The enhanced recovery after surgery (ERAS) protocol is a complex set of measures that improves patient outcomes in the adult population. The main goal of the protocol is to sustain homeostasis by mitigating the metabolic stress induced by surgical procedures. Hence, the search for similar solutions in paediatric patients since the benefits in the paediatric population are less well known.

The principles of the ERAS protocol were presented. A questionnaire survey was prepared to assess the preparation for the implementation of ERAS in paediatric surgery departments. Heads of all 19 clinical centres from Poland providing colorectal surgery in children were invited to participate. Seven centres responded to the survey. The questionnaire included four general questions related to the familiarity with ERAS and specific questions about the implementation of the 23-item protocol.

Five centres confirmed familiarity with the principles of the protocol and two of them confirmed the use of ERAS. The lowest number of implemented procedures was six, while the highest number was 18 out of 23. No centre implemented the zero fluid balance strategy. However, as many as five of the seven centres avoided preoperative fasting, three centres avoided mechanical bowel preparation, and three respondents used early oral nutrition in the postoperative period.

The ERAS protocol is commonly used and accepted worldwide. Other surgical teams may use the information contained in the manuscript to create or improve their ERAS protocol.

Validating postoperative nausea and vomiting (PONV) severity based on antiemetics prescription can help actively manage PONV by the Rhodes Index of Nausea, Vomiting, and Retching (RINVR) scale but is relatively complicated. This study aims to validate the RINVR scale on PONV intensity with prescribed antiemetics usage, and further simplify and validate this scale to serve as the simplified PONV severity score (SPONVSS) and its effects on sleep quality and vitality.

This study analyzed data from patients who underwent anesthesia with sleep and vitality reports after surgery. We assessed the PONV severity by RINVR. We also simplified the RINVR score with one element selected from each dimension of PONV. The RINVR score and all 18 simplified combinations were validated with antiemetic usage. These scores were used to study patient-reported sleep quality and vitality.

The AUC of the RINVR score and 18 combinations have a similar high impact on antiemetics administration, sleep, and vitality. Nausea frequency, vomiting, and retching times were chosen as the SPONVSS elements because of overall high AUC and convenience in implementation. Multivariate logistic regression analyses show that besides pain, the SPONVSS score provides a significant impact on postoperative sleep and vitality.

We developed a simple and practical scale to monitor PONV intensity in a broad clinical surgical setting. A high SPONVSS score (≥ 3) is an independent risk for rescue antiemesis, poor sleep quality, and vitality. This scale will be useful to monitor the postoperative care quality and improve postoperative care.

Postoperative nausea and vomiting (PONV) is a common adverse event after general surgery. This study aimed to examine the effectiveness and safety of transcutaneous electrical acupoint stimulation (TEAS) for the prevention of nausea and vomiting after laparoscopic surgery.

The Cochrane Library, Pubmed, Embase, and Web of Science databases were accessed from inception to 23 January 2024. The incidence of PONV was the primary outcome measure. The required information size (RIS) of each outcome was estimated by Trial sequential analysis (TSA). The RoB 2.0 tool was used to assess the risk of bias and GRADE to assess the quality of evidence.

Seventeen RCTs including 3698 participants were included. In comparison to the control group, TEAS reduced the incidence of PONV (13 trials, n = 3310; RR, 0.56; 95% CI, 0.46-0.67; I2 = 64%; p < 0.01; RIS = 1100), with the level of evidence graded as low. TEAS reduced the incidence of PON (9 trials, n = 2762; RR, 0.64; 95% CI, 0.52-0.79; I2 = 57%, p < 0.01; RIS = 1595), and was also associated with a lower incidence of POV (9 trials, n = 2797; RR, 0.53; 95% CI, 0.45-0.63; I2 = 0%, p < 0.01; RIS = 773).

The current meta-analysis and TSA provide reliable evidence that TEAS is an effective and safe method to prevent PONV. It may reduce the workload of nursing professionals, alleviate emotional stress, and decrease exposure risk. Adverse events related to TEAS were mild.

Nurses can incorporate TEAS into the rehabilitation nursing of patients experiencing PONV.

Improving comfort during and after surgery is a key concern for anaesthetists and other clinicians. With the inclusion of patient and public involvement, we undertook a Delphi consensus process to update previously recommended endpoints to be used in clinical trials evaluating treatments aiming to improve patient comfort after surgery.

We undertook a systematic review to identify domains and outcome measures of patient comfort used in perioperative studies. Focus groups, workshops, and a multi-round Delphi consensus process that included clinician-researchers and a patient experience and consumer group updated a recommended list of standardised endpoints focused on patient comfort. Consensus was defined as a median item score of 7 or greater and at least 70% of responses achieving a score of 7 or greater on a 9-point Likert scale. Additional ratings were done to determine validity, reliability, feasibility, and patient-centredness. Qualitative analyses were undertaken to identify themes.

Response rates for each of the Delphi rounds were 100%. A final list of eight defined endpoints was identified: supplementary analgesic use, subjective analgesic effectiveness, pain intensity (at rest, during movement, and at 12, 24, and 72 h), postoperative nausea and vomiting (PONV, at 0-6 h, at 6-24 h, and overall), postdischarge nausea and vomiting (PDNV), severe PONV, quality of recovery (QoR-15), and time to mobilisation. All endpoints were assessed as valid, reliable, and feasible measures of patient comfort and were considered patient-centred. Patient and public involvement highlighted the importance of clear communication and shared decision-making to enhance comfort through the surgical journey.

We recommend that at least some of these standardised endpoints be included as outcome measures in clinical trials assessing patient comfort and pain after surgery.

Open Science Framework (10.17605/OSF.IO/DJQFE).

To evaluate the safety of propofol and sevoflurane for general anesthesia in elderly.

All studies on sevoflurane, propofol, and hyperamylasemia from the establishment of Embase, Ovid, Cochrane Library, and Google Scholar from database establishment to December 2024 were searched. Literatures were screened, and data were extracted on the grounds of inclusion and exclusion criteria. Review Manager (RevMan) (Version 5.4. The Cochrane Collaboration.) was used for statistical analysis. Outcomes assessed included time to spontaneous eye opening, extubation time, incidence rate of postoperative cognitive dysfunction (POCD), postoperative delirium, agitation, nausea and vomiting.

Fourteen trials were identified and included in this meta-analysis. The results showed no significant difference in time to spontaneous eye opening (P = 0.54), the incidence of POCD (P = 0.07), postoperative delirium (P = 0.37), and postoperative nausea and vomiting (P = 0.8) between the sevoflurane and propofol groups. Compared with propofol groups, extubation time (P < 0.0001) was significantly shortened by sevoflurane groups. Conversely, compared with sevoflurane, the incidence of postoperative agitation in the propofol group was significantly reduced (P = 0.04).

There was no difference in time to spontaneous eye-opening, the incidence of POCD, postoperative delirium, postoperative nausea, and vomiting between the sevoflurane and propofol groups. However, compared with propofol, sevoflurane can significantly shorten intubation time. The incidence of postoperative agitation (P = 0.04) was significantly lower in the propofol group compared with sevoflurane.

