Abstract Background: The antiemetic effectiveness of olanzapine, as a prophylactic off-label antiemetic drug, for Postoperative Nausea and Vomiting (PONV) is unknown. In this systematic review and meta-analysis, the authors evaluate the efficacy and side effects of olanzapine as a prophylactic antiemetic in adult patients who undergo general anesthesia and assess adverse effects. Methods: A systematic search was done on electronic bibliographic databases in July 2023. Randomized controlled trials of olanzapine as a prophylactic antiemetic for PONV in adults who underwent general anesthesia were included. The authors excluded non-RCTs and retracted studies. The authors set no date of publication or language limits. The outcomes were the incidence of PONV within 24 h postoperatively and the safety of olanzapine. The risk of bias was assessed according to the tool suggested by the National Heart, Lung, and Blood Institute. Results: Meta-analysis included 446 adult patients. Olanzapine reduced on average 38 % the incidence of PONV. The estimated risk ratio (95 % CI) of olanzapine versus control was 0.62 (0.42-0.90), p = 0.010, I2 = 67 %. In the subgroup meta-analysis, doses of olanzapine (10 mg) reduced on average 49 % of the incidence of PONV (RR = 0.51 [0.34-0.77], p = 0.001, I2 = 31 %). Conclusion: This systematic review with meta-analysis indicated that olanzapine as a prophylactic antiemetic alone or combined with other antiemetic agents reduced the incidence of postoperative nausea and vomiting. However, this conclusion must be presented with some degree of uncertainty due to the small number of studies included. There was a lack of any evidence to draw conclusions on side effects. Background offlabel off label drug (PONV unknown metaanalysis, metaanalysis meta analysis, analysis Methods 2023 nonRCTs non RCTs limits 2 Heart Lung Institute Results Metaanalysis Meta 44 3 95 (9 CI 062 0 62 0.6 0.420.90, 042090 0.42 0.90 , 42 90 (0.42-0.90) 0010 010 0.010 I 6 10 (1 mg 4 RR 051 51 0.5 0.340.77, 034077 0.34 0.77 34 77 [0.34-0.77] 0001 001 0.001 . %) Conclusion vomiting However 202 9 ( 06 0. 420 0.420.90 04209 042 0.4 090 0.9 (0.42-0.90 01 0.01 1 05 5 340 0.340.77 03407 034 0.3 077 0.7 7 [0.34-0.77 000 00 0.00 20 0.420.9 0420 04 09 (0.42-0.9 0.0 0.340.7 0340 03 07 [0.34-0.7 0.420. (0.42-0. 0.340. [0.34-0. 0.420 (0.42-0 0.340 [0.34-0 (0.42- [0.34- (0.42 [0.34 (0.4 [0.3 (0. [0. (0 [0 [

Resumo Objetivos Este estudo avaliou a intensidade da dor em idosos acometidos por fratura do quadril internados no setor de emergência e submetidos ao Pericapsular Nerve Group (PENG) block no pré-operatório. Ademais, o grau de flexão tolerável do quadril foi avaliado. Métodos Ensaio clínico, prospectivo, aleatorizado e controlado em grupos paralelos. O grupo controle consiste em idosos com fratura do quadril, submetidos à analgesia sistêmica endovenosa padronizada. O grupo intervenção consiste em idosos com fratura do quadril submetidos ao PENG block e analgesia sistêmica padronizada. Os grupos foram avaliados em repouso e durante o movimento pela escala de dor Pain Assessment in Advance Dementia (PAINAD). Aferiram-se intensidade da dor e redução álgica, assim como o grau de flexão tolerável do quadril fraturado. Todos os pacientes foram avaliados previamente à administração de medicação ou bloqueio e aos 45 minutos, 12, 24 e 36 horas pós-medicação ou bloqueio. Resultados No pré-operatório e 24 horas após o PENG block, idosos com fratura do quadril apresentaram redução significativa da dor em repouso ou movimento em comparação com o controle (p< 0,05), com 60% dos pacientes avaliados em repouso, demonstrando a redução álgica desejável de ≥ 50% e apenas 13,3% do grupo controle com redução álgica desejável. Durante o movimento, após o PENG block, 40% demonstraram redução álgica desejada e nenhum paciente do grupo controle apresentou a redução desejada. Verificou-se, também, no grupo intervenção a melhora significativa da flexão tolerável do quadril (p < 0,05). Conclusão O PENG block no pré-operatório de idosos com fratura do quadril, internados no setor de emergência, proporcionou redução significativa da dor em comparação ao grupo controle. (PENG préoperatório. préoperatório pré operatório. operatório Ademais avaliado clínico prospectivo paralelos padronizada PAINAD. PAINAD . (PAINAD) Aferiramse Aferiram se fraturado 4 minutos 12 2 3 pósmedicação pós p< p 0,05, 005 0,05 , 0 05 0,05) 60 50 133 13 13,3 40 Verificouse, Verificouse Verificou se, Verificou-se também 0,05. (PAINAD 1 00 0,0 6 5 13, 0,

