Current Issue : January - March Volume : 2015 Issue Number : 1 Articles : 8 Articles
Background: Craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). This\nprospective, randomized, double-blind, multi-center study was performed to evaluate the efficacy of prophylactic\nramosetron in preventing PONV compared with ondansetron after elective craniotomy in adult patients.\nMethods: A total of 160 American Society of Anesthesiologists physical status Iââ?¬â??II patients aged 19ââ?¬â??65 years who were\nscheduled to undergo elective craniotomy for various intracranial lesions were enrolled in this study. All patients\nreceived total intravenous anesthesia (TIVA) with propofol and remifentanil. Patients were randomly allocated into\nthree groups to receive ondansetron (4 mg; group A, n = 55), ondansetron (8 mg; group B, n = 54), or ramosetron\n(0.3 mg; group C, n = 51) intravenously at the time of dural closure. The incidence of PONV, the need for rescue\nantiemetics, pain score, patient-controlled analgesia (PCA) consumption, and adverse events were recorded 48 h\npostoperatively.\nResults: Among the initial 160 patients, 127 completed the study and were included in the final analysis. The incidences\nof PONV were lower (nausea, 14% vs. 59% and 41%, respectively; P < 0.001; vomiting, P = 0.048) and the\nincidence of complete response was higher (83% vs. 37% and 59%, respectively; P < 0.001) in group C than in\ngroups A and B at 48 h postoperatively. There were no significant differences in the incidence of PONV or need\nfor rescue antiemetics 0ââ?¬â??2 h postoperatively, but significant differences were observed in the incidence of PONV\nand complete response among the three groups 2ââ?¬â??48 h postoperatively. No statistically significant intergroup\ndifferences were observed in postoperative pain, PCA consumption, or adverse events.\nConclusion: Intravenous administration of ramosetron at 0.3 mg reduced the incidence of PONV and rescue\nantiemetic requirement in craniotomy patients. Ramosetron at 0.3 mg was more effective than ondansetron at 4\nor 8 mg for preventing PONV in adult craniotomy patients....
Background: Robotic-assisted laparoscopic prostatectomy (RALP) gained much popularity during the last decade.\nAlthough the influence of intraoperative fluid management on patients� outcome has been largely discussed in\ngeneral, its impact on perioperative complications and length of hospitalization in patients undergoing RALP has\nnot been examined so far. We hypothesized that a more restrictive fluid management might lead to a shortened\nlength of hospitalization and a decreased rate of complications in our patients.\nMethods: Retrospective analysis of data of 182 patients undergoing RALP at an University Hospital (first series of\nRALP performed at the center).\nResults: The amount of fluid administered was initially normalized for body mass index of the patient and the\nduration of the operation and additionally corrected for age and the interaction of these variables. The application\nof crystalloids (multiple linear regression model, estimate = ?0.044, p = 0.734) had no effect on the length of\nhospitalization, whereas a negative effect was found for colloids (estimate = ?8.317, p = 0.021). Additionally, a\nsignificant interaction term between age and the amount of colloid applied (estimate = 0.129, p = 0.028) was\ncalculated. Evaluation of the influence of intraoperative fluid administration using multiple logistic regression\nmodels corrected for body mass index, duration of the surgery and additionally for age revealed a negative effect\nof crystalloids on the incidence of an anastomotic leak between bladder and urethra (estimate = ?23.860, p = 0.017),\nwith a significant interaction term between age and the amount of crystalloids (estimate = 0.396, p = 0.0134).\nColloids had no significant effect on this particular complication (estimate = 1.887, p = 0.524). Intraoperative blood\nloss did not alter the incidence of an anastomotic leak (estimate = 0.001, p = 0.086), nor did it affect the length of\nhospitalization (estimate = 0.0001, p = 0.351).\nConclusions: In accordance to the findings of our study, we suggest that a standardized, more restrictive fluid\nmanagement might be beneficial in patients undergoing RALP. In older patients this measure would be able to\nshorten the length of hospitalization and to decrease the incidence of anastomosis leakage as a major complication....
