British journal of anaesthesia
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Randomized Controlled Trial
Efficacy of palonosetron for the prevention of postoperative nausea and vomiting: a randomized, double-blinded, placebo-controlled trial.
The aim of this study was to evaluate the efficacy of palonosetron, the latest 5-HT3 receptor antagonist, for the prevention of postoperative nausea and vomiting (PONV) during the first 72 h after operation. ⋯ Palonosetron 0.075 mg i.v. effectively reduced the incidence of PONV during the first 72 h after operation, with most of the reduction occurring in the first 24 h.
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Approximately a quarter of a billion people undergo surgery every year hoping that the operation will alleviate symptoms, cure diseases, and improve quality-of-life. A concern has arisen that, despite the benefits of surgery, elderly patients might suffer neurological injury from surgery and general anaesthesia leading to persistent cognitive decline. However, many studies of postoperative cognition have had methodological weaknesses, including lack of suitable control groups, dissociation of cognitive outcomes from surgical outcomes, sub-optimal statistical techniques, and absence of longitudinal preoperative cognitive assessments. ⋯ Postoperative complications, ongoing inflammation, and chronic pain are probably modifiable risk factors for persistent postoperative cognitive decline. When surgery is successful with minimal perioperative physiological perturbations, elderly patients can expect cognition to follow its preoperative course. Furthermore, when surgery alleviates symptoms and enhances quality-of-life, postoperative cognitive improvement is a possible and desirable outcome.
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Randomized Controlled Trial
β2-Adrenoceptor gene variants affect vasopressor requirements in patients after thoracic epidural anaesthesia.
While the β2-adrenoceptor pathway is essential for cardiovascular regulation, the impact of ADRB2 gene variations on circulatory responses is unclear, possibly due to neural compensatory mechanisms. We tested the hypotheses that (i) sympathetic block by thoracic epidural anaesthesia (TEA) unmasks the influence on arterial pressure of genetic variations and (ii) vasopressor requirements during TEA depend on ADRB2 gene variation. ⋯ The ADRB2 Glu27 allele is an independent predictor of arterial hypotension and vasopressor requirements after TEA. Neural block can unmask genetic influences on neurohumoral regulation. Clinical trial registration DRKS00005260.
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Varying levels of female sex hormones during the menstrual cycle were found to influence the central nervous system. The goal of the present study was to investigate whether the median (50%) effective effect-concentration (EC50) of propofol inducing loss of consciousness (LOC) varies between the luteal and the follicular phases of the menstrual cycle. ⋯ During general anaesthesia, patients in the luteal phase of the menstrual cycle had a lower propofol EC50 for LOC and a shorter emergence time compared with those in the follicular phase. Differences in progesterone levels between menstrual phases may contribute to these anaesthetic effects. Registry number of clinical trial ChiCTR-RCH-12002755.
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Randomized Controlled Trial
Effect of palonosetron on the QTc interval in patients undergoing sevoflurane anaesthesia.
Palonosetron is a recently introduced 5-HT3 receptor antagonist for postoperative nausea and vomiting. Detailed standardized evaluation of corrected QT (QTc) interval change by palonosetron under sevoflurane anaesthesia is lacking. We evaluated QTc intervals in patients who are undergoing surgery with sevoflurane anaesthesia and receive palonosetron. ⋯ There was no significant difference in the QTc intervals during the perioperative period, whether 0.075 mg of palonosetron is administered before or after sevoflurane anaesthesia. Palonosetron may be safe in terms of QTc intervals during sevoflurane anaesthesia. Clinical trial registration ClinicalTrials.gov: NCT01650961.