Soon Im Kim

Comparison of ramosetron with ondansetron for prevention of postoperative nausea and vomiting in patients undergoing gynaecological surgery

BACKGROUNDnRamosetron is a new selective 5-hydroxytryptamine type 3 (5-HT(3)) receptor antagonist that reportedly has more potent antiemetic effects compared with other 5-HT(3) receptor antagonists. The purpose of this study was to evaluate the efficacy of ramosetron for the prevention of postoperative nausea and vomiting (PONV) with that of ondansetron or placebo in high-risk patients undergoing gynaecological surgery.nnnMETHODSnIn this prospective, randomized, double-blinded, placebo-controlled study, 162 healthy patients who were undergoing gynaecological operation under general anaesthesia using sevoflurane were enrolled. Patients were divided into three groups: the ramosetron group (0.3 mg i.v.; n=54), the ondansetron group (8 mg i.v.; n=54), and the placebo group (normal saline i.v.; n=54). The treatments were given before the end of surgery. The incidence of PONV, severity of nausea, and the use of rescue antiemetic requirements during the first 24 h after surgery were evaluated.nnnRESULTSnThe incidence of nausea was lower in the ramosetron (50%) and ondansetron (44%) groups compared with the placebo group (69%) (P<0.05). In addition, the incidence of vomiting was lower in both the ramosetron (17%) and the ondansetron (20%) groups than in the placebo group (44%) during the first 24 h after surgery (P<0.05). The visual analogue scale score for nausea was also lower in the ramosetron and ondansetron groups compared with the placebo group (P<0.05). The proportion of patients requiring rescue antiemetics was significantly lower with ramosetron (15%) when compared with the placebo group (41%) during the 24 h after surgery (P<0.05). However, there were no significant differences in the incidence of nausea and vomiting, severity of nausea, and required rescue PONV between the ramosetron and the ondansetron groups.nnnCONCLUSIONSnRamosetron 0.3 mg i.v. was as effective as ondansetron 8 mg i.v. in decreasing the incidence of PONV and reducing nausea severity in female patients during the first 24 h after gynaecological surgery.

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.

Prevention of pain with the injection of microemulsion propofol: a comparison of a combination of lidocaine and ketamine with lidocaine or ketamine alone

Background Aquafol, a microemulsion propofol, causes more severe and frequent pain on injection than propofol. The purpose of this study was to compare a combination of lidocaine and ketamine on aquafol-induced pain with lidocaine or ketamine alone during the induction of anesthesia. Methods In this prospective, randomized, double-blinded study, 130 healthy patients who were undergoing elective surgery under general anesthesia were enrolled. The patients received IV lidocaine 40 mg plus ketamine 25 mg (Group LK, n = 43), lidocaine 40 mg (Group L, n = 42), or ketamine 25 mg (Group K, n = 45) with a rubber tourniquet on the forearm 1 min before the injection of microemulsion propofol. The pain score was assessed by a 4-point verbal rating scale (VRS) at 10 seconds after injection of microemulsion propofol 30 mg and during the injection of the remaining total dose. Results The incidence and severity of pain was significantly lower in Group LK than Group L or Group K at 10 seconds after the injection of microemulsion propofol 30 mg (P < 0.05). And the incidence and severity of pain was significantly lower in Group LK and Group K than Group L during the injection of the remaining total dose (P < 0.05). Conclusions Pretreatment with IV lidocaine 40 mg plus ketamine 25 mg with a rubber tourniquet on the forearm 1 min before the injection of microemulsion propofol is more effective than lidocaine 40 mg or ketamine 25 mg alone in preventing pain from the injection of microemulsion propofol.

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.