Background: Bedside assessment of lung volume in clinical practice is crucial to adapt ventilation strategy. We\ncompared bedside measures of lung volume by helium multiple-breath washout technique (EELVMBW,He) and\neffective lung volume based on capnodynamics (ELV) to those assessed from spiral chest CT scans (EELVCT) under\ndifferent PEEP levels in control and surfactant-depleted lungs.\nMethods: Lung volume was assessed in anaesthetized mechanically ventilated rabbits successively by measuring\ni) ELV by analyzing CO2 elimination traces during the application of periods of 5 consecutive alterations in inspiratory/\nexpiratory ratio (1:2 to 1.5:1), ii) measuring EELVMBW,He by using helium as a tracer gas, and iii) EELVCT from CT scan\nimages by computing the normalized lung density. All measurements were performed at PEEP of 0, 3 and 9 cmH2O in\nrandom order under control condition and following surfactant depletion by whole lung lavage.\nResults: Variables obtained with all techniques followed sensitively the lung volume changes with PEEP. Excellent\ncorrelation and close agreement was observed between EELVMBW,He and EELVCT (r = 0.93, p < 0.0001). ELV\noverestimated EELVMBW,He and EELVCT in normal lungs, whereas this difference was not evidenced following surfactant\ndepletion. These findings resulted in somewhat diminished but still significant correlations between ELV and EELVCT\n(r = 0.58, p < 0.001) or EELVMBW,He (0.76, p < 0.001) and moderate agreements.\nConclusions: Lung volume assessed with bedside techniques allow the monitoring of the changes in the lung\naeration with PEEP both in normal lungs and in a model of acute lung injury. Under stable pulmonary haemodynamic\ncondition, ELV allows continuous lung volume monitoring, whereas EELVMBW,He offers a more accurate estimation, but\nintermittently....
Background: Epidural lipomatosis (EL) is an increase of adipose tissue, normally occurring in the epidural space,\nsufficient to distort the thecal sac and compress neural elements. There is a lack of knowledge of risk factors,\nimpact on patientâ��s symptoms, and its possible association with epidural steroid injections.\nMethods: History, physical examination, patient chart, and MRI were analyzed from 856 outpatients referred for\nepidural steroid injections. Seventy patients with signs of EL on MRI comprised the study group. Thirty-four randomly\nselected patients comprised the control group. The severity of EL was determined by the MRI assessment. The impact\nof EL was determined by the patientâ��s history and physical examination. Logistic regression was used to correlate the\nprobability of developing EL with BMI and epidural steroid injections.\nResults: EL was centered at L5 and S1 segments. The average BMI for patients with EL was significantly greater than\nthat of control group (36.0 �± 0.9 vs. 29.2 �± 0.9, p <0.01). The probability of developing EL with increasing BMI was linear\nup to the BMI of 35 after which it plateaued. Triglycerides were significantly higher for the EL group as compared to\ncontrols (250 �± 30 vs. 186 �± 21 mg/dL p < 0.01). The odds of having EL were 60% after two epidural steroid injections,\n90% after three epidural steroid injections and approached 100% with further injections, independent of BMI. Other risk\nfactors considered included alcohol abuse, use of protease inhibitors, levels of stress, hypothyroidism and genetic\npredisposition. However there were insufficient quantities to determine statistical significance with a degree of\nconfidence. The impact of EL on patientâ��s symptoms correlated with EL severity with Spearman correlation coefficient\nof 0.73 at p < 0.01 significance level.\nConclusions: The BMI and triglycerides levels were found to be significantly elevated for the EL group, pointing\nto an increased risk of EL occurrence in progressively more obese US population. The data also revealed a strong\ncorrelation between the number of subsequent epidural steroid injections and EL occurrence calling for caution\nwith the use of corticosteroids....