Postoperative nausea and vomiting (PONV) are frequent complications that can occur after surgical procedures. Sugammadex, known for its effectiveness as a muscle relaxant antagonist, offers several advantages over neostigmine, however, there is still insufficient evidence to demonstrate its superiority in reducing PONV. This meta-analysis sought to assess the efficacy of sugammadex versus neostigmine in the management of PONV. Two independent investigators conducted a comprehensive review of randomized controlled trials (RCTs) across PubMed, Embase, and the Cochrane Library. The meta-analysis was performed using Review Manager software. Our meta-analysis scrutinized twenty studies that included 3248 participants. The results showed that sugammadex was effective in reducing postoperative nausea (RR = 0.65, 95% CI 0.48 to 0.88) versus neostigmine. Sugammadex reduced the dosage of opioids (SMD = 0.55, 95% CI -0.18 to 1.27) compared with neostigmine when the time of administration is T2 (RR = 0.54, 95% CI 0.31 to 0.93). The use of sugammadex markedly lowered the occurrence of nausea during non-laparoscopic surgical procedures (RR = 0.42, 95% CI 0.27 to 0.65). This study demonstrated that sugammadex outperformed neostigmine in reducing PONV. Various factors, including the type of surgical procedure, timing of drug administration and dosage, might influence the efficacy of sugammadex.

To investigate the impact of retracted trials on the production and use of healthcare evidence in the evidence ecosystem.

Retrospective cohort study based on forward citation searching.

Retraction Watch up to 5 November 2024.

Randomised controlled trials in humans that were retracted for any reason.

Forward citation searching via Google Scholar and Scopus was used to identify evidence synthesis research (21 November 2024) that quantitatively incorporated retracted trials. Data were independently extracted by two groups of researchers. The results of meta-analyses were updated after exclusion of the retracted trials. The proportions of meta-analyses that changed direction of the pooled effect and/or the significance of the P value were estimated. A generalised linear mixed model was used to investigate the association between the number of included studies and the impact, measured by odds ratio and 95% confidence interval (CI). The impact of distorted evidence on clinical practice guidelines was also investigated on the basis of citation searching.

The searches identified 1330 retracted trials and 847 systematic reviews that quantitatively synthesised retracted trials, with a total of 3902 meta-analyses that could be replicated. After the potential clustering effects were accounted for, the exclusion of the retracted trials led to a change in the direction of the pooled effect in 8.4% (95% CI 6.8% to 10.1%), in its statistical significance in 16.0% (14.2% to 17.9%), and in both direction and significance in 3.9% (2.5% to 5.2%) and a >50% change in the magnitude of the effect in 15.7% (13.5% to 17.9%). An obvious non-linear association existed between the number of included studies and the impact on the results, with a lower number of studies having higher impact (eg, for 10 studies versus ≥20 studies, change of direction: odds ratio 2.63, 95% CI 1.29 to 5.38; P<0.001). Evidence from 68 systematic reviews with conclusions distorted by retracted trials was used in 157 guideline documents.

Retracted trials have a substantial impact on the evidence ecosystem, including evidence synthesis, clinical practice guidelines, and evidence based clinical practice. Evidence generators, synthesisers, and users must pay attention to this problem, and feasible approaches that assist with easier identification and correction of such potential contamination are needed.

Open Science Framework (https://osf.io/7eazq/).

Multimodal analgesia (MA) is a cornerstone in perioperative pain management, enhancing pain relief and minimizing opioid consumption by targeting various pain pathways. This study conducts a bibliometric analysis of MA research from 2013 to 2023 to understand its development and impact on perioperative care.

A comprehensive literature search of the Web of Science Core Collection (WOSCC) was conducted, covering publications from January 2013 to December 2023. Data were analyzed using VOSviewer and other bibliometric tools to identify publication trends, key contributors, and emerging research themes.

The analysis identified 1,939 studies on MA, with a notable increase in annual publications since 2020. The USA, China, and Canada were the leading contributors. Key terms like Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Enhanced Recovery After Surgery (ERAS), and Patient-Controlled Analgesia (PCA) were frequently associated with MA. Significant journals included the Cureus Journal of Medical Science and Anesthesia and Analgesia. Influential authors such as Richard D. Urman and Henrik Kehlet were highlighted for their contributions. The research showed significant advancements and growing global interest in MA.

The study underscores the growing importance of MA in perioperative pain management, with significant contributions from leading countries and researchers. Future research should focus on optimizing pain management protocols, enhancing patient recovery, and reducing opioid dependency through MA.

Enhanced recovery after surgery (ERAS) is an innovative perioperative management approach designed to shorten the recovery time, improve patient safety and quality of care, and enhance overall satisfaction. Successful implementation of ERAS requires active collaboration between healthcare providers and patients to facilitate a timely return to daily activities. The ERAS protocol, originally developed for colorectal surgery, has gradually been expanded and adapted to other major surgeries, and more recently, to Cesarean deliveries. Enhanced recovery after Cesarean delivery (ERAC) presents unique challenges due to its distinct patient population, comprising relatively young women. Its dual focus on maternal recovery and neonatal well-being sets it apart from conventional ERAS protocols. Several components of the ERAC protocol have been adapted from the ERAS recommendations; however, supporting evidence remains limited. This review examines the current ERAC protocol and considers the types of research needed to establish an evidence-based ERAC protocol in the future.

Postoperative nausea and vomiting (PONV) after orthognathic surgery remains one of the most common side effects despite the use of several medications.

The study aimed to compare the frequencies of PONV between a combination of metoclopramide with granisetron and granisetron alone.

A randomized double-blind clinical trial was conducted in 66 consecutive patients who underwent orthognathic surgery at the Department of Oral and Maxillofacial Surgery at Bezmialem Vakif University. Patients with contraindications such as hypersensitivity to medications, gastrointestinal or metabolic disorders, renal insufficiency, electrolyte imbalances, pregnancy, neurological diseases, prolonged QT interval, or mental retardation were excluded.

The predictor variable was the antiemetic treatment (combination vs single therapy). Participants were randomized to either the metoclopramide with granisetron group (group GM) or the granisetron-only group (group G).

The outcome variable was PONV status, measured using the simplified postoperative nausea and vomiting impact scale. The participants were assessed at baseline (when fully awake) and during the subsequent 24 hours.

Patient characteristics, total drug doses, systolic and diastolic blood pressure, peripheral arterial oxygen saturation, Apfel's PONV risk score, total bleeding volume, infused fluid volume, surgery duration, PONV incidence, visual analog scale scores, tramadol requirement, and the use of rescue antiemetics were determined as covariates.

Data were analyzed using the Mann-Whitney U test with P value less than.05 considered significant.

The sample consisted of 60 participants, with 30 patients in each treatment group. The mean age was 30 ± 11.6 years in group G and 25.63 ± 10 years in group GM (P = .1); 42% of participants were male (P = .8). PONV scores at the second hour were 1.56 ± 1.45 in group G and 0.79 ± 0.90 in group GM (P = .03). The difference between the groups was statistically significant (P < .001). Participants in group G had a 1.61-fold higher risk of vomiting than those in the group GM (Relative risk = 1.61; 95% CI, 1.313 to 1.962).

Compared to granisetron alone, the combination of granisetron and metoclopramide was associated with significant PONV control in patients undergoing orthognathic surgery. A multimodal approach may be adopted to reduce the incidence of PONV in patients undergoing maxillofacial surgery.

The objective of this study is to assess the impact of a quantitative early activity program, integrated into the Enhanced Recovery After Surgery (ERAS) protocol on gastrointestinal function in patients undergoing laparoscopic pancreatoduodenectomy (LPD).

