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Journal of the West African College of... 2023Postoperative ileus remains the most common cause of prolonged hospital stay after abdominal surgery. Various agents have been tested in the treatment of postoperative...
BACKGROUND
Postoperative ileus remains the most common cause of prolonged hospital stay after abdominal surgery. Various agents have been tested in the treatment of postoperative ileus but no agent alone has achieved effectiveness as postoperative ileus is of multifactorial aetiology.
OBJECTIVES
The aim of this study was to assess the effects of combined use of gum-chewing and parenteral metoclopramide on the duration of postoperative ileus after abdominal surgery.
MATERIALS AND METHODS
This was a randomised controlled study of patients aged 16-65 years who underwent elective abdominal surgeries. Patients were randomised into a gum-metoclopramide (GM) group, a gum-only (G) group, a metoclopramide-only (M) group and a control (C) group. Patients in the GM group chewed gum and received intravenous metoclopramide, each 8 hourly. In G group, patients chewed only gum, whereas those in M group received only 10mg of intravenous metoclopramide, 8 hourly. To C group, 10 mL of intravenous sterile water was given 8 hourly. Patients were monitored for time to passage of first flatus or faeces. Groups were compared for the duration of postoperative ileus and duration of hospital stay using analysis of variance. Statistical significance was set at a value of <0.05.
RESULTS
Fifty-two out of the 105 recruited patients were eligible for analysis. The male-to-female ratio was 1:1.9 with a median age of 57.0 years (interquartile range [IQR] =16 years). Prolonged postoperative ileus occurred in 9.4% ( 5) of the patients (GM = 2, G = 1, M = 2, C = 0; = 0.604) and was associated with longer duration of nasogastric tube use ( = 0.028). The duration of postoperative ileus was 3 days (IQR = 2), 2.5 days (IQR = 3.3), 4 days (IQR = 1.5) and 3 days (IQR = 2) in the GM, G, M, and C groups, respectively ( = 0.317), whereas the median duration of hospital stay was 7 days (IQR = 3), shortest in G group (6.5 days, IQR = 8) and longest in M group (9 days, IQR = 3) ( = 0.143).
CONCLUSIONS
The combined use of gum-chewing and parenteral metoclopramide had no effect on the duration of postoperative ileus following abdominal surgeries in adult surgical patients.
PubMed: 38449558
DOI: 10.4103/jwas.jwas_38_23 -
General Hospital Psychiatry 2024Long COVID can include impaired cognition ('brain fog'; a term encompassing multiple symptoms) and mental health conditions. We performed a systematic review and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Long COVID can include impaired cognition ('brain fog'; a term encompassing multiple symptoms) and mental health conditions. We performed a systematic review and meta-analysis to estimate their prevalence and to explore relevant factors associated with the incidence of impaired cognition and mental health conditions.
METHODS
Searches were conducted in Medline and PsycINFO to cover the start of the pandemic until August 2023. Included studies reported prevalence of mental health conditions and brain fog in adults with long COVID after clinically-diagnosed or PCR-confirmed SARS-CoV-2 infection.
FINDINGS
17 studies were included, reporting 41,249 long COVID patients. Across all timepoints (3-24 months), the combined prevalence of mental health conditions and brain fog was 20·4% (95% CI 11·1%-34·4%), being lower among those previously hospitalised than in community-managed patients(19·5 vs 29·7% respectively; p = 0·047). The odds of mental health conditions and brain fog increased over time and when validated instruments were used. Odds of brain fog significantly decreased with increasing vaccination rates (p = ·000).
CONCLUSIONS
Given the increasing prevalence of mental health conditions and brain fog over time, preventive interventions and treatments are needed. Research is needed to explore underlying mechanisms that could inform further research in development of effective treatments. The reduced risk of brain fog associated with vaccination emphasizes the need for ongoing vaccination programs.
Topics: Adult; Humans; Post-Acute COVID-19 Syndrome; Mental Health; Prevalence; COVID-19; SARS-CoV-2; Mental Fatigue
PubMed: 38447388
DOI: 10.1016/j.genhosppsych.2024.02.009 -
BMC Anesthesiology Feb 2024We aimed to evaluate the efficacy of midodrine as a prophylaxis against post-spinal hypotension in elderly patients undergoing hip arthroplasty. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
We aimed to evaluate the efficacy of midodrine as a prophylaxis against post-spinal hypotension in elderly patients undergoing hip arthroplasty.
METHODS
This randomized controlled trial included elderly patients undergoing hip arthroplasty under spinal anesthesia. Ninety minutes before the procedure, patients were randomized to receive either 5-mg midodrine or placebo (metoclopramide). After spinal anesthesia, mean arterial pressure (MAP) and heart rate were monitored every 2 min for 20 min then every 5 min until the end of the procedure. Post-spinal hypotension (MAP < 80% baseline) was treated with 10 mg ephedrine. The primary outcome was intraoperative ephedrine consumption. Secondary outcomes were the incidence of post-spinal hypotension, bradycardia, and hypertension (MAP increased by > 20% of the baseline reading).
RESULTS
We analyzed 29 patients in the midodrine group and 27 in the control group. The intraoperative ephedrine consumption was lower in the midodrine group than in the control group (median [quartiles]: 10 [0, 30] mg versus 30 [20, 43] mg, respectively, P-value: 0.002); and the incidence of intraoperative hypotension was lower in the midodrine group than that in the control group. The incidence of hypertension and bradycardia were comparable between the two groups.
CONCLUSION
The use of 5 mg oral midodrine decreased the vasopressor requirements and incidence of hypotension after spinal anesthesia for hip surgery in elderly patients.
CLINICAL TRIAL REGISTRATION
This study was registered on September 22, 2022 at clinicaltrials.gov registry, NCT05548985, URL: https://classic.
CLINICALTRIALS
gov/ct2/show/NCT05548985 .
Topics: Humans; Aged; Midodrine; Ephedrine; Anesthesia, Spinal; Bradycardia; Arthroplasty, Replacement, Hip; Hypotension; Vasoconstrictor Agents; Hypertension; Double-Blind Method
PubMed: 38355397
DOI: 10.1186/s12871-024-02442-8 -
Cureus Feb 2024Restless leg syndrome (RLS) is a chronic disorder characterized by a compulsive urge to move the legs, accompanied by various subjective symptoms and a distinctive...
Restless leg syndrome (RLS) is a chronic disorder characterized by a compulsive urge to move the legs, accompanied by various subjective symptoms and a distinctive nyctimeral pattern. A negligent entity is drug-induced RLS, which may be challenging to recognize by practitioners due to its rarity. Among various drugs that can induce or exacerbate RLS, metoclopramide is notable; however, the literature primarily describes cases related to its intravenous forms. In this case presentation, a 33-year-old male experienced drug-related gastrointestinal (GI) symptoms after starting semaglutide for weight loss. Semaglutide was discontinued, and oral metoclopramide was administered to manage the GI symptoms. Subsequently, he developed RLS-like symptoms, which resolved within 48 hours of stopping metoclopramide. His family history included chronic RLS. Laboratory tests were normal. The case highlights a potential link between drug administration and transient RLS symptoms. This case suggests that RLS can be a rare, reversible side effect of oral metoclopramide. It emphasizes the need for careful monitoring of RLS symptoms in patients using this drug and highlights the variability of side effects depending on the method of drug administration. The case serves as a reminder of the unpredictable nature of drug reactions and the importance of vigilance in pharmacotherapy.
PubMed: 38327722
DOI: 10.7759/cureus.53754 -
Frontiers in Pharmacology 2024The colossal global burden of diabetes management is compounded by the serious complication of hypoglycemia. Protective physiologic hormonal and neurogenic... (Review)
Review
The colossal global burden of diabetes management is compounded by the serious complication of hypoglycemia. Protective physiologic hormonal and neurogenic counterregulatory responses to hypoglycemia are essential to preserve glucose homeostasis and avert serious morbidity. With recurrent exposure to hypoglycemic episodes over time, these counterregulatory responses to hypoglycemia can diminish, resulting in an impaired awareness of hypoglycemia (IAH). IAH is characterized by sudden neuroglycopenia rather than preceding cautionary autonomic symptoms. IAH increases the risk of subsequent sudden and severe hypoglycemic episodes in patients with diabetes. The postulated causative mechanisms behind IAH are complex and varied. It is therefore challenging to identify a single effective therapeutic strategy. In this review, we closely examine the efficacy and feasibility of a myriad of pharmaceutical interventions in preventing and treating IAH as described in clinical and preclinical studies. Pharmaceutical agents outlined include N-acetyl cysteine, GABA A receptor blockers, opioid receptor antagonists, AMP activated protein kinase agonists, potassium channel openers, dehydroepiandrosterone, metoclopramide, antiadrenergic agents, antidiabetic agents and glucagon.
PubMed: 38323079
DOI: 10.3389/fphar.2024.1349004 -
Revista Espanola de Enfermedades... Feb 2024Ogilvie syndrome is a functional disorder of colonic motility that causes acute and progressive dilation, which can lead to necrosis and perforation. Early diagnosis and...
Ogilvie syndrome is a functional disorder of colonic motility that causes acute and progressive dilation, which can lead to necrosis and perforation. Early diagnosis and management are essential to avoid serious complications. The case of a patient with Ogilvie syndrome refractory to medical and endoscopic treatment that required surgery is presented. This is a 68-year-old man with decreased level of consciousness and abdominal distension for 3 days. Last bowel movement 4 days ago. The data and tests appear in table 1. We are faced with a patient with neurological alteration and hemodynamically unstable secondary to complicated Ogilvie syndrome. After admission to the ICU, where a 2.5 mg bolus of neostigmine was administered, he was transferred to the ward. Despite 250 mg of intravenous erythromycin every 6 hours together with metoclopramide every 8 hours, high doses of polyethylene glycol and daily cleansing enemas and rectal catheterization, only a brief and mild improvement is achieved. Given the failure of conservative measures, colectomy was performed, achieving complete resolution. Ogilvie syndrome is a functional disorder1 that usually associates predisposing factors that impact intestinal motility 2 ; In our case: bedridden, the use of anticholinergics, hydroelectric alteration both due to the use of antidepressants and the creation of a third space secondary to colonic dilation and severe intestinal ischemia². In one third it is resolved by early correction of the triggering factors, adding neostigmine if necessary with high rates of effectiveness¹. In our case, a second bolus of neostigmine could have been administered or even as an infusion since greater efficacy has been demonstrated in this way given its short half-life². Electrolyte imbalance is a predictor of poor response to neostigmine, a factor that was associated with our patient 3. Colonic decompression and finally surgery are reserved as a last measure, being necessary in a very small percentage as in this case 1. As a preventive measure, the administration of 29.5 g of oral polyethylene glycol per day has been effective 4. Therefore, we should suspect Ogilvie syndrome in patients with predisposing factors who present acute dilation of the colon without mechanical obstruction, and although it usually resolves with medical and endoscopic treatment, we should not delay surgery to avoid complications.
PubMed: 38305678
DOI: 10.17235/reed.2024.10287/2024 -
BMC Pharmacology & Toxicology Jan 2024Postoperative nausea and vomiting (PONV) after total joint arthroplasty is common and associated with delayed recovery. This study was performed to evaluate the efficacy... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison of three different prophylactic treatments for postoperative nausea and vomiting after total joint arthroplasty under general anesthesia: a randomized clinical trial.
BACKGROUND
Postoperative nausea and vomiting (PONV) after total joint arthroplasty is common and associated with delayed recovery. This study was performed to evaluate the efficacy of three different prophylactic regimens for PONV after total joint arthroplasty under general anesthesia.
METHODS
Patients undergoing primary total hip or knee arthroplasty were randomized to Group A (ondansetron), Group B (10 mg dexamethasone plus ondansetron and mosapride), or Group C (three doses of 10 mg dexamethasone plus ondansetron and mosapride). The primary outcome was the total incidence of PONV during postoperative 48 h. The secondary outcomes were complete response, rescue antiemetic treatment, opioid consumption, time until first defecation, postoperative appetite score, satisfaction score, length of hospital stay, blood glucose level, and complications.
RESULTS
Patients in Group C experienced a lower incidence of total PONV (29.3%, p = 0.001) and a higher incidence of complete response (70.7%, p = 0.001) than did patients in Group A (51.9%, 48.2%, respectively). Patients in Group C also experienced a lower incidence of severe PONV (4.3%) than patients in Group A (25.9%, p<0.001) and B (20.4%, p<0.001). Moreover, less rescue antiemetic treatment (1.4 ± 0.5 mg Metoclopramide) and postoperative opioid consumption (1.8 ± 0.3 mg Oxycodone, 6.0 ± 1.0 mg Pethidine) was needed in Group C. Additionally, a shorter time until first defecation, shorter length of stay, and better postoperative appetite scores and satisfaction scores were detected in patients in Group C. A slight increase in the fasting blood glucose level was observed in Group C, and the complications were comparable among the groups.
CONCLUSION
Combined use of ondansetron, mosapride and three doses of dexamethasone can provide better antiemetic effectiveness, postoperative appetite, bowel function recovery, and pain relief than a single dose or ondansetron only.
TRIAL REGISTRATION INFORMATION
The protocol was registered at the Chinese Clinical Trial Registry (ChiCTR1800015896, April 27, 2018).
Topics: Humans; Postoperative Nausea and Vomiting; Antiemetics; Ondansetron; Analgesics, Opioid; Blood Glucose; Double-Blind Method; Dexamethasone; Arthroplasty; Anesthesia, General; Benzamides; Morpholines
PubMed: 38291490
DOI: 10.1186/s40360-024-00735-9 -
Molecular Pharmaceutics Feb 2024P-glycoprotein (P-gp, encoded in humans by the gene and in rodents by the genes) is a membrane transporter that can restrict the intestinal absorption and tissue...
P-glycoprotein (P-gp, encoded in humans by the gene and in rodents by the genes) is a membrane transporter that can restrict the intestinal absorption and tissue distribution of many drugs and may also contribute to renal and hepatobiliary drug excretion. The aim of this study was to compare the performance and sensitivity of currently available radiolabeled P-gp substrates for positron emission tomography (PET) with the single-photon emission computed tomography (SPECT) radiotracer [Tc]Tc-sestamibi for measuring the P-gp function in the kidneys and liver. Wild-type, heterozygous (), and homozygous () knockout mice were used as models of different P-gp abundance in excretory organs. Animals underwent either dynamic PET scans after intravenous injection of [C]-desmethyl-loperamide, ()-[C]verapamil, or [C]metoclopramide or consecutive static SPECT scans after intravenous injection of [Tc]Tc-sestamibi. P-gp in the kidneys and liver of the mouse models was analyzed with immunofluorescence labeling and Western blotting. In the kidneys, mice had intermediate P-gp abundance compared with wild-type and mice. Among the four tested radiotracers, renal clearance of radioactivity (CL) was significantly reduced (-83%) in mice only for [Tc]Tc-sestamibi. Biliary clearance of radioactivity (CL) was significantly reduced in mice for [C]-desmethyl-loperamide (-47%), [C]metoclopramide (-25%), and [Tc]Tc-sestamibi (-79%). However, in mice, CL was significantly reduced (-47%) only for [Tc]Tc-sestamibi. Among the tested radiotracers, [Tc]Tc-sestamibi performed best in measuring the P-gp function in the kidneys and liver. Owing to its widespread clinical availability, [Tc]Tc-sestamibi represents a promising probe substrate to assess systemic P-gp-mediated drug-drug interactions and to measure renal and hepatic P-gp function under different (patho-)physiological conditions.
Topics: Humans; Mice; Animals; ATP Binding Cassette Transporter, Subfamily B, Member 1; Metoclopramide; Tomography, X-Ray Computed; ATP Binding Cassette Transporter, Subfamily B; Positron-Emission Tomography; Radiopharmaceuticals; Liver; Tomography, Emission-Computed, Single-Photon; Kidney; Nitriles; Organotechnetium Compounds; Mice, Knockout
PubMed: 38225758
DOI: 10.1021/acs.molpharmaceut.3c01036 -
Emergencias : Revista de La Sociedad... Dec 2023
Topics: Humans; Metoclopramide; Amphetamine
PubMed: 38116976
DOI: 10.55633/s3me/E016.2023 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Dec 2023To investigate the effect of gastric antrum ultrasonography in evaluating gastric emptying after oral administration of 300 mL carbohydrates two hours before cesarean...
OBJECTIVE
To investigate the effect of gastric antrum ultrasonography in evaluating gastric emptying after oral administration of 300 mL carbohydrates two hours before cesarean section, and to analyze the risk factors of gastric emptying in pregnant women.
METHODS
From August 2020 to February 2021, a total of 80 patients, aged 22-43 years, body mass index (BMI) < 35 kg/m, gestational age≥36 weeks, falling into American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ, scheduled for cesarean sections in Peking University International Hospital were recruited and divided into two groups: the intervention group (=40)and the control group (=40). In the intervention group, solid food was restricted after 22:00, the patients were required to take 300 mL carbohydrates two hours before cesarean section. In the control group, solid food and liquid intake were restricted after 22:00 the night before surgery. All the patients received assessment of preoperative feeling of thirst and starvation with visual analogue scale (VAS). The cross-sectional area (CSA)of gastric antrum was measured in supine position and right supine position before anesthesia, the gastric volume (GV)and the gastric volume/weight(GV/W)of the two groups was further calculated. Perlas A semi-quantitative grading assessments were performed in each patient. The blood pressure and heart rate were recorded at admission(T0), 5 minutes after anesthesia (T1), immediately after fetal delivery (T2) and at the end of the surgery (T3). The occurrence of nausea and vomiting during the operation and 24 hours after the operation were recorded.
RESULTS
One case in each group was excluded because the antrum was not clearly identified during the ultrasound assessments. In the semi-sitting position, the CSA was (5.07±1.73) cm in the intervention group . (5.24±1.96) cm in the control group, respectively; in the right lateral decubitus position, CSA was (7.32±2.17) cm in the intervention group . (7.25±2.24) cm in the control group, GV was (91.74±32.34) mL . (90.07±31.68) mL, GV/W was (1.27±0.40) mL/kg . (1.22±0.41) mL/kg, respectively; all the above showed no significant difference between the two groups ( > 0.05). Perlas A semi-quantitative grading showed 0 in 20 patients (51.3%), 1 in 16 (41%), 2 in 3 (7.7%)in the intervention group and 0 in 22 (56.4%), 1 in 15 (38.5%), 2 in 2 (5.1%)in the control group, the proportion of Perlas A semi-quantitative grading showed no significant difference between the two groups ( > 0.05). For the patients with Perlas A semi-quantitative grade 2 (3 cases in the intervention group and 2 cases in the control group), metoclopramide 0.2 mg/kg was intravenously injected before anesthesia. No aspiration case was observed in this study. The intervention group was endured less thirst and hunger ( < 0.05). There was no significant difference in blood pressure and heart rate between the two groups at each time point ( > 0.05). There was no significant difference in the incidence of intraoperative hypotension between the two groups ( > 0.05). There was no significant difference in the incidence of nausea intraoperatively and postoperatively between the two groups ( > 0.05).
CONCLUSION
Ultrasonography of gastric antrum can provide objective basis for evaluating gastric emptying of pregnant women perioperatively. 300 mL carbohydrates intake two hours before surgery, which does not increase GV and the risk of reflux aspiration, and is helpful in minimizing disturbance to the patient's physiological status, therefore leading to better clinical outcome.
Topics: Humans; Female; Pregnancy; Gastric Emptying; Cesarean Section; Prospective Studies; Ultrasonography; Carbohydrates; Nausea
PubMed: 38101793
DOI: 10.19723/j.issn.1671-167X.2023.06.020