Catalina M. Martínez

Adding haloperidol to morphine for patient-controlled analgesia (PCA) reduces nausea and vomiting after short stay surgery: randomized, controlled

SUMMARY Background Morphine Patient-Controlled Analgesia (PCA) increases the frequency of postoperative nausea and vomiting (PONV) and the effectiveness adding haloperidol is unknown. Methods 145 women scheduled to undergo short-stay surgery under general anaesthesia were randomly assigned in two groups: One group received 2 mg i.v. of haloperidol 30 minutes before the end of surgery plus 2 mg mixed with 50 mg of morphine for administration via PCA (Group H); the other group received the same analgesic scheme for pain management using two comparable i.v. boluses of saline (Group P). Furthermore, both groups received dexamethasone 4 mg during anaesthesia induction. Ondansetron (4 mg i.v.) was used for antiemetic rescue. Participants and outcomes assessors were blinded to group assignment. The primary endpoints were incidence of nausea, vomiting and antiemetic requirements during the first 24 hours after surgery. Secondary endpoints included sedation and morphine requirement. Results Cumulative data at 24 hours showed that the group H had less nausea (71.2% vs. 20.6%; RR 0.29 [95% CI: 0.17-0.46]) and vomiting (47% vs. 11.8%; RR 0.25; [95% CI: 0.12-0.49]), and required less ondansetron (66.7% vs. 17.7%), but had an increased incidence of sedation (NNH: 3.5; 95% CI, 2.3-6.7). The NNT for Total response (no nausea, no vomiting/retching) was 2.5 (0–2 hours) and 2 (2–24 hours). Conclusion A bolus of haloperidol 2 mg prior to the end of surgery followed by 2 mg mixed with 50 mg of Morphine for PCA administration can significantly reduce the frequency of PONV but at a cost of increased sedation.

Single-Nucleotide Polymorphisms in NOD1, RIPK2, MICB, PLCE1, TNF, and IKBKE Genes Associated with Symptomatic Dengue in Children from Colombia

Functional immunological evidence supports the impact that the host genetic variability has on the susceptibility to develop asymptomatic or symptomatic dengue infection. Children are more prone to develop severe dengue. Thus, we have evaluated possible associations between single-nucleotide polymorphisms (SNPs) located in immune genes and the development of symptomatic dengue in children from two Colombian populations with differences in genetic backgrounds and geographical features. We genotyped 15 SNPs (in 12 genes) in 298 symptomatic children and 648 healthy controls. Ancestry proportions (APs) were inferred by genotyping 29 ancestry informative markers. We observed four SNPs associated with susceptibility to develop dengue in NOD1, RIPK2, MICB, or PLCE1 genes. Conversely, we found one SNP in TNF gene and two haplotypes in the IKBKE gene associated with resistance to develop dengue. These associations were adjusted by gender, APs, and the population of origin because the association of polymorphisms may be different in admixed populations like Colombian. To our knowledge, this is the first reported association study with dengue in IKBKE, RIPK2, and NOD1 genes. We have also confirmed previously reported associations in MICB and PLCE1 genes with dengue. Overall, our results contribute to the understanding of the genetic susceptibility/resistance to develop symptomatic dengue. Nevertheless, these associations must be validated through functional analysis.