Perioperative data from 203 patients who underwent LPD at the Department of Comprehensive Treatment of Pancreatic Cancer, Fudan University Shanghai Cancer Center, between January 2021 and December 2022 were analyzed retrospectively. The patients were categorized into 2 groups based on their nursing plans. Group A received the standard perioperative ERAS nursing plan, while group B followed the ERAS plan supplemented with a quantitative early activity program. We assessed postoperative outcomes including bowel sound recovery time, time to first anal exhaust, time to first mobilization, activity compliance 1-week postsurgery, and incidence of postoperative breakthrough pain.

We compared several postoperative metrics between group A and group B. Specifically, the time to bowel sound recovery was 62.39±17.89 hours in group A versus 56.45±22.85 hours in group B. The time to first anal exhaust was 78.88±71.99 hours in group A compared with 63.62±24.73 hours in group B. The time to first mobilization was 56.98±18.66 hours in group A versus 49.85±20.48 hours in group B. In addition, activity compliance 1-week postsurgery and the incidence of postoperative breakthrough pain (1.55±2.01 times in group A vs. 0.94±1.16 times in group B) were also compared. All these differences were statistically significant ( P <0.05). Conversely, the incidence of postoperative complications and the length of hospital stay (11.20±5.69 d in group A vs. 12.47±6.67 d in group B) did not reveal any significant differences ( P >0.05).

The quantitative early activity program for LPD, based on the ERAS protocol, enhances the adherence to postoperative activity and decreases the incidence of breakthrough pain, thereby facilitating gastrointestinal function recovery in patients. This approach merits clinical adoption.

Postoperative nausea and vomiting (PONV) is the most common side effect after laparoscopic sleeve gastrectomy (LSG), affecting patients' postoperative recovery and increasing the medical and economic burden. This study aimed to analyze the relationship between serum pepsinogen and PONV.

Patients with obesity who underwent LSG in our center between January 2021 and December 2022 were divided into PONV and NoPONV groups and analyzed retrospectively. Binary logistic regression analysis was used to determine the independent risk factors for PONV.

219 female patients were enrolled, with an average BMI of 36.74 ± 8.34 kg/m2 and aged 32.61 ± 6.18 years. PONV occurred in 157 patients (71.7%). The influencing factors of PONV with different severity were analyzed, and the results showed that the severity of postoperative pain (χ2 = 13.169, p-values = 0.004), PGI (χ2 = 14.625, p-values = 0.002), PGII (χ2 = 25.916, p-values = 0.000), and PGR (χ2 = 17.697, p-values = 0.001) had statistical significance. Binary logistic regression showed that PGI was a risk factor for PONV with a OR (ng/mL) value of 1.013 (95% CI: 1.001-1.024, p-values = 0.037), while PGR was a protective factor for PONV with an OR(ng/mL) value of 0.952 (95% CI: 0.925-0.979, p-values = 0.001).

The incidence of PONV after LSG is high. Higher PGI may be a risk factor for promoting PONV after LSG. The higher the preoperative PGI, the later the onset of PONV; the longer the duration, the more serious the degree.

Postoperative nausea and vomiting are common complications after gynecologic laparoscopic surgery. Pyridoxine has been recommended as a first-line drug to prevent and treat nausea and vomiting during pregnancy; however, its efficacy in preventing postoperative nausea and vomiting remains unclear.

Patients of 18 to 65 yr old who received elective gynecologic laparoscopic surgery under general anesthesia were randomized into either the pyridoxine group or the control group. The pyridoxine group received 0.2 g of vitamin B 6 before anesthesia induction, and the control group received normal saline intravenously. Both groups received a similar regimen of combined intravenous and inhalation general anesthesia. All patients received dexamethasone (intravenous) after anesthesia induction and ondansetron (intravenous) before surgery completion. Postoperative nausea and vomiting occurrence was recorded according to the patients' self-reported data. Other clinical data were collected from hospital system, and concentrations of blood interleukin-6 and substance P were measured by enzyme-linked immunosorbent assay.

A total of 442 patients were screened, and 240 patients were equally randomized to the pyridoxine or control group. The incidence of postoperative nausea and vomiting was statistically significant lower in the pyridoxine group than in the control group (16.7% [20 of 120] vs . 35.8% [43 of 120]; relative risk = 0.47 [95% CI, 0.29 to 0.74]; absolute risk reduction = 0.20 [95% CI, 0.08 to 0.30]; P = 0.001), and pyridoxine decreased the incidence of postoperative nausea (12.5% [15 of 120] vs . 35% [42 of 120]; relative risk = 0.36 [95% CI, 0.21 to 0.61]; absolute risk reduction = 0.23 [95% CI, 0.12 to 0.33]; P < 0.001). There were no statistical differences in postoperative vomiting, time to the first postoperative nausea and vomiting occurrence, pain, serum interleukin-6 and substance P, and leukocyte and neutrophil counts.

In this single-center randomized trial, pyridoxine plus dexamethasone and ondansetron reduced the incidence of postoperative nausea and vomiting in patients undergoing elective gynecologic laparoscopic surgery under general anesthesia. These findings need to be validated in multicenter studies in diverse populations to ensure generalizability.

Extended stays in the postanesthesia care unit (PACU) pose challenges in high-volume endoscopies. This study investigates the impact of intraoperative fentanyl use on PACU duration, postoperative pain, and financial implications in outpatient endoscopy.

A retrospective analysis of upper/lower endoscopies at our facility (2020-2022) was conducted, focusing on the relationship between fentanyl use, PACU duration, and pain scales. Financial impacts were also assessed.

Among 11,488 patients, 5787 (50.4%) received intraoperative fentanyl, and 5225 (45.5%) had a long stay at PACU (> 50 min). A larger proportion of patients in the long-stay group (> 50 min) received fentanyl (56.3% vs. 45.4%, P < 0.01), and they reported higher Numeric Rating Scale (NRS) pain scores (> 5 in 3.6% vs. 1.2%, P < 0.01). The median PACU time was longer for fentanyl recipients (52 vs. 48 min, P < 0.01). Multivariable analysis identified fentanyl use, older age, and higher ASA scores (≥ 3) as significant factors for prolonged PACU durations. Fentanyl did not significantly reduce postoperative pain (scores > 5: 2.8% for fentanyl users vs. 2.2% for nonusers). Furthermore, most patients reported no pain post-surgery (93.0% for fentanyl users vs. 95.2% for nonusers). Fentanyl recipients did not have shorter PACU stays within any pain scale category. Financial simulations suggest that fentanyl-free anesthesia management could notably decrease the financial burden within endoscopy operations. Specifically, our institution could have realized an annual saving of at least US $100,308.

Intraoperative fentanyl increases PACU duration by approximately 4 min per patient in endoscopies, without markedly improving pain management. Avoiding fentanyl could lead to significant time and cost savings.

Health care disparities affect care across all medical fields, including pediatric anesthesia. Recent studies have revealed differences in pediatric perioperative care especially in anesthetic and analgesic choices. Additionally, Black children face higher 30 day postoperative mortality and more serious adverse events compared to White children. While strategies to address these disparities have been proposed, significant work is still needed.

