Purpose: Recent warnings regarding the safety of droperidol have limited use of this drug as an antiemetic. Haloperidol, a butyrophenone derivative similar to droperidol, has not been rigorously evaluated as an antiemetic. The aim of this study was to compare the prophylactic antiemetic efficacy of haloperidol vs ondansetron for the prevention of postoperative nausea and vomiting (PONV) after general anesthesia.Methods: Ninety non-smoking female patients were eligible to participate in this randomized double-blinded study. Approximately 30 min before the end of surgery, patients were randomly assigned to receive either haloperidol 2 mg iv, or ondansetron 4 mg iv, respectively. The incidence of PONV, average pain and sedation scores, recovery times, and changes of the rate-corrected QT (QTc) interval were observed postoperatively. Results:The proportion of patients who experienced PONV in the first 24 hr was similar in the two groups (28% and 26% for haloperidol and ondansetron groups, respectively). The incidence of PONV was significantly less in both groups than predicted according to the patients' underlying risks (53% for the haloperidol group, P = 0.016; 51% for the ondansetron group, P = 0.015). Pain scores, sedation scores, and recovery times were similar in the two groups, and no prolongation of the QTc interval was observed in either group. Conclusions: Haloperidol 2 mg iv given 30 min before the end of surgery is effective in preventing PONV, with efficacy comparable to ondansetron 4 mg iv for the first 24 hr after general anesthesia.

Purpose: Previous investigations suggest that inhaled anesthetics may produce cutaneous analgesia. The objective of this study was to evaluate whether inhaled anesthetics have a direct analgesic effect on skin. Methods: We conducted subcutaneous injections of one of three inhaled anesthetics (halothane, isoflurane, and enflurane) or one of two local anesthetics (lidocaine and procaine) at various dosages in rats (n = 6 rats, for each dose of each drug). Subcutaneous injections of vehicles (saline or olive oil) were used as controls (n = 6 rats for each vehicle). We constructed concentration-response curves, wherein the concentrations of drugs tested in subcutaneous tissue fluid were estimated by calculation, and the cutaneous analgesic effects of drugs were evaluated by pinprick tests on skin.Results: Like local anesthetics, subcutaneous injection of inhaled anesthetics produced concentration-dependent, cutaneous analgesia which attained maximum (complete cutaneous analgesia) at high concentration. This effect was reversible and localized in the area of injection. On the basis of 50% effective concentration, the ranking of potencies was lidocaine > halothane > isoflurane > enflurane > procaine (P < 0.05 for all differences). Subcutaneous injections of vehicles did not produce cutaneous analgesia. Conclusions: Like local anesthetics (lidocaine and procaine), subcutaneous injections of inhaled anesthetics (halothane, isoflurane, and enflurane) produced a concentration-dependent, cutaneous, analgesic effect at the site of injection. Inhaled anesthetics have a direct analgesic effect on skin. Méthode : Nous avons procédé à des injections sous-cutanées d'un de trois agents anesthésiques volatils (halothane, isoflurane et enflurane) ou d'un de deux agents anesthésiques locaux (lidocaïne et procaïne) à différentes doses chez des rats (n = 6 rats, pour chaque dose de chaque agent). Nous avons eu recours à des injections sous-cutanées de véhicules (solution salée ou huile d'olive) comme témoins (n = 6 rats pour chaque véhicule). Nous avons élaboré des courbes concentration-effet, dans lesquelles les concentrations des agents à l'étude dans le liquide tissulaire sous-cutané ont été estimées par calcul, et les effets analgésiques cutanés des agents

Purpose: Postoperative nausea and vomiting (PONV) occurs frequently after general anesthesia. We evaluated the timing of 2 mg iv doses of haloperidol on the efficacy of this drug as a prophylactic antiemetic for PONV. Methods: Ninety-four non-smoking female patients with a history of motion sickness and/or PONV (Apfel's simplified risk score = 3; predicted incidence of PONV = 60%) were eligible to participate in this randomized, double-blind study. Patients were divided into two groups. Group 1 patients received haloperidol 2 mg iv during induction of anesthesia. Group 2 patients received haloperidol 2 mg iv approximately 30 min before the end of surgery. The occurrence of nausea and vomiting, nausea scores, pain scores, sedation levels, and adverse effects (cardiac arrhythmias, and extrapyramidal effects) were recorded by a trained, blinded investigator. Results:The percentages of patients who experienced PONV in the first 24 hr were similar for the two groups (Group 1 = 30%; Group 2 = 26%, P = 0.645). The incidence of PONV was significantly smaller in both groups than that predicted (60%) according to the patients' underlying risks (Group 1, P = 0.004; Group 2, P = 0.001). Nausea scores, pain scores, sedation scores, emergence times, and time to first rescue treatment were similar in the two groups. No adverse effects attributable to the study medication were observed. Conclusion:The timing of administration of haloperidol 2 mg iv does not influence its antiemetic efficacy. The recovery profiles were also similar whether haloperidol was administered at the start, or at the end of surgery. Reports of Original InvestigationsThe timing of haloperidol administration does not affect its prophylactic antiemetic efficacy Address correspondence to: Dr. Yi Lee, Department of Anesthesiology, Buddhist Tzu-Chi Medical Center, Buddhist Tzu-Chi University School of Medicine, No. 707, Section 3, Chung-Yang Road, Hualien, Taiwan, ROC. E-mail: drleeyi2001@yahoo.com.tw There were no direct funding sources (departmental, hospital, institutional, commercial) supporting this work. There are no commercial or non-commercial affiliations that were, or might be perceived to be, a conflict of interest amongst the authors relating to publication of the data. The clinical trial registration number (Buddhist Tzu Chi Medical Center): IRB094-41.

The aim of this study is to evaluate the effectiveness of technetium-99m tetrofosmin (Tc-99m TF) single photon emission computed tomography (SPECT) of head and neck for detecting suspected recurrence of nasopharyngeal carcinomas (NPCs) when magnetic resonance imaging (MRI) findings are indeterminate. MRI was performed 4 months after radiotherapy and 26 NPC patients with indeterminate MRI findings were included. MRI, Tc-99m TF SPECT, and biopsy were performed within 1 week. The final results were based on histopathologic findings and clinical follow-up for at least 6 months. For detecting recurrent NPC in indeterminate MRI findings, the sensitivity, specificity, and accuracy of Tc-99m TF SPECT were 92.3%, 100.0%, and 96.2%, respectively. Based on this result, we can suggest Tc-99m TF SPECT is effective to detect recurrent NPC when MRI findings are indeterminate. However, further studies including a larger NPC patient population are warranted to determine the exact role and clinical usefulness of Tc-99m TF SPECT to differentiate benign lesions and recurrent NPC when MRI findings are indeterminate.