SummaryA prospective interview-based survey on the incidence of postoperative nausea and vomiting in 1107 in-patients aged 4-86 years was conducted during a 3-month period. Nausea, emetic episodes and the need for anti-emetic medication were recorded for 24 h postoperatively. In the recovery room, the incidence of nausea and vomiting was 18% and 5%, respectively. Over the whole 24-h period, these figures were 52% and 25%, respectively; severe nausea was experienced by 8%. The highest incidence of emetic sequelae was observed in gynaecological patients; 52% of the 822 patients who received general anaesthesia and 38% of the 285 patients who received regional anaesthesia reported nausea. The most important predictive factors associated with an increased risk for nausea and vomiting were female gender, a previous history of postoperative sickness, a longer duration of surgery, nonsmoking and a history of motion sickness. Based on these five items, a simple score predicting the risk of nausea and vomiting was constructed with a moderately good discriminating power. Nausea and emetic episodes still persist as the most common complaints following anaesthesia and surgery. Many adults find postoperative nausea and vomiting even more distressing than postoperative pain. The overall incidence of postoperative nausea and vomiting in the recovery room is around 10% [1] but ranges from 20% to 30% during the first 24 h after surgery according to recent reports [1][2][3][4]. Despite the advances in modern anaesthetic practice and surgical techniques, there is still room for improvement in identifying the causative factors as well as in the prophylaxis and treatment of this problem.The objective of this epidemiological survey of postoperative complications was to get representative numerical estimates of the present incidence of postoperative nausea and vomiting for different types of common surgical procedures in a tertiary care setting. The aim was also to analyse the predictive factors associated with these symptoms and to construct a risk score based on patient-related factors, as well as on some key anaesthetic and surgical factors. Methods

The default-mode network (DMN) is a set of specific brain regions whose activity, predominant in the resting-state, is attenuated during cognitively demanding, externally-cued tasks. The cognitive correlates of this network have proven difficult to interrogate, but one hypothesis is that regions in the network process episodic memories and semantic knowledge integral to internally-generated mental activity. Here, we compare default-mode functional connectivity in the same group of subjects during rest and conscious sedation with midazolam, a state characterized by anterograde amnesia and a reduced level of consciousness. Although the DMN showed functional connectivity during both rest and conscious sedation, a direct comparison found that there was significantly reduced functional connectivity in the posterior cingulate cortex during conscious sedation. These results confirm that low-frequency oscillations in the DMN persist and remain highly correlated even at reduced levels of consciousness. We hypothesize that focal reductions in DMN connectivity, as shown here in the posterior cingulate cortex, may represent a stable correlate of reduced consciousness.

Experts from the five Nordic countries offer consensus recommendations for safe clinical practice of neuraxial blocks and how to minimize the risks of serious complications from spinal bleeding. A brief version of the recommendations is available on http://www.ssai.info.

No abstract

In terms of pain scores, epidural analgesia is superior to that provided by IV remifentanil. However, there was no difference in the pain relief scores between the treatments.