Pub Date : 2024-10-30DOI: 10.1097/ALN.0000000000005283
Jai N Darvall, Anurika P De Silva, Britta von Ungern-Sternberg, David A Story, Andrew J Davidson, Megan L Allen, An Tran-Duy, Cindy Schultz-Ferguson, Vi Ha, Sabine Braat, Kate Leslie
Background: Postoperative nausea and vomiting (PONV) is common after general anesthesia, with consequences for patient outcomes, satisfaction with care and healthcare costs. Our aim was to compare a new treatment, chewing gum, with a widely-used intravenous agent, ondansetron, to treat PONV in female patients in the post anesthesia care unit (PACU).
Methods: We conducted a multicenter, randomized, controlled non-inferiority trial in 17 hospitals in Australia and New Zealand. Female patients aged ≥12 years undergoing volatile anesthetic-based general anesthesia for laparoscopic or breast surgery were enrolled. Protocolized anti-emetic prophylaxis was administered. Patients who developed PONV in the PACU were randomized to either 15 min of chewing gum or 4 mg of intravenous ondansetron. The primary outcome was cessation of nausea, retching or vomiting, with no recurrence nor rescue medication for 2 h after administration of the randomized intervention (i.e., complete response).
Results: Of 865 enrolled patients, 218 were randomized. In a per-protocol analysis, 50 of 105 (47.6%) ondansetron-treated patients compared with 31 of 103 (30.1%) chewing gum-treated patients achieved the primary outcome (absolute risk difference [95% confidence interval (CI)] -17.3 [-30.4 to -4.3] %), not reaching our prespecified non-inferiority limit. Time to complete response was longer for patients randomized to chewing gum (hazard ratio [95% CI] 0.53 [0.34, 0.83]), and they were more likely to receive antiemetics in the 24 h after surgery (absolute risk difference [95% CI] 14.07 [1.65, 26.49]).
Conclusions: Chewing gum cannot be recommended as an alternative to ondansetron for treatment of PONV in female patients administered antiemetic prophylaxis.
{"title":"Chewing gum to treat postoperative nausea and vomiting in female patients: a multicenter randomized trial.","authors":"Jai N Darvall, Anurika P De Silva, Britta von Ungern-Sternberg, David A Story, Andrew J Davidson, Megan L Allen, An Tran-Duy, Cindy Schultz-Ferguson, Vi Ha, Sabine Braat, Kate Leslie","doi":"10.1097/ALN.0000000000005283","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005283","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nausea and vomiting (PONV) is common after general anesthesia, with consequences for patient outcomes, satisfaction with care and healthcare costs. Our aim was to compare a new treatment, chewing gum, with a widely-used intravenous agent, ondansetron, to treat PONV in female patients in the post anesthesia care unit (PACU).</p><p><strong>Methods: </strong>We conducted a multicenter, randomized, controlled non-inferiority trial in 17 hospitals in Australia and New Zealand. Female patients aged ≥12 years undergoing volatile anesthetic-based general anesthesia for laparoscopic or breast surgery were enrolled. Protocolized anti-emetic prophylaxis was administered. Patients who developed PONV in the PACU were randomized to either 15 min of chewing gum or 4 mg of intravenous ondansetron. The primary outcome was cessation of nausea, retching or vomiting, with no recurrence nor rescue medication for 2 h after administration of the randomized intervention (i.e., complete response).</p><p><strong>Results: </strong>Of 865 enrolled patients, 218 were randomized. In a per-protocol analysis, 50 of 105 (47.6%) ondansetron-treated patients compared with 31 of 103 (30.1%) chewing gum-treated patients achieved the primary outcome (absolute risk difference [95% confidence interval (CI)] -17.3 [-30.4 to -4.3] %), not reaching our prespecified non-inferiority limit. Time to complete response was longer for patients randomized to chewing gum (hazard ratio [95% CI] 0.53 [0.34, 0.83]), and they were more likely to receive antiemetics in the 24 h after surgery (absolute risk difference [95% CI] 14.07 [1.65, 26.49]).</p><p><strong>Conclusions: </strong>Chewing gum cannot be recommended as an alternative to ondansetron for treatment of PONV in female patients administered antiemetic prophylaxis.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1097/ALN.0000000000005230
Lidia Mora, Marc Maegele, Oliver Grottke, Andreas Koster, Philipp Stein, Jerrold H Levy, Gabor Erdoes
{"title":"Four-factor Prothrombin Complex Concentrate Use for Bleeding Management in Adult Trauma.","authors":"Lidia Mora, Marc Maegele, Oliver Grottke, Andreas Koster, Philipp Stein, Jerrold H Levy, Gabor Erdoes","doi":"10.1097/ALN.0000000000005230","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005230","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1097/ALN.0000000000005222
Girish P Joshi
{"title":"Preoperative Strategies for Patients on Glucagon-like Peptide-1 Receptor Agonists Navigating Current Controversies and Future Directions.","authors":"Girish P Joshi","doi":"10.1097/ALN.0000000000005222","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005222","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Midazolam is a short-acting benzodiazepine frequently used in the perioperative setting. This study aimed to investigate the potential impact of intraoperative midazolam on postoperative delirium (POD) in older patients undergoing non-cardiac surgery.
