Postoperative nausea and vomiting (PONV) are still common following surgery. This is not only distressing to the patient, but increases costs. The thorough understanding of the mechanism of nausea and vomiting and a careful assessment of risk factors provide a rationale for appropriate management of PONV. Strategy to reduce baseline risk and the adoption of a multimodal approach will most likely ensure success in the management of PONV.

Single-shot "kiddie caudal" with bupivacaine alone is losing popularity because of its duration of 4-8 h. In a prospective randomized double-blind clinical study, we assessed and compared the efficacy of ketamine, midazolam, and neostigmine coadministered with bupivacaine in a caudal epidural to provide intraoperative and postoperative pain relief. Eighty children (ASA status I) aged 5-10 yr undergoing unilateral inguinal herniotomy were allocated randomly in equal numbers (n = 20) into 4 groups to receive a caudal injection of 0.25% bupivacaine (1 mL/kg) with or without ketamine (0.5 mg/kg), midazolam (50 microg/kg), and neostig-mine (2 microg/kg), after the induction of standardized general anesthesia without premedication. Monitoring for pain, sedation, postoperative nausea/vomiting, dizziness, and pruritus was performed by anesthesiologists blinded to the study allocation. The time to first analgesic administration (paracetamol syrup) was longer (P < 0.05) in the bupivacaine-neostigmine group and the bupivacaine-midazolam group than in the other groups. Undesirable effects, such as emesis, pruritus, and dizziness, were comparable in all groups. However, the incidence of hallucination was more frequent in the bupivacaine-ketamine group compared with the other groups. This study shows that single-shot caudal coadministration of bupivacaine-neostigmine and bupivacaine-midazolam was associated with an extended duration of postoperative pain relief.

The combination (granisetron plus dexamethasone) further increases the chance of complete response than granisetron alone. Therefore, the combination might be considered clinically relevant in a high risk setting.

Background:Propofol is one of the widely used intravenous (i.v.) anaesthetics, although pain on injection still remains a considerable concern for the anaesthesiologists. A number of techniques has been tried to minimize propofol-induced pain with variable results. Recently, a 5-HT3 antagonist, ondansetron pre-treatment, has been shown to reduce propofol-induced pain. The aim of our randomized, placebo-controlled, double-blinded study was to determine whether pre-treatment with intravenous granisetron, which is routinely used in our practice for prophylaxis of post-operative nausea and vomiting, would reduce propofol-induced pain.Methods:Eighty-two women, aged 18–50 years, American society of Anaesthesiologist grading (ASA) I–II, scheduled for various surgeries under general anaesthesia were randomly assigned to one of the two groups. One group received 2 mL 0.9% sodium chloride while the other group received 2 mL granisetron (1 mg/mL), and were accompanied by manual venous occlusion for 1 min. Then, 2 mL propofol was injected through the same cannula. Patients were asked by a blinded investigator to score the pain on injection of propofol with a four-point scale: 0=no pain, 1=mild pain, 2=moderate pain, 3=severe pain.Results:Twenty-four patients (60%) complained of pain in the group pre-treated with normal saline as compared with six (15%) in the group pre-treated with granisetron. Pain was reduced significantly in the granisetron group (P<0.05). Severity of pain was also lesser in the granisetron group compared with the placebo group (2.5% vs. 37.5%).Conclusion:We conclude that pre-treatment with granisetron along with venous occlusion for 1 min for prevention of propofol-induced pain was highly successful.

P u b l i c a t i o n s ( w w w . m e d k n o w . c o m ) .Postoperative fever is one of the most common problems seen in the postoperative ward. Most cases of fever immediately following surgery are self-limiting. The appearance of postoperative fever is not limited to specific types of surgery. Fever can occur immediately after surgery and seen to be related directly to the operation or may occur sometime after the surgery as a result of an infection at the surgical site or infections that involve organs distant from the surgery. Therefore, during evaluating postoperative fever, it is important to recognize when a wait -and -see approach is appropriate, when further work-up is needed and when immediate action is indicated.Fever clinically significant. [1] Fever is a rise of the normal core temperature of an individual that exceeds the normal daily variation and Measurement of body temperature occurs in connection with an increase in the hypothalamic Temperature taken orally is about 0.5°C higher than that taken in the axilla or is about 0.5°C below than that taken rectally. Rectal temperature is considered core.The According to studies of healthy individuals 18 to 40 lower oral readings are probably attributable to mouth years of age, the mean oral temperature is 36.8° ± 0.4°C breathing, which is a particularly important factor in (98.2° ± 0.7°F) with low levels at 6 am and higher levels patients with respiratory infections and rapid breathing. between 4 to 6 pm. The maximum oral temperature is Lower oesophageal temperature closely reflects core 37.2°C (98.9°F) at 6am and 37.7°C (99.9°F) at 4 pm; temperature. [2] these values define the 99 th percentile for healthy Abstract set point.individuals. In light of these studies, an am temperature of greater than 37.2°C (98.9°F) or a pm temperature of greater than 37.7°C (99.9°F) would define a fever. However, there is no coding definition or uniform clinical definition of a significant fever. Temperatures exceeding 38°C (100.4°F) and persisting for more than two postoperative days are generally considered to be From: