No description available.

Diss. (sammanfattning) Linköping : Univ., 2004. / Härtill 4 uppsatser.

ABSTRACT Purpose: Dexamethasone provides potent analgesic and antiemetic effects. Sevoflurane are associated with an increased incidence of postoperative nausea and vomiting (PONV) and delayed patient discharge compared to propofol. This study was designed to evaluate whether the prophylatic use of dexamethasone with sevoflurane could minimize the incidence of PONV and facilitate early recovery after outpatient anorectal surgery. Methods: Forty outpatients undergoing anorectal surgery were randomly assigned to receive either dexamethasone (5 mg IV; n=20) or an equal volume of saline (n=20) before the induction of anesthesia. Anesthesia was induced with sevoflurane 8% and N2O 67% in oxygen (at 6 L/min) followed by placement of laryngeal mask. Anesthesia was maintained with sevoflurane 2-4% end-tidal in combination with N2O 50% in oxygen 3 L/min. All patients were allowed to breathe spontaneously during the operation. The postoperative nausea and vomiting (PONV), VAS pain score and patient satisfaction were recorded. Results: The incidence of PONV and VAS pain score were significant lower in dexamethasone-treated patients compared with saline-treated ones. The time required for discharge was significantly shorter in dexamethasone-treated patients. Above all, the dexamethasone-treated patients expressed higher satisfaction index. There was no significant difference in recovery time for eye opening, response to commands, orientation, and ambulatory. Conclusions: The prophylactic administration of dexamethasone reduces the incidence of PONV andVAS pain score, promotes recovery to home readiness, and improves the satisfaction after the anesthesia with spontaneously breathing of sevoflurane through laryngeal mask in outpatients undergoing anorectal surgery.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 6 uppsatser.

Thesis (M.A.)--Northern Kentucky University, 2008. / Made available through ProQuest. Publication number: AAT 1454014. ProQuest document ID: 1679682531. Includes bibliographical references (p. 34-36)

Yes / Nausea and vomiting are common symptoms in palliative care. Haloperidol is often used as an antiemetic in this context, although direct evidence supporting this practice is limited. To evaluate the efficacy and clinical use of haloperidol as an antiemetic in nonpalliative care contexts to inform practice, the authors conducted a rapid review of (i) published evidence to supplement existing systematic reviews, and (ii) practical aspects affecting the use of haloperidol including formulations and doses that are commonly available internationally. In nausea and vomiting related to cancer treatment, haloperidol was superior to control in two small studies. In postoperative nausea and vomiting (PONV), two randomized controlledtrials found treatment with haloperidol comparable to ondansetron. In palliative care, an observational study found a complete response rate of 24% with haloperidol (one in four patients) which would be consistent with a number needed to treat (NNT) of 3 to 5 derived from PONV. There remains insufficient direct evidence to definitively support the use of haloperidol for the management of nausea and vomiting in palliative care. However, generalizing evidence from other clinical contexts may have some validity.

