Pub Date : 2016-12-01DOI: 10.1016/j.aat.2016.12.002
Chuen-Chau Chang (Section Editor), Chih-Shung Wong
{"title":"Postoperative nausea and vomiting free for all: A solution from propofol?","authors":"Chuen-Chau Chang (Section Editor), Chih-Shung Wong","doi":"10.1016/j.aat.2016.12.002","DOIUrl":"10.1016/j.aat.2016.12.002","url":null,"abstract":"","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 4","pages":"Pages 106-107"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2016.12.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91086020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1016/j.aat.2016.11.001
Chia-Chun Chuang, Jen-Yin Chen, Chien-Ching Lee
{"title":"Severe acute peripheral edema induced by noninvasive blood pressure cuff in an elderly patient with hypoalbuminemia under general anesthesia","authors":"Chia-Chun Chuang, Jen-Yin Chen, Chien-Ching Lee","doi":"10.1016/j.aat.2016.11.001","DOIUrl":"10.1016/j.aat.2016.11.001","url":null,"abstract":"","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 4","pages":"Pages 129-130"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2016.11.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82466313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1016/j.aat.2016.09.002
Hideki Matsuura, Satoki Inoue, Masahiko Kawaguchi
Objectives
The current consensus guidelines for managing postoperative nausea and vomiting (PONV) suggest that one of anesthetic risk factors is the use of volatile anesthetics. However, in clinical settings, it is rare to perceive propofol to be superior to volatile anesthetics for the prevention of PONV. To assess whether PONV is related to the type of anesthetic delivered, we compared the incidence and duration of PONV between propofol anesthesia and sevoflurane anesthesia.
Methods
We performed a retrospective review of an institutional registry containing 21606 general anesthesia cases conducted following ethics board approval. Anesthesia for all patients was managed with propofol or sevoflurane. To avoid channeling bias, a propensity score analysis was used to generate a set of matched cases (propofol anesthesia) and controls (sevoflurane anesthesia), yielding 2554 matched patient pairs. The incidence and sustained rate of symptoms were compared as the primary outcomes.
Results
In the unmatched population, a higher incidence of PONV occurred following propofol anesthesia compared to sevoflurane anesthesia (propofol vs. sevoflurane anesthesia: 18.9% vs. 15.3%, respectively, p < 0.0001). The sustained rate of PONV over the course after propofol anesthesia was also higher than that following sevoflurane anesthesia (p < 0.001). Conversely, less PONV occurred after propofol compared to sevoflurane after propensity matching (propofol vs. sevoflurane anesthesia: 20.4% vs. 23.3%, respectively, p = 0.01). However, the sustained rate of PONV over the course after propofol anesthesia did not differ from that following sevoflurane anesthesia (p = 0.09).
Conclusions
Propofol could decrease the incidence of PONV compared with sevoflurane, although the duration of PONV was not affected as found in previous reports.