Abstract Objectives This study evaluated pain intensity in elderly subjects with hip fractures admitted to the emergency sector and undergoing preoperative pericapsular nerve group (PENG) block. Additionally, the degree of tolerable hip flexion was assessed. Methods A prospective, randomized, and controlled clinical trial with parallel groups. The control group consisted of elderly subjects with hip fractures undergoing standardized intravenous systemic analgesia. The intervention group consisted of elderly patients with hip fractures undergoing PENG block and standardized systemic analgesia. The groups were evaluated at rest and during movement using the Pain Assessment in Advanced Dementia (PAINAD) scale. We determined pain intensity and reduction, in addition to the degree of tolerable flexion of the fractured hip. All patient assessments occurred before the medication or block administration and at 45 minutes, 12, 24, and 36 hours postmedication or block. Results Preoperatively and 24 hours after PENG block, elderly subjects with hip fracture showed a significant reduction in pain at rest or movement compared to control patients (p< 0.05), with 60% of patients assessed at rest demonstrating desirable pain reduction (≥50%) and only 13.3% of the control group achieving the desired pain reduction. During movement, after undergoing PENG block, 40% of subjects demonstrated the desired pain reduction and no patient from the control group. The intervention group also showed a significant improvement in the tolerable hip flexion group (p< 0.05). Conclusion Preoperative PENG block in elderly subjects with hip fractures admitted to the emergency sector provided a significant reduction in pain compared with the control group. (PENG Additionally prospective randomized analgesia PAINAD (PAINAD scale 4 minutes 12 3 2 p< p (p 0.05, 005 0.05 , 0 05 0.05) 60 ≥50% 50 (≥50% 133 13 13.3 40 0.05. . 1 00 0.0 6 ≥50 5 (≥50 13. 0. ≥5 (≥5 ≥ (≥ (

OBJECTIVES: To evaluate the addition of a fourth antiemetic intervention in patients at high risk for postoperative nausea and vomiting (PONV). METHODS: High-risk patients (Apfel score 3 or 4) scheduled for unilateral mastectomy were randomly allocated in one of two groups, oral aprepitant (oral aprepitant 80 mg, intravenous dexamethasone 8 mg, and palonosetron 0.075 mg) and oral placebo (oral placebo, intravenous dexamethasone 4 mg, and palonosetron 0.075 mg). Patients and caregivers were blinded to the group assignments. The primary efficacy endpoints included the incidence of nausea and vomiting, and the secondary endpoints included use of rescue antiemetics during a 48-hour postoperative period. ClinicalTrials.gov: NCT02431286. RESULTS: One hundred patients were enrolled in this study and 91 were analyzed, 48 in group A and 43 in group P. No patient presented with nausea or vomiting in the first 2 hours after surgery. From the 2nd to the 6th hour, the incidence of PONV was 8.33% in group A and 9.30% in group P. In the first 24 hours, the incidence of PONV was 27.08% in the group A and 20.93% in group P. From the 24th to the 48th hour, the incidence of PONV was 8.33% in group A and 13.95% in group P. There were no statistically significant differences in PONV between groups. CONCLUSION: The addition of aprepitant as a third antiemetic resulted in no significant reduction in the incidence of PONV in this population. However, the incidence of PONV was reduced in relation to the general population.

