nodal resection, and immediate subpectoral tissue expander or implant reconstruction. Patients were grouped based on treatment: those receiving the protocol - oral a cetaminophen, p regabalin, c elecoxib, and transdermal s copolamine (APCS); those receiving none (NONE), and those receiving partial protocol (OTHER). Logistic regression models were used to compare PONV among treatment groups, adjusting for patient and procedural variables. Among 305 cases, the mean age was 47 years (21–74), with 64% undergoing a bilateral procedure and 85% having had a concomitant nodal procedure. A total of 44.6% received APCS, 30.8% received OTHER, and 24.6% received NONE. The APCS group had the lowest rate of PONV (40%), followed by OTHER (47%), and NONE (59%). Adjusting for known preoperative variables, the odds of PONV were significantly lower in the APCS group versus the NONE group (OR=0.42, 95% CI: 0.20, 0.88 p = 0.016). Premedication with a relatively inexpensive combination of oral non-opioids and an anti-nausea medication was associated with a significant reduction in PONV in a high-risk cohort. Use of a standardized protocol can lead to improved care while optimizing the patient experience. [ABSTRACT FROM AUTHOR]

Background: Oral Dopmeridone is a prokinetic drug that enhance gastric emtptying, which has a positive effect in decreasing the gastric residual volume, subsequently decreasing the risk of pulmonary aspiration Aim of the Work: This study to aimed to assess the effect of oral Domperidone preoperatively on gastric residual volume by ultrasound for patients undergoing elective surgeries under general anesthesia as a primary outcome and postoperative nausea and vomiting as a secondary outcome. Patients and Methods: We applied our study on 40 patients were divided into two equal groups: Group A (study group): The patients received 400 ml of apple juice as a clear fluid, two hours preoperatively, and oral Domperidone tab (Motilium 10mg/tab, Janssen comp.) & Group B (control group): The patients received 400 ml of apple juice as a clear fluid two hours preoperatively with a placebo (Folic acid 500mcg, dietary supplement), with the same inclusion and exclusion criteria. Results: There was statistically significant decrease mean in group A compared to group B according to Ultrasound Measurements in the right lateral position after 2 hrs has been demonstrated about D1 right lateral position; D2 right lateral position; CSA right lateral position and calculated gastric volume right lateral position (ml). In addition to a statistically significant decrease mean in after 2hrs. compared to after 1hr. according to Ultrasound Measurements in the right lateral position about D1 right lateral position; D2 right lateral position; CSA right lateral position and Calculated gastric volume right lateral position (mL) in group A. There is also a statistically significant decrease mean in after 2hrs. compared to after 1hr. according to Ultrasound Measurements in the right lateral position about D1 semi-sitting; D2 right lateral; CSA right lateral position and Calculated gastric volume right lateral position (mL) in group B. At last, there has been a statistically significant higher change (after 2hrs.-1hr.) in group A compared to group B according to Ultrasound Measurements in the right lateral position about D1 right lateral position; D2 right lateral position; CSA right lateral position and Calculated gastric volume right lateral position (mL), with p-value (p < 0.05 significant). Conclusion: Preoperative oral Domperidone intake was able to decrease the GRV measured by ultrasound, more than the decrease of GRV by applying placebo. [ABSTRACT FROM AUTHOR]

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.