{"title":"The risk of postoperative nausea and vomiting between surgical patients received propofol and sevoflurane anesthesia: A matched study","authors":"Hideki Matsuura, Satoki Inoue, Masahiko Kawaguchi","doi":"10.1016/j.aat.2016.09.002","DOIUrl":"10.1016/j.aat.2016.09.002","url":null,"abstract":"<div><h3>Objectives</h3><p>The current consensus guidelines for managing postoperative nausea and vomiting (PONV) suggest that one of anesthetic risk factors is the use of volatile anesthetics. However, in clinical settings, it is rare to perceive propofol to be superior to volatile anesthetics for the prevention of PONV. To assess whether PONV is related to the type of anesthetic delivered, we compared the incidence and duration of PONV between propofol anesthesia and sevoflurane anesthesia.</p></div><div><h3>Methods</h3><p>We performed a retrospective review of an institutional registry containing 21606 general anesthesia cases conducted following ethics board approval. Anesthesia for all patients was managed with propofol or sevoflurane. To avoid channeling bias, a propensity score analysis was used to generate a set of matched cases (propofol anesthesia) and controls (sevoflurane anesthesia), yielding 2554 matched patient pairs. The incidence and sustained rate of symptoms were compared as the primary outcomes.</p></div><div><h3>Results</h3><p>In the unmatched population, a higher incidence of PONV occurred following propofol anesthesia compared to sevoflurane anesthesia (propofol vs. sevoflurane anesthesia: 18.9% vs. 15.3%, respectively, p < 0.0001). The sustained rate of PONV over the course after propofol anesthesia was also higher than that following sevoflurane anesthesia (p < 0.001). Conversely, less PONV occurred after propofol compared to sevoflurane after propensity matching (propofol vs. sevoflurane anesthesia: 20.4% vs. 23.3%, respectively, p = 0.01). However, the sustained rate of PONV over the course after propofol anesthesia did not differ from that following sevoflurane anesthesia (p = 0.09).</p></div><div><h3>Conclusions</h3><p>Propofol could decrease the incidence of PONV compared with sevoflurane, although the duration of PONV was not affected as found in previous reports.</p></div>","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 4","pages":"Pages 114-120"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2016.09.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86540695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1016/j.aat.2016.12.001
James L. Reynolds (Globalization Editor), Wei-Zen Sun (Editor-in-Chief)
{"title":"Journeys and journals east and west","authors":"James L. Reynolds (Globalization Editor), Wei-Zen Sun (Editor-in-Chief)","doi":"10.1016/j.aat.2016.12.001","DOIUrl":"10.1016/j.aat.2016.12.001","url":null,"abstract":"","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 4","pages":"Pages 103-105"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2016.12.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86906069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1016/j.aat.2016.10.003
Takeshi Murouchi
{"title":"Quadratus lumborum block intramuscular approach for pediatric surgery","authors":"Takeshi Murouchi","doi":"10.1016/j.aat.2016.10.003","DOIUrl":"10.1016/j.aat.2016.10.003","url":null,"abstract":"","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 4","pages":"Pages 135-136"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2016.10.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76029588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1016/j.aat.2016.11.004
Sergey S. Simakov, Xenia I. Roubliova, Alexey A. Ivanov, Anar K. Kaptaeva, Madina I. Mazitova, Ospan A. Mynbaev
{"title":"Respiratory acidosis in obese gynecological patients undergoing laparoscopic surgery independently of the type of ventilation","authors":"Sergey S. Simakov, Xenia I. Roubliova, Alexey A. Ivanov, Anar K. Kaptaeva, Madina I. Mazitova, Ospan A. Mynbaev","doi":"10.1016/j.aat.2016.11.004","DOIUrl":"10.1016/j.aat.2016.11.004","url":null,"abstract":"","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 4","pages":"Pages 131-133"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2016.11.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91109402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1016/j.aat.2016.11.002
Fang Peng , Shijiang Liu , Youli Hu , Min Yu , Jing Chen , Cunming Liu
Background
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a key part of multimodal perioperative analgesia. This study aimed to evaluate the influence of perioperative NSAIDs application on complications after gastrointestinal surgery by using meta-analysis.
Methods
A systematic review of published literature was conducted by searching computerized databases including PubMed, CBM, Springer, Chinese Academic Journals, and China Info since the databases were published until June 2015. The articles and retrospective references regarding complications after gastrointestinal surgery were collected to compare postoperative complications associated with NSAIDs or other analgesics. After they were assessed by randomized controlled trials and extracted by the standard of the Jadad systematic review, the homogeneous studies were pooled using RevMan 5.3 software. The meta-analysis was performed on five postoperative complications: postoperative anastomotic leak, cardiovascular events, surgical site infection, nausea and vomiting, and intestinal obstruction.
