Logistic Regression Analysis of Fixed Patient Factors for Postoperative Sickness: A Model for Risk Assessment

Palazzo, M. G. A.; Evans, R. Scott

doi:10.1093/bja/70.2.135

Cited by 206 publications

(170 citation statements)

References 9 publications

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“…The use of opioid analgesics (e.g. morphine and codeine in this study) is needed to control postoperative pain but they also increase the incidence of PONV 1,34,35 especially in outpatients who become mobile more quickly. 3 6 The use of opioid analgesics did not vary among the study groups (Table II).…”

Section: Discussionmentioning

confidence: 99%

Additive anti-emetic efficacy of prophylactic ondansetron with droperidol in out-patient gynecological laparoscopy

Belo

Koutsoukos

2000

Can J Anesth/J Can Anesth

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Purpose: To determine the efficacy of ondansetron and droperidol, alone and in combination, administered for prophylaxis of postoperative nausea and vomiting (PONV) in women undergoing general anesthesia for outpatient gynecological laparoscopy.Methods: Following Institutional Ethics Board approval and patient consent, 160 female out-patients scheduled for laparoscopy were randomly allotted in a double-blind fashion to receive: i) saline (placebo), ii) 4 mg ondansetron, iii) 1.25 mg droperidol, or iv) 4 mg ondansetron and 1.25 mg droperidol combination intravenously on induction. Following a standardized general anesthesia, patients were interviewed and assessed for PONV at various times.Results: During the first 24 hr after surgery, the incidence of PONV in the placebo group was 71%. This was reduced to 61% with droperidol alone (P = 0.334), to 46% with ondansetron alone (P = 0.027), and to 23% with the combination group (P < 0.001). A statistically significant difference was observed between combination and droperidol (P < 0.001) and between combination and ondansetron (P = 0.036). There were fewer requests for rescue medication from the combination group (7.7%) than from the ondansetron and placebo groups. Conclusion:The results of this study suggest that the combination of 4 mg ondansetron and 1.25 mg droperidol is more efficacious as a prophylactic anti-emetic than either agent alone during the 24 hr post-surgery. This additive effect may be due to the different mechanisms of action of ondansetron and droperidol.Objectif : Déterminer l'efficacité de l'ondansétron et du dropéridol, seuls ou combinés, administrés comme prophylaxie des nausées et vomissements postopératoires (NVPO) chez des patientes sous anesthésie générale lors d'une laparoscopie gynécologique en clinique externe.Méthode : Après avoir obtenu l'autorisation du Comité d'éthique médicale et le consentement des patientes, on a procédé à l'étude de 160 femmes, réparties au hasard en double aveugle, qui ont reçu avant la laparoscopie ambulatoire prévue : i) une solution salée (placebo), ii) 4 mg d'ondansétron, iii) 1,25 mg de dropéridol, ou iv) une combinaison intraveineuse de 4 mg d'ondansétron et de 1,25 mg de dropéridol à l'induction de l'anesthésie. Après l'anesthésie générale standard, les patientes ont été interrogées sur les NVPO à différents temps.Résultats : Pendant les 24 premières heures postopératoires, l'incidence des NVPO ont été de 71 % dans le groupe placebo. Cette incidence a été réduite à 61% avec de dropéridol employé seul (P = 0,334), à 46 % avec l'ondansétron seul (P = 0,027) et à 23 % avec la combinaison des deux médicaments (P < 0,001). Une différence statistiquement différente a été observée entre la combinaison et le dropéridol (P < 0,001) et entre la combinaison et l'ondansétron (P = 0,036). On enregistre moins de demandes de médication de rattrapage provenant des patientes qui ont reçu la combinaison de médicaments (7,7 %) que de celles qui ont reçu l'ondansétron ou le placebo.Conclusion : Les résultats de l'étude suggèr...

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Section: Discussionmentioning

confidence: 99%

Additive anti-emetic efficacy of prophylactic ondansetron with droperidol in out-patient gynecological laparoscopy

Belo

Koutsoukos

2000

Can J Anesth/J Can Anesth

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“…Postoperative nausea and vomiting (PONV) is commoner for women, for those prone to motion sickness and when opiates are administered [23,24]. Using our model, described elsewhere [25,26], to study PONV following day case laparoscopy, we compared PONV and other unwanted effects of M6G and morphine.…”

Section: Discussionmentioning

confidence: 99%

“…When administered systemically to animals, the relative potency of M6G to morphine is much closer [3, 5, 8], but in humans the evidence is conflicting, in part because of different methods of assessing analgesia [10][11][12][13][14][15][16][17][18] . M6G has a better toxicity profile for respiratory depression, nausea, sedation, and itching, in humans [11-13, 15, 18-20] if not for animals [9, 21, 22].Postoperative nausea and vomiting (PONV) is commoner for women, for those prone to motion sickness and when opiates are administered [23,24]. Using our model, described elsewhere [25,26], to study PONV following day case laparoscopy, we compared PONV and other unwanted effects of M6G and morphine.…”

