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Brazilian Journal of Anesthesiology... 2022Procedures for Postoperative Nausea and Vomiting (PONV) prevention are mostly based on identification of the risk factors before administering antiemetic drugs. The...
BACKGROUNDS
Procedures for Postoperative Nausea and Vomiting (PONV) prevention are mostly based on identification of the risk factors before administering antiemetic drugs. The purpose of this study was to evaluate the impact of the extended use of antiemetic on the PONV in the Postanesthetic Care Unit (PACU).
METHODS
Two separate 4-year periods (2007...2010, P1, and (2015...2018, P2) were evaluated. During P1, the protocol consisted of dexamethasone and droperidol for patients with a locally adapted high PONV score, followed by ondansetron for rescue in the PACU. For Period 2, dexamethasone (8 mg) and ondansetron (4 mg) were administered in patients under general or regional anesthesia, or sedation longer than 30 minutes, while droperidol (1.25 mg) in rescue was injected in cases of PONV in the PACU. An Anesthesia Information Management System was used to evaluate the intensity score of PONV (1 to 5), putative compliance, sedation, and perioperative opioid consumption upon arrival in the PACU.
RESULTS
A total of 27,602 patients were assessed in P1 and 36,100 in P2. The administration of dexamethasone and ondansetron increased several fold (p < 0.0001). The high PONV scores were more improved in P2 than in P1, with scores (3+4+5) for P1 vs. P2, p < 0.0001. Overall, 99.7% of the patients in P2 were asymptomatic at discharge. Morphine consumption decreased from 6.9..1.5 mg in P1 to 3.5 .. 1.5 mg in P2 (p < 0.0001).
DISCUSSION
The extension of pharmacological prevention of PONV was associated with a decrease in the intensity of severe PONV. However, uncertainty regarding confounding factors should not be ignored. IRB: n.. 92012/33465.
Topics: Humans; Postoperative Nausea and Vomiting; Ondansetron; Droperidol; Retrospective Studies; Antiemetics; Neoplasms; Dexamethasone; Double-Blind Method
PubMed: 34216701
DOI: 10.1016/j.bjane.2021.06.007 -
Journal of Evidence-based Medicine Sep 2021In this abridged version of the recently published Cochrane review on antiemetic drugs, we summarize its most important findings and discuss the challenges and the time... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
In this abridged version of the recently published Cochrane review on antiemetic drugs, we summarize its most important findings and discuss the challenges and the time needed to prepare what is now the largest Cochrane review with network meta-analysis in terms of the number of included studies and pages in its full printed form.
METHODS
We conducted a systematic review with network meta-analyses to compare and rank single antiemetic drugs and their combinations belonging to 5HT₃-, D₂-, NK₁-receptor antagonists, corticosteroids, antihistamines, and anticholinergics used to prevent postoperative nausea and vomiting in adults after general anesthesia.
RESULTS
585 studies (97 516 participants) testing 44 single drugs and 51 drug combinations were included. The studies' overall risk of bias was assessed as low in only 27% of the studies. In 282 studies, 29 out of 36 drug combinations and 10 out of 28 single drugs lowered the risk of vomiting at least 20% compared to placebo. In the ranking of treatments, combinations of drugs were generally more effective than single drugs. Single NK receptor antagonists were as effective as other drug combinations. Of the 10 effective single drugs, certainty of evidence was high for aprepitant, ramosetron, granisetron, dexamethasone, and ondansetron, while moderate for fosaprepitant and droperidol. For serious adverse events (SAEs), any adverse event (AE), and drug-class specific side effects evidence for intervention effects was mostly not convincing.
CONCLUSIONS
There is high or moderate evidence for at least seven single drugs preventing postoperative vomiting. However, there is still considerable lack of evidence regarding safety aspects that does warrant investigation.