JUSTIFICATIVA E OBJETIVOS: Síndrome de Jeune, ou Distrofia Torácica Asfixiante, é uma doença autossômica recessiva. Esta síndrome é caracterizada por uma displasia óssea com variadas anormalidades: torácica, pancreática, cardíaca, hepática, renal e da retina. A idade em que o quadro clínico dos pacientes se apresenta está correlacionada com a gravidade da doença. Esses pacientes apresentam policondrodistrofia com costelas largas, curtas, horizontais e junções costocondrais irregulares levando a uma caixa torácica rígida e reduzida com grau de injúria respiratória variado. RELATO DO CASO: Paciente do sexo masculino, 4 meses, 7 kg, portador de Distrofia Torácica Asfixiante. Apresentava-se intubado e com caixa torácica reduzida. Ecocardiograma: hipertensão pulmonar leve. Tomografia de tórax: hipoplasia pulmonar. Submetido à toracoplastia bilateral e toracotomia sob anestesia geral. Manutenção da anestesia: infusão contínua de sufentanil e sevoflurano. Parâmetros ventilatórios: ventilação mecânica ciclada à pressão. Com a abertura do tórax, houve melhora dos parâmetros ventilatórios e, após o posicionamento da prótese torácica, observou-se limitação ventilatória. Decidiu-se pela diminuição da prótese torácica com consequente melhora da ventilação. CONCLUSÕES: É imprescindível o diagnóstico de todas as anormalidades presentes para o correto manejo anestésico. Foi necessária observação para adequar ventilação pré- e pós-toracotomia/toracoplastia e para manter o paciente hemodinamicamente estável. A forma mais adequada para ventilação mecânica é a ciclada à pressão para vencer a barreira mecânica. No intraoperatório, é desejável manter o pico de pressão inspiratória o mais baixo possível para minimizar o risco de barotrauma, de impedimento do retorno venoso e diminuição do débito cardíaco.

BACKGROUND AND OBJECTIVES: Jeune Syndrome or Asphyxiating Thoracic Dystrophy is a recessive autosomal disease. This syndrome is characterized by a bone dysplasia with varied abnormalities: thoracic, pancreatic, cardiac, hepatic, renal and retinal. Patients' age when the clinical condition is experienced correlates with the disease severity. These patients experience polychondrodystrophy with large, short, horizontal ribs and irregular costochondral junctions resulting in a rigid and reduced thoracic cage with varied respiratory injury level. CASE REPORT: Male patient, 4 months-old, 7 kg, suffering with Asphyxiating Thoracic Dystrophy, intubated and presented with reduced thoracic cage. Echocardiogram: mild pulmonary hypertension. Chest tomography: pulmonary hypoplasia. Patient submitted to bilateral thoracoplasty and thoracotomy with general anesthesia. Anesthesia maintenance: sufentanil e sevoflurane continuous infusion. Ventilation parameters: pressure-cycled mechanical ventilation. Thorax opening provided improvement of the ventilation parameters, but after thoracic prosthesis placement, ventilation was limited. Reduction of the thoracic prosthesis was considered with consequent improvement of ventilation. CONCLUSIONS: Diagnosis of all present abnormalities is essential for the correct anesthetic management. Observation was necessary to adequate pre- and post-thoracotomy/thoracoplasty ventilation and to maintain patient hemodynamically stable. Pressure-cycled mechanical ventilation is the most adequate type of ventilation to overcome the mechanical barrier. In the intraoperative setting, the ideal is to maintain the inspiratory pressure peak as low as possible to minimize the risk of barotrauma, venous return impairment and reduced cardiac output.

JUSTIFICATIVA Y OBJETIVOS: El Síndrome de Jeune o Distrofia Torácica Asfixiante, es una enfermedad autosómica recesiva. Ese síndrome se caracteriza por una displasia ósea con varias anormalidades: torácica, pancreática, cardiaca, hepática, renal y de la retina. La edad en que el cuadro clínico de los pacientes aparece está correlacionada con la severidad de la enfermedad. Esos pacientes presentan una policondrodistrofia con las costillas anchas, cortas, horizontales y con junciones costocondrales irregulares con una caja torácica rígida y reducida con un grado de daño respiratorio variado. RELATO DEL CASO: Paciente del sexo masculino, 4 meses, 7 kg, portador de Distrofia Torácica Asfixiante. Estaba intubado y con la caja torácica reducida. Ecocardiograma: hipertensión pulmonar leve. Tomografía de tórax: hipoplasia pulmonar. Sometido a la toracoplastia bilateral y a la toracotomía bajo anestesia general. Mantenimiento de la anestesia: infusión continua de sufentanil y sevoflurano. Parámetros ventilatorios: ventilación mecánica ciclada a presión. Con la abertura del tórax, se notó una mejoría de los parámetros ventilatorios y después del posicionamiento de la prótesis torácica, se observó una limitación ventilatoria. Decidimos realizar la disminución de la prótesis torácica con la consecuente mejoría de la ventilación. CONCLUSIONES: Es imprescindible el diagnóstico de todas las anormalidades presentes para el correcto manejo anestésico. Se hizo necesaria la observación para adecuar la ventilación pre y pos toracotomía/toracoplastia y mantener al paciente hemodinámicamente estable. La forma más adecuada para la ventilación mecánica es la ciclada a presión para vencer la barrera mecánica. En el intraoperatorio debemos mantener el pico de presión inspiratoria lo más bajo posible para minimizar el riesgo de barotrauma, de impedimento del retorno venoso y la disminución del débito cardíaco.