Nitric oxide index is not a predictor of cognitive dysfunction following laparotomy.

STUDY OBJECTIVE: To determine the associations between postoperative cognitive dysfunction (POCD) and plasma concentrations of stable nitric oxide products [nitric oxide index (NOi)]. DESIGN: Prospective study. SETTING: Academic hospital. PATIENTS: 28 ASA physical status I, II, and III physical status patients undergoing major non-cardiac surgery. INTERVENTIONS: Cognitive assessment was performed preoperatively and postoperatively at 4 days (early) and 6 weeks (late). MEASUREMENTS: Serial measurements of plasma NOi were recorded. MAIN RESULTS: Early POCD with a deficit in one cognitive domain was present in 18 patients (64%), and in 8 patients (28%) with deficits in two or more cognitive domains. Late POCD was evident in three patients (20%) who had a deficit in one domain. Eight patients were lost to late follow-up. There was no difference in baseline or subsequent serum concentrations of NOi between those who showed early and late POCD and those who showed no POCD. CONCLUSION: Factors other than nitric oxide-mediated injury is responsible for POCD following major non-cardiac surgery.

Continuous gastric decompression for postoperative nausea and vomiting after coronary revascularization surgery.

Postoperative nausea and vomiting is common after cardiac surgery and may contribute to significant morbidity. Gastric decompression during anesthesia has been used for postoperative nausea and vomiting prophylaxis in shorter duration noncardiac surgery with conflicting results. We tested the hypothesis that gastric decompression during elective coronary revascularization surgery with cardiopulmonary bypass and continued afterwards until tracheal extubation would reduce the incidence of vomiting or retching and nausea. In a prospective, randomized, cohort study, 104 patients with at least 2 Apfel's risk factors for postoperative nausea and vomiting were allocated to receive a gastric tube on free gravity drainage after induction of anesthesia (n = 52) or to a control group (n = 52). The gastric tube was removed simultaneously with tracheal extubation postoperatively. The primary outcome measure was the incidence of vomiting or retching. Secondary outcomes included the incidence and severity of nausea measured on a visual analog scale. The incidence of vomiting or retching was 13.4% in patients with gastric decompression, compared with 11.5% in the control group (P = 0.7). Similarly, there was no statistically significant difference between the two groups in the incidence of nausea (32.7% versus 25.0%, P = 0.6), median severity of nausea on a visual analog scale at 12 h (25; range, 0-55 mm versus 30; range, 0-60 mm, P = 0.4), or antiemetics administration (38.5% versus 28.8%, P = 0.3). Continuous gastric decompression during coronary revascularization surgery and afterwards until tracheal extubation did not reduce the incidence of vomiting or retching or the incidence and severity of nausea in these patients.