Methods: This study included patients aged ≥ 65 years who received general anaesthesia between April 2020 and April 2022 in multiple hospitals across China. POD occurring within 7 days was assessed using the 3-minute Diagnostic Interview for Confusion Assessment Method (3D-CAM). Univariable and multivariable logistic regression models based on the random effects were used to determine the association between midazolam administration and the occurrence of POD, presented as risk ratio (RR) and 95% confidence intervals (CI). Kaplan-Meier cumulative incidence curve was plotted to compare the distribution of time to POD onset between patients who received midazolam and those who did not. Subgroup analyses based on specific populations were performed to explore the relationship between midazolam and POD.
Results: In all, 5,663 patients were included, of whom 723 (12.8%) developed POD. Univariate and multivariable logistic regression analyses based on random effects of different hospitals showed no significant association between midazolam medication and POD among older population (unadjusted RR=0.96, 95% CI: 0.90-1.30, P=0.38; adjusted RR=1.09, 95% CI: 0.91-1.33, P=0.35). Kaplan-Meier curve showed no difference in the distribution of time to POD onset (Hazard ratio [HR]=1.02, 95%CI: 0.88-1.18, P=0.82). The results of subgroup analyses found that intraoperative midazolam treatment was not associated with POD in the specific subgroups of patients.
Conclusions: Intraoperative administration of midazolam may not be associated with an increased risk of POD in older patients undergoing non-cardiac surgery.
背景:咪达唑仑是一种短效苯二氮卓类药物,常用于围术期环境。本研究旨在探讨术中使用咪达唑仑对接受非心脏手术的老年患者术后谵妄(POD)的潜在影响:本研究纳入了 2020 年 4 月至 2022 年 4 月期间在中国多家医院接受全身麻醉的年龄≥ 65 岁的患者。采用 3 分钟意识障碍诊断访谈评估法(3D-CAM)对 7 天内发生的 POD 进行评估。基于随机效应的单变量和多变量Logistic回归模型用于确定咪达唑仑用药与POD发生之间的关系,以风险比(RR)和95%置信区间(CI)表示。绘制了 Kaplan-Meier 累计发病率曲线,以比较接受和未接受咪达唑仑治疗的患者之间 POD 发病时间的分布情况。根据特定人群进行了分组分析,以探讨咪达唑仑与 POD 之间的关系:总共纳入了 5,663 名患者,其中 723 人(12.8%)出现了 POD。基于不同医院随机效应的单变量和多变量逻辑回归分析表明,在老年人群中,咪达唑仑用药与 POD 之间无显著关联(未调整 RR=0.96,95% CI:0.90-1.30,P=0.38;调整 RR=1.09,95% CI:0.91-1.33,P=0.35)。卡普兰-梅耶曲线显示,POD发病时间分布无差异(危险比[HR]=1.02,95%CI:0.88-1.18,P=0.82)。亚组分析结果显示,术中咪达唑仑治疗与特定亚组患者的POD无关:结论:在接受非心脏手术的老年患者中,术中使用咪达唑仑可能与 POD 风险增加无关。
{"title":"The effect of intraoperative midazolam on postoperative delirium in older surgical patients: a prospective, multicentre cohort study.","authors":"Hao Li, Chang Liu, Yu Yang, Qing-Ping Wu, Jun-Mei Xu, Di-Fen Wang, Jing-Jia Sun, Meng-Meng Mao, Jing-Sheng Lou, Yan-Hong Liu, Jiang-Bei Cao, Chong-Yang Duan, Wei-Dong Mi","doi":"10.1097/ALN.0000000000005276","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005276","url":null,"abstract":"<p><strong>Background: </strong>Midazolam is a short-acting benzodiazepine frequently used in the perioperative setting. This study aimed to investigate the potential impact of intraoperative midazolam on postoperative delirium (POD) in older patients undergoing non-cardiac surgery.</p><p><strong>Methods: </strong>This study included patients aged ≥ 65 years who received general anaesthesia between April 2020 and April 2022 in multiple hospitals across China. POD occurring within 7 days was assessed using the 3-minute Diagnostic Interview for Confusion Assessment Method (3D-CAM). Univariable and multivariable logistic regression models based on the random effects were used to determine the association between midazolam administration and the occurrence of POD, presented as risk ratio (RR) and 95% confidence intervals (CI). Kaplan-Meier cumulative incidence curve was plotted to compare the distribution of time to POD onset between patients who received midazolam and those who did not. Subgroup analyses based on specific populations were performed to explore the relationship between midazolam and POD.