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Droperidol 0.625 mg IV before emergence from general anesthesia effectively reduces postoperative nausea and vomiting (PONV) in the general surgical population. Our randomized, double-blinded, placebo-controlled study demonstrated a reduction in PONV from 41% to 7%. Droperidol is a safe and inexpensive alternative to ondansetron. Droperidol, ondansetron, and promethazine are also equally effective in treating PONV in the postanesthesia care unit.

No abstract

No safety concerns were indicated for the use of rFVIIa in patients at all doses tested; rFVIIa reduced adjusted blood loss and adjusted transfusions during spinal surgery.

Patient-controlled transnasal butorphanol analgesia following outpatient surgeryTo the Editor:The increasing use of same-day discharge surgery has required that patients be discharged from hospital following more extensive surgical procedures. Butorphanol, a mixed opioid agonist-antagonist, has been shown to provide analgesia similar to parenterally administered narcotics. Rapid absorption and a minimum of respiratory depression suggest that transnasal butorphanol (TNB) may be a useful analgesic following ambulatory surgery.We conducted an open-label, observational study of TNB enrolling 28 ASA I-III patients undergoing a variety of ambulatory procedures at the Ottawa HospitalCivic Campus. Following written, informed, consent patients received a standardized general anesthetic including a prophylactic anti-emetic and a NSAID. Following discharge from the post-anesthesia care unit, patients were instructed to self administer a I mg spray of TNB every 30 min prn to control pain.Total TNB consumed in the postoperative period averaged 4.4 + 2.0 mg. Nausea, sedation, and dysphoria were reported by 10 to 20% of patients. Pain in seven patients could not be adequately controlled following 3 mg TNB administered over 90 min and was treated with parenteral opioids.Previous research has demonstrated that TNB and acetaminophen + codeine (T3) were similarly effective in treating pain following musculoskeletal trauma. Given that TNB did not provide effective analgesia in 25% of patients in this case series it is unlikely that TNB offers sufficient advantage over T3 to justify its expense (CDN$ 80.77 vs CDN$ 11.94). Future research is required to identify a safe, effective, and inexpensive means of treating pain following ambulatory surgery.