Postoperative nausea and vomiting (PONV) is defined as the joint or individual occurrence of nausea, retching and vomiting within 24-48h after an operation. The peripheral and central nervous systems are involved in the development of PONV. The pathogenesis of PONV is multifactorial. Patient-related, anaesthesia-related and surgery-related risk factors can be present. Some of the risk factors for PONV were combined to form PONV risk scores (e.g., the simplified risk score for predicting postoperative nausea and vomiting from Apfel et al.), with the help of which the risk of PONV can be estimated with a sensitivity and specificity of 65-70%. For certain collectives specialised PONV risk scores should be prioritised. The antiemetic strategy is divided into three areas: modification of the anaesthetic procedure, pharmacological and nonpharmacological interventions. These can be applied individually or combined in the sense of a multimodal PONV prophylaxis.

Postoperative nausea and vomiting is common after general anesthesia, with consequences for patient outcomes, satisfaction with care, and healthcare costs. The aim was to compare a new treatment, chewing gum, with a widely used intravenous agent, ondansetron, to treat postoperative nausea and vomiting in female patients in the postanesthesia care unit.

This study was a multicenter, randomized, controlled noninferiority trial in 17 hospitals in Australia and New Zealand. Female patients aged 12 yr or older undergoing volatile anesthetic-based general anesthesia for laparoscopic or breast surgery were enrolled. Protocolized antiemetic prophylaxis was administered. Patients who developed postoperative nausea and vomiting in the postanesthesia care unit were randomized to either 15 min of chewing gum or 4 mg intravenous ondansetron. The primary outcome was cessation of nausea, retching, or vomiting with no recurrence nor rescue medication for 2 h after administration of the randomized intervention ( i.e. , complete response).

Of 865 enrolled patients, 218 were randomized. In a per-protocol analysis, 50 of 105 (47.6%) ondansetron-treated patients compared with 31 of 103 (30.1%) chewing gum-treated patients achieved the primary outcome (absolute risk difference [95% CI], -17.3 [-30.4 to -4.3]%), not reaching the prespecified noninferiority limit. The time to complete response was longer for patients randomized to chewing gum (hazard ratio [95% CI], 0.53 [0.34 to 0.83]), and they were more likely to receive antiemetics in the 24 h after surgery (absolute risk difference [95% CI], 14.1 [1.6 to 26.5]%).

Chewing gum cannot be recommended as an alternative to ondansetron for treatment of postoperative nausea and vomiting in female patients administered antiemetic prophylaxis.

To evaluate the methodological and reporting quality of clinical practice guidelines/expert consensus for ambulatory surgery centers published since 2000, combining manual assessment with large language model (LLM) analysis, while exploring LLMs' feasibility in quality evaluation.

We systematically searched Chinese/English databases and guideline repositories. Two researchers independently screened literature and extracted data. Quality assessments were conducted using AGREE II and RIGHT tools through both manual evaluation and GPT-4o modeling.

54 eligible documents were included. AGREE II domains showed mean compliance: Scope and purpose 25.00%, Stakeholder involvement 20.16%, Rigor of development 17.28%, Clarity of presentation 41.56%, Applicability 18.06%, Editorial independence 26.39%. RIGHT items averaged: Basic information 44.44%, Background 36.11%, Evidence 14.07%, Recommendations 34.66%, Review and quality assurance 3.70%, Funding and declaration and management of interests 24.54%, Other information 27.16%. LLMs'-evaluated documents demonstrated significantly higher scores than manual assessments in both tools. Subgroup analyses revealed superior quality in documents with evidence retrieval, conflict disclosure, funding support, and LLM integration (P <0.05).

Current guidelines and consensus related to day surgery need to improve their methodological quality and quality of reporting. The study validates LLMs' supplementary value in quality assessment while emphasizing the necessity of maintaining manual evaluation as the foundation.

Orthognathic surgery entails a high risk of blood ingestion, which causes postoperative nausea and vomiting (PONV). Throat packs are placed to combat this problem. However, the efficacy of throat packs in reducing blood ingestion and PONV is debatable. We aimed to review the existing literature and pool the estimates of the quality of gastric contents, PONV, and throat pain associated with and without the use of throat packs among patients undergoing orthognathic surgery. Globally recognized databases (PubMed, Scopus, Embase, CINAHL, and Web of Science) were searched to identify relevant studies, and 2 randomized controlled trials comprising 84 participants were included. A qualitative analysis of the gastric contents showed that throat packs are not practical barriers against the ingestion of blood during orthognathic surgery. The meta-analysis revealed that placement of throat packs during orthognathic surgery did not reduce the incidence of PONV (p value = 1) and caused higher postoperative throat pain (p value = 0.02). Thus, the current review provides no evidence in favor of throat packs during orthognathic surgery. The role of throat packs in preventing blood ingestion is questionable due to a limited number of studies. They play no significant role in preventing PONV and increase postoperative throat pain.

Background/Objectives: The aim of this paper was to evaluate the safety of surgical intervention using anesthesia and ophthalmological parameters in pediatric strabismus patients. The design involved retrospective case series. Methods: The setting was the Department of Ophthalmology, Medical University Vienna, Austria. Participants: In total, 208 children aged 0-18 years who underwent strabismus surgery due to exotropia or esotropia between 2013 and 2020 were included. Main outcomes and measures: Information regarding the duration of surgery, intra- and postoperative complications, the postoperative angle of deviation (AoD), and functional outcomes (visual acuity, stereovision) were analyzed. Results: The mean age at the time of surgery was 6.0 ± 4.1 years (range 0.6-18.0). The mean anesthesia time among all patients was 75.9 ± 19.3 min. The mean surgery and anesthesia time did not differ between the age groups. Longer anesthesia durations and surgery durations did not have a significant effect on the occurrence of intraoperation complications (p = 0.610 and p = 0.190, respectively). Intraoperative complications were recorded in 53% (most frequent triggering of oculocardiac reflex (OCR)) of the patients, and postoperative complications in 22% (the most frequent were postoperative nausea and vomiting and pain). An OCR was triggered more often in children older than 6 years than in younger children (p = 0.016). The mean angle of deviation was significantly reduced from preoperative to postoperative measurements. Preoperative stereovision tests were positive in 35% of the patients and increased to over 80% postoperatively. Conclusions: Strabismus surgery performed under general anesthesia in children aged 0 to 18 years is safe with regard to both surgical and anesthetic complications. A significant decrease in the angle of deviation and high rate of stereovision could be achieved with a low rate of re-treatments. However, the retrospective design, absence of standardized documentation, and limited sample size may affect the consistency and comparability of this study's findings.

The purpose of this study is to assess the effectiveness of aromatherapy for postoperative nausea and vomiting (PONV) after total knee arthroplasty (TKA) under spinal anesthesia.

Prospective randomized four-arm placebo-controlled trials METHODS: One hundred and twenty subjects were allocated to each of the four groups based on the application of aromatic oil in subjects manifesting PONV: group 1 (lavender), group 2 (lemon), group 3 (peppermint), and group 4 (normal saline placebo). Aromatherapy was administered to all subjects immediately after surgery. Antiemetics were provided to subjects with significant nausea or vomiting. The severity of nausea and vomiting in subjects post-TKA was evaluated using the Halpin nausea and vomiting scale (HNV). The HNV and the concentration of antiemetic drug use were evaluated. Subjects' satisfaction with treatment for PONV was evaluated at discharge.

HNV scores did not differ significantly between groups immediately after surgery until the third postoperative day (P > .05). The amount of antiemetic drug used in group 3 was significantly lower among the groups (P = .030). The subject satisfaction scale did not differ significantly among groups (P = .837).

