Eduardo Zarate

The use of transcutaneous acupoint electrical stimulation for preventing nausea and vomiting after laparoscopic surgery.

Nonpharmacologic techniques may be effective in preventing postoperative nausea and vomiting (PONV). This sham-controlled, double-blinded study was designed to examine the antiemetic efficacy of transcutaneous acupoint electrical stimulation (TAES) in a surgical population at high risk of developing PONV. We studied 221 outpatients undergoing laparoscopic cholecystectomy with a standardized general anesthetic technique in this randomized, multicenter trial. In the TAES group, an active ReliefBand® (Woodside Biomedical, Inc., Carlsbad, CA) device was placed at the P6 acupoint, whereas in the Sham and Placebo groups, an inactive device was applied at the P6 acupoint and at the dorsal aspect of the wrist, respectively. The ReliefBand was applied after completion of electrocautery and remained in place for 9 h after surgery. The incidence of PONV and need for “rescue” medication were evaluated at predetermined time intervals. TAES was associated with a significantly decreased incidence of moderate-to-severe nausea as denoted on the Functional Living Index—Emesis score for up to 9 h after surgery (5%–11% for the TAES group vs 16%–38% [P < 0.05] and 15%–26% [P < 0.05] for Sham and Placebo groups, respectively). TAES was also associated with a larger proportion of patients free from moderate to severe nausea symptoms (73% vs 41% and 49% for Sham and Placebo groups, respectively;P < 0.05). However, there were no statistically significant differences among the three groups with regard to incidence of vomiting or the need for rescue antiemetic drugs. We conclude that TAES with the ReliefBand at the P6 acupoint reduces nausea, but not vomiting, after laparoscopic cholecystectomy.

A comparison of the costs and efficacy of ondansetron versus dolasetron for antiemetic prophylaxis

The optimal dose and timing of 5-HT3 antagonist administration for prophylaxis against postoperative nausea and vomiting (PONV) remains controversial. Although 5-HT3 antagonists seem to be most effective when administered near the end of surgery, there are no data on the comparative efficacy or costs associated with the 5-HT3 antagonists dolasetron and ondansetron when administered at the end of the operation. In this double-blinded study, 200 outpatients undergoing otolaryngologic procedures with a standardized general anesthetic received 4 (O4) or 8 mg (O8) of ondansetron or 12.5 (D12.5) or 25 mg (D25) of dolasetron IV within 30 min before the end of surgery. A blinded observer recorded the emetic episodes, maximum nausea score, recovery room resource and drug use, nursing time spent managing PONV, times to achieve discharge criteria from the Phase 1 and 2 recovery units, postdischarge emesis, and patient satisfaction. Total costs were calculated by using the perspective of a free-standing surgicenter. There were no differences in patient demographics, incidence of PONV, need for rescue medications, time spent in the recovery areas, unanticipated hospital admissions, or patient satisfaction among the four treatment groups. The mean total costs (95% confidence intervals) to prevent PONV in one patient were lowest in the D12.5 group:

Fast-track cardiac anesthesia: use of remifentanil combined with intrathecal morphine as an alternative to sufentanil during desflurane anesthesia.

23.89 (17.18–28.79) vs

Comparison of Adenosine and Remifentanil Infusions as Adjuvants to Desflurane Anesthesia

37.81 (30.29–45.32),

Antiemetic Activity of Propofol after Sevoflurane and Desflurane Anesthesia for Outpatient Laparoscopic Cholecystectomy

33.91 (28.92–39.35), and

Fast-track cardiac anesthesia: A comparison of remifentanil plus intrathecal morphine with sufentanil in a desflurane-based anesthetic

75.18 (61.13–89.24) for D25, O4, and O8, respectively. Excluding nursing labor costs did not alter this finding:

FAST-TRACKING AFTER CARDIAC SURGERY: EFFECT OF INTRATHECAL MORPHINE ON POSTOPERATIVE PAIN, OPIOID REQUIREMENT AND EXTUBATION TIME*

18.51 (14.18–22.85),

A COMPARISON OF REMIFENTANIL AND SUFENTANIL IN COMBINATION WITH DESFLURANE FOR FAST-TRACKING AFTER CARDIAC SURGERY

34.77 (28.03–41.49),

USE OF ADENOSINE AS ALTERNATIVE TO REMIFENTANIL FOR CONTROL OF ACUTE AUTONOMIC RESPONSES DURING SURGERY

31.77 (28.92–39.35), and

EFFECT OF THE LOCATION OF TRANSCUTANEOUS ELECTRICAL STIMULATION ON PONV AFTER EAR SURGERY: ACUPOINT VS NONACUPOINT

71.76 (58.17–85.35) for D12.5, D25, O4, and O8, respectively. We conclude that 12.5 mg of dolasetron IV is more cost effective than 4 mg of ondansetron IV for preventing PONV after otolaryngologic surgery and is associated with similar patient satisfaction. Implications When administered at the end of surgery, 12.5 mg of dolasetron IV is as effective as 25 mg of dolasetron IV, 4 mg of ondansetron IV, and 8 mg of ondansetron IV in preventing emetic symptoms after otolaryngologic surgery and was associated with similar patient satisfaction at a reduced cost. There were no differences in the antiemetic efficacy of the 4 and 8 mg doses of ondansetron.