Se Jin Lee

Efficacy of palonosetron for the prevention of postoperative nausea and vomiting: a randomized, double-blinded, placebo-controlled trial

BACKGROUNDnThe aim of this study was to evaluate the efficacy of palonosetron, the latest 5-HT3 receptor antagonist, for the prevention of postoperative nausea and vomiting (PONV) during the first 72 h after operation.nnnMETHODSnIn this randomized, double-blinded, placebo-controlled study, 204 healthy inpatients who were undergoing elective surgery with general anaesthesia were enrolled. Patients were divided into two groups: the palonosetron group (palonosetron 0.075 mg i.v.; n=102) and the placebo group (normal saline i.v.; n=102). The treatments were given after the induction of anaesthesia. The incidence of nausea, vomiting, severity of nausea, and the use of rescue anti-emetics during the first 72 h after surgery were evaluated.nnnRESULTSnThe incidence of PONV was lower in the palonosetron group compared with the placebo group during the 0-24 h (33% vs 47%) and 0-72 h period (33% vs 52%) (P<0.05), but not during the 24-72 h postoperative period (6% vs 11%). The incidence of nausea was also significantly lower in the palonosetron group than in the placebo group during the 0-24 and 0-72 h period (P<0.05), but not during the 24-72 h postoperative period. However, there were no significant differences in the incidence of vomiting, and the use of rescue anti-emetics between the groups.nnnCONCLUSIONSnPalonosetron 0.075 mg i.v. effectively reduced the incidence of PONV during the first 72 h after operation, with most of the reduction occurring in the first 24 h.

Application of triamcinolone acetonide paste to the endotracheal tube reduces postoperative sore throat: a randomized controlled trial.

PurposeThis study was performed to examine whether applying triamcinolone acetonide paste as a lubricant to endotracheal tubes (ETTs) reduces the incidence and severity of postoperative sore throat (POST) more effectively than applying chlorhexidine gluconate jelly.MethodsThis was a randomized controlled clinical trial. Patients enrolled in the study were ages 20 to 70xa0yr, American Society of Anesthesiologists’ physical status I and II, and scheduled for elective laparoscopic cholecystectomy. The patients were divided randomly into two groups, the chlorhexidine group and the triamcinolone group. Prior to endotracheal intubation, ETTs in the chlorhexidine group were lubricated with 0.1% chlorhexidine gluconate jelly, whereas the ETTs in the triamcinolone group were lubricated with 0.1% triamcinolone acetonide paste 0.5xa0mg. During the 24xa0hr after the operation, we recorded the incidence and severity of POST and the incidence of cough, hoarseness, dysphagia, nausea, and dry throat.ResultsOf the 150 patients initially enrolled, 143 patients were included in the study. The incidence of POST was significantly lower in the triamcinolone group compared with the chlorhexidine group (differencexa0=xa052.4%; 95% confidence interval, 36.8% to 64.2%; Pxa0<xa00.001). The severity score for the triamcinolone group was significantly lower than that for the chlorhexidine group. The frequencies of coughing, hoarseness, dysphagia, nausea, and dry throat were similar in the two groups for the first 24 hr after surgery.ConclusionsTriamcinolone acetonide paste applied along the length of the ETT resulted in clinically important and statistically significant decreases in the incidence and severity of POST compared with the application of chlorhexidine jelly. (ClinicalTrials.govxa0number, CT00908817).RésuméObjectifCette étude a été réalisée afin d’observer si la pâte de triamcinolone, appliquée pour lubrifier les sondes endotrachéales (SET), réduisait l’incidence et la gravité des maux de gorge postopératoires de façon plus efficace que la gelée de gluconate de chlorhexidine.MéthodeCette étude clinique randomisée contrôlée a recruté des patients ASA I-II (classification de l’American Society of Anesthesiologists) âgés de 20 à 70 ans et devant subir une cholécystectomie par laparoscopie non urgente. Les patients ont été randomisés en deux groupes. Dans le groupe chlorhexidine, les SET ont été lubrifiés avec de la gelée de gluconate de chlorhexidine à 0,1xa0%, alors que dans le groupe triamcinolone, les SET ont été lubrifiés avec 0,5xa0mg de pâte d’acétonide de triamcinolone à 0,1xa0% avant l’intubation endotrachéale. L’incidence et la gravité des maux de gorge postopératoires et l’incidence de toux, d’enrouement, de dysphagie, de nausée et de gorge sèche ont été enregistrées pendant les 24xa0h suivant l’opération.RésultatsParmi les 150 patients recrutés au début de l’étude, 143 ont été inclus. L’incidence des maux de gorge postopératoires était significativement plus basse dans le groupe triamcinolone que dans le groupe chlorhexidine (différencexa0=xa052,4xa0%, intervalle de confiance 95xa0%xa0: 36,8xa0% à 64,2xa0%, Pxa0<xa00,001). Le score de gravité était significativement plus bas dans le groupe triamcinolone que dans le groupe chlorhexidine. La fréquence de la toux, de l’enrouement, de la dysphagie, de la nausée et / ou de gorge sèche était semblable dans les deux groupes durant les premières 24xa0h après la chirurgie.ConclusionLa pâte d’acétonide de triamcinolone appliquée sur toute la longueur de la SET a entraîné des réductions importantes d’un point de vue clinique et statistiquement significatives de l’incidence et de la gravité des maux de gorge postopératoires par rapport à la gelée de chlorhexidine. (ClinicalTrials.gov numéro, NCT00908817).

