PREVENTION OF POST OPERATIVE VOMITING

J Med Assoc Thai Vol. 89 No. 12 2006 2003 Effectiveness of Ginger for Prevention of Nausea and Vomiting after Gynecological Laparoscopy Sirirat Apariman MD*, Sawinee Ratchanon MD*, Budsaba Wiriyasirivej MD* * Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration Medical College and Vajira Hospital Objective:To study the effectiveness of ginger for prevention of nausea and vomiting after gynecological laparoscopy. Material and Method: From July 2005 to October 2005, 60 inpatients who underwent laparoscopic opera- tions for non-cancer gynecologic conditions at Bangkok Metropolitan Administration Medical College or Vajira Hospital were randomized into Group A (n = 30) or Group B (n = 30). Group A received 3 capsules of ginger (1 capsule contained 0.5 g of ginger powder) while Group B received 3 capsules of placebo. Both groups received their medicine 1 hour prior the operation. Nausea and vomiting were assessed with the Visual Analogue Scores (VAS) and presence of vomiting at 2 and 6 hours after the operation. Results: Median VAS at 2 hours post operation of Group A was not significantly different from that of Group B with the median of 0 (range, 0-5.4) and 0.15(range, 0-10) respectively (95%CI from -2.59 to 0.90 and p = 0.142). At 6 hours post operation, the median VAS of Group A was significantly lower than group B, 0.55(range, 0-7.4) versus 2.80(range,0-10) (95%CI from -3.61 to -0.73 and p = 0.015). Presence of vomiting at 2 hours was not different between the two groups, 10% in Group A and 20% in Group B (95%CI from -28% to 8% and p = 0.278). At 6 hours, 23.3% of group A had an episode of vomiting compared to 46.7% of group B (95%CI from -47% to 1% and p = 0.058). Conclusion: Ginger has shown efficacy for prevention of nausea and borderline significance to prevention vomiting after gynecological laparoscopy at 6 hour post operation. Keywords: Ginger, Nausea, Vomiting, Gynecological laparoscopy Nausea and vomiting are common complica- tions after laparoscopic surgery with the incidence ranging from 25-40% (1-3) . The symptoms usually occur during the first 4 to 6 hours post operation period and rarely lasts longer than 24 hours (4) . Although most patients developed only minimal symptoms, some might experience severe symptoms that can cause serious complications such as electrolyte imbalance, dehydration, gastric content aspiration, prolonged recovery time, prolonged hospitalization, and bad impression to the subsequent surgery (5) . Effective prevention of post operative nausea and vomiting certainly leads to less undesirable sequelae and probably a better outcome of treatment. Recently, many evidences have been emerg- ing that ginger (Zingiber officinale Roscoe), a local medicinal herb, has significant antiemetic effect (3,6-8) . The action of ginger has direct effects on the gastro- intestinal tract (9-11) . An active ingredient of ginger is 6-gingerol, which is responsible for the aromatic, spas- molytic, carminative and absorbent properties of gin- ger (9,10) . Ginger is a traditional herb that is inexpensive, does not have serious adverse effects (9,10,12-16) and has no CNS (extrapyramidal) side effects (9-11) . Many studies reported the antiemetic effect of ginger in many cir- cumstances such as morning sickness (17) , motion sick- ness (18) , nausea and vomiting after chemotherapy (19) , and post operatively (3,6-8) . PROPHYLAXIS OF POSTOPERATIVE VOMITING and NAUSEA AN INADEQUATE CLINICAL INTEREST MD Nguyen Xuan Nhat Anesthesiologic department INTRODUCTION • Post operative vomiting and nausea (POVN) is a common and distressing in children patient • The general incidence of vomiting is about 30%, nausea is about 50% and high – risk patient is about 80% • Unresolved POVN may result in PACU, and increase care cost INTRODUCTION • The goal of POVN prophylaxis is to decrease POVN and therefore patientrelated distress and reduce health cost • This guideline is to provide comprehensive information to physicians, nurses, pharmacists, and health care providers strategy to prevent and treat POVN INTRODUCTION Patient factors B Age: Above yrs: markedly increased risk B History of POV: is an independent risk factor of subsequent POV in children Motion sickness: is likely an independent risk factor of C subsequent POV in children D Gender: Post pubertal girls have an increased incidence of POV, which may be related with sex hormone Preoperative anxiety: Well conducted in school – aged children Smoking: In adult: less susceptive to POV, In children: no data published Obesity: No relationship between obesity and POV Surgical factors A Strabismus surgery A Tonsillectomy C Surgical duration > 30 under GA Adenoidectomy Anesthetic factors A Volatile agents: Increase risk of emesis B Perioperative opioids: Increase risk of POV with long – acting agents B Perioperative fluids: Intraoperative