Incidência e profilaxia de náuseas e vômitos na recuperação pós-anestésica de um hospital-escola terciário / Incidencia y profilaxis de náuseas y vómitos en la recuperación postanestésica de un hospital -escuela terciario / Incidence and prophylaxis of nausea and vomiting in post-anesthetic recovery in a tertiary teaching hospital

JUSTIFICATIVA E OBJETIVOS: Náuseas e vômitos pós-operatórios (NVPO) constituem complicação freqüente e potencialmente grave que aumenta o tempo de recuperação pós-anestésica (RPA) e implica insatisfação dos pacientes. Avaliação do risco para NVPO e instituição de profilaxia visando ao bem-estar dos pacientes e à redução de custos têm sido freqüentes em publicações médicas. Este estudo observacional avaliou a incidência, fatores de risco e adequação e efetividade da profilaxia para NVPO na RPA de um hospital-escola terciário. MÉTODO: As informações obtidas a partir de prontuários e questionários aplicados aos pacientes incluíram idade, fatores preditivos maiores para NVPO (sexo feminino, história prévia, não-tabagismo, uso pós-operatório de opióides), profilaxia administrada, ocorrência de NVPO, tipo de cirurgia e anestesia, utilização de óxido nitroso, estado clínico e tempo de permanência na RPA. RESULTADOS: Observou-se incidência de 18,5 por cento de náuseas e 8,5 por cento de vômitos no pós-operatório imediato. Observou-se, ainda, correlação entre fatores maiores de risco e ocorrência de NVPO. Não se observou correlação entre tais fatores e a utilização de medicação antiemética profilática, bem como entre sua utilização e a ocorrência de NVPO. Contudo, observou-se tendência à administração de medicação profilática em pacientes jovens do sexo feminino. CONCLUSÕES: A preocupação dos anestesiologistas da instituição com NVPO ficou estabelecida. Contudo, a ausência de correlação entre risco e profilaxia sugere realização empírica e pouco efetiva. Fatores não-avaliados são sugeridos pela ausência de correlação entre NVPO e o uso de antieméticos. Orientação dos anestesiologistas quanto a condutas profiláticas mais eficientes pode aprimorar os cuidados à população atendida.

BACKGROUND AND OBJECTIVES: Postoperative nausea and vomiting (PONV) is frequent and potentially a severe complication that increases the length of anesthetic recovery and causes patient dissatisfaction. The evaluation of the risk of PONV and institution of prophylactic measures aiming the well-being of patients and cost reduction are frequent in the medical literature. This observational study evaluated the incidence, risk factors, and adjustment and effectivity of the prophylaxis of PONV in the recovery room of a tertiary teaching school. METHODS: Information obtained from patients' records and questionnaires answered by patients included age, major predictive factors for PONV (female gender, history, absence of smoking, and postoperative use of opioids), prophylactic drugs administered, development of PONV, type of surgery and anesthesia, use of nitrous oxide, clinical status, and length of stay in the recovery room. RESULTS: An incidence of 18.5 percent of nausea and 8.5 percent of vomiting in the immediate postoperative period was observed. A correlation between major risk factors and the development of PONV was also observed. A correlation between those factors and prophylactic anti-emetic drugs, as well as between their use and the development of PONV, was not observed. However, a tendency to administer prophylactic medication to young female patients was observed. CONCLUSIONS: The concerns of the anesthesiologists of the institution with PONV were evident. However, the absence of correlation between risk and prophylaxis suggests an empirical and ineffective procedure. Factors that were not evaluated were suggested by the absence between PONV and the use of anti-emetic drugs. The orientation for anesthesiologists regarding more effective prophylactic measures can improve care of the population assisted.

JUSTIFICATIVA Y OBJETIVOS: Náuseas y vómitos postoperatorios (NVPO) constituyen una complicación frecuente y potencialmente grave que aumenta el tiempo de recuperación postanestésica (RPA) e implica en una insatisfacción de los pacientes. Evaluación del riesgo para NVPO e institución de profilaxis para alcanzar el bienestar de los pacientes, y la reducción de los costes has sido frecuentes en publicaciones médicas. Este estudio de observación evaluó la incidencia, los factores de riesgo y la adecuación y efectividad de la profilaxis para NVPO en la RPA de un hospital-escuela terciario. MÉTODO: Las informaciones obtenidas a partir de historias clínicas y cuestionarios aplicados a los pacientes incluyeron la edad, factores predictibles mayores para NVPO (sexo femenino, historial previo, no tabaquismo, uso postoperatorio de opioides), profilaxis administrada, incidencia de NVPO, tipo de cirugía y anestesia, utilización de óxido nitroso, estado clínico y tiempo de permanencia en la RPA. RESULTADOS: Se observó incidencia de un 18,5 por ciento de náuseas y un 8,5 por ciento de vómitos en el postoperatorio inmediato. También se observó una correlación entre los factores mayores de riesgo e incidencia de NVPO. No se observó correlación entre tales factores y la utilización de medicación antiemética profiláctica, como tampoco en su utilización y en la incidencia de NVPO. Sin embargo, se observó una tendencia a la administración de medicación profiláctica en pacientes jóvenes del sexo femenino. CONCLUSIONES: La preocupación de los anestesiólogos de la institución con NVPO quedó establecida. Pero la falta de una correlación entre el riesgo y la profilaxis sugiere la realización empírica y poco efectiva. Factores no evaluados se sugieren por la falta de correlación entre NVPO y el uso de antieméticos. Orientación de los anestesiólogos en cuanto a las conductas profilácticas más eficientes puede perfeccionar los con la población atendida.