Uma das manifestações mais comuns em sala de recuperação anestésica é a náusea, geralmente associada à anestesia. Além do aspecto subjetivo do desconforto, os pacientes que não apresentam melhora desse sintoma podem ter alta retardada, tanto da sala de recuperação anestésica quanto hospitalar. Como conseqüências, temos a demora do retorno às funções normais, a elevação dos custos hospitalares e um menor grau de satisfação do paciente. O objetivo do presente estudo foi realizar uma análise crítica das evidências disponíveis na literatura sobre os fatores relacionados e características definidoras do diagnóstico de enfermagem náusea, no período pós-operatório imediato, por meio de uma revisão integrativa. No desenvolvimento deste estudo, utilizaram-se como fonte de levantamento de dados quatro base de dados: Lilacs, Pubmed, Cinahl e Cochrane - Revisões Sistemáticas, e a amostra constituiu-se de 31 estudos. A análise das publicações selecionadas demonstrou que as náuseas e vômitos no período pós-operatório são considerados eventos relacionados e, na maioria das vezes, avaliados como um evento único. Os fatores relacionados identificados, de acordo com a freqüência de aparecimento e nível de evidência, foram: sexo feminino, não fumante, história prévia de náuseas e vômitos no pós-operatório, história de náusea associada ao movimento, idade, tipo de cirurgia, uso de opióides no trans e pós-operatório, uso de anestésicos voláteis e administração de óxido nitroso. Em relação às características definidoras evidenciamos nos estudos analisados: palidez, taquicardia, aumento na salivação, transpiração, sensação de calor e frio, rubor, consciência do impulso do vômito, tonturas, bradicardia, dilatação pupilar, variações na pressão arterial, respiração profunda, rápida e irregular. A importância de aperfeiçoar e legitimar os elementos que fazem parte da Taxonomia II da NANDA (2006) está em possibilitar aos profissionais enfermeiros que atuam em centro cirúrgico e recuperação pós-anestésica o planejamento da assistência de enfermagem ao paciente nos três períodos da experiência cirúrgica, visando à minimização das complicações no pósoperatório e promover uma reabilitação mais rápida e tranqüila. / Nausea is one of the most common adverse events in the pots-anesthesia recovery room. It is usually associated to anesthesia. Besides the subjective aspect it can be very distressing for patients. The patients who are suffering from nausea and do show any improvement at all may have a late discharge from both the post-anesthesia recovery room and the hospital. The delayed return to normal functions, the high hospital costs, and the lower degree of the patient\'s satisfaction are some of the consequences. The aim of the present study was to perform a critical analysis of the available evidences in the literature about the related factors and the defining characteristics of nursing diagnosis nausea over the immediate postoperative period by means of an integrative review. During the development of this study systematic reviews and four databases for data collection were used: Lilacs, Pubmed, Cinahl, and Cochrane. From the screened reports, 31 of those were potentially relevant for the purpose of this study. The analysis of the retrieved studies showed that vomiting and nausea in the postoperative period are considered to be closely related and most of the time no distinction can be made between nausea and vomiting. The identified factors related according to the rate of appearance and evidence level were the following: female gender, non-smoking, prior history of vomiting and nausea in the postoperative period, history of nausea associated to motion, age, type of surgery, opioid use in a trans- and a postoperative period, use of volatile anesthetics, and nitrous oxide administration. In relation to the defining characteristics we highlighted the following: pallor, tachycardia, an increased secretion of saliva (sialorrhea, salivation), and perspiration, sensation of cold and heat, blush, awareness of the vomiting impulse, dizziness, bradycardia, pupillary dilation, arterial blood pressure changes, deep, fast, and irregular breathing. The importance to improve and to validate the NANDA\'s Taxonomy II (2006) elements is to enable the registered nurses, who work at surgery centers and anesthesia recovery rooms, to plan the nursing care for the patient in the 3-period of surgical experience aiming at to minimizing the complications in the postoperative period and to stimulate a fast and an undisturbed rehabilitation.

Aim: The aim of the study was to evaluate the differences in postoperative pain, nausea and time of discharge in children 3-12 years old after undergoing Tonsillectomy (TE) or Tonsillotomy (TT) at the post anaesthetic care unit (PACU), children’s ward and at home.  Background: TE involves risk of bleeding, severe postoperative pain and nausea. TT is a less invasive method with lower risk of bleeding and postoperative pain and nausea according to performed studies. Method: A prospective, comparative follow-up study design. Eighty-seven children from December 2008 until April 2009 in the ages 3-12 undergoing TE or TT participated. Visual analogue scale (VAS) was used for children’s pain and nausea assessments. Result/Findings: Significantly fewer children operated on by the TT assessed postoperative pain ≥ 3 according to the VAS than children operated on by the TE in both the PACU and the children’s ward. A significant difference of postoperative nausea was only present during the care at the PACU and children’s ward with fewer TT children that assessed nausea VAS ≥ 3. The time of postoperative care was shorter among the TT children in both the PACU and the children’s ward. Postoperative pain and pain related difficulties in eating after discharge was significantly more present among the TE children compared to the TT children. Conclusion: The results of our study indicated that TT is a more favourable alternative than TE in children.