fluids may reduce POV in day case surgery Children should drink before discharge, but not mandatory C Nitrous oxide: Without increasing of POV D Anticholinesterase drugs (Neostigmine): Increase POV in children Pharmacological Prevention of POVN A A High risk: IV ondansetron 0.05 mg/kg and Dexamethasone 0.15 mg/kg Increased risk: only either IV ondansetron 0.05 mg/kg or Dexamethasone 0.15 mg/kg D High risk: considered intravenous anesthesia and alternatives to opioid analgesia Pharmacologic combination Treatment established POVN B IV ondansetron 0.05 mg/kg who have not been given prophylaxis D Another class should be given, who has been given prophylaxis Thanks for listening safe surgery saves lives BioMed Central Page 1 of 9 (page number not for citation purposes) Journal of Orthopaedic Surgery and Research Open Access Research article The use of average Pavlov ratio to predict the risk of post operative upper limb palsy after posterior cervical decompression Koon-Man Sieh* 1 , Siu-Man Leung 1 , Judy Suk Yee Lam 2 , Kai Yin Cheung 1 and Kwai Yau Fung 1 Address: 1 Department of Orthopaedics and Traumatology, Alice Ho Mui Ling Nethersole Hospital, Tai Po, NT, Hong Kong SAR, PR China and 2 Department of Diagnostic Radiology and organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, PR China Email: Koon-Man Sieh* - siehkm1@yahoo.com.hk; Siu-Man Leung - dr.sm.leung@hotmail.com; Judy Suk Yee Lam - judysylam@yahoo.com; Kai Yin Cheung - kenkyc@cuhk.edu.hk; Kwai Yau Fung - kyfung@ort.cuhk.edu.hk * Corresponding author Abstract Study Design: A retrospective study was conducted to study the post operative upper limb palsy after laminoplasty for cervical myelopathy. Objective: To identify a reliable and simple preoperative radiological parameter in predicting the risk of post operative upper limb palsy. Background: Post operative upper limb palsy is one of the causes of patient dissatisfaction after surgery. There had been no simple, standard preoperative radiological parameters reliably predict the occurrence of this problem. Materials and methods: Seventy-four patients received posterior cervical decompression from 1998 to 2008. Medical record and preoperative radiological information were evaluated. Clinical presentations of the palsy were described. The relationship between the occurrence of palsy and different preoperative radiological information is analyzed. Results: Eighteen patients (24.3%) presented with post operative upper limb palsy. Majority of patients presented with dysesthesia (17/18) and with deficit of the C5 segment (17/18). Ten patients presented with pure dysesthesia and 8 patients presented with mixed motor-sensory deficit and dysesthesia. Multilevel involvement was exclusively presented in patients with motor weakness. A longer duration of symptom (16.7 Vs 57.2 days) was noticed in patients in the motor deficit group. Average Pavlov ratio less then 0.65 (P = 0.027, Odds Ratio = 3.68) and compression at the C3/4 in preoperative MRI image (P = 0.025, Odds Ratio = 6) were significant risk factors for development of this problem. Conclusion: Post operative upper limb palsy is not uncommon and thorough preoperative explanation is important. There is a spectrum of clinical presentation and patients with multi-level involvement and motor deficit are associated with poorer prognosis. Average Pavlov ratio < 0.65 and compression at C3/4 segment on preoperative MRI image are simple and reliable preoperative predictor for the development of this problem. Published: 7 July 2009 Journal of Orthopaedic Surgery and Research 2009, 4:24 doi:10.1186/1749-799X-4-24 Received: 19 March 2009 Accepted: 7 July 2009 This article is available from: http://www.josr-online.com/content/4/1/24 © 2009 Sieh et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits RESEARC H ARTIC LE Open Access Revision of failed hip resurfacing to total hip arthroplasty rapidly relieves pain and improves function in the early post operative period Nemandra A Sandiford 1* , Sarah K Muirhead-Allwood 1,2 , John A Skinner 2 Abstract We reviewed the results of 25 consecutive patients who underwent revision of a hip resurfacing prosthesis to a total hip replacement. Revisions were performed for recurrent pain and effusion, infection and proximal femoral fractures. Both components were revised in 20 cases. There were 12 male and 13 female patients with average time to revision of 34.4 and 26.4 months respectively. The mean follow up period was 12.7 months (3 to 31). All patients reported relief of pain and excellent satisfaction scores. Two patients experienced stiffness up to three months post operatively. Pre operative Oxford, Harris and WOMAC hip scores were 39.1, 36.4 and 52.2 respectively. Mean post operative scores at last follow up were 17.4, 89.8 and 6.1 respectively (p < 0.001 for each score). These results show that con- version of hip resurfacing