Background: Patients undergoing painless egg retrieval are prone to preoperative anxiety, and whether preoperative anxiety induces postoperative nausea and vomiting (PONV) is debated. The primary objective of this prospective, randomized, controlled study was to compare the clinical effect of ondansetron in preventing PONV for patients with and without preoperative anxiety. The secondary objective was to investigate whether preoperative anxiety was associated with PONV., Methods: The self-rating anxiety scale (SAS) was used to assess the anxiety patients undergoing painless egg retrieval. Patients with a SAS standard score of 50-60 were selected to the anxiety group (n=105); and patients with a SAS standard score of 25-35 were assigned to the non-anxiety group (n=104). Venous blood samples of both groups of patients were obtained during admission and 1 hour after surgery, and all serotonin (5-HT) levels were tested using an enzyme-linked immunosorbent assay. The anxiety group was then randomly assigned into two subgroups: ondansetron (AO group, n=53) and placebo saline (AS group, n=52). Similarly, patients in the non-anxiety group were also randomly assigned to one of two subgroups: ondansetron (NO group, n=51) and placebo saline (NS group, n=53). The AO and NO groups received 8 mg (4 mL) of intravenous ondansetron 15 minutes before surgery, while the AS and NS groups received an equivalent volume (4 mL) of normal saline. We then analyzed the vital signs, risk factors for nausea and vomiting, intraoperative anesthetic doses, incidences of nausea and vomiting in 24 hours after surgery, serum 5-HT level before and after surgery, other adverse responses, pain scores, and satisfaction., Results: A total of 200 patients eventually completed this study. The serum 5-HT values in the anxiety group were higher before and after surgery than in the non-anxiety group (P<0.05), but there was no significant difference in serum 5-HT before and after surgery in the same group (P>0.05). The incidence of PONV was more significant in the AS group than in the NS group (P<0.05). The incidence of PONV was also higher in the AS group than in the AO group (P<0.05). Still, there was no statistically significant difference between the NO and NS groups (P>0.05). There were no significant differences between the four groups in vital signs, risk factors for nausea and vomiting, intraoperative anesthetic doses, other adverse responses and pain scores (P>0.05). Patients in the AS group had lower satisfaction scores than those in the other three groups (P<0.05)., Conclusions: Patients experiencing preoperative anxiety have a greater risk of PONV following painless egg retrieval compared to those without preoperative anxiety. Ondansetron can reduce the occurrence of PONV in patients with preoperative anxiety, but it has no discernible preventative effect in non-anxious patients., Trial Registration: Chinese Clinical Trial Registry ChiCTR2400079504., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-24-175/coif). A.K. has received honoraria for lecturing from CSL Behring GmbH (Switzerland) and advisory honoraria from Astrazeneca (Switzerland) and Pharmacosmos (Switzerland). The other authors have no conflicts of interest to declare., (2024 Gland Surgery. All rights reserved.)

Background: Postoperative nausea and vomiting (PONV) is one of the most frequent complications following strabismus surgery. Penehyclidine, an anticholinergic agent, is widely used as premedication. This study investigated the effect of preoperative penehyclidine on PONV in patients undergoing strabismus surgery. Methods: In this prospective, randomized, double-blind study, patients scheduled for strabismus surgery under general anesthesia were randomly assigned to either penehyclidine (n = 114) or normal saline (n = 104) group. Penehyclidine was administrated immediately after anesthesia induction, and normal saline was substituted as control. PONV was investigated from 0 to 48 h after surgery. Intraoperative oculocardiac reflex (OCR) was also recorded. Results: Compared with normal saline, penehyclidine significantly reduced PONV incidence (30.7% vs. 54.8%, P < 0.01) and mitigated PONV severity as indicated by severity scoring (P < 0.01). Compared with normal saline, penehyclidine also significantly reduced OCR incidence (57.9% vs. 77.9%, P < 0.01) and mitigated OCR severity, as indicated by the requirement for atropine rescue (77.3% vs. 90.1%, P < 0.05) and the maximum decrease of heart rate during OCR (23.1 ± 9.4 bpm vs. 27.3 ± 12.4 bpm, P < 0.05). The recovery course did not differ between groups. Conclusions: Penehyclidine administrated after anesthesia induction significantly reduced the incidence of PONV and alleviated intraoperative OCR in patients undergoing strabismus surgery. Trial registration: ClinicalTrials.gov (NCT04054479). Retrospectively registered August 13, 2019. [ABSTRACT FROM AUTHOR]

