Higher Incidence Of Nausea Research Articles

Influence of Sedation on Patients’ Perceptions and Recovery in Patients Undergoing Minor Perianal Procedures under Spinal Saddle Block

Objectives: Additional intra-operative sedation may help improve acceptability and comfort of anaesthesia in patients undergoing minor anorectal (perianal) procedures under spinal saddle block. This observational study was done to determine which patients request sedatives and to what extent sedatives affect the patients’ recovery. Subjects and Methods: During a 6-month period, 500 patients undergoing minor perianal procedures received 1.0 ml hyperbaric bupivacaine (0.5%). On request, a light sedation with propofol in bolus application was provided. Patients were evaluated postoperatively using a standardized questionnaire about their perceptions before, during and 48 h after the administration of anaesthesia. Results: More female (91/143, 63.6%) than male (136/259, 52.5%) patients (p = 0.0312) received sedation. Patients with sedation were significantly younger (46.7 ± 13.8 vs. 50 ± 13.8 years, p = 0.0171) and had a lower body mass index (BMI; 25.6 ± 4.3 vs. 27.5 ± 5.1, p < 0.0001). Time to mobilization and first micturition was significantly longer in patients with sedation (4.8 vs. 4.4 h, p = 0.0194 and 5.8 vs. 5.4 h, p = 0.0188), which was associated with a higher incidence of nausea (7.5 vs. 1.7%, p = 0.0083). Conclusions: Female gender, younger age, lower body weight and lower BMI were associated with higher subjective requirements for sedation. The use of sedation showed prolongation of time to first mobilization and micturition and a higher incidence of nausea.

Efficacy of orally disintegrating ondansetron in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy: a randomised, double‐blind placebo controlled study

Peri-operative prophylactic anti-emetics are commonly used parenterally. Orally disintegrating ondansetron is efficacious during chemotherapy. Therefore, we aimed to study the efficacy of orally disintegrating ondansetron for postoperative nausea and vomiting. In a randomised, double-blind, placebo controlled trial on 109 patients scheduled for laparoscopic cholecystectomy, oral ondansetron was compared to intravenous ondansetron and placebo. The anaesthetic technique was standardised. Mean time (SD) to tolerating oral intake was delayed in the placebo group to 366.1 (77.6) min compared to oral 322.9 (63.7) min and intravenous 322.4 (65.2) min groups. This is corroborated by a higher incidence of nausea and vomiting in the control group during the first 6 h postoperatively (control 44.4%, oral 17.7%, intravenous 18.2%). There was no significant difference between oral and intravenous groups. In conclusion, orally disintegrating ondansetron was as efficacious as intravenous ondansetron in the peri-operative phase and may be a viable option for prophylaxis of emesis in day care surgery.

Observation of effects of butorphanol and fentanyl for postoperative patients and its nursing

Objective To compare the effects of butorphanol and fentanyl for postoperative patient controlled intravenous analgesia (PCIA), and explore the different nursing measures. Methods 100 patients were randomly divided into two groups with 50 cases each:group A(butorphanol),and group B (fentanyl). The PCA model for both groups was set with background infusion 2 ml/h, bolus of 2 ml with lock time 15 min. The Blood Pressure(BP), heart rate(HR), analgesic score (VAS), sedation score, patient satisfaction, nausea, vomiting, respiratory, sleep quality, gastrointestinal peristalsis, urinary retention were observed at 4,12,24,36 hours after operation. Results Adequate analgesia and patient satisfaction were achieved in both groups. The sedation score was higher in group A than group B(P>0.05). There were higher incidence of nausea, vomiting among B group. Conclusions With close clinical observation and reasonable nuring care, butorphanol and fentanyl could both provide satisfactory analgesia and sedation effects. However, the sedation score was higher in butorphanol and nurses should pay attention to patients' sleep quality. There were higher incidence of nausea, vomiting among patients with fentanyl, so nurses should pay attention to prevent patients from respiratory depression. Key words: Postoperative Care; Analgesia; Butorphanol; Fentanyl; Patient-Controlled

A118G Single Nucleotide Polymorphism of Human μ-Opioid Receptor Gene Influences Pain Perception and Patient-controlled Intravenous Morphine Consumption After Intrathecal Morphine for Postcesarean Analgesia