Syfte: Syftet med denna studie var att jämföra graden av smärta och illamående hos två patientgrupper inom ortopedi som smärtlindrades med tablett Dolcontin/Depolan/Morfin eller tablett Oxycontin/Oxynorm postoperativt dag 0, 1 och 2. Syftet var även att undersöka vilka riskfaktorer enligt Apfel Risk Score som kan påverka grad av illamående samt att undersöka om en korrelation fanns mellan preoperativ information och incidensen av postoperativt illamående och kräkning (PONV). Metod: En komparativ studie med kvantitativ ansats. Data samlades in genom två olika enkäter, varav en enkät fylldes i av patienterna och en enkät av sjuksköterskorna. 48 patienter inkluderades i studien, 24 per substans. Både kvinnor och män som genomgått elektiva knä- eller höftarteroplastikoperationer deltog i studien och de var mellan 31-77 år. Mätinstrumentet som sjuksköterskorna använde sig av för att skatta smärta och illamående var visuell analog skala (VAS). Data analyserades i Statistic Package for the Social Science (SPSS) 10.1 med x2-test, oberoende t-test samt Mann-Whitney U-test. Resultat: Resultatet i studien visade att inte fanns någon signifikant skillnad gällande smärta och de två substanserna. Det fanns en signifikant skillnad gällande illamående och de två substanserna. Inget signifikant samband påvisades mellan illamående och riskfaktorerna i Apfel Risk Score. Det fanns heller inget signifikant samband mellan incidensen av PONV och patientens upplevelse av att ha fått noggrann information preoperativt. Slutsats: Då dokumentationen av smärta och illamående enligt VAS på sjuksköterskeenkäterna var bristfällig, kan inga säkra slutsatser dras. Mer forsknings krävs således inom detta område. / Aim: The aim of this study was to compare the rating of pain and nausea in two groups of patients in orthopedics that was pain relieved with tablet Dolcontin/Depolan/Morphine or tablet Oxycontin/Oxynorm postoperative day 0, 1 and 2. The aim was also to investigate the risk factors according to Apfel Risk Score that may affect the degree of nausea and to investigate whether a correlation existed between preoperative information and the incidence of postoperative nausea and vomiting (PONV). Method: A comparative study with quantitative approach. Data were collected through two different questionnaires, one that was filled out by the patients and the other questionnaire by the nurses. The study included 48 patients, 24 per substance. Both men and women, between 31-77 years old, who would undergo elective knee or hip replacement surgery, participated in the study. The measuring instrument that the nurses used to estimate the pain and nausea were visual analogue scale (VAS). Data were analyzed in the Statistic Package for the Social Science (SPSS) 10.1 with the x2-test, independent t-test and Mann-Whitney U-test. Results: The results of the study showed that there was no significant difference regarding pain and the two compounds. There was a significant difference regarding nausea and the two compounds. No significant correlation was found between nausea and the risk factors in the Apfel Risk Score. There was no significant correlation between the incidence of PONV and patient experience of receiving accurate information preoperatively. Conclusion: As the documentation of pain and nausea according to VAS on the nursing surveys were poor, no firm conclusions can be drawn. Further studies are necessary to confirm the results of this study.

Background: The incidence of postoperative nausea and vomiting (PONV) can be reduced by dexamethasone. Single dose administration may cause elevated blood glucose levels in obese adults. No data are available for children. Objective: The aim was to evaluate perioperative blood glucose changes related to body weight in children who received dexamethasone. Methods: This prospective observational study included 62 children. All patients received total intravenous anesthesia and a single dose of dexamethasone (0.15mg/kg, maximum 8mg). Blood glucose levels were measured up to 6 hours. Standard deviation scores (SDS) were calculated using age- and gender-specific BMI percentiles, p<0.05. Results: 62 children (11.5±2.9years, median SDS 0.43, 29% overweight/obese) were included. Blood glucose level increased from 5.52±0.52 to 6.74±0.84mmol/l 6h after dexamethasone without correlation to the BMI-SDS. Conclusions: This study shows an increase of perioperative blood glucose (normoglycemic ranges) after single dose of dexamethasone but no BMI-dependent effect in children. Therefore, low-dose dexamethasone may be used in obese children for PONV prophylaxis.