Aromatherapy using peppermint oil reduced the amount of antiemetics used to treat PONV after TKA under spinal anesthesia with comparable subject satisfaction. Lavender and lemon oils did not reduce the use of antiemetics after TKA.

Ondansetron and dexamethasone combination is effective for prophylaxis against postoperative nausea and vomiting (PONV). Ondansetron, when compared to dexamethasone, is known to cause more adverse effects and is relatively expensive. The present study evaluated the efficacy of standard dose and low dose ondansetron, i.e. 100 μg/kg and 50 μg/kg, respectively, with dexamethasone 8 mg for PONV prophylaxis in laparoscopic cholecystectomy (LC).

After the approval from the Institutional Ethics Committee-Human Research [IEC-HR] and prospective CTRI registration, this randomized, double-blind interventional study was conducted following informed consent from each participant. Patients aged 18-65 years of either sex, with ASA physical status I or II, undergoing LC under general anesthesia, were included and divided into groups C and L. Patients in groups C and L received 100 μg and 50 μg of ondansetron, respectively, in combination with 8 mg dexamethasone. The incidence of PONV in first 6 hrs, PONV score, rescue antiemetic consumption, rescue analgesia, and hemodynamic parameters were recorded.

A total of 110 patients were included with 55 in each group. Incidence of PONV in the first 6 hours was found to be higher in 1-2 hour- and 2-3-hour time intervals in group L; but was significant only at 1-2-hour time interval (P < 0.05). Proportion of patients needing rescue antiemetic in the first 6 hours was higher in group L but was not statistically significant.

We observed that 50 μg/kg combination of ondansetron was associated with higher incidence of post operative nausea in the immediate postoperative period than 100 μg/kg dose; however, no significant difference was observed in incidence of post-operative vomiting between two doses following LC.

In this editorial, we reviewed the article by Li et al. We aimed to explore various perspectives to further mitigate the risk factors for postoperative nausea and vomiting (PONV), which could significantly reduce its incidence and related postoperative complications. PONV is highly prevalent among patients undergoing bariatric surgery, yet there are relatively few related studies. Currently, the mainstream bariatric surgery methods include laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. Despite the effectiveness of surgery in helping patients lose weight, postoperative PONV may occur, potentially leading to various complications (such as aspiration and wound dehiscence). A retrospective study by Li et al has compared the impact of different operative positions during laparoscopic sleeve gastroplasty on the incidence of PONV, providing new insights into the clinical practice aimed at reducing PONV incidence and thereby improving patient's postoperative experience.

Postoperative nausea and vomiting (PONV) are common complications following thyroid cancer surgery, impacting patient well-being, prognosis, and potentially leading to severe complications. Frailty, a critical risk factor for postoperative complications, has not been thoroughly investigated concerning PONV in thyroid cancer patients. This study aimed to explore the correlation between frailty and PONV in thyroid cancer patients. A retrospective analysis was conducted on 908 patients who underwent radical thyroid cancer surgery at Jinan Central Hospital between January 2016 and September 2022. Patients were classified into the PONV group (626 patients) and the non-PONV group (282 patients). General and clinical data were collected for comparison. Independent risk factors for PONV were identified using univariate and multivariate logistic regression analyses. ROC curves evaluated the diagnostic efficiency of various indicators. A predictive model for PONV risk factors was developed, verified using ROC curves, and a scoring system was established. Age, Apfel score, modified frailty index (mFI) score, free fatty acids, uric acid, homocysteine (HCY), and fasting blood glucose were identified as independent risk factors for PONV through multivariable logistic regression analysis. The model achieved an area under the curve of 0.893 (0.871-0.915) in the ROC curve, with a sensitivity of 83.2%, specificity of 79.1%, and a maximum Youden index value of 0.623. mFI exhibited the strongest correlation with PONV post-radical thyroid cancer surgery, with a correlation coefficient of 0.523. The modified frailty index is a significant predictor of postoperative nausea and vomiting in patients undergoing thyroid cancer surgery.

To investigate the association between intravenous methylprednisolone administration and the risk of surgical site infection (SSI) following posterior lumbar fusion (PLF) surgery.

This retrospective, single-center study analyzed data from 800 adult patients who underwent elective PLF surgery at our institution. Patients were classified according to postoperative intravenous methylprednisolone administration. Univariate and multivariable logistic regression, and subgroup analysis were used to assess the association between methylprednisolone administration and SSI risk, as well as its impact on postoperative pain management.

Our analysis showed no significant association between intravenous methylprednisolone administration and the development of a SSI after PLF. Subgroup analyses suggested that methylprednisolone was potentially protective in patients with a body mass index (BMI) < 25 kg/m2. In addition, patients treated with methylprednisolone had significantly lower pain scores in the early postoperative period, and lower incidence of postoperative nausea and vomiting (PONV) compared to patients not treated with methylprednisolone. However, there was no significant difference in pain scores between the 2 groups at 4 weeks postoperatively.

This study suggests that intravenous methylprednisolone administration may not increase the risk of SSI after single-level PLF. In addition, it appears to have a beneficial effect on postoperative pain management and PONV, especially during the early recovery phase.

Postoperative nausea and vomiting (PONV) is a prevalent and distressing complication, especially in laparoscopic surgeries. This review compares the efficacy and safety of palonosetron and ondansetron in preventing PONV after laparoscopic surgery.

A systematic review was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library to identify comparative studies that reported the efficacy (nausea and vomiting) at three postoperative time points T1 (0-2 hours), T2 (2-6 hours), T3 (6-24 hours) and safety (incidence of adverse effects). Meta-analysis of relative risk was performed using a random effect model and subgroup analysis based on factors such as antiemetic dose and timing of administration, type of surgery, and anesthetic agents.

Twenty-one randomized controlled trials were published between 2011 and 2022, involving 2,043 participants. Nineteen trials were included in the meta-analysis (efficacy, 17; safety, 11). The pooled risk ratio revealed that patients receiving palonosetron demonstrated significantly less likelihood of developing nausea and vomiting at various postoperative time points. Subgroup analysis indicated significantly less PONV when palonosetron was administered before intubation and in combination with isoflurane anesthesia. Headache, dizziness, constipation, and drowsiness were the most commonly reported. The safety profiles of palonosetron and ondansetron were comparable.

Palonosetron exhibits superior efficacy within the first 24 hours postoperatively and requires less rescue antiemetic intervention compared to ondansetron in laparoscopic surgery patients. Both demonstrate nearly comparable safety profiles. Future trials focusing on cardiac safety (QT interval) and cost consideration are needed.

The perioperative use of gabapentin has been suggested to reduce postoperative pain and opioid consumption. However, there is a variation in clinical practice, the type of surgery and the administration time seem to be distinct between the available studies. We assess whether gabapentin administered before surgery reduces postoperative pain in patients who have undergone inguinal hernioplasty.

This is a double-blind, randomized, and placebo-controlled trial.

Seventy-seven patients scheduled for inguinal hernioplasty were randomized in two groups to receive gabapentin (900 mg) or placebo in the perioperative period. The primary outcome was analgesia measured by visual analog scale up to 30 days after surgery. The secondary outcomes such as morphine consumption, nausea, headache, and sedation have been also described.

