Effect of preoperative hydration on postoperative nausea and vomiting

Postoperative nausea and vomiting [PONV] remains one of the most common postoperative complications, causing discomfort, patient dissatisfaction, delayed discharge and increased costs. Our aim: Was to determine whether preoperative IV rehydration with a balanced salt solution would decrease the incidence of PONV in patients at increased risk for these symptoms. Sixty female patients [physical status ASA class I and II] presenting for laparoscopic cholecystectomy were included in the study and were instructed to fast from the previous midnight. Patients were randomly assigned to either a control group [group 1] or a high infusion group [group 2] according to the volume of fluid infused preoperatively. Patients of control group [group 1] didn't receive pre-operative fluid bolus, whereas patients of the high infusion group [group 2] received pre-operative fluid bolus of Ringer's solution in a volume of 1.5 mL kg[-1] h[-1] of fasting time. This volume was completely administered in group 2 before induction of anesthesia, over approximately 30 min, in the preoperative holding area. The incidence of PONV, was assessed by a blinded investigator during the stay in post anesthesia care unite [PACU], and at 6, 12 and after 24 hrs postoperatively. Post-operative adverse effects [thirst, pain and drowsiness], and the need for supplemental antiemetic and analgesic therapy were also recorded during stay in PACU and for 24 hrs. The incidence of PONV and the need for anti-emetics were significantly reduced in the high volume infusion group at all time intervals. The high volume infusion group also had decreased postoperative thirst, drowsiness, and pain scores and required less supplemental analgesia. Preoperative hydration effectively reduces the incidence of PONV, antiemetic and analgesic requirements in patients with increased risk of PONV

Comparison between fibreoptic and blind nasotracheal intubation criteria in awake surgical patients

This work was designed to compare the applicability of awake blind nasal and that of fibreopiic nasotacheal intubation in thirty adult sedated patients [ASA I and It] in whom the trachea planned to be intubated nasally. They were scheduled for elective oral or maxillofacial surgery under general anaethesia. They were randomly assigned into two equal groups according to the method used for intubation [n=15per group]. After complete airway block, group [I] patients were intubated using blind nasal technique, while group [II] patients were intubated using fibreoptic technique. Twelve patients were intubated at first attempt, two at second and one patient at third attempt in blind nasal group, while eleven intubated at first, three at second and one at third attempt in the fibreoptic group. These differences were insignificant. The mean time required for successful intubation was significantly less in blind nasal group [83.1 +/- 12.5] seconds than in fibreoptic group [97.5 +/- 17.1] seconds. Also, success rate, heamodynamic changes and adverse events were comparable in both groups. in conclusion: this study showed that blind nasal and fibreoptic nasotracheal intubation are valuable techniques in awake sedated patients. There was no significant difference between the success rate of both techniques. Blind nasal intubation under topical anesthesia may provide an alternative safe method in cases of anticipated difficult intubation, particulariy if fibreoptic bronchoscope is not available or failed to pass through the glottis as the view is obscured by blood and/or secretions

Propacetamol versus placebo for management of acute postoperative pain after elective tonsillectomy in children

The analgesic efficacy and safety of propacetamol, an injectabie prodrug of acetaminophen, was assessed versus placebo after elective tonsillectomy operation in children. Using a double-blind, randomized parallel group design, 70 children aged 6-12 years were included to evaluate the effect of a single iv infusion of 40 mg/kg propacetamol versus a single infusion of 100 ml normal saline [placebo] given at the recovery room. Analgesic efficacy was assessed on pain scores rated on a four-points verbal scale, a five-points visual scale [faces] and a four-points pain relief verbal scale; before administration [TO] and 0.25, 0.5, 1, 2, 3, 4, 5 and 6 hours after the infusion. The global efficacy was rated on a five-point scale at the end of the study. Rescue medication was allowed freely and the time for re-medication as well as the occurrence of any side effects was recorded. Propacetamol was statistically superior to placebo on all assessment criteria. The global final efficacy evaluation demonstrated 12 patients in the propacetamol group with good and very good scores compared to only one patient in the placebo group. Rescue medication was used in 40% of patients in the propacetamo! group versus 83% in the placebo group. No serious side effects were recorded in both groups and pain at the infusion arm was noticed in 4 patients with propacetamol and 2 patients in the placebo group [P> 0.05]. We concluded that, although propacetamol 40 mg/kg infusion may provide greater pain relief than placebo in children after tonsillectomy operation without any significant adverse effects, it is better to be used as a complementary drug to other analgesics in the treatment of moderate to severe postoperative pain

addition of dexmedetomidine to lidocaine improves the quality of intravenous regional anesthesia block

