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Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report
The intraprocedural immobilization of selected subsets of patients undergoing pars plana vitrectomy (PPV) requires the performance of general anesthesia (GA), which entails the intraoperative use of hypnotics and titration of opioids. The Adequacy of Anesthesia (AoA) concept of GA guidance optimizes...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468095/ https://www.ncbi.nlm.nih.gov/pubmed/34575281 http://dx.doi.org/10.3390/jcm10184172 |
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author | Pluta, Aleksandra Stasiowski, Michał Jan Lyssek-Boroń, Anita Król, Seweryn Krawczyk, Lech Niewiadomska, Ewa Żak, Jakub Kawka, Magdalena Dobrowolski, Dariusz Grabarek, Beniamin Oskar Szumera, Izabela Missir, Anna Rejdak, Robert Jałowiecki, Przemysław |
author_facet | Pluta, Aleksandra Stasiowski, Michał Jan Lyssek-Boroń, Anita Król, Seweryn Krawczyk, Lech Niewiadomska, Ewa Żak, Jakub Kawka, Magdalena Dobrowolski, Dariusz Grabarek, Beniamin Oskar Szumera, Izabela Missir, Anna Rejdak, Robert Jałowiecki, Przemysław |
author_sort | Pluta, Aleksandra |
collection | PubMed |
description | The intraprocedural immobilization of selected subsets of patients undergoing pars plana vitrectomy (PPV) requires the performance of general anesthesia (GA), which entails the intraoperative use of hypnotics and titration of opioids. The Adequacy of Anesthesia (AoA) concept of GA guidance optimizes the intraoperative dosage of hypnotics and opioids. Pre-emptive analgesia (PA) is added to GA to minimize intraoperative opioid (IO) usage. The current additional analysis evaluated the advantages of PA using either COX-3 inhibitors or regional techniques when added to AoA-guided GA on the rate of presence of postoperative nausea and vomiting (PONV), oculo-emetic (OER), and oculo-cardiac reflex (OCR) in patients undergoing PPV. A total of 176 patients undergoing PPV were randomly allocated into 5 groups: (1) Group GA, including patients who received general anesthesia alone; (2) Group T, including patients who received preventive topical analgesia by triple instillation of 2% proparacaine 15 min before induction of GA; (3) Group PBB, including patients who received PBB; (4) Group M, including patients who received PA using a single dose of 1 g of metamizole; (5) Group P, including patients who received PA using a single dose of 1 g of acetaminophen. The incidence rates of PONV, OCR, and OER were studied as a secondary outcome. Despite the group allocation, intraoperative AoA-guided GA resulted in an overall incidence of PONV in 9%, OCR in 12%, and OER in none of the patients. No statistically significant differences were found between groups regarding the incidence of OCR. PA using COX-3 inhibitors, as compared to that of the T group, resulted in less overall PONV (p < 0.05). Conclusions: PA using regional techniques in patients undergoing PPV proved to have no advantage when AoA-guided GA was utilised. We recommend using intraoperative AoA-guided GA to reduce the presence of OCR, and the addition of PA using COX-3 inhibitors to reduce the rate of PONV. |
format | Online Article Text |
id | pubmed-8468095 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-84680952021-09-27 Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report Pluta, Aleksandra Stasiowski, Michał Jan Lyssek-Boroń, Anita Król, Seweryn Krawczyk, Lech Niewiadomska, Ewa Żak, Jakub Kawka, Magdalena Dobrowolski, Dariusz Grabarek, Beniamin Oskar Szumera, Izabela Missir, Anna Rejdak, Robert Jałowiecki, Przemysław J Clin Med Article The intraprocedural immobilization of selected subsets of patients undergoing pars plana vitrectomy (PPV) requires the performance of general anesthesia (GA), which entails the intraoperative use of hypnotics and titration of opioids. The Adequacy of Anesthesia (AoA) concept of GA guidance optimizes the intraoperative dosage of hypnotics and opioids. Pre-emptive analgesia (PA) is added to GA to minimize intraoperative opioid (IO) usage. The current additional analysis evaluated the advantages of PA using either COX-3 inhibitors or regional techniques when added to AoA-guided GA on the rate of presence of postoperative nausea and vomiting (PONV), oculo-emetic (OER), and oculo-cardiac reflex (OCR) in patients undergoing PPV. A total of 176 patients undergoing PPV were randomly allocated into 5 groups: (1) Group GA, including patients who received general anesthesia alone; (2) Group T, including patients who received preventive topical analgesia by triple instillation of 2% proparacaine 15 min before induction of GA; (3) Group PBB, including patients who received PBB; (4) Group M, including patients who received PA using a single dose of 1 g of metamizole; (5) Group P, including patients who received PA using a single dose of 1 g of acetaminophen. The incidence rates of PONV, OCR, and OER were studied as a secondary outcome. Despite the group allocation, intraoperative AoA-guided GA resulted in an overall incidence of PONV in 9%, OCR in 12%, and OER in none of the patients. No statistically significant differences were found between groups regarding the incidence of OCR. PA using COX-3 inhibitors, as compared to that of the T group, resulted in less overall PONV (p < 0.05). Conclusions: PA using regional techniques in patients undergoing PPV proved to have no advantage when AoA-guided GA was utilised. We recommend using intraoperative AoA-guided GA to reduce the presence of OCR, and the addition of PA using COX-3 inhibitors to reduce the rate of PONV. MDPI 2021-09-15 /pmc/articles/PMC8468095/ /pubmed/34575281 http://dx.doi.org/10.3390/jcm10184172 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Pluta, Aleksandra Stasiowski, Michał Jan Lyssek-Boroń, Anita Król, Seweryn Krawczyk, Lech Niewiadomska, Ewa Żak, Jakub Kawka, Magdalena Dobrowolski, Dariusz Grabarek, Beniamin Oskar Szumera, Izabela Missir, Anna Rejdak, Robert Jałowiecki, Przemysław Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report |
title | Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report |
title_full | Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report |
title_fullStr | Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report |
title_full_unstemmed | Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report |
title_short | Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report |
title_sort | adverse events during vitrectomy under adequacy of anesthesia—an additional report |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468095/ https://www.ncbi.nlm.nih.gov/pubmed/34575281 http://dx.doi.org/10.3390/jcm10184172 |
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