Background: Infratentorial craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). Enhanced Recovery After Surgery (ERAS) protocols have been shown in multiple surgical disciplines to improve outcomes, including reduced PONV. However, very few studies have described the application of ERAS to infratentorial craniotomy. The aim of this study was to examine whether our ERAS protocol for infratentorial craniotomy could improve PONV. Methods: We implemented an evidence-based, multimodal ERAS protocol for patients undergoing infratentorial craniotomy. A total of 105 patients who underwent infratentorial craniotomy were randomized into either the ERAS group (n = 50) or the control group (n = 55). Primary outcomes were the incidence of vomiting, nausea score, and use of rescue antiemetic during the first 72 h after surgery. Secondary outcomes included postoperative anxiety level, sleep quality, and complications. Results: Over the entire 72 h post-craniotomy observation period, the cumulative incidence of vomiting was significantly lower in the ERAS group than in the control group. Meanwhile, the incidence of vomiting was significantly lower in the ERAS group on postoperative days (PODs) 2 and 3. Notably, the proportion of patients with mild nausea (VAS 0–4) was higher in the ERAS group as compared to the control group on PODs 2 or 3. Additionally, the postoperative anxiety level and quality of sleep were significantly better in the ERAS group. Conclusion: Successful implementation of our ERAS protocol in infratentorial craniotomy patients could attenuate postoperative anxiety, improve sleep quality, and reduce the incidence of PONV, without increasing the rate of postoperative complications. Trial registration: ChiCTR-INR-16009662, 27 Oct 2016, Clinical study on the development and efficacy evaluation of Enhanced Recovery After Surgery (ERAS) in Neurosurgery. [ABSTRACT FROM AUTHOR]

Postoperative nausea and vomiting (PONV) and post-discharge nausea and vomiting (PDNV) are frequent unpleasant complaints that patients and clinicians report after surgery. PONV and PDNV have been associated with postoperative complications and hospital discharge delays. Despite the extensive evidence describing the use of several regimens in different surgical populations, the ideal regimen has not been established. Several antiemetic drugs have been evaluated in more than 1000 clinical controlled trials for management of this complex emetogenic pathway, including the 5-hydroxytryptamine (5-HT3) receptor antagonists, dopamine receptor antagonists, neurokinin-type receptor antagonists, antihistaminics, anticholinergics, and corticosteroids, with the 5-HT3 receptor antagonists being the most commonly used for PONV prophylaxis. Because of the complex emetogenic pathway and multifactorial etiology of PONV, a multimodal approach using two or more drugs that act at different neuro-receptor sites is suggested in patients with one or more risk factors to successfully address PONV and reduce its incidence. Nevertheless, the most studied regimens in randomized clinical trials (RCTs) are the combination of serotonin 5-HT3 receptor antagonists with dexamethasone or dopamine receptor antagonists (droperidol). Therefore, the safest and more effective combination regimen appears to be the use of serotonin 5-HT3 receptor antagonist antiemetic drugs with dexamethasone. [ABSTRACT FROM AUTHOR]

Background: Infratentorial craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). Enhanced Recovery After Surgery (ERAS) protocols have been shown in multiple surgical disciplines to improve outcomes, including reduced PONV. However, very few studies have described the application of ERAS to infratentorial craniotomy. The aim of this study was to examine whether our ERAS protocol for infratentorial craniotomy could improve PONV.Methods: We implemented an evidence-based, multimodal ERAS protocol for patients undergoing infratentorial craniotomy. A total of 105 patients who underwent infratentorial craniotomy were randomized into either the ERAS group (n = 50) or the control group (n = 55). Primary outcomes were the incidence of vomiting, nausea score, and use of rescue antiemetic during the first 72 h after surgery. Secondary outcomes included postoperative anxiety level, sleep quality, and complications.Results: Over the entire 72 h post-craniotomy observation period, the cumulative incidence of vomiting was significantly lower in the ERAS group than in the control group. Meanwhile, the incidence of vomiting was significantly lower in the ERAS group on postoperative days (PODs) 2 and 3. Notably, the proportion of patients with mild nausea (VAS 0-4) was higher in the ERAS group as compared to the control group on PODs 2 or 3. Additionally, the postoperative anxiety level and quality of sleep were significantly better in the ERAS group.Conclusion: Successful implementation of our ERAS protocol in infratentorial craniotomy patients could attenuate postoperative anxiety, improve sleep quality, and reduce the incidence of PONV, without increasing the rate of postoperative complications.Trial Registration: ChiCTR-INR-16009662, 27 Oct 2016, Clinical study on the development and efficacy evaluation of Enhanced Recovery After Surgery (ERAS) in Neurosurgery. [ABSTRACT FROM AUTHOR]

