Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer

<p>Abstract</p> <p>Background</p> <p>Dexamethasone has been reported to reduce postoperative symptoms after different surgical procedures. We evaluated the efficacy of preoperative dexamethasone in ameliorating postoperative nausea and vomiting (PONV), and pain after mastectomy.</p> <p>Methods</p> <p>In this prospective, double-blind, placebo-controlled study, 70 patients scheduled for mastectomy with axillary lymph node dissection were analyzed after randomization to treatment with 8 mg intravenous dexamethasone (<it>n </it>= 35) or placebo (<it>n </it>= 35). All patients underwent standardized procedures for general anesthesia and surgery. Episodes of PONV and pain score were recorded on a visual analogue scale. Analgesic and antiemetic requirements were also recorded.</p> <p>Results</p> <p>Demographic and medical variables were similar between groups. The incidence of PONV was lower in the dexamethasone group at the early postoperative evaluation (28.6% <it>vs</it>. 60%; <it>p </it>= 0.02) and at 6 h (17.2% <it>vs</it>. 45.8%; <it>p </it>= 0.03). More patients in the placebo group required additional antiemetic medication (21 <it>vs</it>. 8; <it>p </it>= 0.01). Dexamethasone treatment significantly reduced postoperative pain just after surgery (VAS score, 4.54 ± 1.55 <it>vs</it>. 5.83 ± 2.00; <it>p </it>= 0.004), at 6 h (3.03 ± 1.20 <it>vs</it>. 4.17 ± 1.24; <it>p </it>< 0.0005) and at 12 h (2.09 ± 0.85 <it>vs</it>. 2.54 ± 0.98; <it>p </it>= 0.04). Analgesics were required in more patients of the control group (21 <it>vs</it>. 10; <it>p </it>= 0.008). There were no adverse events, morbidity or mortality.</p> <p>Conclusions</p> <p>Preoperative intravenous dexamethasone (8 mg) can significantly reduce the incidence of PONV and pain in patients undergoing mastectomy with axillary dissection for breast cancer.</p> <p>Trial registration number</p> <p>NCT01116713</p

Reversal by Org 25969 is not affected by sevoflurane compared with propofol

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Impacts of forests and forestation on hydrological services in the Andes: A systematic review

Several Andean countries have planned to restore forest cover in degraded land to enhance the provision of multiple ecosystem services in response to international commitments such as the Bonn Challenge. Hydrological services, e.g. water supply, hydrological regulation and erosion mitigation, are particularly important to sustain the life of more than fifty million Andean people. While rapid and important forest cover changes have occurred during recent decades, critical information on the impact of forestation on hydrological services has not yet been synthesized in the context of Andean ecosystems. We define forestation as the establishment of forest by plantation or natural regeneration on areas that either had forest in the past or not. To help improve decision-making on forestation in the Andes, we reviewed the available literature concerning the impacts of forestation on water supply, hydrological regulation and mitigation of erosion and landslides. We also examined available data on the most relevant hydrological processes such as infiltration, evapotranspiration and runoff in forest stands. Hydrological services from native forests were also included as a reference state for comparing processes and services provided by forestation. Following systematic review protocols, we synthesized 155 studies using different methods, including meta-analyses and meta-regressions. Results show that forestation has had clear impacts on degraded soils, through reducing water erosion of soils and risk of moderate floods, increasing soil infiltration rate by 8 and topsoil organic matter (SOM). We found that 20 years of tree plantation was sufficient to recover infiltration rate and sediment yield close to the levels of native forests whereas SOM, soil water storage and surface runoff of native forests could not be recovered by forestation in the time scales examined. The benefits in terms of hydrological regulation are at the expense of a reduction in total water supply since forest cover was associated with higher water use in most Andean regions. Forestation with native species was underrepresented in the reviewed studies. The impact of forestation on landslides has also been largely overlooked in the Andes. At high elevations, exotic tree plantations on Andean grasslands (e.g. páramo and puna) had the most detrimental consequences since these grasslands showed an excellent capacity for hydrological regulation and erosion mitigation but also a water yield up to 40% higher than tree plantations. People engaged in forest restoration initiative should be aware that hydrological services may take some time for society and the environment to show clear benefits after forestation