Jen-Yin Chen

The Prophylactic Effect of Haloperidol Plus Dexamethasone on Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopically Assisted Vaginal Hysterectomy

BACKGROUND:Haloperidol, a major tranquilizer, has been found to have a potent antiemetic effect on postoperative nausea and vomiting (PONV), but the prophylactic effect of haloperidol plus dexamethasone on PONV has not been evaluated. We evaluated the prophylactic effect of haloperidol plus dexamethasone to either given alone, placebo or droperidol on PONV in patients undergoing a laparoscopic-assisted vaginal hysterectomy. METHODS:Four hundred adult women (n = 80 in each of five groups) scheduled for a laparoscopic-assisted vaginal hysterectomy were enrolled in a randomized, double-blind, placebo, and positive-control study. Fifteen minutes after the induction of anesthesia, patients received an IV injection of either saline (group S), droperidol 1.25 mg (group D), haloperidol 2 mg (group H), dexamethasone 5 mg (group Dx), or haloperidol 2 mg plus dexamethasone 5 mg (group H + Dx) to prevent PONV. The occurrence of PONV and medication-related side effects were recorded. RESULTS:The incidences of PONV (0–24 h) in the D (36%), H (37%), Dx (38%), and H + Dx (19%) groups were significantly lower than in the S group (65%; P < 0.05 for each comparison). The H + Dx group had the lowest incidence of PONV (19%; P < 0.05 for each comparison) of the five study groups. No differences were found between the D, H, and Dx groups. Also, no differences were found among the five groups in the side effects of QT prolongation, intensity of postoperative pain, level of sedation, and occurrence of extra-pyramidal symptoms. CONCLUSION:Prophylactic haloperidol 2 mg plus dexamethasone 5 mg produced a greater reduction in the incidence of PONV than did either drug used alone, placebo or droperidol without increasing perioperative adverse outcomes.

Plasma vitamin C is lower in postherpetic neuralgia patients and administration of vitamin C reduces spontaneous pain but not brush-evoked pain.

ObjectivesPlasma vitamin C concentrations have been suggested to be related to pain modulation in postherpetic neuralgia (PHN), an intractable neuropathic pain syndrome. In this study, we first compared plasma concentrations of vitamin C between healthy volunteers and PHN patients and then designed a symptom-based and mechanism-based approach to assess the analgesic effect of intravenous vitamin C on spontaneous and brush-evoked pain. MethodsStudy 1 was cross-sectional that enrolled 39 healthy volunteers and 38 PHN patients. Study 2 was a double-blinded, placebo-controlled intervention study, which comprised 41 patients randomly allocated into the ascorbate group and placebo. Each patient received normal saline infusion with or without ascorbate on days 1, 3, and 5 and answered questionnaires that included side effects; numeric rating pain scale (NRS) on spontaneous and brush-evoked pain on days 1, 3, 5, and 7; and patient global impression of change on spontaneous and brush-evoked pain on day 7. ResultsStudy 1 revealed that plasma concentrations of vitamin C were significantly lower in patients with PHN than in healthy volunteers (P<0.001). Study 2 showed that ascorbate treatment effectively restored plasma vitamin C concentrations in the patients and decreased spontaneous pain by 3.1 in NRS from baseline to day 7, as compared with a decrease of 0.85 in NRS by placebo treatment (P<0.001). Conversely, ascorbate treatment did not significantly affect brush-evoked pain. Ascorbate treatment also resulted in a better efficacy than placebo in patient global impression of change on spontaneous pain (P<0.001) on day 7 and did not affect brush-evoked pain. No side effects were observed. ConclusionsPlasma vitamin C status plays a role in PHN, and intravenous ascorbate helps relieve spontaneous pain in PHN.

Shiunko and acetylshikonin promote reepithelialization, angiogenesis, and granulation tissue formation in wounded skin.

Shiunko is a traditional botanic formula (ointment) used clinically for treating wounded skin. The aim of the present study was to compare the effects of Shiunko and acetylshikonin, and its active ingredient, with those of gentamicin and silver sulfadiazine ointments, two disinfectants for wound healing. Wounds were cut in the backs of Sprague-Dawley rats. Different bacterial inoculations (Pseudomonas aeruginosa and Staphylococcus aureus) and treatments (Shiunko, acetylshikonin, gentamicin, silver sulfadiazine, and vehicle ointments) were used to treat these wounds. We found that rats treated with Shiunko and acetylshikonin on both the sterilized and infected wounds showed higher rates of reepithelialization than those treated with the other ointments (p < 0.05) during a 7-day observation. In the histological study, rats treated with Shiunko and acetylshikonin on both the sterilized and infected wounds showed greater reepithelialization, angiogenesis, and granulation tissue formation than rats treated with the other ointments (p < 0.05) on day 5 after the wounds had been sutured. Differences between rats treated with Shiunko and acetylshikonin ointments were not statistically significant. In conclusion, topically applying Shiunko and acetylshikonin on wounded skin promoted wound healing. Both ointments were effective on sterilized and infected wounds.