Topics: Adult; Anesthesia, General; Antiemetics; Humans; Network Meta-Analysis; Pharmaceutical Preparations; Postoperative Nausea and Vomiting
PubMed: 34043870
DOI: 10.1111/jebm.12429 -
The Western Journal of Emergency... Dec 2020
Topics: Antiemetics; Droperidol; Drug Therapy, Combination; Humans; Retrospective Studies; Risk
PubMed: 33856329
DOI: 10.5811/westjem.2020.9.49870 -
The Western Journal of Emergency... Jan 2021
Topics: Droperidol; Emergency Service, Hospital; Humans; Incidence; Long QT Syndrome
PubMed: 33856328
DOI: 10.5811/westjem.2020.9.49486 -
Annals of Emergency Medicine Aug 2021Intramuscular medications are commonly used to treat agitation in the emergency department (ED). The purpose of this study is to compare intramuscular droperidol and... (Comparative Study)
Comparative Study Observational Study
STUDY OBJECTIVE
Intramuscular medications are commonly used to treat agitation in the emergency department (ED). The purpose of this study is to compare intramuscular droperidol and olanzapine for treating agitation.
METHODS
This was a prospective observational study of ED patients receiving intramuscular droperidol or olanzapine for acute agitation. The treating physician determined the medication and dose; however, over time drug shortages made either olanzapine (July to September 2019) or droperidol (November 2019 to March 2020) unavailable, creating a natural experiment. The primary outcome was time to adequate sedation, assessed by the Altered Mental Status Scale (AMSS), defined as time to AMSS score less than or equal to 0.
RESULTS
We analyzed 1,257 patients (median age 42 years; 73% men); 538 received droperidol (median dose 5 mg) and 719 received olanzapine (median dose 10 mg). The majority of patients (1,086; 86%) had agitation owing to alcohol intoxication. Time to adequate sedation was 16 minutes (interquartile range 10 to 30 minutes) for droperidol and 17.5 minutes (interquartile range 10 to 30 minutes) for olanzapine (absolute difference -0.7 minutes; 95% confidence interval -2.1 to 0.5 minutes). Adjusted Cox proportional hazard model analysis revealed no difference between groups in time to sedation (hazard ratio for adequate sedation for droperidol compared with olanzapine 1.12; 95% confidence interval 1.00 to 1.25). Patients receiving olanzapine were more likely to receive additional medications for sedation (droperidol 17%; olanzapine 24%; absolute difference -8% [95% confidence interval -12% to -3%]). We observed no difference between drugs regarding adverse effects except for extrapyramidal adverse effects, which were more common with droperidol (n=6; 1%) than olanzapine (n=1; 0.1%).
CONCLUSION
We found no difference in time to adequate sedation between intramuscular droperidol and olanzapine.
Topics: Adult; Antipsychotic Agents; Droperidol; Emergency Service, Hospital; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Olanzapine; Pharmaceutical Preparations; Prospective Studies; Psychomotor Agitation; Quality Improvement; Time Factors
PubMed: 33846015
DOI: 10.1016/j.annemergmed.2021.01.005 -
International Journal of Colorectal... Jul 2021Early post-operative delirium (EPOD) is a frequent complication following colorectal surgery. The present study investigated the risk factors for EPOD after laparoscopic...
PURPOSE
Early post-operative delirium (EPOD) is a frequent complication following colorectal surgery. The present study investigated the risk factors for EPOD after laparoscopic colorectal surgery in elderly patients.
METHODS
A retrospective study was conducted among 208 patients ≥70 years old who underwent laparoscopic colorectal surgery. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with the EPOD.
RESULTS
The overall incidence of EPOD was 10.1% (21/208). The univariate analysis showed that an older age (≥80 years old; P=0.002), sleeping pill medication before surgery (P=0.037), a history of dementia (P=0.030) and cerebrovascular disease (P=0.017), elevated levels of D-dimer (P=0.016), maximum intraoperative temperature ≥37 °C (P=0.036), and non-continuous usage of droperidol with analgesia (P=0.005) were associated with EPOD. The multivariate logistic regression analysis revealed an older age (≥80 years old; odds ratio [OR]: 6.26, 95% confidence interval [CI]: 1.94-20.15, P=0.002), sleeping pill medication before surgery (OR: 5.39, 95% CI: 1.36-21.28, P=0.016), history of cerebrovascular disease (OR: 3.91, 95% CI: 1.12-13.66, P=0.033), and maximum intraoperative temperature ≥37 °C (OR: 5.10, 95% CI: 1.53-16.92, P=0.008) to be independent risk factors. When the patients were divided into groups according to the number of positive risk factors, the prevalence rate was 6.5%, 16.0%, and 63.6% for patients with 1, 2, and 3 positive risk factors, respectively.