Patients who received gabapentin had lower postoperative pain scores compared to the control group, P < .001. The postoperative morphine use was significantly lower in the gabapentin (5.3%) versus placebo group (74.4%), P < .001. No significant difference between groups was observed for the occurrence of adverse events.

The perioperative administration of gabapentin was effective in reducing postoperative pain and had an important effect in decreasing morphine use. Together, our data reveal a long-lasting opioid-sparing effect of gabapentin in patients who underwent inguinal hernioplasty.

The incidence of limb fractures in patients living with HIV (PLWH) is increasing. However, due to their immunodeficiency status, the operation and rehabilitation of these patients present unique challenges. Currently, it is urgent to establish a standardized perioperative rehabilitation plan based on the concept of enhanced recovery after surgery (ERAS). This study aimed to validate the effectiveness of ERAS in the perioperative period of PLWH with limb fractures.

A total of 120 PLWH with limb fractures, between January 2015 and December 2023, were included in this study. We established a multidisciplinary team to design and implement a standardized ERAS protocol. The demographic, surgical, clinical, and follow-up information of the patients were collected and analyzed retrospectively.

Compared with the control group, the ERAS group had a shorter operating time, hospital stay, preoperative waiting time, postoperative discharge time, less intraoperative blood loss, and higher albumin and haemoglobin on the first postoperative day. The time to removal of the urinary catheter/drainage tube was shortened, and the drainage volume was also significantly reduced in the ERAS group. There was no significant difference in the visual analogue scale (VAS) scores on postoperative return to the ward, but the ERAS group had lower scores on the first, second, and third postoperative days. There were no significant differences in the incidence of complications, other than 10% more nausea and vomiting in the control group. The limb function scores at one-year follow-up were similar between the two groups, but time to radiological fracture union and time to return to physical work and sports were significantly reduced in the ERAS group.

The implementation of a series of perioperative nursing measures based on the concept of ERAS in PLWH with limb fracture can significantly reduce the operating time and intraoperative blood loss, reduce the occurrence of postoperative pain and complications, and accelerate the improvement of the functional status of the affected limb in the early stage, which is worthy of applying in more medical institutions.

Background/Objectives: Enhanced recovery after surgery (ERAS) protocols optimize perioperative care and improve recovery. This study evaluated the effectiveness of ERAS in one- or two-level posterior lumbar fusion surgeries, focusing on perioperative medication use, pain management, and functional outcomes. Methods: Eighty-eight patients undergoing lumbar fusion surgery between March 2021 and February 2022 were allocated into pre-ERAS (n = 41) and post-ERAS (n = 47) groups. Outcomes included opioid and antiemetic consumption, pain scores (numerical rating scale (NRS)), functional recovery (Oswestry Disability Index (ODI) and EuroQol 5 Dimension (EQ-5D)), and complication rates. Pain was assessed daily for the first four postoperative days and at 6 months. Linear Mixed Effects Model analysis evaluated pain trajectories. Results: The post-ERAS group showed significantly lower opioid (p = 0.005) and antiemetic (p < 0.001) use. No significant differences were observed in NRS pain scores in the first 4 postoperative days. At 6 months, the post-ERAS group reported significantly lower leg pain (p = 0.002). The time:group interaction was not significant for back (p = 0.848) or leg (p = 0.503) pain. Functional outcomes at 6 months, particularly ODI and EQ-5D scores, showed significant improvement in the post-ERAS group. Complication rates were lower in the post-ERAS group (4.3% vs. 19.5%, p = 0.024), while hospital stay and fusion rates remained similar. Conclusions: The ERAS protocol significantly reduced opioid and antiemetic use, improved long-term pain management and functional recovery, and lowered complication rates in lumbar fusion patients. These findings support the implementation of ERAS protocols in spinal surgery, emphasizing their role in enhancing postoperative care.

Introduction Orthognathic surgery frequently leads to immediate postoperative pain (IPP) and postoperative nausea and vomiting (PONV), impacting patient recovery and satisfaction. This study aims to identify key determinants contributing to IPP and PONV following orthognathic surgery. Methods A retrospective cohort study was conducted involving patients who underwent orthognathic surgery at Kurume University Hospital between January 2020 and December 2023. Patients were divided into two groups: "mandible alone" and "bimaxillary." Independent variables, including patient-related, surgery-related, and anesthesia-related variables, were evaluated against IPP and PONV using multivariate logistic regression analysis. Results The study enrolled 181 patients who underwent orthognathic surgery with an average age of 26.6 ± 8.1 years (range: 16-54 years), of which 139 patients (76.8%) were women. Multivariate analysis identified low body mass index (BMI) as a common significant related factor for both IPP (adjusted odds ratio {OR}, 3.70; P = 0.0034) and PONV (adjusted OR, 2.80; P = 0.022). Inhalation anesthesia was significantly associated with IPP (adjusted OR, 9.07; P = 0.049), while higher blood loss and increased local anesthesia volumes were associated with PONV (adjusted OR, 0.35 and 0.31; P = 0.005 and 0.016, respectively). Conclusion BMI, total blood loss, anesthesia method, and the total amount of local anesthesia may be significant related factors of postoperative complications following orthognathic surgery. These findings can inform preoperative assessments and anesthesia management to improve patient outcomes.

Postoperative nausea and vomiting (PONV) is a common sequela of surgery in patients undergoing general anesthesia. Amisulpride has shown promise in its ability to treat PONV. The objective of this study was to determine if amisulpride is associated with significant changes in PACU efficiency within a fast-paced ambulatory surgery center.

This was a retrospective cohort study of 816 patients at a single ambulatory surgery center who experienced PONV between 2018 and 2023. The two cohorts analyzed were patients who did or did not have amisulpride among their anti-emetic regimens in the PACU during two distinct time periods (before and after amisulpride was introduced). The primary outcome of the study was PACU length of stay. Both unmatched analysis and a linear multivariable mixed-effects model fit by restricted maximum likelihood (random effect being surgical procedure) were used to analyze the association between amisulpride and PACU length of stay. We performed segmented regression to account for cohorts occurring during two time periods.

Unmatched univariate analysis revealed no significant difference in PACU length of stay (minutes) between the amisulpride and no amisulpride cohorts (115 min vs 119 min, respectively; P = 0.07). However, when addressing confounders by means of the mixed-effects multivariable segmented regression, the amisulpride cohort was associated with a statistically significant reduction in PACU length of stay by 26.1 min (P < 0.001).

This study demonstrated that amisulpride was associated with a significant decrease in PACU length of stay among patients with PONV in a single outpatient surgery center. The downstream cost-savings and operational efficiency gained from this drug's implementation may serve as a useful lens through which this drug's widespread implementation may further be rationalized.

The most troublesome complaint after general anaesthesia and surgery, especially laparoscopic surgeries, is postoperative nausea and vomiting (PONV). We routinely use pharmacologic prophylaxis to prevent PONV. In patients undergoing laparoscopic procedures, we assessed the effectiveness of palonosetron compared to ondansetron combined with dexamethasone in preventing the incidence of PONV.

This was a prospective, randomised, double-blind study that included 60 patients aged 18 to 60 years of either sex belonging to ASA physical status I or II undergoing elective laparoscopic surgeries. Before induction of anaesthesia, patients were randomised into two equal groups to receive either 0.075mg of palonosetron (group 1) or 4mg of ondansetron with 4mg of dexamethasone (group 2). Any incidence of nausea or vomiting along with the severity was assessed using the visual analogue scale, and the need for the rescue antiemetic was noted. Statistical analysis was done using an independent sample T-test, chi-square test, and Fisher's exact test. P-value <0.05 was considered statistically significant.

