Incidence Of Postoperative Headache Research Articles

Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache in Patients Undergoing Lower Abdominal Surgeries

Abstract Background Postdural puncture headache (PDPH) is a complication of spinal anesthesia or lumbar puncture and is an unpleasant experience for the patient as well as the anesthetist. It is thought to result from meningeal traction related to low cerebrospinal fluid (CSF) pressure or cerebral vasodilation as an indirect effect of decreased CSF pressure. Neostigmine is a reversible inhibitor of the enzyme cholinesterase, which results in an increased concentration of the neurotransmitter acetylcholine. It produces cholinergic-mediated analgesia and has been used as an adjunct analgesic postoperatively. Neostigmine can pass through the choroid plexus but not the blood–brain barrier, the central effect of both neostigmine and atropine influence both CSF secretion and cerebral vascular tone which are the primary pathophysiological changes in PDPH. Objective Assess the effectiveness of postdural anesthesia with addition of Neostigmine and Atropine versus conventional postdural anesthesia. Patients and Methods A 90 patients were included in our prospective randomized controlled double-blind study that was conducted at Ain Shams University Hospitals for 4 months on patients who fulfilled the inclusion criteria: patients with ASA Grade I & II, aged from (18 to 40) years old and scheduled for cesarean section. All patients aged >18 or <40, body weight >50, ASA III, IV, patients with uncontrolled chronic diseases such as hypertension, cardiac, renal, hepatic, cerebral diseases and peripheral vascular diseases, patients with history of PDPH, chronic headache, cluster headache, migraine, convulsions, cerebrovascular accident, signs of meningismus, preeclampsia, eclampsia coagulopathy, and previous neurological diseases and patients with history of bronchial asthma were excluded. Patients were divided into 2 groups: Group I (experimental group): neostigmine and atropine and Group II (placebo group): Saline placebo. Results The results of this study showed that incidence of postoperative headache was significantly lower among the intervention group, furthermore, VAS was significantly lower in the experimental arm versus placebo one. However, there was no significant difference regarding demographic, vital signs, and need for post-operative analgesia. The presented study showed that there is statistically non-significant difference between the studied groups regarding age, weight, and height and body mass index. There is statistically non-significant difference between the studied groups regarding duration of surgery. Conclusion After demonstrating many management options for post dural puncture headache (PDPH), in this study, we tried to prove the value of the use of neostigmine as a new management option that looks promising to alleviate the symptoms of such distressing condition. The current study results proved that the drug reduced the number of cases that experienced (PDPH) after spinal anesthesia for lower segment caesarean section, and how it prevent &control headache. A combination of neostigmine and atropine are effective in managing PDPH by reducing the associated VAS score and preventing persistence of headache.

A Single Prophylactic Dose of Ondansetron Given at Cessation of Postoperative Propofol Sedation Decreases Postoperative Nausea and Vomiting in Cardiac Surgery Patients: A Randomized Controlled Trial.

