Jelly snakes to reduce early postoperative vomiting in children after adenotonsillectomy: The randomized controlled snakes trial.

BACKGROUND: Despite the use of dual antiemetic agents, postoperative nausea and vomiting (PONV) occurs in an unacceptably large number of patients post-tonsillectomy. There has been increased interest in alternative and non-pharmacological treatments for PONV e.g., chewing gum. We investigated if chewing a large confectionary jelly snake had prophylactic antiemetic effects postoperatively in young children. METHODS: Prospective, open-label randomised controlled trial of 240 patients, 2-16 years. Patients administered a confectionary jelly snake to chew postoperatively were compared with a control group. The primary outcome was the number of episodes of vomiting within 6 h of the operation on an intention-to-treat basis. SECONDARY OUTCOMES: incidence of nausea, vomiting at 6 and 24 h, rescue antiemetic use, acceptability, delayed discharge. RESULTS: 233 patients were randomised to receive the confectionary snake (snake group, 118) or standard care (control group, 115). The number of vomiting episodes in 6 h was similar between groups on an intention-to-treat basis, with 39 episodes across 22 (19%) patients in the control group and 31 across 19 (16%) patients in the snake group (p = 0.666). From post anaesthetic care unit until 24 h there was no difference in doses of antiemetics or delayed discharge due to PONV. A secondary as per protocol analysis did not change this result. CONCLUSIONS: Chewing of confectionery jelly snakes within one hour of waking following adenotonsillectomy with vapour-maintained anaesthesia and two prophylactic antiemetics did not further reduce the incidence of early vomiting. REGISTRATION: prospective registration at the Australia and New Zealand Clinical Trials Registry (ACTRN12618000637246).

Flight system morphology and minimum flight temperature in North American cicadas (Insecta: Hemiptera: Cicadidae).

Thermal responses in cicadas have been studied for many years. The minimum flight temperature (MFT) does not show the same relationship to habitat and behavior as other thermal responses. We measured live mass, wing length, wingspan, wing area and wing loading in an attempt to correlate these morphological parameters to the MFT. We analyzed both intraspecific (in Magicicada cassinii (Fisher, 1852)) and interspecific relationships of the wing morphology and the ability of the cicadas to fly in a large number of North American cicada taxa (n=119). A total of 109 species and 10 subspecies from 17 genera, six tribes, and three subfamilies including all major North American habitats were studied. Analyses show that wing morphology (wing length, wingspan, wing area and wing loading) scales to body size as predicted by geometric similarity (all P<0.0001) for all species and wing area and wing loading (both P<0.0001) in M. cassinii. Mass (P=0.0105), wing length (P=0.0006), wingspan (P=0.0006), wing area (P=0.0055), and wing loading (P=0.0455) all demonstrate a significant correlation to MFT between species, as would be predicted by aerodynamic theory, but not within species. However, the low correlation coefficients suggest the flight system has minimal influence on the MFT of cicadas. Specific physiological adaptations appear to be responsible for the between species variability in MFT rather than being the result of modifications to the flight system morphology.