The Effect of Anesthetics and Opioids for Postoperative Nausea and Vomiting in General Anesthesia

BACKGROUND: A number of anesthetic factors may influence the risk of postoperative nausea and vomiting (PONV) throughout various mechanisms. This study analyzed the effect of different anesthetics and opioids with regards to PONV. METHODS: Ninety ASA physical status 1 and 2 patients, who were scheduled for minor orthopedic or plastic surgery, were randomly assigned for three groups to receive either propofol-fentanyl (Group PF), propofol-femifentanil (Group PR) or sevoflurane-fentanyl (Group SF). Anesthesia was induced with propofol or pentothal sodium, rocuronium and fentanyl (2microg/kg) or remifentanil (1microg/kg). Anesthesia was maintained with BIS (bispectral index) value in the range of 40-60 and blood pressure and heart rate within 20% of baseline. The incidence and severity score of PONV, the administration of metoclopramide, visual analogue scale (VAS) for pain were assessed at 2, 12, 24 hours postoperatively. RESULTS: The incidence of PONV in SF group was significantly higher than in PF and PR group during 0-2 hours period (P < 0.05). The incidence of PONV in SF and PF group was significantly higher than in PR group during 2-12 h period (P < 0.05). There were no significant differences among the groups in gender, the administration of antiemetics and postoperative VAS. CONCLUSIONS: With propofol based anesthesia, short-cting remifentanil resulted in a lower incidence of PONV during 2-12 h period than fentanyl. Propofol-fentanyl anesthesia decreases the incidence of PONV compared with sevoflurane-entanyl during 0-2 hours postoperatively.

Rupture of Thoracic Empyema for Femur Neck Fracture Surgery under Combined Spinal-Epidural Anesthesia: A case report / 대한마취과학회지

Thoracic empyema can result from the pleural accumulation of infected fluid or the infection of accumulated pleural fluid. The causes of empyema are pneumonia, surgery of lung, mediastinum, diaphragm, trauma, and so on. The impact of anesthetic technique (regional versus general versus combination of both) on the respiratory complication rate has not been established. A 86-yr-old male patient, who had COPD about 15 years and chronic empyema for several months, scheduled to operation for a femur neck fracture. We report a case that this patient with COPD and empyema operated under combined spinal-epidural anesthesia and converted to general anesthesia because of the rupture of the chronic empyema.