The overall incidence of PONV was 18% (11 patients), all of which were of mild to moderate severity. The palonosetron group had a lesser incidence of PONV, in three patients (10%) when compared to eight patients (26.6%) in the ondansetron and dexamethasone combination group over a period of 48 hours, but the difference was not statistically significant (P=0.854). The need for the rescue antiemetic was also comparable between both the groups (P=0.129), two patients required the rescue antiemetic (6.66%) in the palonosetron group, while in the ondansetron and dexamethasone group, six patients required the rescue antiemetic (20%).

Both palonosetron and ondansetron with dexamethasone prove to be comparably effective in preventing PONV in laparoscopic surgeries and achieving a complete response for a longer period, thus requiring fewer rescue medications with no adverse reaction.

Intrathecal morphine provides effective analgesia for a range of operations. However, widespread implementation into clinical practice is hampered by concerns for potential side-effects. We undertook a systematic review, meta-analysis, and meta-regression with the primary objective of determining whether a threshold dose for non-pulmonary complications could be defined and whether an association could be established between dose and complication rates when intrathecal morphine is administered for perioperative or obstetric analgesia.

We systematically searched the literature for randomised controlled trials comparing intrathecal morphine vs control in patients undergoing any type of surgery under general or spinal anaesthesia, or women in labour. Primary outcomes were rates of postoperative nausea and vomiting, pruritus, and urinary retention within the first 24 postoperative hours, analysed according to doses (1-100 μg; 101-200 μg; 201-500 μg; >500 μg), type of surgery, and anaesthetic strategy. Trials were excluded if doses were not specified.

Our analysis included 168 trials with 9917 patients. The rates of postoperative nausea and vomiting, pruritus, and urinary retention were significantly increased in the intrathecal morphine group, with an odds ratio (95% confidence interval) of 1.52 (1.29-1.79), P<0.0001; 6.11 (5.25-7.10), P<0.0001; and 1.73 (1.17-2.56), P=0.005, respectively. Meta-regression could not establish an association between dose and rates of non-pulmonary complications. There was no subgroup difference according to surgery for any outcome. The quality of evidence was low (Grading of Recommendations Assessment, Development, and Evaluation [GRADE] system).

Intrathecal morphine significantly increased postoperative nausea and vomiting, pruritus, and urinary retention after surgery or labour in a dose-independent manner.

PROSPERO (CRD42023387838).

Effective and secure pain management following video-assisted thoracoscopic surgery (VATS) is crucial for rapid postoperative recovery. This study evaluated analgesic and sedative effects of sufentanil and promethazine in patient-controlled intravenous analgesia (PCIA) post-thoracic surgery, along with potential adverse reactions.

In this prospective, randomized, controlled, double-blind, clinical study, 60 patients (American Society of Anesthesiologists status I-III) undergoing VATS were enrolled. The patients were randomized into experimental (Group P) or control (Group C) groups. PCIA was administered post-general anesthesia using a double-blind method. Group P received sufentanil (3 μg/kg) + promethazine (1 mg/kg) + 0.9% sodium chloride solution (100 mL total), while Group C received sufentanil (3 μg/kg) + 0.9% sodium chloride solution (100 mL total). PCIA settings included a 1-mL bolus and 15-min locking time. The primary outcomes were the visual analog scale (VAS) at rest and during coughing and sedation (Ramsay) scores at 6, 12, 24, and 48 h. The secondary outcomes were rescue drug use rate, hemodynamic parameters (mean arterial pressure and heart rate), percutaneous oxygen saturation, respiratory rate, and occurrence of adverse reactions.

Group P exhibited lower resting and coughing VAS scores at 6, 12, 24, and 48 h, plus decreased incidence of nausea and vomiting within 48 h post-surgery compared with Group C (p < 0.05). No significant differences were observed in pruritus, sedation (Ramsay) scores, mean arterial pressure, heart rate, oxygen saturation, or respiratory rate between the two groups (p > 0.05).

The combination of sufentanil and promethazine for postoperative intravenous analgesia could effectively reduce adverse effects such as nausea and vomiting, contributing to postoperative pain relief.

The safety of triple antiemetic therapy consisting of ondansetron, haloperidol, and a steroid, to surgical patients is unknown.

To determine the incidence of torsade de pointes (TdP) or death following perioperative administration of triple antiemetic therapy.

A retrospective cohort study identified 19,874 patients who received 22,202 doses of triple antiemetics during the 2.5-year time frame from March 4, 2020 to September 7, 2022 for surgical nausea prophylaxis or treatment of nausea. These patients above were cross-matched with an electrocardiogram and adverse outcome database; this identified 226 patients with documentation of a QTc > 450 ms, all ventricular tachycardias including TdP within 48 hours of receiving triple antiemetic therapy, or death within 7 days of receiving ondansetron.

There were 3 patients who had documented VT (n = 3), but there were no documented incidents of TdP (n = 0). There were 9 codes called on patients within 48 hours of medication administration, and none of them were due to ventricular arrythmias (n = 0). A total of 11 patients died within 7 days of triple antiemetic therapy. Ten of the 11 deaths were determined to not be from the triple antiemetic. One patient died at home within 24 hours of the procedure of an unknown cause (n = 1).

No episodes of TdP were identified in patients receiving triple antiemetic therapy perioperatively, though the cause of death in 1 patient could not be determined. This suggest that low-dose triple antiemetic therapy is low risk for the development of TdP.

A history of severe nausea and vomiting during pregnancy (SNVP) is a risk factor for postoperative nausea and vomiting (PONV). This study aimed to explore potentially effective treatment strategies and potential genetic factors underlying SNVP risk-related PONV.

A total of 140 female patients undergoing breast cancer surgery were assigned to either the study group (70 with SNVP) or the control group (70 with mild to moderate nausea and vomiting during pregnancy (MNVP)). Patients in each group were randomly assigned to two different treatment subgroups and received either ondansetron plus dexamethasone (OD) or OD + TEAS (ODT) (transcutaneous electrical acupoint stimulation, TEAS). Blood samples were collected from patients before induction (D0) and 24 h (D1) after surgery for growth differentiation factor 15 (GDF-15) evaluation. The primary outcome was the incidence of PONV within 36 h. The secondary outcome was the serum GDF-15 level.

The incidence of PONV in the SNVP group was significantly higher than that in the MNVP group within 24 h (P < 0.005). In the SNVP group, ODT-treated patients had less PONV than those in the OD-treated group during the 6-12 h (P = 0.033) and 12-24 h (P = 0.008) intervals, while within 6 h, there were fewer vomiting cases in the ODT-treated group (SNVP-ODT vs. SNVP-OD, 7/33 vs. 19/35, P = 0.005). The preoperative GDF-15 serum levels in patients with SNVP were significantly higher (P = 0.004). Moreover, higher preoperative GDF-15 serum levels correlated with a higher incidence of PONV (P = 0.043).

TEAS showed significant effect on PONV treatment in patients with SNVP. A higher serum GDF-15 level was associated with a history of SNVP, as well as a higher risk of PONV.