CONCLUSION
Our findings suggest that an older age, sleeping pill medication before surgery, history of cerebrovascular disease, and maximum intraoperative temperature ≥37 °C are independent risk factors of EPOD after laparoscopic colorectal surgery in elderly patients.
Topics: Aged; Aged, 80 and over; Colorectal Neoplasms; Delirium; Humans; Laparoscopy; Postoperative Complications; Retrospective Studies; Risk Assessment; Risk Factors
PubMed: 33782764
DOI: 10.1007/s00384-021-03919-5 -
Emergency Medicine Australasia : EMA Oct 2021Administration of a sedative agent is required for safe transport of prehospital patients with severe agitation to EDs. Ambulance services in Australasia use ketamine,...
OBJECTIVE
Administration of a sedative agent is required for safe transport of prehospital patients with severe agitation to EDs. Ambulance services in Australasia use ketamine, droperidol or midazolam as first line agent but the optimal agent is uncertain. In Victoria, intramuscular (IM) ketamine is used. The present study aimed to examine the prehospital characteristics and ED outcomes of patients with severe agitation after IM ketamine administration.
METHODS
A retrospective review was conducted for patients who received IM ketamine for severe agitation over a 2-year period. Data were sourced from Ambulance Victoria and linked to hospital data. The primary outcome was time to sedation. Data collected included baseline characteristics, adverse events and ED outcomes.
RESULTS
Three hundred and fifty-eight prehospital cases transported to 32 hospitals were included. Outcome data were available for 305 patients (21 hospitals). Median age was 31 years (IQR 23-40). 71.2% were male. Adequate sedation was achieved in 96.9% of cases in a median time of 5.0 min (IQR 3.0-7.0; range 1-31 min). Adverse events were transient hypoxia (5.0%), hyper-salivation (4.2%) and emergence reactions (0.8%). A total of 45 (14.8%) patients were intubated; two prehospital.
CONCLUSION
Intramuscular ketamine is effective with a low rate of prehospital complications in severely agitated patients in the prehospital setting. Given the variation in ambulance practice in Australasia, prospective, randomised trials in the prehospital setting comparing ketamine to other sedating agents such as droperidol in patients with severe agitation are required.
Topics: Adult; Allied Health Personnel; Female; Humans; Ketamine; Male; Prospective Studies; Psychomotor Agitation; Retrospective Studies; Young Adult
PubMed: 33763938
DOI: 10.1111/1742-6723.13755 -
Journal of Emergency Nursing May 2021After the increasing legalization of cannabis, there has been a rising trend in cannabis consumption, especially among heavy users. Cannabinoid hyperemesis syndrome is a... (Review)
Review
After the increasing legalization of cannabis, there has been a rising trend in cannabis consumption, especially among heavy users. Cannabinoid hyperemesis syndrome is a syndrome of cyclic vomiting related to chronic cannabis use. The difficulty of diagnosis and treatment of this syndrome has led to a disproportionately high use of health care resources. Although the exact mechanism of cannabinoid hyperemesis syndrome is still unknown, patients typically progress through prodromal, hyperemetic, and recovery phases. Persistent vomiting in a patient who reports relief with hot showers should trigger the consideration of cannabinoid hyperemesis syndrome as a possible diagnosis. For treatment, antipsychotics such as haloperidol or droperidol have been shown to be more effective than conventional antiemetics for symptom control. Capsaicin should also be considered, given its positive efficacy and low adverse-effect profile. Providers must be aware of cannabinoid hyperemesis syndrome, its diagnosis, and treatment, given the increasing prevalence. Further research is required to elicit the exact mechanism and additional therapies for this syndrome.
Topics: Antiemetics; Cannabinoids; Humans; Marijuana Abuse; Syndrome; Vomiting
PubMed: 33712244
DOI: 10.1016/j.jen.2020.11.006 -
Emergency Medicine Australasia : EMA Apr 2021
Topics: Antipsychotic Agents; Conscious Sedation; Droperidol; Humans; Problem Behavior
PubMed: 33561901
DOI: 10.1111/1742-6723.13744