Background: Aim of the study was to compare the short-term effects of oxygen therapy via a high-flow nasal\ncannula (HFNC) on functional and subjective respiratory parameters in patients with acute hypoxic respiratory failure\nin comparison to non-invasive ventilation (NIV) and standard treatment via a Venturi mask.\nMethods: Fourteen patients with acute hypoxic respiratory failure were treated with HFNC (FiO2 0.6, gas flow\n55 l/min), NIV (FiO2 0.6, PEEP 5 cm H2O Hg, tidal volume 6ââ?¬â??8 ml/kg ideal body weight,) and Venturi mask (FiO2 0.6,\noxygen flow 15 l/min,) in a randomized order for 30 min each. Data collection included objective respiratory and\ncirculatory parameters as well as a subjective rating of dyspnea and discomfort by the patients on a 10-point scale.\nIn a final interview, all three methods were comparatively evaluated by each patient using a scale from 1 (=very\ngood) to 6 (=failed) and the patients were asked to choose one method for further treatment.\nResults: PaO2 was highest under NIV (129 Ã?± 38 mmHg) compared to HFNC (101 Ã?± 34 mmHg, p <0.01 vs. NIV) and\nVM (85 Ã?± 21 mmHg, p <0.001 vs. NIV, p <0.01 vs. HFNC, ANOVA). All other functional parameters showed no\nrelevant differences. In contrast, dyspnea was significantly better using a HFNC (2.9 Ã?± 2.1, 10-point Borg scale)\ncompared to NIV (5.0 Ã?± 3.3, p <0.05), whereas dyspnea rating under HFNC and VM (3.3 Ã?± 2.3) was not significantly\ndifferent. A similar pattern was found when patients rated their overall discomfort on the 10 point scale: HFNC\n2.7 Ã?± 1.8, VM 3.1 Ã?± 2.8 (ns vs. HFNC), NIV 5.4 Ã?± 3.1 (p <0.05 vs. HFNC). In the final evaluation patients gave the best\nratings to HFNC 2.3 Ã?± 1.4, followed by VM 3.2 Ã?± 1.7 (ns vs. HFNC) and NIV 4.5 Ã?± 1.7 (p <0.01 vs. HFNC and p <0.05\nvs. VM). For further treatment 10 patients chose HFNC, three VM and one NIV.\nConclusions: In hypoxic respiratory failure HFNC offers a good balance between oxygenation and comfort\ncompared to NIV and Venturi mask and seems to be well tolerated by patients....
Background: Postoperative nausea and vomiting (PONV) is one of the most common postsurgical complications.\nPalonosetron, a 5-hydroxytryptamine receptor antagonist, is effective for PONV prevention. Herein, we compared\npalonosetron and aprepitant (a neurokinin-1 receptor antagonist) for PONV prevention in patients indicated for\nlaparoscopic gynaecologic surgery.\nMethods: Ninety-three patients who were scheduled to undergo laparoscopic gynaecologic surgery under general\nanaesthesia were assigned to receive either a single intravenous injection of 0.075-mg palonosetron or 40-mg oral\naprepitant in a double-blind randomised trial. The primary efficacy end points included complete response (visual\nanalogue scale [VAS] nausea score <4 and no use of rescue therapy) 0ââ?¬â??48 h after surgery. Nausea severity (0ââ?¬â??10)\nand use of rescue therapy were monitored for 0ââ?¬â??48 h. The secondary efficacy end points were the effect of\naprepitant quantified using a 10-point VAS for pain, consumption of intravenous patient-controlled analgesia, and\nuse of rescue analgesics.\nResults: Aprepitant was non-inferior to palonosetron in terms of complete response 0ââ?¬â??48 hours after surgery (74%\nvs. 77%). At 0 and 2 h after administration, the nausea severity with 40-mg aprepitant was significantly lesser than\nthat with 0.075-mg palonosetron (P < 0.05). At 6 and 24 h after administration, fentanyl consumption with 40-mg\naprepitant was significantly lower than that with 0.075-mg palonosetron. Greater amounts of rescue analgesics were\nrequired in the aprepitant group.\nConclusions: Palonosetron and aprepitant were both effective for PONV prevention in the patients indicated for\nlaparoscopic gynaecologic surgery. The drugs can be used in combination for multimodal therapy because they\nbind to different receptors. More research is needed to evaluate the effects of aprepitant on pain management\nin humans....