Change of Post-anesthetic Recovery Time after Colorectal Surgery with N-acetyl-cysteine Infusion / 대한마취과학회지

BACKGROUND: The gut is an important area for inflammatory responses. Gut manipulation during open laparotomy compared with laparoscopic surgery, increases the inflammatory responses. Laparoscopic assisted colectomy (LC) with less bowel manipulation might minimize the inflammatory responses and oxidative stress, and offer a faster postanesthetic recovery than an open colectomy (OC). This study evaluated the effect of N-acetyl-cysteine (NAC), an antioxidant, on the recovery after colectomy. METHODS: 116 colorectal tumor patients were reviewed retrospectively. The patients were divided into 3 groups; LC by surgeon A (A - L), OC by surgeon A (A - O) and OC by surgeon B (B - O). The postanesthetic recovery scores (PARS) were compared. In the prospective randomized controlled trial, the colorectal tumor patients were assigned to one of four groups; laparoscopic assisted colectomy (L - N) with NAC infusion (L + N), open colectomy (O - N) with NAC infusion (O + N). In the NAC groups, NAC (5 mg/kg/h) was infused after intubation to extubation. The PARS were compared. RESULTS: In the retrospective study, the time to reach 10 points, which satisfies the discharge criteria in the PACU, was significantly lower in the A-L group than in the other groups. In the prospective study, the time to 10 points was shorter in the O + N group than in the O-N group. NAC offered no added benefits to the L + N and L-N groups. CONCLUSIONS: NAC offered faster recovery in the OC group but not in the LC group.

Emergence from Anesthesia is Dependent on Age and Physical Status, but not on Operation Site and Operation Time / 대한마취과학회지

BACKGROUND: For most patients, recovery from anesthesia is a smooth uneventful. But for some, recovery can be life threatening. To prevent this, adequate and prompt evaluation of patients on recovery state is essential. Activity, respiration, circulation, awareness, and color are comprehensively assessed by PAR score. So we performed this clinical study to compare ongoing changes in PAR score and the effects of age, physical status, operation site and operation time on PAR score were evaluated. METHODS: Two hundred and fifty-four patients (ASA 1, 2) undergoing elective surgery under general anesthesia were evaluated in our recovery room. They were anesthetized with enflurane or isoflurane, and nitrous oxide, and were transferred to the recovery room when SpO2 was more than 97% and there was no supplemental oxygen during transport. Once there, O2 5 l/min was administered via a face mask to all the patients. Assessment of each patient's PAR score was made at ten-minute intervals by the same anesthesiologist. RESULTS: Emergence from anesthesia was significantly dependent on patient's age, preoperative physical status but not on operation site and time. PAR score was significantly increased according to PAR-stay time regardless of age, physical status, operation site or time. CONCLUSION: In evaluating the postanesthetic recovery state, it seems to be important to consider patient's age and physical status.

A Study on Correlations Between Postanesthetic Recovery Score and Postanesthetic Recovery Room Stay Time / 대한마취과학회지

BACKGROUND: It is one of anesthesiologist's important tasks to know the accurate recovery state of a patient after general anesthesia. Postanesthetic recovery score (PARS) has been widely used as a measure of evaluating recovery state because it is simple, easy to apply and applicapable to all situations. In this study, we investigated whether there were correlations between PARS and PAR-stay time, and examined factors influencing PAR-stay time. METHODS: Two hundreds and five patients were selected randomly. PARS was measured in each patient immediately after he or she arrived at PAR. Correlations between PARS and PAR-stay time were studied. And other variables such as age, sex, physical status, operation site and anesthetic time were studied as influencing factors on PAR-stay time. RESULTS: There were no significant correlations between PARS and PAR-stay time. PARS was influenced by the operation site only. And PAR-stay time was influenced by the patient's age only. CONCLUSIONS: In evaluating the postanesthetic recovery state, it seems to be important to consider not only PARS but also other factors such as patient's age.