ABSTRACT
Background: Postoperative nausea and vomiting [PONV] is a well-known entity following surgical procedures and may result in serious complications include aspiration of gastric contents, prolonged recovery period, impaired surgical wound healing. Laparoscopic surgery alone is a known risk factor for PONV and different treatment options with various agents are preferred for PONV prophylaxis and treatment
Aim: We aimed to review advantages and disadvantages of various drugs and combination regimens for prophylaxis and treatment of PONV after different types of laparoscopic procedures
Methodology: We made a comprehensive PubMed search using search terms PONV, laparoscopic surgery, prophylaxis, treatment, drug, without considering publication time period
Findings: Relatively traditional anti-emetics, including anticholinergics, antihistamines and phenothiazines, have more prominent side effect profiles. Using different receptor antagonists [serotonin 5-HT3, neurokinin, dopamine receptor antagonists] especially when combined with agents of same group or from various different groups, e.g. dexamethasone - a strong corticosteroid, naloxone - an opioid receptor antagonist, or propofol - an intravenous anesthetic and hypnotic, effective anti-emesis can be achieved
Conclusion: Combinations of antiemetic agents of different groups is more effective in prevention of postoperative nausea and vomiting
ABSTRACT
Background: Dental treatment procedures in childhood may trigger high levels of anxiety and fear. In these circumstances sedation protocols with different agents serve acceptable, safe and effective treatment environments. We aimed to investigate the better and safer sedation regimen being used in our institution
Methodology: We retrospectively investigated medical and anesthesia reports of 553 children, who underwent dental treatments with different anesthetic agents. Total anesthesia time, intraoperative vital signs [heart rates, peripheral oxygen saturation and arterial blood pressure], perioperative complications including tachycardia, bradycardia, hypo/ hypertension, respiratory depression, bronchospasm, nausea, vomiting, agitation and/or hallucinations were recorded. The results were analyzed by SPSS [version 20.0] using independent T-test, Wilcoxon, Mann-Whitney, and Pearson Chi-square tests as appropriated. Data are expressed as mean + standard deviation or median [25%-75%], [minimum-maximum], or as n [%]
Results: The shortest anesthesia time was recorded with sevoflurane anesthesia while longest was recorded in ketamine IM + ketamine IV + midazolam IM + midazolam IV group [18.88 +/- 9.45 versus 58.57 +/- 17.73 minutes]. There was no recorded side effect in 405 [73.2%] procedures while tachycardia in 114 [20.6%], hypotension or hypertension in 9 [1.6%], respiratory depression in 6 [1.15] patients and bradycardia in 5 [0.9%] patients were recorded. 4 patients [0.7%] were suffered from bronchospasm. Tachycardia was most common in ketamine IM + ketamine IV administered group [n=26, 22.8%]. In contrast there was no recorded tachycardia in patients sevoflurane alone or propofol alone groups [0 patient in both groups]. Postoperative nausea and vomiting rates were lowest in ketofol procedures. Postoperative agitation and hallucination rates were higher in ketofol bolus + ketofol infusion procedure [12.7%]
Conclusion: Sedation with different anesthetics either alone or combined during pediatric dentistry can be accepted as safe and comfortable for both patients and healthcare professionals. We suggest that less complication rates with ketofol regimens noted in this study needs to be investigated in more strongly designed future studies