No abstract

BackgroundPostoperative nausea and vomiting (PONV) is one of the most common postoperative complications of general anesthesia in pediatrics. Aromatherapy has been shown to be effective in treating PONV in adults. Given the encouraging results of the adult studies, we planned to determine feasibility of doing a large-scale study in the pediatric population.MethodsOur group conducted a pilot randomized controlled trial examining the effect of aromatherapy on post-operative nausea and vomiting in patients 4–16 undergoing ambulatory surgery at a single center. Nausea was defined as a score of 4/10 on the Baxter Retching Faces Scale (BARF scale). A clinically significant reduction was defined as a two-point reduction in Nausea. Post operatively children were administered the BARF scale in 15 min internals until discharge home or until nausea score of 4/10 or greater. Children with nausea were randomized to saline placebo group or aromatherapy QueaseEase™ (Soothing Scents, Inc, Enterprise, AL: blend of ginger, lavender, mint and spearmint). Nausea scores were recorded post intervention.ResultsA total of 162 subjects were screened for inclusion in the study. Randomization occurred in 41 subjects of which 39 were included in the final analysis. For the primary outcome, 14/18 (78 %) of controls reached primary outcome compared to 19/21 (90 %) in the aromatherapy group (p = 0.39, Eta 0.175). Other outcomes included use of antiemetic in PACU (control 44 %, aromatherapy 52 % P = 0.75, Eta 0.08), emesis (Control 11 %, 9 % aromatherapy, P = 0.87, Eta = 0.03). There was a statistically significant difference in whether subjects continued to use the intervention (control 28 %, aromatherapy 66 %, p-value 0.048, Eta 0.33).ConclusionAromatherapy had a small non-significant effect size in treating postoperative nausea and vomiting compared with control. A large-scale randomized control trial would not be feasible at our institution and would be of doubtful utility.Trial registrationClinicalTrials.gov NCT02663154.

The aim of this prospective observational study was to determine if children undergoing bilateral myringotomy and tympanostomy tube insertion with a sevoflurane anesthetic plus intravenous propofol and ketorolac experienced a lower incidence of emergence agitation than those receiving a sevoflurane anesthetic alone. Duration of procedure, length of stay in post-anaesthesia care and level of nursing effort required to care for patients were also assessed. In this study, 49 children younger than 13 years of age received a sevoflurane anesthetic. Fifty-one percent of these patients also received a single injection of propofol 1 mg/kg and ketorolac 0.5 mg/kg at the end of the procedure. Patients were assessed for emergence agitation using the Pediatric Anesthesia Emergence Delirium scale in the post-anaesthesia care unit. Four children receiving a sevoflurane anesthetic alone experienced emergence agitation, while no children receiving propofol and ketorolac experienced emergence agitation (p = 0.05). The length of stay until discharge from the hospital was 6.98 min longer for patients receiving propofol and ketorolac but did not reach statistical significance (p = 0.23). Nurses reported greater ease in caring for patients receiving the propofol and ketorolac injection (recovery questionnaire score 4.50 vs. 3.75, p = 0.002). In this study, adding a single injection of intravenous propofol and ketorolac to the end of a brief sevoflurane anesthetic for bilateral myringotomy with tube insertion was associated with a lower incidence of emergence agitation without significantly increasing the time to discharge from the hospital.

Plasma adiponectin levels are inversely related to several components of the metabolic syndrome and therapeutics that target adiponectin secretion are emerging. Consumption of fish oil is associated with improved metabolic profile, however, there is additional evidence that the protein component of fish may also have metabolic benefits. The aim of this study was to examine the effects of fish fatty acids and peptides on adiponectin assembly and secretion in differentiated 3T3‐L1 adipocytes. Treatment with polyunsaturated fatty acids (PUFAs) increased total cellular adiponectin levels but did not increase adiponectin secretion. In addition, two fractions of molecular weight fractionated (<1000 dalton) salmon peptides, but not cod peptides, stimulated adiponectin synthesis and secretion. Subcellular fractionation on sucrose density gradients revealed that the majority of cellular adiponectin is located in the endoplasmic reticulum (ER). Treatment of the cells with Brefeldin A prevented adiponectin secretion and caused cellular accumulation of the high molecular weight adiponectin oligomers. These data suggest that the ER is an important site of cellular adiponectin accumulation and that treatment with PUFAs or salmon peptides can increase adiponectin in this adipocyte model.Grant Funding Source: Heart and Stroke Foundation of Canada and Natural Sciences and Engineering Research Council of Canada