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confidence: 99%

Facial fractures and submental tracheal intubation

Amin

Dill-Russell²,

Manisalı

et al. 2002

Anaesthesia

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SummarySubmental tracheal intubation is a simple, quick and effective alternative to oral and nasal tracheal intubation or tracheostomy in the surgical management of selected patients with craniomaxillofacial injuries. It has a low morbidity and it does not impede the surgical field, allowing for temporary maxillo-mandibular fixation (jaw wiring) intra-operatively, and nasal assessment, manipulation and bone grafting, either simultaneously or as an independent procedure. We report 12 cases utilizing this technique in this retrospective study, this includes 11 patients with midfacial fractures and associated base of skull fractures, and one patient who underwent an elective Le Fort III advancement. The techniques and indications for submental tracheal intubation are described.Keywords Anaesthesia: equipment; tubes tracheal. Intubation tracheal: submental; complications. Correspondence to: Mr M. Amin E-mail: michaelamin@doctors.org.uk Accepted: 6 February 2002 There are specific problems associated with airway management in patients with midface or panfacial fractures and possible base of skull fractures. Nasal tracheal intubation in these patients is controversial, particularly if performed without the benefits of a fibreoptic bronchoscope, because of the potential complications, including cranial intubation, epistaxis and intracranial or sinonasal infection [1][2][3][4]. Furthermore, comminuted midface or naso-orbito-ethmoidal complex fractures may cause a physical obstruction to the passage of a nasal tube and the tube may interfere with the assessment and reduction of these fractures [5]. It is often necessary during the reduction of facial fractures to establish dental occlusion and perform temporary maxillo-mandibular fixation (jaw wiring) intra-operatively. This precludes the use of an oral tube at this point in the procedure and may therefore necessitate a tube change.Tracheostomy is still considered the treatment of choice for patients with extensive craniomaxillofacial injuries and multisystem trauma and those who require long-term ventilatory support. However, it is associated with significant morbidity and complications such as haemorrhage, surgical emphysema, tube blockage, recurrent laryngeal nerve injury, tracheal stenosis and poor scar appearance [6].An alternative method of establishing an airway in patients who require maxillofacial surgery but who do not require long-term ventilatory support is to perform submental tracheal intubation, the technique being originally described by Hernández Altemir in 1986 [7]. This provides a secure airway and allows unimpeded surgical access to the oral cavity and midface, whilst avoiding the potential complications associated with nasal intubation and tracheostomy. MethodsTo perform this technique, the patient's trachea is intubated orally using an armoured tracheal tube. Prior to this the universal connector must be removed or cut off and replaced with a removable connector to allow easy detachment. Patients who are already intubated must have Anaesthesia, ...

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“…Using logistic regression analysis, they concluded that the probability of postoperative sickness in the first 24 hr after surgery can be estimated using the following equation: logit postoperative sickness = -5.03 + 2.24 (postoperative opioids) + 3.97 (previous sickness history) + 2.4 (gender) + 0.78 (history of motion sickness) -3.2 (gender × previous sickness history). 28 Subsequently, Koivuranta studied 1,107 in-patients and used a logistic regression model to generate a score based on the strongest five predictors for PONV: score = 0.93 (if female) + 0.82 (if previous PONV) + 0.75 (if duration of surgery over 60 min) + 0.61 (if nonsmoker) + 0.59 (if history of motion sickness). 16 More recently, in a study of 2,722 patients, Apfel et al developed a simplified risk score consisting of four predictors: female gender, history of motion sickness D Level of evidence based on study design I Large randomized, controlled trial, n $ 100 per group II Systematic review III Small randomized, controlled trial, n < 100 per group IV Non-randomized, controlled trial or case report V Expert opinion Strength of conclusion or recommendation A Good evidence to support the conclusion or recommendation B Fair evidence to support the conclusion or recommendation C Insufficient evidence to recommend for or against or PONV, non-smoking status and the use of opioids for postoperative analgesia.…”

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confidence: 99%

Evidence-based management of postoperative nausea and vomiting: a review

Habib

Gan

2004

Can J Anesth/J Can Anesth

196

106

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P Pu ur rp po os se e: : To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV).S So ou ur rc ce e: : Literature from randomized controlled trials, systematic reviews, logistic regression analyses and expert opinion in the management of PONV.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The etiology of PONV is multifactorial. Patient, anesthesia, and surgery related risk factors have been identified. Universal PONV prophylaxis is not cost-effective. Identification of patients at high-risk of PONV allows targeting prophylaxis to those who will benefit most from it. No prophylaxis is needed for patients at low risk for PONV. For patients at moderate risk for PONV, prophylaxis using a single antiemetic or a combination of two agents should be considered. Double and triple antiemetic combinations should be considered for patients at high risk for PONV. Furthermore, a multimodal approach should be adopted incorporating steps to keep the baseline risk of PONV low. The optimum cost-effective approach to the management of PONV will differ between an ambulatory centre and an inpatient hospital setting. For the treatment of established PONV in patients who failed prophylaxis, patients should not receive a repeat dose of the prophylactic antiemetic. Rather, a drug acting at a different receptor should be used. Beyond six hours after surgery, patients can be treated with any of the agents used for prophylaxis, except dexamethasone and transdermal scopolamine.C Co on nc cl lu us si io on n: : PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature. Objectif : Énoncer des lignes de conduite fondées sur des données probantes pour la prévention et le traitement des nausées et des vomissements postopératoires (NVPO). Source : Les publications d'essais contrôlés et randomisés, les études méthodiques, les analyses de régression logistique et l'opinion d'experts sur le traitement des NVPO. Constatations principales : L'origine des NVPO est multifactorielle. Les facteurs de risque reliés au patient, à l'anesthésie et au type de chirurgie sont connus. La prévention universelle des NVPO n'est pas rentable. L'identification des patients à haut risque de NVPO permet

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Logistic Regression Analysis of Fixed Patient Factors for Postoperative Sickness: A Model for Risk Assessment

Cited by 206 publications

References 9 publications

Additive anti-emetic efficacy of prophylactic ondansetron with droperidol in out-patient gynecological laparoscopy

Additive anti-emetic efficacy of prophylactic ondansetron with droperidol in out-patient gynecological laparoscopy

Facial fractures and submental tracheal intubation

Evidence-based management of postoperative nausea and vomiting: a review

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