</p><p><strong>Results: </strong>In all, 5,663 patients were included, of whom 723 (12.8%) developed POD. Univariate and multivariable logistic regression analyses based on random effects of different hospitals showed no significant association between midazolam medication and POD among older population (unadjusted RR=0.96, 95% CI: 0.90-1.30, P=0.38; adjusted RR=1.09, 95% CI: 0.91-1.33, P=0.35). Kaplan-Meier curve showed no difference in the distribution of time to POD onset (Hazard ratio [HR]=1.02, 95%CI: 0.88-1.18, P=0.82). The results of subgroup analyses found that intraoperative midazolam treatment was not associated with POD in the specific subgroups of patients.</p><p><strong>Conclusions: </strong>Intraoperative administration of midazolam may not be associated with an increased risk of POD in older patients undergoing non-cardiac surgery.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1097/ALN.0000000000005231
Girish P Joshi, Teresa LaMasters, Tammy L Kindel
{"title":"Preprocedure Care of Patients on Glucagon-like Peptide-1 Receptor Agonists: A Multisociety Clinical Practice Guidance.","authors":"Girish P Joshi, Teresa LaMasters, Tammy L Kindel","doi":"10.1097/ALN.0000000000005231","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005231","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1097/ALN.0000000000005204
Adriana D Oprea, Guillermo E Umpierrez, BobbieJean Sweitzer, David L Hepner
{"title":"Perioperative Management of Patients Taking Glucagon-like Peptide-1 Receptor Agonists: Applying Evidence to Clinical Practice.","authors":"Adriana D Oprea, Guillermo E Umpierrez, BobbieJean Sweitzer, David L Hepner","doi":"10.1097/ALN.0000000000005204","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005204","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1097/ALN.0000000000005229
Alexandre Mansour, Thomas Lecompte, Nicolas Nesseler, Isabelle Gouin-Thibault
{"title":"Antithrombin Levels during Venoarterial ECMO: Reply.","authors":"Alexandre Mansour, Thomas Lecompte, Nicolas Nesseler, Isabelle Gouin-Thibault","doi":"10.1097/ALN.0000000000005229","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005229","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1097/ALN.0000000000005236
Justin C Cordova
{"title":"A Poem for Henry.","authors":"Justin C Cordova","doi":"10.1097/ALN.0000000000005236","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005236","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1097/ALN.0000000000005228
Gennaro Martucci, Shu Y Lu, Yuko Mishima, Kenichi A Tanaka
{"title":"Antithrombin Levels during Venoarterial ECMO: Comment.","authors":"Gennaro Martucci, Shu Y Lu, Yuko Mishima, Kenichi A Tanaka","doi":"10.1097/ALN.0000000000005228","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005228","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1097/ALN.0000000000005196
Adriana L Grossman
{"title":"Life and Death in the Land of Women.","authors":"Adriana L Grossman","doi":"10.1097/ALN.0000000000005196","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005196","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}