Postoperative nausea and vomiting (PONV) is a common occurrence after cardiac surgery. However, in contrast to other surgical populations, routine PONV prophylaxis is not a standard of care in cardiac surgery. We hypothesized that routine administration of a single prophylactic dose of ondansetron (4 mg) at the time of stopping postoperative propofol sedation before extubation in the cardiac surgery intensive care unit would decrease the incidence of PONV. With institutional human ethics board approval and written informed consent, we conducted a randomized controlled trial in patients ≥19 years of age with no history of PONV undergoing elective or urgent cardiac surgery procedures requiring cardiopulmonary bypass. The primary outcome was the incidence of PONV in the first 24 hours postextubation, compared by the χ test. Secondary outcomes included the incidence and times to first dose of rescue antiemetic treatment administration, the incidence of headaches, and the incidence of ventricular arrhythmias. PONV within the first 24 hours postextubation occurred in 33 of 77 patients (43%) in the ondansetron group versus 50 of 82 patients (61%) in the placebo group (relative risk, 0.70 [95% confidence interval {CI}, 0.51-0.95]; absolute risk difference, -18% [95% CI, -33 to -2]; number needed to treat, 5.5 [95% CI, 3.0-58.4]; χ test, P = .022). Kaplan-Meier "survival" analysis of the times to first rescue antiemetic treatment administration over 24 hours indicated that patients in the ondansetron group fared better than those in the placebo group (log-rank [Mantel-Cox] test; P = .028). Overall, 32 of 77 patients (42%) in the ondansetron group received rescue antiemetic treatment over the first 24 hours postextubation versus 47 of 82 patients (57%) in the placebo group (relative risk, 0.73 [95% CI, 0.52-1.00]; absolute risk difference, -16% [95% CI, -31 to 1]); P = .047. There were no significant differences between the groups in the incidence of postoperative headache (ondansetron group, 5 of 77 patients [6%] versus placebo group, 4 of 82 patients [5%]; Fisher exact test; P = .740) or ventricular arrhythmias (ondansetron group, 2 of 77 patients [3%] versus placebo group, 4 of 82 patients [5%]; P = .68). These findings support the routine administration of ondansetron prophylaxis at the time of discontinuation of postoperative propofol sedation before extubation in patients following cardiac surgery. Further research is warranted to optimize PONV prophylaxis in cardiac surgery patients.

Efficacy of ondansetron for postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery: a meta-analysis of randomized controlled trials

Objective To evaluate the effcacy and safety of 5-HT3 receptor inhibitor ondansetron injected in the postoperative nausea and vomiting (PONV) in patients undergoing gynecological laparoscopic surgery under general anesthesia.Methods We searched the CNKI,CBM,Chongqing VIP,Wanfang Data Base,Pubmed,Springer,Embase,and Web of knowledge to identify randomized controlled trials (RCTs) about ondansetron in preventing PONV in patients undergoing gynecological laparoscopic surgery under general anesthesia from 1995 to 2012.We also consulted references of the included studies for omission.The methodological quality of the included RCTs was assessed and data were extracted according to the standard of the Cochrane Handbook 5.0.1.The meta-analyses were performed by Stata1 1.0 software.A total of 18 RCTs involving 1 597 patients were included.Results The results of meta-analyses showed that:① Effcacy:a single intravenous injection of ondansetron could decrease the incidence of PONV in patients undergoing gynecological laparoscopic surgery under general anesthesia (RR=0.210,95％CI=0.164-0.268),and a single 8 mg Ⅳ dose of ondansetron is no more effective than a single 4 mg Ⅳ dose of Ondansetron for prevention (RR=0.948,95％ CI =0.433-2.075),furthermore,ondanstron administered at the beginning of the gynecological laparoscopic procedures is more effective in preventing PONV than at the end of the surgery (RR=0.450,95％CI=0.290-0.698).Moreover,equivalent effcacy was seen between the ondansetron and droperidol in reducing PONV in patients undergoing gynecological laparoscopic survey,but the combination of ondansetron and droperidol further attenuated this incidence when compared to 4 mg ondansetron alone.② Safety:ondansetron injected could not significantly lessen the incidence of postoperative headache and fever.Conclusions A single 4 mg Ⅳ dose of ondansetron injected at the beginning of the gynecological laparoscopic survey can significantly decrease the incidence of PONV after general anesthesia,and it will not increase the adverse effect and the incidence of postoperative complications.And the combination of ondansetron and low dose of droperidol is more efficacious as a prophylactic antiemetic than ondansetron alone in women undergoing general anesthesia for gynecological laparoscopy. Key words: Randomized controlled trials; Meta-analysis; Ondansetron; Postoperative nausea and vomiting; gynecological; laparoscopic surgery

Perioperative Complications of Blood Brain Barrier Disruption Under General Anesthesia: A Retrospective Review

