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  • 1
    Online Resource
    Online Resource
    Effects of aprepitant on post-operative nausea and vomiting in patients with congenital heart disease undergoing cardiac surgery or catheterization procedures: a retrospective study with subjects as their own historical control
    Frontiers Media SA ; 2023
    In:  Frontiers in Anesthesiology Vol. 2 ( 2023-9-8)
    Details
    In: Frontiers in Anesthesiology, Frontiers Media SA, Vol. 2 ( 2023-9-8)
    Abstract: For patients undergoing cardiac surgery and catheterization procedures, severe post-operative nausea and vomiting (PONV) can occur despite standard anti-emetic interventions. Aprepitant, a neurokinin-1 (NK-1) receptor blocker, is safe and effective at preventing PONV resistant to standard therapies. Methods Patients with a history of severe PONV presenting for cardiac surgery or catheterization procedures from January 1, 2018 to January 6, 2021 were identified. After pharmacist approval, patients received aprepitant pre-operatively (Dose: 80 mg for weight & gt;50 kg, 40 mg for weight 30–50 kg). A retrospective chart review was performed. Primary outcomes of the incidence of PONV and PONV-related complications were evaluated. Results Seventeen patients were included with a mean age of 16.0 years at the time of their initial procedure, which acted as the “control” procedure, and 17.5 years when they received aprepitant. After the control procedure 64.7% of patients required rescue anti-emetics. When this group of patients received aprepitant pre-operatively at their subsequent procedure, only 17.6% required rescue medication ( p  = 0.005). Similarly, 64.7% of patients suffered at least one PONV-related complication after the control procedure. With aprepitant use pre-operatively, 5.9% of the same patients experienced a PONV-complication ( p  = 0.0003). Specifically, unplanned ICU admission due to severe PONV after catheterization procedures decreased from 55.6% (5/9) in the control group to 0 after these patients were treated pre-emptively with aprepitant ( p  = 0.01). For surgical patients, there were significant decreases in PONV-related complications including delayed oral intake and delayed ambulation ( p  = 0.04) in the aprepitant group compared to the control group. Discussion This small, retrospective study supports the conclusion that preoperative aprepitant administration in patients undergoing cardiac catheterization or cardiac surgery with a history of congenital heart disease and severe PONV significantly reduces the incidence of PONV and PONV-related complications. Decreasing these complications will likely improve the surgical experience for patients and families while also decreasing hospital costs and improving efficiency.
    Type of Medium: Online Resource
    ISSN: 2813-480X
    URL: Article
    DOI: 10.3389/fanes.2023.1190383
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2023
    detail.hit.zdb_id: 3164679-7
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  • 2
    Online Resource
    Online Resource
    Breathing circuit compliance and accuracy of displayed tidal volume during pressure‐controlled ventilation of infants: A quality improvement project
    Wiley ; 2017
    In:  Pediatric Anesthesia Vol. 27, No. 9 ( 2017-09), p. 935-941
    Details
    In: Pediatric Anesthesia, Wiley, Vol. 27, No. 9 ( 2017-09), p. 935-941
    Abstract: Anesthesia machines have evolved to deliver desired tidal volumes more accurately by measuring breathing circuit compliance during a preuse self‐test and then incorporating the compliance value when calculating expired tidal volume. The initial compliance value is utilized in tidal volume calculation regardless of whether the actual compliance of the breathing circuit changes during a case, as happens when corrugated circuit tubing is manually expanded after the preuse self‐test but before patient use. We noticed that the anesthesia machine preuse self‐test was usually performed on nonexpanded pediatric circuit tubing, and then the breathing circuit was subsequently expanded for clinical use. We aimed to demonstrate that performing the preuse self‐test in that manner could lead to incorrectly displayed tidal volume on the anesthesia machine monitor. The goal of this quality improvement project was to change the usual practice and improve the accuracy of displayed tidal volume in infants undergoing general anesthesia. Methods There were four stages of the project: (i) gathering baseline data about the performance of the preuse self‐test and using infant and adult test lungs to measure discrepancies of displayed tidal volumes when breathing circuit compliance was changed after the initial preuse self‐test; (ii) gathering clinical data during pressure‐controlled ventilation comparing anesthesia machine displayed tidal volume with actual spirometry tidal volume in patients less than 10 kg before (machine preuse self‐test performed while the breathing circuit was nonexpanded) and after an intervention (machine preuse self‐test performed after the breathing circuit was fully expanded); (iii) performing department‐wide education to help implement practice change; (iv) gathering postintervention data to determine the prevalence of proper machine preuse self‐test. Results At constant pressure‐controlled ventilation through fully expanded circuit tubing, displayed tidal volume was 83% greater in the infant test lung (mean± SD TV 15±5 vs 9±4 mL ; mean [95% CI ] difference=6.3 [5.6, 7.1] mL , P 〈 .0001) and 3% greater in the adult test lung (245±74 vs 241±72 mL ; difference=5 [1, 10] mL , P =.0905) when circuit compliance had been measured with nonexpanded tubing compared to when circuit compliance was measured with fully expanded tubing. The clinical data in infants demonstrated that displayed tidal volume was 41% greater than actual tidal volume (difference of 10.4 [8.6, 12.2] mL ) when the circuit was expanded after the preuse self‐test (preintervention) and 7% greater (difference of 2.5 [0.7, 4.2] mL ) in subjects when the circuit was expanded prior to the preuse self‐test (postintervention) ( P 〈 .0001). Clinical practice was changed following an intervention of departmental education: the preuse self‐test was performed on expanded circuit tubing 11% of the time prior to the intervention and 100% following the intervention. Conclusion Performing a preuse self‐test on a nonexpanded pediatric circuit that is then expanded leads to falsely elevated displayed tidal volume in infants less than 10 kg during pressure‐controlled ventilation. Overestimation of reported tidal volume can be avoided by expanding the breathing circuit tubing to the length which will be used during a case prior to performing the anesthesia machine preuse self‐test. After department‐wide education and implementation, performing a correct preuse self‐test is now the standard practice in our cardiac operating rooms.
    Type of Medium: Online Resource
    ISSN: 1155-5645 , 1460-9592
    URL: Issue
    URL: Article
    DOI: 10.1111/pan.2017.27.issue-9
    DOI: 10.1111/pan.13164
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2008564-3
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