Abdominal surgery is a critical surgery, with more and more attention being paid to postoperative life quality and associated complications in recent years. Among these complications, postoperative gastrointestinal dysfunction is the most common complication of abdominal surgery. Acupuncture therapy is a treatment approach based on the Traditional Chinese Medicine theory, and its feasibility in aiding gastrointestinal recovery after abdominal surgery is supported by both Traditional Chinese Medicine theory and animal experiments. A lot of clinical research has been conducted to evaluate its efficacy, albeit with limitations, and at preliminary stages. Moreover, intervention timing, acupoint selection, and patient benefits should also be considered in clinical practices. This article summarizes the progress of clinical research on acupuncture therapy in gastrointestinal recovery after abdominal surgery and discusses related issues and operations, with the aim to provide new insights and prospects for the incorporation of acupuncture into the Enhanced Recovery After Surgery protocol.

The use of haloperidol in pain management has been a topic of interest for several decades. Haloperidol is a widely used antipsychotic medication with unique pharmacologic properties that make it a potential candidate for pain management. However, the efficacy and safety of haloperidol for pain management remain controversial. This narrative review provides a summary of the current literature on the use of haloperidol for pain management, including its pharmacology, clinical effectiveness, adverse effects, and dosing regimens. We performed a comprehensive search of the literature for this review. The most robust clinical data from the past decade suggest that haloperidol has good efficacy in the treatment of pain related to gastroparesis and migraines and has shown promise for opioid use reduction in patients with chronic pain or receiving palliative care. The overall side effect profile is excellent, with zero reported events of QT-related cardiac arrest and minimal reports of sedation and transient extrapyramidal effects such as akathisia. Dosing regimens used were heterogeneous, with most ranging from 1 to 5 mg per dose via intravenous, intramuscular, or oral route. Studies with designs that isolated the effects of haloperidol from combinations of other drugs were extremely limited. Further high-quality prospective studies are needed to determine the ideal role of haloperidol in the routine clinical management of painful conditions.

The procedure with the highest rate of opioid prescription in plastic surgery is abdominoplasty. Additionally, plastic surgery patients are at a particularly elevated risk of becoming opioid-dependent. The main objective of this study was to perform a systematic review and create an algorithm for a multimodal pain regimen specific to patients undergoing abdominoplasty. A systematic search of the research literature was performed to summarize the prevailing understanding of multimodal pain control in the management of abdominoplasty. The initial search yielded 448 articles. Sixty-eight manuscripts were identified for full-text review. The effectiveness of current strategies was evaluated by way of pain scores, opioid usage, and length of stay, as well as other measures of physical function such as time to early mobilization. In 32 studies involving 2451 patients, the efficacy of different pain regimens during abdominoplasty was evaluated. Among nontraditional, opioid-sparing analgesia, efficacy of treatment interventions for improved pain and decreased opioid usage was found inall studies. Among local infusion studies, efficacy of treatment interventions for improved pain and decreased opioid usage was found in 78% of studies. Last, among regional block studies, efficacy of treatment interventions for improved pain was found in 87%, with 73% efficacy for decreased opioid usage. Multimodal pain regimens in abdominoplasty have the potential to play an important role in opioid-sparing practices in medicine by incorporating nonopioid pain adjuvants such as nonsteroidal anti-inflammatory drugs and transversus abdominis plane blocks in the preoperative, perioperative, and postoperative periods.

Surgical patients are routinely subjected to long periods of fasting, a practice that can exacerbate the metabolic response to trauma and impair postoperative recovery. The aim of this study was to evaluate the association between preoperative fasting time and clinical outcomes in surgical patients.

An observational, prospective study with a non-probabilistic sample that included patients of both sexes, aged over 18, undergoing elective surgeries. Data were extracted from electronic medical records, and a questionnaire was applied in 48 hours after surgery. Variables related to postoperative discomfort were assessed using an 11-point numeric rating scale.

The sample consisted of 372 patients, and the duration of the surgical event ranged from 30-680 minutes. The incidence of nausea (26.34%) was twice that of vomiting (13.17%) and showed an association with the surgical procedure's size (p = 0.018). A statistically significant difference was observed only between pain intensity and preoperative fasting times for liquids (p = 0.007) and postoperative fasting time (p = 0.08). The occurrence of postoperative complications showed no association with preoperative fasting time (p = 0.850).

Although no association was observed between preoperative fasting time and surgical complications, it is noteworthy that both recommended and actual fasting time exceeded the proposed on clinical guidelines.

Postoperative nausea and vomiting (PONV) is a common adverse effect of anesthesia. Identifying risk factors for PONV is crucial because it is associated with a longer stay in the post-anesthesia care unit, readmissions, and perioperative costs. This retrospective study used artificial intelligence to analyze data of 37,548 adult patients (aged ≥20 years) who underwent surgery under general anesthesia at Tohoku University Hospital from January 1, 2010 to December 31, 2019. To evaluate PONV, patients who experienced nausea and/or vomiting or used antiemetics within 24 hours after surgery were extracted from postoperative medical and nursing records. We create a model that predicts probability of PONV using the gradient tree boosting model, which is a widely used machine learning algorithm in many applications due to its efficiency and accuracy. The model implementation used the LightGBM framework. Data were available for 33,676 patients. Total blood loss was identified as the strongest contributor to PONV, followed by sex, total infusion volume, and patient's age. Other identified risk factors were duration of surgery (60-400 min), no blood transfusion, use of desflurane for maintenance of anesthesia, laparoscopic surgery, lateral positioning during surgery, propofol not used for maintenance of anesthesia, and epidural anesthesia at the lumbar level. The duration of anesthesia and the use of either sevoflurane or fentanyl were not identified as risk factors for PONV. We used artificial intelligence to evaluate the extent to which risk factors for PONV contribute to the development of PONV. Intraoperative total blood loss was identified as the potential risk factor most strongly associated with PONV, although it may correlate with duration of surgery, and insufficient circulating blood volume. The use of sevoflurane and fentanyl and the anesthesia time were not identified as risk factors for PONV in this study.

Postoperative nausea and vomiting (PONV) refers to nausea and vomiting that occurs within 24-h after surgery or in the post-anesthesia care unit (PACU). Previous studies have reported that the use of remimazolam, a newer benzodiazepine (BDZ) hypnotic, for anesthesia results in less PONV. In this study, we compared the rate of PONV between sevoflurane and remimazolam after general anesthesia.

In this prospective randomized controlled trial, participants aged 20-80 years who underwent elective laparoscopic cholecystectomy or hemicolectomy were randomized to either the remimazolam or sevoflurane group. The primary outcome was PONV incidence for 24-h after surgery. Secondary outcomes comprised of PONV at 30-min post-surgery, postoperative additional antiemetic use, and Quality of Recovery-15 (QOR-15) score at 24-h postoperatively.

Forty patients were enrolled in the study. The remimazolam group exhibited significantly lower rates of PONV for 24-h after surgery than did the sevoflurane group (remimazolam group vs. sevoflurane group; 5% vs. 45%, P = 0.003, respectively). The use of dexamethasone, a rescue antiemetic administered within 24 h of surgery, was substantially lower in the remimazolam group than in the sevoflurane group (0% in remimazolam vs. 30% in sevoflurane, P = 0.020). The QOR-15 score at 24-h after surgery showed no significant difference between the two groups.

Compared to sevoflurane, opting for remimazolam as an intraoperative hypnotic may decrease the incidence of PONV and reduce antiemetic use for 24 h after laparoscopic surgery.