Blood brain barrier disruption enhances drug delivery in primary central nervous system lymphoma. In this study, we report adverse events that were encountered intraoperatively and in the postoperative period in these patients. A retrospective analysis of 17 patients documenting demographic data, preprocedure medical history, intraoperative, and postoperative anesthetic complications was conducted between January 2002 and December 2004. Seventeen patients underwent 210 treatments under general anesthesia with a mean of 12.4+/-7.2 treatments per patient. Focal seizures occurred in 13% of patients. Generalized motor seizures occurred in 4 treatment sessions in 2 different patients. The incidence of seizures was significantly higher when the internal carotid artery was used for injection, as opposed to the vertebral artery (20.8% and 6.02%, respectively, P=0.0034). Tachycardia associated with ST segment depression occurred 9 times (4.3%) in 3 patients. One patient had significant ST segment elevation (more than 1.5 mm). Transient cerebral vasospasm after methotrexate injection occurred in 9% of patients. Postoperative nausea and vomiting were observed in 11.9% of patients. After emergence, lethargy and obtundation occurred in 7.6% of the cases. The incidence of postoperative headache and reversible motor deficits was 6% and 3.8%, respectively. Our review highlights the problems that were encountered during blood brain barrier disruption under anesthesia and in the postoperative period. Further prospective studies are required for comprehensive evaluation of intraprocedure and postprocedure complications that will allow development of an optimal anesthetic plan and will improve patient outcome by preventing potential complications.

SPINAL ANAESTHESIA IN YOUNG PATIENTS USING A 29-GAUGE NEEDLE: TECHNICAL CONSIDERATIONS AND AN EVALUATION OF POSTOPERATIVE COMPLAINTS COMPARED WITH GENERAL ANAESTHESIA

One hundred patients aged 18-49 yr, undergoing elective arthroscopy of the knee joint, were allocated randomly to either spinal anaesthesia using a 29-gauge spinal needle or general anaesthesia. Dural puncture was considered difficult in 18% of the patients receiving spinal anaesthesia. In three patients (6%) it was necessary to supplement the spinal anaesthetic with general anaesthesia. Spinal and general anaesthesia were otherwise uneventful in all patients. The incidence of postoperative headache was similar in the two groups. One patient developed post dural puncture headache following spinal anaesthesia. This headache was of short duration and disappeared without treatment. Spinal anaesthesia caused more backache than general anaesthesia, otherwise the frequency of postoperative complaints was the same or lower. Ninety-six percent of the patients receiving spinal anaesthesia would prefer the same anaesthetic for a similar procedure in the future.

HEADACHE FOLLOWING HALOTHANE ANAESTHESIA

SUMMARY The frequency of headache occurring in the postoperative period following three common anaesthetic techniques is described. The incidence following anaesthesia with halothane and controlled ventilation was found to be significantly higher than in a similar group in which halothane was not used. The two groups were otherwise comparable in all respects. A third technique employing halothane and spontaneous respiration showed a still higher incidence of headache when compared with the halothane and controlled ventilation method, but this difference was not statistically significant. In ten patients (20 per cent of those receiving halothane) headache was the main postoperative complaint. The possible relationships between the headaches after halothane and the effect of this drug on the cerebral vasculature and cerebrospinal fluid pressure are discussed. Headache is usually considered a minor sequel of anaesthesia (Edmonds-Seal and Eve, 1962; Thomas, 1963) other than when occurring after deliberate or inadvertent subarachnoid tap. However, headache assumes greater importance in the immediate postoperative period in an out-patient or in early ambulant patients after relatively minor procedures. This study was designed to investigate the influence of halothane on the incidence of postoperative headache. MATERIAL AND METHODS

A DEVICE FOR FACILITATING THE USE OF FINE GAGE LUMBAR PUNCTURE NEEDLES

In making lumbar punctures for spinal anesthesia it is desirable to use as fine a needle as possible in order to lessen the incidence of postoperative headache. The fine needles, however, are quite flexible. This makes it difficult, in traversing resistant tissue such as the posterior spinous ligament, to retain the direction of the needle. If the conical point of Greene is used it is sometimes almost impossible to puncture the skin. In order to overcome these difficulties I have devised a small cannula, the lumen of which just fits the spinal needle to be used. This cannula has a sharp cutting point and a somewhat wide flange at the base, and is 1¼ inches long. It is used by being inserted through the skin and posterior spinous ligament much like a thumb-tack. Thus it acts as a guide and path for the slender spinal needle, which will then