Vitreoretinal surgeries require the administration of general anesthesia (GA) in selected groups of patients. The administration of intraoperative rescue narcotic analgesia (IRNA) during GA poses the risk of postoperative nausea and vomiting (PONV). The surgical pleth index (SPI), a crucial component of the adequacy of anesthesia (AoA) guidance of GA, optimizes the intraoperative titration of IRNA. The current analysis evaluated the risk factors for the occurrence of PONV and the oculo-cardiac reflex (OCR) in patients undergoing pars plana vitrectomy (PPV) under AoA guidance. In total, 175 patients undergoing PPV were randomly allocated to receive either GA with SPI-guided IRNA administration using fentanyl alone or in addition to different preoperative analgesia techniques. Any incidence of PONV or OCR was recorded. Obesity, overweight, smoking status, motion sickness, postoperative intolerable pain perception, female gender, fluid challenge and arterial hypertension did not correlate with an increased incidence of PONV or OCR under AoA guidance. Diabetes mellitus, regardless of insulin dependence, was found to correlate with the increased incidence of PONV. The AoA regimen including SPI guidance of IRNA presumably created similar conditions for individual subjects, so no risk factors of the occurrence of PONV or OCR were found, except for diabetes mellitus. We recommend using AoA guidance for GA administration to reduce OCR and PONV rates.

Abstract Background Successful breastfeeding is a goal set forth by the World Health Organization to improve neonatal care. Increasingly, patients express the desire to breastfeed, and clinicians should facilitate successful breastfeeding. The primary aim of this study is to determine if postoperative nausea and vomiting (PONV) or postoperative pain are associated with decreased breastfeeding success after cesarean delivery. Methods This is a historical cohort study using the Stony Brook Elective Cesarean Delivery Database. Self-reported breastfeeding success at 4 weeks postoperative was analyzed for associations with postoperative antiemetic use and postoperative pain scores. Breastfeeding success was also analyzed for associations with patient factors and anesthetic medications. Results Overall, 86% of patients (n = 81) who intended on breastfeeding reported breastfeeding success. Breastfeeding success was not associated with postoperative nausea or vomiting as measured by post anesthesia care unit antiemetic use (15% use in successful vs. 18% use in unsuccessful, p = 0.67) or 48-h antiemetic use (28% use in successful group vs 36% use in unsuccessful group, p = 0.732). Pain visual analog scale scores at 6, 12 and 24 h postoperatively were not significantly different between patients with or without breastfeeding success. Breastfeeding success was associated with having had at least 1 previous child (86% vs 36%, p

Abstract Background As a drug originally introduced for its anticonvulsant effects, gabapentin has been recently shown to be effective in the treatment of nausea and vomiting in various clinical settings. This study compared the antiemetic efficacy of oral gabapentin, intravenous ramosetron and gabapentin plus ramosetron in patients receiving fentanyl-based patient-controlled analgesia after laparoscopic gynecologic surgery. Methods One hundred and thirty two patients undergoing laparoscopic gynecologic surgery under general anesthesia were allocated randomly into three groups: group G received 300 mg oral gabapentin 1 h before anesthesia, group R received 0.3 mg intravenous ramosetron at the end of surgery, and group GR received a combination of 300 mg oral gabapentin 1 h before anesthesia and 0.3 mg intravenous ramosetron at the end of surgery. Postoperative nausea, retching, vomiting, rescue antiemetic drug use, pain, rescue analgesic requirements and adverse effects were assessed at 0–2, 2–24 and 24–48 h after surgery. Postoperative nausea and vomiting (PONV) was defined as the presence of nausea, retching or vomiting. Results The incidence of complete response (no PONV and no rescue antiemetics up to 48 h postoperatively) was significantly higher in group GR (26/40, 65%) than group G (16/40, 40%; P = 0.025) and group R (18/44, 41%; P = 0.027), whereas there was no significant difference between group G and group R (P = 0.932). There were no significant between-group differences in the incidence of emetic episodes, use of rescue antiemetics, severe emesis, use of rescue analgesics or any adverse effects. Postoperative pain scores were also similar among groups. Conclusions The combination with gabapentin and ramosetron is superior to either drug alone for prevention of PONV after laparoscopic gynecologic surgery. Trial registration ClinicalTrials.gov NCT02617121 , registered November 25, 2015.