to total hip arthroplasty has high satisfaction rates. These results compare favourably with those for revision total hip arthroplasty. Introduction Metal on Metal (MoM) hip resurfacing has become increasingly popular over the last decade. Data from the United Kingdom (UK) National Joint Registry [1] suggest that while hip resurfacing (HR) procedures account for approximately 10% of all hip arthroplasty procedures in the UK annually, the actual numb er of hip resurf acings performed is steadily increasing from 2,338 in 2004 to 5,596 in 2007 [1]. The proposed benefits of HR compared to total hip replacement include femoral bone preserva- tion, increased stability, improved proprioception of the hip joint and technically less demanding conversion to a total hip replacement if necessary, particularly on the femoral side. This is most relevant to young, active patients. While early results of Metal on Metal hip resurfacing have been promising, complications have been reported which require revision. These include femoral neck frac- tures [2] and recurrent pain and effusions thought to be related to a n aseptic lymphocytic vasculitis associated lesion (ALVAL) syndrome [3]. Large destructive lesions (pseudo tumors) have also been reported which lead to soft tissue loss around the hip joint[4]. While it may be relatively straightforward to revise a hip resurfacing to a total hip replacement, the resu lts of this proced ure are unknown. If there is a complication rate of a less invasive procedure (hip resurfacing versus total hip replacement) then one needs to know the functional outcome of the revision procedure when considering it in young, active, high demand patients. This prospective study analyses the early functional out- come of a cohort of patients who underwent conversion of a hip resurfacing to a total hip replacement. We examine the population undergoing revision and the indications for revision. Parameters BioMed Central Page 1 of 6 (page number not for citation purposes) World Journal of Surgical Oncology Open Access Research Prediction of post-operative necrosis after mastectomy: A pilot study utilizing optical diffusion imaging spectroscopy Roshni Rao* 1 , Michel Saint-Cyr 2 , Aye Moe Thu Ma 1 , Monet Bowling 1 , Daniel A Hatef 2 , Valerie Andrews 1 , Xian-Jin Xie 3 , Theresa Zogakis 1 and Rod Rohrich 2 Address: 1 Department of Surgery, Division of Surgical Oncology, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9155, USA, 2 Department of Plastic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390- 9155, USA and 3 Department of Clinical Sciences-Division of Biostatistics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9155, USA Email: Roshni Rao* - Roshni.Rao@utsouthwestern.edu; Michel Saint-Cyr - Michel.Saint-Cyr@UTSouthwestern.edu; Aye Moe Thu Ma - atma@chpnet.org; Monet Bowling - mwbowlin@iupui.edu; Daniel A Hatef - dan.hatef@gmail.com; Valerie Andrews - Valerie.Andrews@UTSouthwestern.edu; Xian-Jin Xie - Xian-Jin.Xie@UTSouthwestern.edu; Theresa Zogakis - t.g.zogakis@att.net; Rod Rohrich - Rod.Rohrich@UTSouthwestern.edu * Corresponding author Abstract Introduction: Flap necrosis and epidermolysis occurs in 18-30% of all mastectomies. Complications may be prevented by intra-operative detection of ischemia. Currently, no technique enables quantitative valuation of mastectomy skin perfusion. Optical Diffusion Imaging Spectroscopy (ViOptix T.Ox Tissue Oximeter) measures the ratio of oxyhemoglobin to deoxyhemoglobin over a 1 × 1 cm area to obtain a non-invasive measurement of perfusion (StO 2 ). Methods: This study evaluates the ability of ViOptix T.Ox Tissue Oximeter to predict mastectomy flap necrosis. StO 2 measurements were taken at five points before and at completion of dissection in 10 patients. Data collected included: demographics, tumor size, flap length/ thickness, co-morbidities, procedure length, and wound complications. Results: One patient experienced mastectomy skin flap necrosis. Five patients underwent immediate reconstruction, including the patient with necrosis. Statistically significant factors contributing to necrosis included reduction in medial flap StO 2 (p = 0.0189), reduction in inferior flap StO 2 (p = 0.003), and flap length (p = 0.009). Conclusion: StO 2 reductions may be utilized to identify impaired perfusion in mastectomy skin flaps. Synopsis In this pilot study of ten patients, increased mastectomy flap length, a significant drop in medial and inferior StO 2 measurements by Optical Diffusion Imaging Spectros- copy (ViOptix T.Ox Tissue Oximeter) intra-operatively predicted post-operative mastectomy skin flap necrosis. Published: 25 November 2009 World Journal of Surgical Oncology 2009, 7:91 doi:10.1186/1477-7819-7-91 Received: 23 September 2009 Accepted: 25 November 2009 This article is available from: http://www.wjso.com/content/7/1/91 © 2009 Rao