Changes in the relationship between the right internal jugular vein and an anatomical landmark after head rotation

Background This study was performed to ultrasonographically demonstrate the changes in relationship between the right internal jugular vein (IJV) and an anatomical landmark in two different head positions: neutral and rotated. Methods This was a randomized clinical trial. One hundred patients scheduled for elective surgery under general anesthesia with endotracheal intubation were enrolled in this study. The patients were placed in the supine position with a neutral head position and without a pillow. The apex of the triangle formed by the sternal and clavicular heads of the sternocleidomastoid muscle and clavicle was marked (AL point : anatomical landmark point). Ultrasonography of the neck anatomy was performed and the skin was marked at the central point of the IJV (US point: ultrasonography point). The other investigator measured the distance from the AL point to the US point (AL-US distance). The patients head was then turned 30° to the left; the same procedure was repeated and the AL-US distance was again measured. The changes in AL-US distance were calculated. Results The AL-US distance increased significantly after 30° head rotation compared with that in a head neutral position. The mean ± SD of the AL-US distance was 0.28 ± 0.78 cm in the neutral head position and 0.83 ± 1.03 cm in the head rotated position. Conclusions The anatomical landmark point becomes more distant from the actual right IJV point and moves more medially after head rotation. We suggest minimizing the angle of head rotation and taking this distance into consideration when using the landmark-guided method.

A comparison of sufentanil and fentanyl for patient- controlled epidural analgesia in arthroplasty

Background The use of lipid soluble opioids such as fentanyl, alfentanil and sufentanil are recently on the increase for patient-controlled epidural analgesia (PCEA). In this study, the effects and adequate dose of sufentanil in arthroplasty were investigated. Methods Eighty patients scheduled for arthroplasty were enrolled for the study. Seventy-one patients (ASA physical status I-III) were randomly allocated into four groups. All groups received 0.1% ropivacaine through PCEA and each group received either fentanyl (group F: fentanyl 4 µg/ml) or sufentanil (group S1: sufentanil 0.5 µg/ml, group S2: sufentanil 0.75 µg/ml, and group S3: sufentanil 1.0 µg/ml). Postoperative pain scores were evaluated using VAS (visual analog scale, 0-10) and side effects such as hypotension, nausea/vomiting, pruritus and the degree of satisfaction were evaluated at 1, 6, 12, 24, 48 hours after surgery. Results Postoperative pain score (VAS) decreased gradually and the highest VAS score was recorded at 1 hour postoperative for all four groups. There were no differences in the degree of satisfaction and postoperative pain score between all groups. The incidence of pruritus was significantly lower in group S1 than in groups S2 and S3. Conclusions The incidence of side effects were significantly lower in group S1 (0.1% ropivacaine plus sufentanil 0.5 µg/ml). Therefore, 0.5 µg/ml of sufentanil through PCEA is the recommended dose for postoperative pain control in arthroplasty.