The addition of alpha [2]-adrenoceptor agonists to local anesthetic solutions provides better analgesic properties when used for local, spinal, epidural or peripheral blocks. The present study was designed to test the hypothesis that the addition of dexmedetomidine ['highly selective and specific alpha[2]-adrenoceptor agonist] may improve the quality of IV regional anesthesia block during upper extremities surgery. Forty adult patients assigned for carpal tunnel decompression under regional IV anesthesia, were allocated randomly in a double blind, randomised study to receive 40 ml of 0.5% lidocaine solution and either 1 ml of normal soline or 100 micro g dexmedetmoidine [Precedex-Abbot] as 1ml solution. Pain at tourniquet site as well as surgical site was rated on a visual analogue scale [VAS], and a verbal rating scale [VRS] every 15 min during tourniquet placement and every 15 minute for 1 hour after tourniquet deflation. Sedation score, arterial blood pressure heart rate, arterial O[2] saturation and the duration of postoperative analgesia were also recorded. VAS and VRS scores were significantly lower in the precedex group 15, 30 and 45 minutes after tourniquet inflation at both surgical and tourniquet sites. Also it was significantly lower in the precedex group at surgical site after tourniquet deflation. There was no significant difference between both groups as regards the duration of tolerance of distal tourniquet, arterial blood pressure, O[2] saturation as well as sedation scores. The duration of postoperative analgesia was significantly longer in the precedex group. We concluded that dexmedetomidine improves the quality of regional IV block when added to lidocaine solution: it decreases tourniquet pain, increases analgesia at surgical site and prolongs the duration of postoperative analgesia, without any significant systemic side effects

Effect of preoperative ondansetron on postoperative patient controlled tramadol consumption

Tramadol is an atypical Opioid. It has a dual mechanism of action. The first mechanism is through its weak affinity to opioid receptors with some selectivity for mu-receptors and is produced mainly by its Ml- metabolite. The other mechanism relates to increased central synaptic levels of noradrenaline and serotonin, both are transmitters in the descending pathways that ensure analgesia. Both pharmacokinetic and pharmacodynamic interactions have been hypothsized between tramadol and the antiemetic Ondansetron. Ondansetron competes with tramadol for the Cytochrome P450-2D6 and therefore reduces its M1-metabolite. Ondansetron also blocks 5HT3 receptors, which partially contribute to tramadol analgesia. The aim of this study was to find out the clinical effect of preoperative prophylactic ondansetron administration on postoperative tramadol PCA demand. Sixty patients ASA I or II undergoing orthopedic surgery were studied. Patients were randomly allocated to receive either Ondansetron 4mg slowly IV at time of induction of anaesthesia or placebo. Intravenous Tramadol PCA was used for 24 hours postoperatively in both groups [Loading dose =1 mg/ kg., On-demand bolus = 20 mg. Lock-out interval = 10 minutes and total 4 hours dose limit =400 mg]. Tramadol consumption was recorded at I, 2, 4, 8, 12 and 24 hours following initiation of PCA. The incidence of postoperative nausea and vomiting was registered. The total 24 hours tramadol consumption in the ondansetron group was significantly higher than in the placebo group [612 +/- 72 versus 472 +/- 129.5 mg]. This higher consumption of tramadol occurred mainly during the first 4 hours, then the tramadol consumption was nearly similar in both groups after that. The overall incidence of nausea and vomiting was not significantly different between both groups [50% versus 40%]. A single prophylactic dose of ondansetron given at the time of induction of anaesthesia will increase the postoperative analgesic consumption of tramadol and does not reduce the incidence of PONV

Effect of preoperative hydration on postoperative nausea and vomiting

This study was carried out on 80 patients scheduled for laparoscopic gynaecological or surgical operations. Our aim was to assess the effect of preoperative hydration on the incidence of postoperative nausea and vomiting after laparoscopic surgery. Our patients were scheduled into two groups [40 patients each] according to the volume of preoperative fluid infused. In the control group, patients received 2ml/kg Lactated Ringer solution, where in the high infusion group, patients received 20ml/kg Lactated Ringer solution 30 min before induction of anaesthesia in the preoperative area. In the postoperative period, the episodes of nausea and vomiting were recorded during stay in the recovery room, 2h later, and after 24h. Also the number of patients who required anti-emetics or the occurrence of any adverse effects [thirst and drowsiness] was recorded. Our results showed a less incidence of postoperative nausea, vomiting and adverse effects in the high infusion group compared to the control group. We concluded that supplemental preoperative fluid load reduce the incidence of postoperative adverse clinical outcome such as nausea, vomiting, thirst, and drowsiness