Background Previous studies have shown that genetic variability at position 118 of the human mu-opioid receptor gene altered patients' response to intravenous morphine. The purpose of this study was to investigate whether this polymorphism contributes to the variability in response to morphine for postcesarean analgesia. Methods After investigators obtained informed consent, 588 healthy women received 0.1 mg intrathecal morphine for postcesarean analgesia. Their blood samples were genotyped for the A118G polymorphism-A118 homozygous (AA), heterozygous (AG), or homozygous for the G allele (GG). Pain scores, the severity of nausea and vomiting, the incidence of pruritus, and the total self-administered intravenous morphine were recorded for the first 24 postoperative hours. Results Two hundred seventy women (46%) were AA, 234 (40%) were AG, and 82 (14%) were GG. The 24-h self-administered intravenous morphine consumption was lowest in the AA group (P = 0.001; mean, 5.9; 95% confidence interval, 5.1-6.8) versus the AG (8.0; 6.9-9.1) and GG groups (9.4; 7.3-11.5). Pain scores were lowest in the AA group and highest in the GG group, with a statistically significant difference detected between AA, AG, and GG (P = 0.049). Total morphine consumption was also influenced by patients' age and paying status. AA group was associated with the highest incidence of nausea (26 of 272 [9.6%]; P = 0.02) versus the other two groups (13 of 234 [5.6%] and 1 of 82 [1.2%] for AG and GG, respectively). Conclusion Genetic variation at position 118 of the mu-opioid receptor is associated with interindividual differences in pain scores, self-administered intravenous morphine, and the incidence of nausea postoperatively.

A118G Single Nucleotide Polymorphism of Human μ-Opioid Receptor Gene Influences Pain Perception and Patient-controlled Intravenous Morphine Consumption after Intrathecal Morphine for Postcesarean Analgesia

Previous studies have shown that genetic variability at position 118 of the human mu-opioid receptor gene altered patients' response to intravenous morphine. The purpose of this study was to investigate whether this polymorphism contributes to the variability in response to morphine for postcesarean analgesia. After investigators obtained informed consent, 588 healthy women received 0.1 mg intrathecal morphine for postcesarean analgesia. Their blood samples were genotyped for the A118G polymorphism-A118 homozygous (AA), heterozygous (AG), or homozygous for the G allele (GG). Pain scores, the severity of nausea and vomiting, the incidence of pruritus, and the total self-administered intravenous morphine were recorded for the first 24 postoperative hours. Two hundred seventy women (46%) were AA, 234 (40%) were AG, and 82 (14%) were GG. The 24-h self-administered intravenous morphine consumption was lowest in the AA group (P = 0.001; mean, 5.9; 95% confidence interval, 5.1-6.8) versus the AG (8.0; 6.9-9.1) and GG groups (9.4; 7.3-11.5). Pain scores were lowest in the AA group and highest in the GG group, with a statistically significant difference detected between AA, AG, and GG (P = 0.049). Total morphine consumption was also influenced by patients' age and paying status. AA group was associated with the highest incidence of nausea (26 of 272 [9.6%]; P = 0.02) versus the other two groups (13 of 234 [5.6%] and 1 of 82 [1.2%] for AG and GG, respectively). Genetic variation at position 118 of the mu-opioid receptor is associated with interindividual differences in pain scores, self-administered intravenous morphine, and the incidence of nausea postoperatively.

(204) Rofecoxib Was More Effective than Codeine with Acetaminophen in the Treatment of Acute Pain

Rofecoxib (VIOXX®) is a selective inhibitor of cyclo-oxygenase-2 and is indicated for the treatment of acute pain. Prior acute pain studies showed similar analgesic efficacy of rofecoxib 50 mg compared with analgesics doses of non-selective NSAIDs. We performed a randomized, double-blind trial to evaluate the efficacy and safety of rofecoxib, a standard fixed formulation of codeine with acetaminophen, and placebo in the treatment of acute pain. Three-hundred ninety-three patients with moderate or severe pain after surgical extraction of at least two 3rd molars were randomized to receive a single dose of rofecoxib 50 mg (n = 182), codeine 60 mg with acetaminophen 600 mg (n = 180), or placebo (n = 31). Efficacy was assessed at 11 pre-specified time points after dosing by pain relief and pain intensity scores. Patient global assessment of study medication was also performed. Baseline characteristics were similar among the groups. The mean age was 21 years; 69.0% were female; and 78.6% had a pain intensity score of “moderate.” For the primary endpoint, total pain relief over 6 hours, rofecoxib was more effective than codeine/acetaminophen (p codeine/acetaminophen; p < 0.001). The time to rescue medication was longer for rofecoxib compared to codeine/acetaminophen (p < 0.001). More patients on codeine/acetaminophen experienced clinical adverse events than rofecoxib (p < 0.05). Patients receiving codeine/acetaminophen versus rofecoxib had higher incidences of nausea (25.0% vs 6.0%; p < 0.001) and vomiting (18.3% vs 3.8%; p < 0.001). In this study, rofecoxib had superior efficacy and gastrointestinal safety compared to codeine/acetaminophen, which provides support for the use of rofecoxib as an alternative option to opioid analgesics in the treatment of acute post-surgical pain.

Incidence of postoperative nausea and emetic episodes after xenon anaesthesia compared with propofol-based anaesthesia

BackgroundXenon has been proved to be safe and efficacious for general anaesthesia in numerous trials. In addition, experimental studies demonstrate that xenon inhibits the 5-hydroxytryptamine type 3 (5-HT3) receptor. As 5-HT3 receptor antagonists are known to decrease postoperative nausea and vomiting (PONV) to an extent comparable with a propofol-based total i.v. technique, we tested the hypothesis that general anaesthesia with xenon would result in a reduced incidence of PONV similar to that observed with propofol-based anaesthesia. MethodsAfter obtaining approval from the local ethics committee and written informed consent, 142 patients were randomized to receive xenon anaesthesia or propofol-based total i.v. anaesthesia (TIVA), both supplemented with remifentanil. The incidence of postoperative nausea and emetic episodes was recorded in the post-anaesthesia care unit and on the ward more than 24 h after anaesthesia. ResultsA total of 142 patients were equally distributed between the xenon and TIVA groups. Anaesthesia was maintained with mean (sd) concentrations of either xenon 61 (2)% or propofol 100 (20) μg kg−1 min−1. Incidences of nausea and emetic episodes over the whole 24-h period were 66.2% and 35.2% in the xenon group and 26.8% and 16.9% in the TIVA group (P<0.001 and P<0.021). ConclusionDespite knowing the 5-HT3 antagonistic properties of xenon, its use is associated with a higher incidence of nausea and emetic episodes compared with TIVA with propofol.

Managed care perspective on three new agents for type 2 diabetes.

Despite effective monotherapy for diabetes, approximately 50% of patients require additional medications after 3 years to achieve target glycosylated hemoglobin (A1C) < 7%. Three new agents, each the first in its therapeutic class with a unique mechanism of action, have been approved for the treatment of type 2 diabetes by the U.S. Food and Drug Administration: pramlintide in March 2005, exenatide in April 2005, and sitagliptin in October 2006. To review the efficacy and safety of 3 new agents for type 2 diabetes (exenatide and pramlintide by subcutaneous injection and sitagliptin by oral administration) and to define their place in therapy given their relatively high cost and unknown long-term safety and efficacy. A MEDLINE search (1950 to June 2007) for English-language articles of studies in human subjects was conducted using these search terms: type 2 diabetes, exenatide, pramlintide, and sitagliptin. This database was supplemented by systematic reviews and meta-analyses through December 2007 and reference citations from the articles identified in the MEDLINE search. Exenatide, pramlintide, and sitagliptin have all been shown to have a modest effect on reducing A1C. In several relatively short-term trials (generally 15-30 weeks in duration), exenatide injection has been shown to be safe and effective for patients with type 2 diabetes who are either at the maximum doses of or cannot tolerate metformin, sulfonylurea, and/or thiazolidinedione therapy and need to further decrease A1C by at least 0.5% to 1%. While weight loss of 1.5 kg to 2.5 kg associated with exenatide is modest, this effect is of obvious value in many patients with type 2 diabetes. Nausea is the most notable side effect with exenatide, occurring in up to 50% of patients within the first 8 weeks of therapy but decreasing to 5% to 10% by week 24. In addition, the risk for hypoglycemia increases 4- to 5-fold when used in combination with sulfonylureas. Like exenatide, pramlintide injection reduces A1C by approximately 0.5% to 1%, carries the advantage of modest weight loss (1.5 kg over 1 year), and has a high incidence of nausea. Pramlintide can also result in severe hypoglycemia because of its ability to enhance the effects of insulin, a concern given that it is only indicated for use in combination with insulin. Sitagliptin is an oral agent that can be used alone or in combination with other oral hypoglycemic agents and has been shown to reduce A1C by 0.5% to 0.7%. It has only been studied in short-term studies, to date, so the long-term safety and efficacy are unknown. There is potential for severe allergic and dermatologic reactions with sitagliptin. The 3 new agents for the management of type 2 diabetes have been shown to reduce A1C by no more than 1.0%, modest by comparison with insulin and the older oral agents. The 3 newer agents have either modest positive effects on body weight or are weight neutral. The longterm safety and efficacy of the 3 newer agents are unknown, and their cost is considerably higher than the first-line agents, metformin and sufonylureas, which are available by generic name. The newer agents offer treatment options in select patients, although their use should be reserved for patients who are not adequately managed by agents with known longterm efficacy and safety, which are often available at a lower cost.

Latest news and product developments

Latest news and product developments

Eficacia del bloqueo interescalénico continuo en comparación a la analgesia intra-articular para el tratamiento del dolor postoperatorio en acromioplastias artroscópicas

To compare the utility of intra-articular analgesia (IA) to that of a continuous interscalene block (CIB) by evaluating the quality of postoperative analgesia, a satisfaction index, and the incidence of complications. A randomized controlled trial enrolling patients classified as ASA 1 or 2. The IA group received 25 mL of ropivacaine 0.2% plus 2 mg of morphine. The CIB group received a 7-mL/h infusion of bupivacaine 0.0625% plus 1 microg/mL of sufentanil. Postoperative pain was expressed on a visual analog scale (VAS) at 2, 4, 6, 12, 24, and 48 hours. Intravenous morphine was used as a rescue analgesic. Morphine use, incidence of adverse effects, and level of patient satisfaction after 48 hours were recorded. Twenty-three patients were randomized to the IA group and 24 to the CIB group. There were no between-group differences in patient characteristics. VAS scores and morphine use were similar in the 2 groups in the first 12 hours but were lower in the CIB group at 24 and 48 hours. The level of patient satisfaction was higher in the CIB group. There was a higher incidence of nausea and/or vomiting in the IA group at 24 and 48 hours. Postoperative pain in the first 12 hours after shoulder surgery can be adequately managed with either IA or CIB. CIB is more effective than IA between 12 and 48 hours after surgery.

Bowel Preparation Effectiveness

This study describes colon visibility and case cancelations of patients taking self-administered outpatient colonoscopy preparation or inpatient preparation at a large north central Texas hospital. The convenience sample of 120 adult patients who were scheduled for a colonoscopy ranged in age from 25 to 88 years. A 33-item investigator-developed questionnaire was used to record patient demographics, type of bowel preparation, signs and symptoms, and colon visualization score obtained during the procedure. On the basis of the visualization scores, there was no significant difference between the outpatient self-administered bowel preparation and the inpatient preparation administered in the hospital setting. There were clinical findings indicating that specific preparation solutions had a slightly higher incidence of nausea or vomiting. Additionally, an opportunity for documentation improvement was identified and reported to the nursing documentation committee for further investigation.

Concerted escalation of dose and dosing duration in a phase I study of the oral camptothecin gimatecan (ST1481) in patients with advanced solid tumors

Gimatecan is an orally bioavailable camptothecin analogue with preclinical findings of promising antitumor activity. A phase I design of concerted dose escalation and dosing duration was implemented to assess the potential schedule dependency of tolerability that emerged from animal studies. Gimatecan was given daily for five consecutive days per week for 1, 2 or 3 weeks every 28 days. Plasma levels of total gimatecan were measured on the first and the last day of treatment in each schedule. Overall, 108 patients were treated with 0.8-7.2 mg/m(2) of gimatecan per cycle. The main toxicity was myelosuppression with dose-limiting thrombocytopenia. In the 1-, 2- and 3-week schedule, the maximum tolerated doses were 4.5, 5.6 and 6.4 mg/m(2). Diarrhea and asthenia were of low grade and of minor clinical relevance, while the higher incidence of nausea and vomiting in the 1-week schedule required the use of antiemetic prophylaxis. Due to the prolonged half-life (approximately 77 h), the plasma concentration of gimatecan increased from the first to the last day of dosing. Six partial responses were observed. Tolerability of gimatecan was schedule dependent. Further testing with schedules taking into account its long persistence in human plasma is worthwhile.

Use of palonosetron 0.25 mg IV daily and incidence of nausea and vomiting in patients undergoing bone marrow transplantation (BMT)

16510 Background: Preparative regimens for BMT are associated with a high incidence of nausea and vomiting, which can negatively affect quality of life. It is important to evaluate the incidence of nausea and vomiting and understand which antiemetic regimens are most effective in these patients in order to improve outcomes. Methods: A retrospective review of patients admitted to the adult BMT Unit at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1/1/05 and 12/31/05 was performed. Currently at MSKCC, palonosetron (0.25 mg IV daily) is used as the main antiemetic agent during the preparative regimen; dexamethasone 20 mg IV is occasionally combined with palonosetron when there is no other contraindication to its use with some preparative regimens. The electronic medical records, as well as the pharmacy computer system, were used to collect demographics, primary diagnosis, BMT type, preparative BMT regimen, days of regimen, whether radiation was included, antiemetic used, and incidence of nausea and vomiting, which were assessed 3 times daily during the administration of the preparative regimen. Results: 176 pts (75 women, 101 men) received BMT; mean age was 50 yrs (18–73). All patients received a highly emetogenic preparative regimen for which the mean duration was 5 days (1–9 days). Over a 1–12 day period the incidence of nausea and vomiting were 78% and 39% in those undergoing an allogeneic transplant compared with 51% and 18% in those undergoing an autologous transplant. Patients with leukemia had the highest incidence of nausea (85%) and vomiting (45%). The rates of nausea and vomiting in those receiving radiation were 81% and 33%, while in those not receiving radiation, the rates of nausea and vomiting were 51% and 20%, respectively. Of patients receiving palonosetron alone, 87% experienced nausea and 41% had vomiting, compared to 48% and 15% for those receiving both palonosetron and dexamethasone. Conclusions: Radiation therapy and allogeneic transplant had higher incidences of nausea and vomiting when compared to autologous transplant. Nausea and vomiting were better controlled in patients receiving palonosetron and dexamethasone compared with those receiving palonosetron alone. No significant financial relationships to disclose.

A survey of postoperative nausea and vomiting in Enugu, Nigeria

Aim: To determine the incidence of post operative nausea and vomiting (PONV) for different types of common surgical procedure in the University of Nigeria Teaching Hospital Enugu, and to analyse the predictive factors associated with PONV. Methods: A prospective interview-based survey on the incidence of post operative nausea and vomiting in 800 in-patients aged 10-80 years was conducted during a six-month period. Cases of nausea and vomiting were recorded for 24 hours postoperatively. To achieve a representative sample of everyday surgery, data were collected from 8 types of common surgical procedures in 4 different operating theatres and departments: general surgery, gynecology, ophthalmology and otolaryngology. Results: In the recovery room, the incidence of nausea and vomiting was 15% and 5% respectively. Over the whole 24 hour period, these figures were 52% and 25%, respectively. The highest incidence of nausea and vomiting was observed in gynaecological patients. The most important predictive factors associated with an increased risk of nausea and vomiting were female gender, previous history of postoperative sickness, a longer duration of surgery and a history of motion sickness. Conclusion: This survey has enhanced our awareness of postoperative nausea and vomiting and raised the possibility of recognizing patients at risk preoperatively. Keywords: post-operative, nausea, vomiting, survey Orient Journal of Medicine Vol. 17(3&4) 2005: 11-16

Use of Neostigmine in the Management of Acute Postoperative Pain and Labour Pain

Neostigmine is a parasympathomimetic agent that has been recently investigated for use as an adjunct analgesic agent in the perioperative and peripartum period. A number of studies have investigated the intrathecal, epidural, caudal and intra-articular routes of administration of this agent, as well as the addition of neostigmine to local anaesthetics used for brachial plexus block and intravenous regional anaesthesia. While the intrathecal administration of neostigmine produced useful analgesic effects in the postoperative period in some studies, the high incidence of adverse events, mainly nausea and vomiting, limit the clinical usefulness of this route of administration. Several studies investigated the postoperative analgesic effects of epidural neostigmine using a number of different regimens. Overall, this route of administration appeared to improve postoperative analgesia in most studies without increasing the incidence of adverse events, and merits further research. Neuraxial administration of neostigmine appears to be safe in the obstetric population, with no reported adverse effects in the mother or fetus. While intrathecal administration is limited by a high incidence of nausea and vomiting in this patient population, the epidural route appears more promising and requires further investigation. The addition of neostigmine to caudal local anaesthetics was associated with improved postoperative analgesia in a number of studies. A dose of 2 microg/kg proved to be effective in several studies but was associated with an increased incidence of vomiting in some studies. Intra-articular administration of neostigmine 500microg produced a useful analgesic effect in the postoperative period in several studies and was not associated with an increase in the incidence of adverse effects. Studies investigating the efficacy of adding neostigmine to the local anaesthetics used for brachial plexus block and intravenous regional anaesthesia reported conflicting results. Further studies are required to determine the place of the administration of neostigmine by these routes.

Comparison of morphine and tramadol by patient‐controlled analgesia for postoperative analgesia after tonsillectomy in children

Tramadol is an alternative to other opioids for postoperative pain management. This prospective, randomized, double-blind study was designed to compare the analgesic efficacy of patient-controlled tramadol with patient-controlled morphine for postoperative pain after tonsillectomy in children. Sixty patients were allocated randomly to receive a patient-controlled analgesia (PCA) with either tramadol (T) or morphine (M), in a double-blind randomized study. When surgery was completed and hemostasis achieved, a standardized loading dose (0.1 mg.kg(-1) in group M, or 1 mg.kg(-1) in group T) was given. Thereafter, the children helped themselves to bolus doses (morphine (0.02 mg.kg(-1)) or tramadol (0.2 mg.kg(-1)) with lock-out times of 10 min without time limit via a PCA device. Scores for pain, sedation, nausea, and the bolus and total PCA doses, hemodynamic parameters and side effects were recorded at 5, 15, 30 min and 1, 2, 4, 6 and 24 h during PCA administration. Pain scores decreased significantly with time in both groups (P < 0.05), but were lower in group M than in group T at 1, 2 and 4 h (P < 0.05). Sedation scores increased with time in both groups (P < 0.05). However there were no significant differences in sedation scores between two groups at any study period, but nausea scores were higher in M group at 4, 6 and 24 h (P < 0.05). Intravenous patient-controlled tramadol is an alternative to patient-controlled morphine for postoperative pain relief in children after tonsillectomy. Morphine gave better postoperative pain relief, but was associated with a higher incidence of nausea than tramadol.

Efficacy and safety of tigecycline monotherapy compared with vancomycin plus aztreonam in patients with complicated skin and skin structure infections: Results from a phase 3, randomized, double-blind trial

To compare the effect of tigecycline monotherapy, a first-in-class, expanded broad spectrum glycylcycline, with the combination of vancomycin and aztreonam (V + A) in the treatment of complicated skin and skin structure infections (cSSSI). A phase 3, double-blind study conducted in 8 countries enrolled adults with cSSSI who required intravenous (IV) antibiotic therapy for > or =5 days. Patients were randomly assigned (1:1) to receive either tigecycline or V + A for up to 14 days. Primary endpoint was the clinical cure rate at the test-of-cure visit. Secondary endpoints included microbiologic efficacy and in vitro susceptibility to tigecycline of bacteria that cause cSSSI. Safety was assessed by physical examination, laboratory analyses, and adverse event reporting. A total of 596 patients were screened for enrollment, 573 were analyzed for safety, 537 were included in the clinical modified intent-to-treat (c-mITT) population, 397 were clinically evaluable (CE), and 228 were microbiologically evaluable (ME). At test-of-cure, cure rates were similar between tigecycline and V + A groups in the CE population (82.9% versus 82.3%, respectively) and in the c-mITT population (75.5% versus 76.9%, respectively). Microbiologic eradication rates (subject level) at test-of-cure in the ME population were also similar between tigecycline and V + A. Frequency of adverse events was similar between groups, although patients receiving tigecycline had higher incidence of nausea, vomiting, dyspepsia, and anorexia, while increased ALT/SGPT, pruritus, and rash occurred significantly more often in V + A-treated patients. This study demonstrates that the efficacy of tigecycline monotherapy for the treatment of patients with cSSSI is statistically noninferior to the combination of V + A.

General anaesthesia for ophthalmic surgery

Local anaesthesia for eye surgery is increasingly popular but there will always be a need for general anaesthesia. Patients may refuse local anaesthesia, may be unable to keep still or lie flat for the duration of surgery or lack the mental facility to co-operate while awake. Young children and those with allergy to local anaesthetic also need general anaesthesia. Careful patient preparation is important before surgery. Attention to diabetic control, adjustments to warfarin or aspirin dosing, thromboembolic prophylaxis and preoperative fasting need to be considered. Eye surgery alone is seldom a true emergency and surgery can usually wait until the stomach is empty. Eye pathology requiring surgery is a feature of many medical conditions and syndromes (e.g. Marfan's, Goldenhars, Sturge-Weber, diabetes). Many patients are elderly with ischaemic heart disease, hypertension, COPD, and renal impairment, which must be assessed before general anaesthesia. Be aware of systemic effects from ophthalmic medications such as hypokalaemia from acetazolamide. The eye requiring surgery should be clearly marked before the patient is anaesthetized. A range of general anaesthetic techniques are suitable for eye surgery, but certain key points are relevant to specific operations. These include the oculocardiac reflex in strabismus and retinal surgery, the use of intraocular gas bubbles in vitreo-retinal operations, controlled hypotension in lacrimal orbital and other oculoplastic procedures and the high incidence of nausea after strabismus surgery. Total intravenous anaesthesia (TIVA) fulfils many of the requirements for the ideal anaesthetic technique for ophthalmic surgery. Blood pressure, heart rate and intraocular pressure are lowered. It is rapidly titratable and recovery is fast. Postoperative nausea is reduced and TIVA works well in renal and hepatic disease. Remifentanil infusion allows nitrous oxide to be avoided and top up doses of muscle relaxants to be minimized during drug ventilation. For most surgery, postoperative pain is mild and NSAIDs work well. Intra operative sub-Tenon local anaesthetic is useful.

Use and Misuse of Triptans in France: Data from the Grim2000 Population Survey

The extent and nature of triptan use for headache relief has been evaluated in a large epidemiological survey in the French general population. Over 25 000 individuals were screened for headache and for triptan use. Of this sample, 290 triptan users were identified from whom extensive data on headache characteristics and healthcare resource consumption were obtained. The use of triptans is relatively infrequent, 0.2% in the general population, with only 7.5% of migraine sufferers using these drugs. The majority of triptan users were female (80%) and presented headache characteristics typical of migraine (80%). The remaining 20% of subjects were thus using triptans for headache types in which the utility of these drugs has not been demonstrated. Among migraineurs, triptan consumers reported more frequent and severe headaches than non-consumers, and reported a higher incidence of nausea and vomiting. The principal determinant of triptan prescription was consultation with a general practitioner (GP), which may itself have been triggered by the severity of the headaches. GPs, rather than specialists, are the primary prescribers of triptans in France.

Comparison of Dexamethasone and Ondansetron for the Prevention of Nausea and Vomiting Using Intravenous Patient-Controlled Analgesia after Gynecologic Surgery

Background: Postoperative nausea and vomiting remain a common problem following gynecologic surgery. This study was designed to compare antiemetic effects and to establish optimal doses for dexamethasone and ondansetron for the prevention of postoperative nausea and vomiting (PONV) during intravenous patient-controlled analgesia after gynecologic surgery. Methods: One hundred and fifty ASA 1-2 patients undergoing elective gynecologic surgery were included. Patients were randomly divided into six groups and received a placebo (group C), dexamethasone 4 mg (group D4), dexamethasone 8 mg (group D8), ondansetron 4 mg (group O4), ondansetron 8 mg (group O8) or dexamethasone 4 mg plus ondansetron 4 mg (group D4O4) after induction. Postoperatively, nausea, vomiting, VAS pain score, headache and itching were recorded in the recovery room (2 h after operation) and in the hospitalization area (12, 24 and 48 h after operation). Results: Group C showed a significantly higher incidence of nausea (56%) and vomiting (32%) than group D4 (nausea: 20%, vomiting: 4%), D8 (nausea: 20%, vomiting: 4%), O4 (nausea: 12%, vomiting: 4%), O8 (nausea: 12%, vomiting: 0%) and D4O4 (nausea: 20%, vomiting: 4%). No differences in the incidence of nausea and vomiting were observed between groups D4, D8, O4, O8 and D4O4. Pain score, total analgesic consumption, duration, and side effects were similar in the groups. Conclusions: Dexamethasone 4 mg, dexamethasone 8 mg, ondansetron 4 mg, ondansetron 8 mg, and dexamethasone 4 mg plus ondansetron 4 mg were found to be equally effective at preventing PONV following gynecological surgery. Dexamethasone was as effective as ondansetron for the prevention of PONV after gynecologic surgery.