et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. World Journal of Surgical Oncology 2009, 7:91 http://www.wjso.com/content/7/1/91 Page 2 of 6 (page number not for citation purposes) Introduction Breast cancer is diagnosed in approximately 200,000 women in the United States every year. Surgical treatment for breast cancer involves either breast conserving surgery (BCT) or total mastectomy. Although recent studies [1] indicate that the majority of patients diagnosed with breast cancer receive BCT, 33% of patients continue to undergo mastectomy [1]. There also appears to be a signif- icant improvement in the utilization of post-mastectomy Open Access Available online http://ccforum.com/content/13/1/R6 Page 1 of 9 (page number not for citation purposes) Vol 13 No 1 Research Automatic versus manual pressure support reduction in the weaning of post-operative patients: a randomised controlled trial Corinne Taniguchi 1 , Raquel C Eid 1 , Cilene Saghabi 1 , Rogério Souza 2 , Eliezer Silva 1 , Elias Knobel 1 , Ângela T Paes 1 and Carmen S Barbas 1,2 1 Adult – ICU – Albert Einstein Hospital, Av. Albert Einstein 627-5 andar – São Paulo, SP, 05651-901, Brazil 2 Pulmonary Division, University of São Paulo, Av Dr Eneas de Carvalho Aguiar 255-room 7079, São Paulo, SP, 05403-900, Brazil Corresponding author: Carmen S Barbas, cbarbas@attglobal.net Received: 26 Jun 2008 Revisions requested: 15 Sep 2008 Revisions received: 20 Oct 2008 Accepted: 26 Jan 2009 Published: 26 Jan 2009 Critical Care 2009, 13:R6 (doi:10.1186/cc7695) This article is online at: http://ccforum.com/content/13/1/R6 © 2009 Taniguchi et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Introduction Reduction of automatic pressure support based on a target respiratory frequency or mandatory rate ventilation (MRV) is available in the Taema-Horus ventilator for the weaning process in the intensive care unit (ICU) setting. We hypothesised that MRV is as effective as manual weaning in post-operative ICU patients. Methods There were 106 patients selected in the post- operative period in a prospective, randomised, controlled protocol. When the patients arrived at the ICU after surgery, they were randomly assigned to either: traditional weaning, consisting of the manual reduction of pressure support every 30 minutes, keeping the respiratory rate/tidal volume (RR/TV) below 80 L until 5 to 7 cmH 2 O of pressure support ventilation (PSV); or automatic weaning, referring to MRV set with a respiratory frequency target of 15 breaths per minute (the ventilator automatically decreased the PSV level by 1 cmH 2 O every four respiratory cycles, if the patient's RR was less than 15 per minute). The primary endpoint of the study was the duration of the weaning process. Secondary endpoints were levels of pressure support, RR, TV (mL), RR/TV, positive end expiratory pressure levels, FiO 2 and SpO 2 required during the weaning process, the need for reintubation and the need for non-invasive ventilation in the 48 hours after extubation. Results In the intention to treat analysis there were no statistically significant differences between the 53 patients selected for each group regarding gender (p = 0.541), age (p = 0.585) and type of surgery (p = 0.172). Nineteen patients presented complications during the trial (4 in the PSV manual group and 15 in the MRV automatic group, p < 0.05). Nine patients in the automatic group did not adapt to the MRV mode. The mean ± sd (standard deviation) duration of the weaning process was 221 ± 192 for the manual group, and 271 ± 369 minutes for the automatic group (p = 0.375). PSV levels were significantly higher in MRV compared with that of the PSV manual reduction (p < 0.05). Reintubation was not required in either group. Non-invasive ventilation was necessary for two patients, in the manual group after cardiac surgery (p = 0.51). Conclusions The duration of the automatic reduction of pressure support was similar to the manual one in the post- operative period in the ICU, but presented more complications, especially no adaptation to the MRV algorithm. Trial Registration Trial registration number: ISRCTN37456640 Introduction The weaning of mechanical ventilation or the removal of mechanical ventilation involves preparation of the patient and the progressive reduction of the ventilatory aid. As soon as the patients ...INTRODUCTION • Post operative vomiting and nausea (POVN) is a common and distressing in children patient • The general incidence of vomiting is about 30%, nausea is about... factors A Volatile agents: Increase risk of emesis B Perioperative opioids: Increase risk of POV with long – acting agents B Perioperative fluids: Intraoperative fluids may reduce POV in day case... risk B History of POV: is an independent risk factor of subsequent POV in children Motion sickness: is likely an independent risk factor of C subsequent POV in children D Gender: Post pubertal