Results
Twelve randomized controlled trials involving 3829 patients met the inclusion criteria. The results of meta-analyses showed the following: (1) postoperative anastomotic leak: NSAIDs (including selective and nonselective NSAIDs) increased the incidence of anastomotic leak [odds ratio (OR) = 3.02, 95% confidence interval (CI): 2.16–4.23, p = 0.00001]. Further results showed that nonselective NSAIDs significantly increased the incidence of anastomotic leak (OR = 2.96, 95% CI: 1.99–4.42, p < 0.00001), and selective NSAIDs had no significant difference as compared with the control group using other analgesics (OR = 2.27, 95% CI: 0.68–7.56, p = 0.18); (2) postoperative cardiovascular events: NSAIDs (selective and nonselective NSAIDs) had no difference when compared with other analgesics (OR = 0.50, 95% CI: 0.23–1.12, p = 0.09); (3) postoperative surgical site infection: NSAIDs (selective and nonselective NSAIDs) and other analgesics had no difference in surgical site infection (OR = 0.77, 95% CI: 0.52–1.15, p = 0.20); (4) postoperative nausea and vomiting: NSAIDs (selective and nonselective NSAIDs) decreased the incidence of nausea and vomiting (OR = 0.53, 95% CI: 0.34–0.81, p = 0.003); (5) postoperative intestinal obstruction: NSAIDs (selective and nonselective NSAIDs) decreased the incidence of intestinal obstruction (OR = 0.35, 95% CI: 0.13–0.89, p = 0.03).
Conclusions
The meta-analysis suggests that postoperative NSAIDs, especially nonselective NSAIDs, could increase the incidence of anastomotic leak.
背景非甾体类抗炎药(NSAIDs)是围手术期多模式镇痛的重要组成部分。本研究旨在通过meta分析评估围手术期应用非甾体抗炎药对胃肠道手术并发症的影响。方法通过检索PubMed、CBM、施普林格、Chinese Academic Journals、China Info等计算机数据库至2015年6月的已发表文献进行系统回顾。收集有关胃肠道术后并发症的文章和回顾性文献，比较非甾体抗炎药或其他镇痛药的术后并发症。采用随机对照试验评估，按Jadad系统评价标准提取后，采用RevMan 5.3软件对均质研究进行汇总。荟萃分析了5种术后并发症:术后吻合口漏、心血管事件、手术部位感染、恶心呕吐和肠梗阻。结果12项随机对照试验3829例患者符合纳入标准。meta分析结果显示:(1)术后吻合口瘘:非甾体抗炎药(包括选择性和非选择性)增加吻合口瘘发生率[优势比(OR) = 3.02, 95%可信区间(CI): 2.16-4.23, p = 0.00001]。进一步结果显示，非选择性非甾体抗炎药显著增加吻合口漏发生率(OR = 2.96, 95% CI: 1.99 ~ 4.42, p <0.00001)，选择性非甾体抗炎药与使用其他镇痛药的对照组比较差异无统计学意义(OR = 2.27, 95% CI: 0.68 ~ 7.56, p = 0.18);(2)术后心血管事件:非甾体抗炎药(选择性和非选择性)与其他镇痛药相比无差异(OR = 0.50, 95% CI: 0.23-1.12, p = 0.09);(3)术后手术部位感染:非甾体抗炎药(选择性和非选择性)与其他镇痛药在手术部位感染方面无差异(OR = 0.77, 95% CI: 0.52 ~ 1.15, p = 0.20);(4)术后恶心呕吐:非甾体抗炎药(选择性和非选择性)降低恶心呕吐发生率(OR = 0.53, 95% CI: 0.34-0.81, p = 0.003);(5)术后肠梗阻:非甾体抗炎药(选择性和非选择性)降低肠梗阻发生率(OR = 0.35, 95% CI: 0.13-0.89, p = 0.03)。结论术后非甾体抗炎药，尤其是非选择性非甾体抗炎药可增加吻合口漏的发生率。非甾体抗炎药可减轻术后恶心呕吐和肠梗阻，但在心血管事件和手术部位感染方面与其他镇痛药无显著差异。
{"title":"Influence of perioperative nonsteroidal anti-inflammatory drugs on complications after gastrointestinal surgery: A meta-analysis","authors":"Fang Peng , Shijiang Liu , Youli Hu , Min Yu , Jing Chen , Cunming Liu","doi":"10.1016/j.aat.2016.11.002","DOIUrl":"10.1016/j.aat.2016.11.002","url":null,"abstract":"<div><h3>Background</h3><p>Nonsteroidal anti-inflammatory drugs (NSAIDs) are a key part of multimodal perioperative analgesia. This study aimed to evaluate the influence of perioperative NSAIDs application on complications after gastrointestinal surgery by using meta-analysis.