Current Issue : October-December Volume : 2025 Issue Number : 4 Articles : 5 Articles
Background Validating postoperative nausea and vomiting (PONV) severity based on antiemetics prescription can help actively manage PONV by the Rhodes Index of Nausea, Vomiting, and Retching (RINVR) scale but is relatively complicated. This study aims to validate the RINVR scale on PONV intensity with prescribed antiemetics usage, and further simplify and validate this scale to serve as the simplified PONV severity score (SPONVSS) and its effects on sleep quality and vitality. Methods This study analyzed data from patients who underwent anesthesia with sleep and vitality reports after surgery. We assessed the PONV severity by RINVR. We also simplified the RINVR score with one element selected from each dimension of PONV. The RINVR score and all 18 simplified combinations were validated with antiemetic usage. These scores were used to study patient-reported sleep quality and vitality. Results The AUC of the RINVR score and 18 combinations have a similar high impact on antiemetics administration, sleep, and vitality. Nausea frequency, vomiting, and retching times were chosen as the SPONVSS elements because of overall high AUC and convenience in implementation. Multivariate logistic regression analyses show that besides pain, the SPONVSS score provides a significant impact on postoperative sleep and vitality. Conclusions We developed a simple and practical scale to monitor PONV intensity in a broad clinical surgical setting. A high SPONVSS score (≥ 3) is an independent risk for rescue antiemesis, poor sleep quality, and vitality. This scale will be useful to monitor the postoperative care quality and improve postoperative care....
Background Nerve blocks are effective in reducing postoperative opioid use and enhancing rehabilitation following total knee arthroplasty. However, few studies compare the analgesic efficacy and functional recovery of adductor canal block (ACB) combined with infiltration between the popliteal artery and the capsule of the knee (iPACK) versus sciatic and femoral nerve blocks (S + F). This study hypothesized that ACB combined with iPACK (A + I) provides comparable analgesia to S + F with superior motor recovery. Methods Data were obtained from a prospectively maintained acute pain service database. After exclusion criteria were applied, 126 patients were analyzed. Propensity-score matching balanced baseline characteristics between the A + I and S + F groups. Numeric rating scale (NRS) scores at different time points were primary outcome. Motor function analysis, including the motor blockade, maximum flexion angle and time to ambulation were secondary outcomes. Results After propensity score matching, patients in the A + I group reported significantly lower NRS pain scores in the post-anesthetic care unit (1.00 ± 0.72 vs. 1.52 ± 1.34; P = 0.026) and on postoperative day 1 at rest (0.66 ± 0.71 vs. 1.07 ± 0.95; P = 0.025) and during movement (1.75 ± 0.75 vs. 2.43 ± 1.19; P = 0.002). Movement-associated pain on postoperative day 2 was also lower in the A + I group (1.45 ± 0.66 vs. 2.34 ± 0.91; P < 0.001). The A + I group exhibited significantly less motor blockade (P < 0.001) and achieved earlier ambulation (1551.75 ± 379.98 vs. 2031.95 ± 764.77 min; P < 0.001). Conclusions The A + I regimen demonstrated superior analgesic efficacy, reduced motor blockade, and earlier ambulation compared to S + F in TKA patients. These findings support the use of A + I for improved recovery....
Background/Objectives: Postoperative delirium has not been well explored in patients undergoing elective hip and knee arthroplasty. This study assessed the incidence of delirium in these patients in the postanesthetic care unit (PACU) and throughout their hospital admission. Predictors of postoperative delirium and impact of delirium on length of stay were also analyzed. Methods: This prospective observational study recruited patients (n = 978) with normal cognitive function presenting for elective primary hip or knee arthroplasty at a single tertiary academic center. Delirium was assessed using the Nursing Delirium Scoring Scale (NuDESC) in the PACU, and twice daily after that on postoperative days 1, 2 and 3, or until discharge, whichever came first. Results: In total, 26 (2.7%) patients developed delirium postoperatively. Unadjusted logistic regression analyses revealed that age; history of cardiovascular, central nervous system, hematologic, endocrinologic, psychiatric disease; postoperative opioid use; and ASA level were associated with an increased risk of delirium, with odds ratios (95% confidence interval) of 1.7 (1.35 to 2.11), 3.6 (1.09 to 12.25), 3.5 (1.53 to 8.03), 2.7 (1.09 to 6.45), 2.3 (1.04 to 4.97), 4.7 (2.10 to 10.70), 0.4 (0.17 to 0.89), and 2.37 (1.05 to 5.33), respectively. A Mann–Whitney U test showed no difference in PACU or hospital length of stay between patients who did and did not have delirium in the PACU (within the first hour). Conclusions: Age, ASA > 3, a history of cardiovascular disease, central nervous system disease, hematologic disease, endocrinologic disease, psychiatric disease and postoperative opioid use are individually associated with postoperative delirium. A future study with an even larger sample size is needed to further evaluate these factors in an adjusted analysis....
Background: Intraoperative nerve monitoring (IONM) is increasingly recognized as an essential technique in thyroid surgery to preserve the integrity of the recurrent laryngeal nerve (RLN) and prevent postoperative complications. Although widely adopted, several technical and anesthetic factors can significantly affect the reliability and interpretation of electromyographic (EMG) signals. Methods: This narrative review summarizes the principles and methodologies of IONM in thyroid surgery, focusing on the mechanisms of RLN injury, the clinical benefits of IONM, and its limitations. Particular emphasis is placed on the anesthesiologic considerations, including the effects of neuromuscular blocking agents and anesthetic maintenance methods for EMG signal quality. Recent advances in alternative IONM techniques are also discussed. Results: IONM facilitates early detection of RLN injury and improves surgical outcomes. However, signal loss and technical errors occur in up to 23% of cases. Appropriate anesthetic management, such as the judicious use of neuromuscular blocking agents and the use of reversal agents like sugammadex, can significantly improve IONM accuracy. Alternative approaches, such as transcutaneous or thyroid cartilage electrode-based monitoring, show promise in overcoming current limitations. Conclusions: IONM is a valuable tool in modern thyroid surgery, aiding in the prevention of RLN injury. Anesthesiologists play a crucial role in optimizing IONM quality by managing factors that affect EMG signals. Ongoing research into novel monitoring techniques is expected to further enhance patient safety and surgical precision....
Objectives: Comparative analyses of anesthetic agents on mutants with altered anesthetic sensitivity remain limited in the current literature. This study examines the sensitivity of various Drosophila melanogaster wild-type strains and mutants to the volatile anesthetics chloroform and isoflurane. We utilized recently identified mutants in ion channel-encoding genes and others historically selected for anesthetic resistance, such as AGAR (autosomal general anesthesia resistant) and har (halothane-resistant). Method: Based on the principles of the conventional inebriometer assay used to isolate these mutants, we developed a new, simpler method to measure the anesthetic response in these flies. Results: Interestingly, we discovered that wild-type flies exhibit varying levels of anesthetic resistance. Contrary to previous reports, AGAR and har mutants showed little resistance to anesthesia using our method. Several ion channel mutants displayed increased resistance or sensitivity. Across all strains, isoflurane was more potent than chloroform. To ensure objectivity, all experiments were conducted double-blind. These findings highlight the variability in anesthetic sensitivity among both wild-type and mutant flies and underscore the importance of assay design in assessing resistance....
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