The prophylactic effect of tropisetron on epidural morphine-related nausea and vomiting: a comparison of dexamethasone with saline.

Tropisetron is a 5-hydroxytryptamine subtype 3 receptor antagonist that is primarily used in the prevention of chemotherapy-induced nausea and vomiting. We evaluated the prophylactic effect of tropisetron on postoperative nausea and vomiting associated with epidural morphine. Dexamethasone and saline served as controls. One-hundred twenty women (n = 40 in each of three groups) undergoing abdominal total hysterectomy under epidural anesthesia were enrolled in this randomized, double-blinded, and placebo-controlled study. At the end of surgery, Group 1 received IV tropisetron 5 mg, whereas Groups 2 and 3 received dexamethasone 5 mg and saline, respectively. We found that tropisetron did not significantly reduce the occurrence of nausea and vomiting associated with epidural morphine. Dexamethasone, however, reduced the total incidence of nausea and vomiting from 59% to 21% (P < 0.01) and the percentage of patients requiring rescue antiemetic from 38% to 13% (P < 0.05). We conclude that IV tropisetron 5 mg did not prevent the occurrence of postoperative nausea and vomiting associated with epidural morphine. IV dexamethasone 5 mg was effective for this purpose.

Propensity Score-matched Comparison of Postoperative Adverse Outcomes between Geriatric Patients Given a General or a Neuraxial Anesthetic for Hip Surgery: A Population-based Study.

Background:The effects of the mode of anesthesia on major adverse postoperative outcomes in geriatric patients are still inconclusive. The authors hypothesized that a neuraxial anesthetic (NA) rather than a general anesthetic (GA) would yield better in-hospital postoperative outcomes for geriatric patients undergoing hip surgery. Methods:The authors used data from Taiwan’s 1997–2011 in-patient claims database to evaluate the effect of anesthesia on in-hospital outcomes. The endpoints were mortality, stroke, transient ischemic stroke, myocardial infarction, respiratory failure, and renal failure. Of the 182,307 geriatric patients who had hip surgery, a GA was given to 53,425 (29.30%) and an NA to 128,882 (70.70%). To adjust for baseline differences and selection bias, patients were matched on propensity scores, which left 52,044 GA and 52,044 NA patients. Results:GA-group patients had a greater percentage and higher odds of adverse in-hospital outcomes than did NA-group patients: death (2.62 vs. 2.13%; odds ratio [OR], 1.24; 95% CI, 1.15 to 1.35; P < 0.001), stroke (1.61 vs. 1.38%; OR, 1.18, 95% CI, 1.07 to 1.31; P = 0.001), respiratory failure (1.67 vs. 0.63%; OR, 2.71; 95% CI, 2.38 to 3.01; P < 0.001), and intensive care unit admission (11.03 vs. 6.16%; OR, 1.95; 95% CI, 1.87 to 2.05; P < 0.001), analyzed using conditional logistic regression. Moreover, patients given a GA had longer hospital stays (10.77 ± 8.23 vs. 10.44 ± 6.67 days; 95% CI, 0.22 to 0.40; P < 0.001) and higher costs (New Taiwan Dollars [NT

Acute Fatal Vasoplegia and Asystole Induced by Intravenous Amiodarone after Cardiopulmonary Bypass in a Patient with Preoperative Cardiogenic Shock

] 86,606 ± NT

Phenothiazine-type antipsychotics may attenuate naloxone-precipitated withdrawal jumping in morphine-dependent mice

74,162 vs. NT

Tianeptine reduces morphine antinociceptive tolerance and physical dependence.

74,494 ± NT

Low dose ketamine and midazolam as supplements for spinal anesthesia.

45,264; 95% CI, 11,366 to 12,859; P < 0.001). Conclusion:For geriatric patients undergoing hip surgery, NA was associated with fewer odds of adverse outcomes than GA.

Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study

Single dose intravenous amiodarone has been widely used and shown to be effective to treat supraventricular and ventricular arrhythemias in cardiac surgery. We, herein, report a 60-year-old female patient, sustaining cardiogenic shock in the course of percutaneous transluminal coronary angioplasty (PTCA) for unstable angina unrelieved by medication including nitroglycerin, succumbed to a life-saving emergent coronary artery bypass grafting (CABG) operation at the end of cardiopulmary bypass (CPB) following a 180 mg bolus dose of amiodarone (3 mg/kg) directed at the ventricular arrhythmias, triggered by protamine and unresponsive to lidocaine treatment. Amiodaroneinduced asystole and vasoplegia were thought to be the causation of the failure of resuscitation. The causes of the development of these complications, the potential hazards of its use and the management relative to the consequential complications are reviewed and discussed.