The effect of intravenous low dose ketamine for reducing postoperative sore throat

Background This study was performed to evaluate the effectiveness of intravenous low dose ketamine for reducing the incidence and severity of postoperative sore throat (POST). Methods This was a prospective, randomized, double-blind clinical trial. The study population consisted of 70 patients between 20 and 70 years old who were classified as American Society of Anesthesiologists I-II and were scheduled for elective laparoscopic cholecystectomy. The patients were divided randomly into two groups. Patients in the ketamine group received an intravenous injection of 0.5 mg/kg of ketamine just before induction, followed by 10 µg/kg/min throughout the operation. Patients in the control group received intravenous saline instead of ketamine. The patients were interviewed 1, 6, and 24 h after the operation. The incidence and severity of POST were recorded. Results No significant differences in the incidence and severity of POST during the 24 h after the operation were found between the two groups (21/31 in the ketamine group vs. 26/34 in the control group, P = 0.398). Conclusions Intravenous injection of low dose ketamine was not effective for reducing POST.

The effect of combination treatment using palonosetron and dexamethasone for the prevention of postoperative nausea and vomiting versus dexamethasone alone in women receiving intravenous patient-controlled analgesia

Background The purpose of this study was to evaluate the effect of palonosetron combined with dexamethasone for the prevention of PONV compared to dexamethasone alone in women who received intravenous patient-controlled analgesia (IV-PCA) using fentanyl. Methods In this randomized, double-blinded, placebo-controlled study, 204 healthy female patients who were scheduled to undergo elective surgery under general anesthesia followed by IV-PCA for postoperative pain control were enrolled. Patients were divided into two groups: the PD group (palonosetron 0.075 mg and dexamethasone 5 mg IV; n = 102) and the D group (dexamethasone 5 mg IV; n = 102). The treatments were given after the induction of anesthesia. The incidence of nausea, vomiting, severity of nausea, and the use of rescue anti-emetics during the first 48 hours after surgery were evaluated. Results The incidence of PONV was significantly lower in the PD group compared with the D group during the 0-24 hours (43 vs. 59%) and 0-48 hours after surgery (45 vs. 63%) (P < 0.05). The severity of nausea during the 6-24 hours after surgery was significantly less in the PD group compared with the D group (P < 0.05). The incidence of rescue antiemetic used was significantly lower in the PD group than in the D group during the 0-6 hours after surgery (13.1 vs. 24.5%) (P < 0.05). Conclusions Palonosetron combined with dexamethasone was more effective in preventing PONV compared to dexamethasone alone in women receiving IV-PCA using fentanyl.

The hemodynamic changes by different end-tidal CO2 under anesthesia using sevoflurane-N2O

BACKGROUNDnHypercapnia augments cardiac output and can initiate a sympathetically mediated release of catecholamines to increase cardiac output. Many studies of hemodynamic changes by hypercapnia under general anesthesia with inhalation anesthetics besides sevoflurane. This study examined the hemodynamic changes by increasing end-tidal carbon dioxide (EtCO2) under sevoflurane-N2O anesthesia.nnnMETHODSnTwenty patients were enrolled in the study. We studied stable, mechanically ventilated patients under general anesthesia maintained with O2 2 L/min - N2O 2 L/min - sevoflurane (1.5-2.5 vol%). Hypercapnia were obtained by reducing tidal volume and respiratory rate. EtCO2 was adjusted to 30, 40, 50 mmHg with each concentration maintained for 15 min. Global hemodynamic variables were monitored with a pulmonary artery catheter.nnnRESULTSnThere were no changes in mean arterial pressure or heart rate by hypercapnia. Acute moderate hypercapnia increased cardiac output (4.9 +/- 1.7, 5.5 +/- 1.7, 6.2 +/- 2.1 L/min; P < 0.05), cardiac index (3.0 +/- 0.9, 3.4 +/- 0.9, 3.8 +/- 1.1 L/min/m2; P < 0.05), pulmonary artery pressure (16.9 +/- 3.7, 19.6 +/- 4.2, 23.0 +/- 4.7 mmHg), but did not decrease systemic vascular resistance (1,558.3 +/- 500.4, 1,423.5 +/- 678.6, 1,156.8 +/- 374.0 dynes.sec/cm5; P > 0.05).nnnCONCLUSIONSnWhen we changed patient EtCO2 to 30, 40, and 50 mmHg, there were no changes in mean arterial blood pressure and heart rate, but systemic vascular resistance decreased, and cardiac output, cardiac index and mean pulmonary arterial pressure increased significantly.