National High Blood Pressure Education Program.

Pain, nausea and vomiting are frequently listed by patients as their most important perioperative concerns. With the change in emphasis from an inpatient to outpatient hospital and office-based medical/surgical environment, there has been increased interest in the ‘big little problem’ of postoperative nausea and vomiting (PONV). Currently, the overall incidence of PONV is estimated to be 25 to 30%, with severe, intractable PONV estimated to occur in approximately 0.18% of all patients undergoing surgery. PONV can lead to delayed postanaesthesia care unit (PACU) recovery room discharge and unanticipated hospital admission, thereby increasing medical costs. The aetiology and consequences of PONV are complex and multifactorial, with patient-, medical- and surgery-related factors. A thorough understanding of these factors, as well as the neuropharmacology of multiple emetic receptors [dopaminergic, muscarinic, cholinergic, opioid, histamine, serotonin (5-hydroxy-tryptamine; 5-HT)] and physiology [cranial nerves VIII (acoustic-vestibular), IX (glossopharyngeal) and X (vagus), gastrointestinal reflex] relating to PONV are necessary to most effectively manage PONV. Commonly used older, traditional antiemetics for PONV include the anticholinergics (scopolamine), phenothiazines (promethazine), antihistamines (diphenhydramine), butyrophenones (droperidol) and benzamides (metoclopramide). These antiemetics have adverse effects such as dry mouth, sedation, hypotension, extrapyramidal symptoms, dystonic effects and restlessness. The newest class of antiemetics used for the prevention and treatment of PONV are the serotonin receptor antagonists (ondansetron, granisetron, tropisetron, dolasetron). These antiemetics do not have the adverse effects of the older, traditional antiemetics. Headache and dizziness are the main adverse effects of the serotonin receptor antagonists in the dosages used for PONV. The serotonin receptor antagonists have improved antiemetic effectiveness but are not as completely efficacious for PONV as they are for chemotherapy-induced nausea and vomiting. Older, traditional antiemetics (such as droperidol) compare favourably with the serotonin receptor antagonists regarding efficacy for PONV prevention. Combination antiemetic therapy improves efficacy for PONV prevention and treatment. In the difficult-to-treat PONV patient (as in the chemotherapy patient), suppression of numerous emetogenic peripheral stimuli and central neuroemetic receptors may be necessary. This multimodal PONV management approach includes use of: (i) multiple different antiemetic medications (double or triple combination antiemetic therapy acting at different neuroreceptor sites); (ii) less emetogenic anaesthesia techniques; (iii) adequate intravenous hydration; and (iv) adequate pain control.

Prevention and Treatment of Postoperative Nausea and Vomiting

https://www.annemergmed.com/article/S0196-0644(05)82569-7/pdf

Ketamine sedation for pediatric procedures: Part 2, Review and implications.

Update on bispectral index monitoring.

A serum concentration profile study on midazolam in children was done. Fifty six children aged 3–10 years took part. The routes investigated were intravenous, intramuscular, rectal and oral at 0.15 mg·kg−1, and the oral at 0.45 mg·kg−1 and 1 mg·kg−1. Serum concentration levels for 5 h were studied using gas liquid chromatography.

The pharmacokinetics of midazolam in paediatric patients

Intramuscular midazolam for pediatric preanesthetic sedation: a double-blind controlled study with morphine.

This double blind study assessed the effect of low dose droperiodol (0.005 mg- kg-1) on the incidence of postoperative vomiting in 200 children in ASA classification I and II, ranging from one to 15 years of age. The results showed that the dose of droperidol used in this study was very effective in reducing vomiting in children 11 to 15 years of age. The duration of stay in the post-anaesthetic care unit was not prolonged and no extrapyramidal symptoms related to the drug were observed.

/pdf/effect-of-low-dose-droperidol-on-postoperative-vomiting-in-los1g7go42.pdf

Effect of low dose droperidol on postoperative vomiting in children

Ketamine hydrochloride for pediatric premedication. I. Comparison with pentazocine.

Endotracheal Tube Ignition during Laryngeal Surgery with Resectoscope

Nalbuphine (EN2234A) is an agonist-antagonist analgesic. It is structurally related to the narcotic analgesic oxymorphone and to the narcotic antagonist naloxone. A double blind study was carried out in 400 children in ASA classification I, ranging from 10 months to 14 years of age, to compare nalbuphine, pentazocine and placebo for paediatric premedication. Our results showed that nalbuphine is comparable to pentazocine as a premedicating agent and superior to placebo, in the doses used, and that premedication is an important adjunct to anaesthesia in children. Following premedication with nalbuphine or pentazocine, there were fewer apprehensive children at the time of induction of anaesthesia and in the recovery room when compared to those receiving placebo injections.

/pdf/comparison-of-the-calming-and-sedative-effects-of-nalbuphine-2c3yer4n3v.pdf

Lucida Rita

Papers

Intramuscular midazolam for pediatric preanesthetic sedation: a double-blind controlled study with morphine.

Effect of low dose droperidol on postoperative vomiting in children

Ketamine hydrochloride for pediatric premedication. I. Comparison with pentazocine.

Endotracheal Tube Ignition during Laryngeal Surgery with Resectoscope

Comparison of the calming and sedative effects of nalbuphine and pentazocine for paediatric premedication