Background: Resective epilepsy surgery is an established and effective method to reduce seizure burden in\ndrug-resistant epilepsy. It was the objective of this study to assess intraoperative blood loss, transfusion\nrequirements and the degree of hypothermia of pediatric epilepsy surgery in our center.\nMethods: Patients were identified by our epilepsy surgery database, and data were collected via retrospective chart\nreview over the past 25 years. Patients up to the age of 6 years were included, and patients with insufficient data\nwere excluded.\nResults: Forty-five patients with an age of 3.2 �± 1.6 (mean �± SD) years and a body weight of 17 [14; 21.5] kg (median\n[25%, 75% percentile]) were analysed. Duration of surgery was 3 h 49 min �± 53 min, which was accompanied by an\nintraoperative blood loss of 150 [90; 300] ml. This corresponded to 11.7 [5.2; 21.4] % of estimated total blood volume,\nranging from 0 to 75%. A minimal haemoglobin count of 8.8 �± 1.4 g/dl was measured, which was substituted with\nerythrocyte concentrate (100 [0; 250] ml) in 23 patients. Body core temperature dropped from 36.0 �± 0.7�°C at baseline\nto a minimum of 35.7 �± 0.7�°C, and increased significantly (p < 0.001) thereafter to 37.1 �± 0.7�°C until the end of surgery.\nA significant (p = 0.0003) correlation between duration of surgery and blood loss (Pearson r = 0.52) was observed.\nHowever, age, minimal body temperature or number of antiepileptic drugs seemed to have no impact on blood loss.\nConclusion: Resective epilepsy surgery is a safe procedure even in the pediatric population, however it is associated\nwith significant blood loss especially during long surgical procedures....
Background: Acute lung injury (ALI) induced by cardiopulmonary bypass (CPB, CPB-ALI) is a common and serious\ncomplication after cardiac surgery. And infants and young children are more prone to CPB-ALI. The purpose of this\nstudy was to investigate the perioperative changes of plasma gelsolin (pGSN) in patients below 3years of age with\ncardiac surgeries and CPB, and determine whether pGSN are associated with the occurrence and severity of\nCPB-ALI.\nMethods: Seventy-seven consecutive patients ?3 years of age with congenital heart diseases (CHD) performed on\nopen heart surgery with CPB were finally enrolled, and assigned to ALI and non-ALI groups according to the\nAmerican-European Consensus Criteria. Plasma concentrations of gelsolin and total protein were measured at\nfollowing 8 time points: before CPB (a), after CPB (b), 2 hours after CPB (c), 6 hours after CPB (d), 12 hours after\nCPB (e), 24 hours after CPB (f), 48 hours after CPB (g) and 72 hours after CPB (h).\nResults: Twenty-seven (35.1%) patients developed CPB-ALI in the study, including eleven (14.3%) patients with\nARDS. The earliest significant drop of pGSN and normalized pGSN (pGSNN) of ALI group both occurred at 6 hours\nafter CPB (p = 0.04 and p < 0.01), which was much earlier than those of non-ALI group (48 hours, p = 0.03 and\n24 hours, p < 0.01); PGSN of ALI group before CPB and 6 hours after CPB were both significantly lower than those\nof non-ALI group (p < 0.01); PGSNN of ALI group before CPB and 6 hours after CPB were both significantly lower\nthan those of non-ALI group (p < 0.01, p = 0.04); PGSN before CPB was the only independent risk factor predicting\nthe occurrence of CPB-ALI (OR, 1.023; 95% CI, 1.007-1.039; p < 0.01) with an AUC of 0.753 (95% CI, 0.626-0.880); The\noptimal cutoff value of pGSN before CPB was 264.2 mg/L, with a sensitivity of 58.3% and a specificity 94.7%. And\nlower pGSN before CPB was significantly associated with the severity of CS-AKI (r = ?0.45, p < 0.01).\nConclusions: Patients developing CPB-ALI had lower plasma gelsolin reservoir and a much more amount and rapid\nconsumption of plasma gelsolin early after operation. PGSN before CPB was an early and sensitive predictor of\nCPB-ALI in infants and young children undergoing cardiac surgery, and was negatively correlated with the\nseverity of CPB-ALI....
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