Effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery

AbstractBackgroundWe investigated the effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery.MethodsPatients were randomly divided into three groups: those maintained with sevoflurane (Group S, n=42), propofol (Group P, n=42), or combined propofol and sevoflurane (Group PS, n=42). We assessed complete response (no postoperative nausea and vomiting and no rescue antiemetic use), incidence of nausea and vomiting, nausea severity score, vomiting frequency, rescue antiemetic use, and postoperative pain at 2 and 24h after surgery.ResultsThe number of patients who exhibited a complete response was greater in Groups P and PS than in Group S at 0–2h (74%, 76% and 43%, respectively, p=0.001) and 0–24h (71%, 76% and 38%, respectively, p<0.0005). The incidence of nausea at 0–2h (Group S=57%, Group P=26% and Group PS=21%, p=0.001) and 0–24h (Group S=62%, Group P=29% and Group PS=21%, p<0.0005) was also significantly different among groups. However, there were no significant differences among groups in the incidence or frequency of vomiting or rescue antiemetic use at 0–24h.ConclusionCombined propofol and volatile anesthesia during laparoscopic gynecological surgery effectively decreases the incidence of postoperative nausea. We term this novel method of anesthesia “combined intravenous-volatile anesthesia (CIVA)”

Anesthesia for deep brain stimulation in a patient with X-linked dystonia-parkinsonism/Lubag disease

Lubag disease is a genetic X-linked dystonia-parkinsonism syndrome afflicting Filipino men. This disease is characterized by dystonia dominating the first 10-15 years of the disorder, which is associated with or replaced by parkinsonian features in later years of life. A 49-year-old man with Lubag disease underwent general anesthesia for deep brain stimulation (DBS) surgery. Anesthesia was maintained mainly with propofol, remifentanil, rocuronium bromide, and sevoflurane. During magnetic resonance imaging, the patient was anesthetized with midazolam, fentanyl, and rocuronium bromide. The surgery was completed safely using these anesthetic agents. After DBS, some symptoms including involuntary movement improved within 10 days

PONV after intraarticular anesthesia

Study Objective : the incidence of postoperative nausea and vomiting (PONV) following single-injection intraarticular anesthesia was compared to that following continuous epidural anesthesia. Design : Prospective, double-blind, randomized study. Setting : University-affiliated teaching hospital. Patients : Forty-eight patients finally participated in this study, and each group contained twenty-four patients. Interventions : Patients scheduled to undergo lower limb surgery under general anesthesia were randomly allocated into two groups, to receive either single-injection intraarticular or continuous epidural anesthesia for postoperative analgesia. Measurements : The incidence and severity of PONV, complete response rates (i.e., no vomiting or rescue antiemetic use), and pain scores were recorded 2, 24, and 48 h postoperatively. Main results : No significant differences between groups were observed in the incidence and severity of PONV, rescue antiemetic use, or complete response rate at any of the time points, but only the use of rescue analgesics was significantly less in continuous epidural anesthesia group during the 2-24h postoperative period (P=0.04). Conclusion : While the use of single-injection intraarticular anesthesia following lower limb surgery did not prevent PONV more than continuous epidural anesthesia in this study, the intraarticular technique still provides greater simplicity, safety, and cost-effectiveness

General anesthesia for electroconvulsive therapy with Brugada electrocardiograph pattern

Brugada syndrome is characterized by an electrocardiograph pattern of right bundle-branch block and has an increased risk for cardiac arrest due to malignant arrhythmia. We describe the successful anesthetic management for electroconvulsive therapy in a patient with Brugada electrocardiograph pattern. Patients with Brugada ECG pattern are not recommended to use neostigmine which augments ST elevation. Sugammadex was administered as a neuromuscular reversal agent in this case. Sugammadex provides rapid reversal of profound rocuronium-induced neuromuscular blockade under propofol anesthesia

Changes in developmental duration of direct-seeded rice in a well-drained paddy field in response to late planting

We investigated changes in the developmental duration of rice cultivars with a wide range of maturities in response to late planting. Elucidating the relationship between cropping season and the progress of growth stages is important for establishing direct-seeded cultivation and creating growth models. Late planting of the intermediate to late maturing cultivars Akidawara and Hoshijirushi decreased the time from emergence to panicle formation and decreased the cumulative effective temperature (CET) and cumulative effective soil temperature (CEST). In the very early maturing cultivars Ichibanboshi and Fusakogane, the changes in number of days, CET, and CEST from emergence to panicle formation with late planting were small. From emergence to heading and maturity, the number of days, CET, and CEST of many cultivars tended to increase until mid-May and then decreased. The changes in the number of days, CET, and CEST caused by late planting were greater for the intermediate to late maturing cultivars than for the very early maturing cultivars. The differences between cultivars were greatest with early May sowing, and then decreased with later planting. Short-day condition revealed significant differences in the duration of vegetative growth and CET among cultivars, but long-day condition erased these differences. These results demonstrate that the photosensitivity and thermosensitivity of cultivars are especially important in crop planning and for creating growth models of direct-seeded rice

Establishment rate of direct-seeded rice in the relay-intercropping system in Kanto region of Japan

The relay intercropping system for cultivating direct-seeding rice and winter cereal is a low-cost method particularly for double cropping, because it eliminates the steps of raising seedlings, paddling, and transplanting. However, in this system, the seedling establishment rate (SER) of rice is low and unstable. The objective of this study was to identify the factors affecting SER to highlight the ways to improve SER. Experiments were conducted in experimental fields in Tsukuba City, Ibaraki Prefecture in 2015 and 2016. To determine the time of rice seed death and to calculate seed survival rates, ‘Akidawara’ seeds were embedded in soil (depth: 3 cm) and dug up after defined periods. We then analyzed the correlation between SER and meteorological factors at two sites (Ibaraki Prefecture and Gunma Prefecture) over the same two years. Based on mean air temperature (MT), we divided the period from seeding to June 20 (when irrigation had been initiated in almost all the fields) into four phases. In Phase 1, the number of days with rainfall (≥5 mm) and soil-wetting days (water potential ≥ −100 kPa) were significantly and negatively correlated with SER. We found that most of the seed deaths occurred after germination, and the germination rates were presumably affected by water absorption during the low temperature phase. Further investigations are needed to understand the occurrences during the seedling emergence period. This study contributes to a better understanding of the factors affecting variations in the SER of direct-seeded rice grown in the relay-intercropping system. List of Abbreviations: DSR: direct-seeded rice; SER: seedling establishment rate; TT: thiuram treatment; SSR: seed survival rate; DS: dead seeds; AGS: already germinated seeds; DSRI: direct-seeding of rice in the inter-row spaces of winter cereals; VWC: volume water content; WP: water potentia