</p></div><div><h3>Methods</h3><p>A systematic review of published literature was conducted by searching computerized databases including PubMed, CBM, Springer, Chinese Academic Journals, and China Info since the databases were published until June 2015. The articles and retrospective references regarding complications after gastrointestinal surgery were collected to compare postoperative complications associated with NSAIDs or other analgesics. After they were assessed by randomized controlled trials and extracted by the standard of the Jadad systematic review, the homogeneous studies were pooled using RevMan 5.3 software. The meta-analysis was performed on five postoperative complications: postoperative anastomotic leak, cardiovascular events, surgical site infection, nausea and vomiting, and intestinal obstruction.</p></div><div><h3>Results</h3><p>Twelve randomized controlled trials involving 3829 patients met the inclusion criteria. The results of meta-analyses showed the following: (1) postoperative anastomotic leak: NSAIDs (including selective and nonselective NSAIDs) increased the incidence of anastomotic leak [odds ratio (OR)<!--> <!-->=<!--> <!-->3.02, 95% confidence interval (CI): 2.16–4.23, <em>p</em> <!-->=<!--> <!-->0.00001]. Further results showed that nonselective NSAIDs significantly increased the incidence of anastomotic leak (OR<!--> <!-->=<!--> <!-->2.96, 95% CI: 1.99–4.42, <em>p</em> <!--><<!--> <!-->0.00001), and selective NSAIDs had no significant difference as compared with the control group using other analgesics (OR<!--> <!-->=<!--> <!-->2.27, 95% CI: 0.68–7.56, <em>p</em> <!-->=<!--> <!-->0.18); (2) postoperative cardiovascular events: NSAIDs (selective and nonselective NSAIDs) had no difference when compared with other analgesics (OR<!--> <!-->=<!--> <!-->0.50, 95% CI: 0.23–1.12, <em>p</em> <!-->=<!--> <!-->0.09); (3) postoperative surgical site infection: NSAIDs (selective and nonselective NSAIDs) and other analgesics had no difference in surgical site infection (OR<!--> <!-->=<!--> <!-->0.77, 95% CI: 0.52–1.15, <em>p</em> <!-->=<!--> <!-->0.20); (4) postoperative nausea and vomiting: NSAIDs (selective and nonselective NSAIDs) decreased the incidence of nausea and vomiting (OR<!--> <!-->=<!--> <!-->0.53, 95% CI: 0.34–0.81, <em>p</em> <!-->=<!--> <!-->0.003); (5) postoperative intestinal obstruction: NSAIDs (selective and nonselective NSAIDs) decreased the incidence of intestinal obstruction (OR<!--> <!-->=<!--> <!-->0.35, 95% CI: 0.13–0.89, <em>p</em> <!-->=<!--> <!-->0.03).</p></div><div><h3>Conclusions</h3><p>The meta-analysis suggests that postoperative NSAIDs, especially nonselective NSAIDs, could increase the incidence of anastomotic leak.","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 4","pages":"Pages 121-128"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2016.11.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75723948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1016/j.aat.2016.11.003
Wangping Zhang
{"title":"Reply to: Respiratory acidosis in obese gynecologic patients undergoing laparoscopic surgery independently of the type of ventilation","authors":"Wangping Zhang","doi":"10.1016/j.aat.2016.11.003","DOIUrl":"10.1016/j.aat.2016.11.003","url":null,"abstract":"","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 4","pages":"Page 134"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2016.11.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76312114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To determine the safety, efficacy, and feasibility of propofol-based anesthesia in gynecological laparoscopies in reducing incidences of postoperative nausea and vomiting compared to a standard anesthesia using thiopentone/isoflurane.