Study Objective: Postoperative delirium (POD) is a common neurological system disorder in surgical patients. Anesthesia providers have a wide choice of sedative agents involving different mechanisms in clinical practice, and the incidence of POD varies regarding which sedative agent administered. This network meta-analysis aimed to comprehensively analyze the safety and efficacy of each choice for patients.Design: A network meta-analysis.Setting: Vanderbilt University Medical Center.Measurements: We searched PubMed, EMBASE, Ovid Medline and Cochrane Central Register of Controlled Trials (CENTRAL) through the end of September 2018 with the registration number CRD42018110585. The randomized controlled trials were identified and extracted by two reviewers independently. Commonly used sedative agents such as placebo, sevoflurane, desflurane, isoflurane, dexmedetomidine, propofol, midazolam, and ketamine were assessed in this network meta-analysis and the primary outcome was the incidence of POD. The data were synthesized by network meta-analysis. Pair-wise meta-analyses were conducted using the random-effects model. Each intervention was ranked according to its corresponding surface under the cumulative ranking curve (SUCRA) values. The GRADE framework was undertaken to evaluate the risk of bias.Main Results: We identified 39 RCTs and 5991 patients in this meta-analysis. Dexmedetomidine was found to be the most effective option in reducing POD, compared to midazolam, propofol, desflurane, and sevoflurane. The results revealed that dexmedetomidine was associated with a lower incidence of POD, whereas midazolam was associated with a significantly higher number of patients with delirium. Midazolam and propofol were also associated with a higher incidence of perioperative hypotension and bradycardia.Conclusion: Our study provided meta-analytic evidence and suggested dexmedetomidine could be considered as the most effective sedative agent to reduce POD. However, clinical practitioners still need to weigh the pros and cons before choosing a sedative agent for individual patient. [ABSTRACT FROM AUTHOR]

Dexamethasone is a synthetic steroid that has been used for many years in the clinical routine due to its anti-inflammatory, anti-allergic and immunosuppressive properties. Furthermore, dexamethasone has been used for a long time for prophylaxis and treatment of chemotherapy-induced nausea and vomiting. In the meantime dexamethasone has been approved as standard for the prophylaxis and treatment of postoperative nausea and vomiting (PONV). This review article outlines the indications and side effects of the perioperative administration of dexamethasone. [ABSTRACT FROM AUTHOR]

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In patients undergoing colonoscopy procedures (CPs), inadequate dosing of hypnotic drugs (HD) and opioid analgesics (OA) during intravenous sedoanalgesia (ISA) may lead to intraprocedural awareness with recall (IAwR), intraprocedural (IPP) and postprocedural pain (PPP), as well as postoperative nausea and vomiting (PONV). The aim of this study was to evaluate whether the titration of HD and OA based on the observance of changing values of state entropy (SE) and surgical pleth index (SPI) (adequacy of anesthesia—AoA), state entropy alone, or standard practice may reduce the number of adverse events. One hundred and fifty-eight patients were included in the final analysis. The rate of IAwR and IPP was statistically more frequent in patients from the C group in comparison with the AoA and SE groups (p < 0.01 and p < 0.05, respectively). In turn, the rate of PPP, PONV, and patients’ and operators’ satisfaction with ISA between groups was not statistically significant (p > 0.05). Changes in hemodynamic parameters, demand for HD, and OA were statistically significant, but of no clinical value. In patients undergoing CPs under ISA using propofol and FNT, as compared to standard practice, intraprocedural SE monitoring reduced the rate of IAwR and IPP, with no influence on the rate of PPP, PONV, or patients’ and endoscopists’ satisfaction. AoA guidance on propofol and FNT titration, as compared to SE monitoring only, did not reduce the occurrence of the aforementioned studied parameters, imposing an unnecessary extra cost.