Sixty ASA (American Society of Anesthesiologists) I and II female patients (aged 20–60 years) scheduled for gynecological laparoscopy were included in the study.
Interventions
Patients in Group A received standard anesthesia with thiopentone for induction and maintenance with isoflurane–fentanyl, and those in Group B received propofol for induction and maintenance along with fentanyl. All patients received nitrous oxide, vecuronium, and neostigmine/glycopyrrolate. No patient received elective preemptive antiemetic, but patients did receive it after more than one episode of vomiting.
Measurements
Assessment for incidence of postoperative nausea and vomiting as well as other recovery parameters were carried out over a period of 24 hours.
Main Results
Six patients (20%) in Group A and seven patients (23.3%) in Group B experienced nausea. Two patients (6.66%) in Group B had vomiting versus 12 (40%) in Group A (p < 0.05). Overall, the incidence of emesis was 60% and 30% in Groups A and B, respectively (p < 0.05). All patients in Group B had significantly faster recovery compared with those in Group A. No patient had any overt cardiorespiratory complications.
Conclusion
Propofol-based anesthesia was associated with significantly less postoperative vomiting and faster recovery compared to standard anesthesia in patients undergoing gynecological laparoscopy.
{"title":"Incidence of postoperative nausea and vomiting following gynecological laparoscopy: A comparison of standard anesthetic technique and propofol infusion","authors":"Pradipta Bhakta , Bablu Rani Ghosh , Umesh Singh , Preeti S. Govind , Abhinav Gupta , Kulwant Singh Kapoor , Rajesh Kumar Jain , Tulsi Nag , Dipanwita Mitra , Manjushree Ray , Vikash Singh , Gauri Mukherjee","doi":"10.1016/j.aat.2016.10.002","DOIUrl":"10.1016/j.aat.2016.10.002","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the safety, efficacy, and feasibility of propofol-based anesthesia in gynecological laparoscopies in reducing incidences of postoperative nausea and vomiting compared to a standard anesthesia using thiopentone/isoflurane.</p></div><div><h3>Design</h3><p>Randomized single-blind (for anesthesia techniques used) and double-blind (for postoperative assessment) controlled trial.</p></div><div><h3>Setting</h3><p>Operation theater, postanesthesia recovery room, teaching hospital.</p></div><div><h3>Patients</h3><p>Sixty ASA (American Society of Anesthesiologists) I and II female patients (aged 20–60 years) scheduled for gynecological laparoscopy were included in the study.</p></div><div><h3>Interventions</h3><p>Patients in Group A received standard anesthesia with thiopentone for induction and maintenance with isoflurane–fentanyl, and those in Group B received propofol for induction and maintenance along with fentanyl. All patients received nitrous oxide, vecuronium, and neostigmine/glycopyrrolate. No patient received elective preemptive antiemetic, but patients did receive it after more than one episode of vomiting.</p></div><div><h3>Measurements</h3><p>Assessment for incidence of postoperative nausea and vomiting as well as other recovery parameters were carried out over a period of 24 hours.</p></div><div><h3>Main Results</h3><p>Six patients (20%) in Group A and seven patients (23.3%) in Group B experienced nausea. Two patients (6.66%) in Group B had vomiting versus 12 (40%) in Group A (<em>p</em> <!--><<!--> <!-->0.05). Overall, the incidence of emesis was 60% and 30% in Groups A and B, respectively (<em>p</em> <!--><<!--> <!-->0.05). All patients in Group B had significantly faster recovery compared with those in Group A. No patient had any overt cardiorespiratory complications.</p></div><div><h3>Conclusion</h3><p>Propofol-based anesthesia was associated with significantly less postoperative vomiting and faster recovery compared to standard anesthesia in patients undergoing gynecological laparoscopy.</p></div>","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 4","pages":"Pages 108-113"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2016.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79250265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Less general anesthetic is required in patients with regional blocks than in those without, as assessed through commonly used anesthesia monitoring parameters such as blood pressure, heart rate, and bispectral index (BIS). Although intraoperative regional anesthesia has become more widely adopted, few studies have confirmed or monitored its anesthetic-sparing effects. Using recent reports of nonintubated video-assisted thoracoscopic surgery (VATS) by BIS-targeted propofol infusion and intraoperative multilevel thoracoscopic intercostal nerve blocks (TINBs), this retrospective study investigated whether the anesthetic-sparing effect can be realized by reducing the effect-site concentration (Ce) to the targeted BIS level or by reducing the blood pressure at the onset of regional blocks.
Methods
A retrospective study of a prospectively collected case series of non-intubated VATS.
Results
Data on 56 adult patients who underwent nonintubated VATS were collected and analyzed. The mean operative time was 121 ± 32 minutes. BIS levels before and after one-lung ventilation/TINBs and surgery were 48% ± 11% and 47% ± 12%, respectively. The Ce of propofol infusion decreased significantly from 3.4 ± 0.8 μg/mL to 3.0 ± 0.7 μg/mL (p < 0.01) after surgery with TINBs. Blood pressure did not change significantly, whereas the heart rate increased moderately but significantly (77 ± 14 beats/minute to 82 ± 15 beats/minute, p < 0.01).
Conclusion
With comparable BIS and blood pressure in the subsequent surgical procedure, the adequacy of anesthesia and the anesthetic component provided by intraoperative TINBs and vagal nerve could be monitored adequately. The anesthetic-sparing effect of intraoperative nerve blocks can be realized when the Ce of propofol infusion was reduced to the target BIS level.
{"title":"Intraoperative multiple intercostal nerve blocks exert anesthetic-sparing effect: A retrospective study on the effect-site concentration of propofol infusion in nonintubated thoracoscopic surgery","authors":"Man-Ling Wang , Ming-Hui Hung , Kuang-Cheng Chan , Jin-Shing Chen , Ya-Jung Cheng","doi":"10.1016/j.aat.2016.07.001","DOIUrl":"10.1016/j.aat.2016.07.001","url":null,"abstract":"<div><h3>Objective(s)</h3><p>Less general anesthetic is required in patients with regional blocks than in those without, as assessed through commonly used anesthesia monitoring parameters such as blood pressure, heart rate, and bispectral index (BIS). Although intraoperative regional anesthesia has become more widely adopted, few studies have confirmed or monitored its anesthetic-sparing effects. Using recent reports of nonintubated video-assisted thoracoscopic surgery (VATS) by BIS-targeted propofol infusion and intraoperative multilevel thoracoscopic intercostal nerve blocks (TINBs), this retrospective study investigated whether the anesthetic-sparing effect can be realized by reducing the effect-site concentration (Ce) to the targeted BIS level or by reducing the blood pressure at the onset of regional blocks.</p></div><div><h3>Methods</h3><p>A retrospective study of a prospectively collected case series of non-intubated VATS.</p></div><div><h3>Results</h3><p>Data on 56 adult patients who underwent nonintubated VATS were collected and analyzed. The mean operative time was 121 ± 32 minutes. BIS levels before and after one-lung ventilation/TINBs and surgery were 48% ± 11% and 47% ± 12%, respectively. The Ce of propofol infusion decreased significantly from 3.4 ± 0.8 μg/mL to 3.0 ± 0.7 μg/mL (<em>p</em> < 0.01) after surgery with TINBs. Blood pressure did not change significantly, whereas the heart rate increased moderately but significantly (77 ± 14 beats/minute to 82 ± 15 beats/minute, <em>p</em> < 0.01).</p></div><div><h3>Conclusion</h3><p>With comparable BIS and blood pressure in the subsequent surgical procedure, the adequacy of anesthesia and the anesthetic component provided by intraoperative TINBs and vagal nerve could be monitored adequately. The anesthetic-sparing effect of intraoperative nerve blocks can be realized when the Ce of propofol infusion was reduced to the target BIS level.</p></div>","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 3","pages":"Pages 77-80"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2016.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34395466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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