Eighty milligrams of aprepitant added to a three-drug multimodal prophylaxis strategy can bring benefits to a high-risk population by reducing PONV episodes and rescue antiemetic requirements. This study was registered in the ClinicalTrials.gov (NCT 02357693) database.

A history of chemotherapy-induced nausea vomiting was a strong predictor for PONV and should be investigated as an added risk factor for PONV in the preoperative period of oncology surgery in prospective studies.

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Inadvertent perioperative hypothermia, defined as a body temperature <36.0°C, is a common outcome of anesthesia that can cause serious consequences to patients. The aim of this study is to determine the prevalence of inadvertent hypothermia among surgical procedures from two referral centers in Brazil and to identify sociodemographic, clinical, or surgery-related predictors of hypothermia. This is a cross-sectional study, conducted at two public hospitals in Brasília, Brazil. After the exclusion of 109 patients, 312 subjects (American Society of Anesthesiologists [ASA] physical status I-III) were enrolled from July 2016 through July 2018. The main outcome measures were the prevalence of hypothermia and its predictors. The mean age of the 312 patients was 43.2 (18.2) years (range 18-85 years), and 186 (59.6%) were female. The prevalence of inadvertent hypothermia was 56.7%. Predictors of hypothermia were perioperative chills ( p = 0.026), patient's body temperature on arrival in the operating room ( p < 0.001), diabetes ( p < 0.001), ASA status III ( p < 0.001), systolic blood pressure ( p < 0.001), general anesthesia ( p < 0.001), medical specialty ( p < 0.001), fentanyl-based anesthesia ( p = 0.002), and surgery time ( p < 0.001). The multivariable model prediction model for hypothermia showed fairly good discrimination (area under the receiver operating characteristic: 79.0%, 95% confidence interval 68.0 to 80.1). Approximately 6 in 10 patients undergoing surgery developed inadvertent perioperative hypothermia. The risk of hypothermia is influenced by a myriad of factors that can be used in simple and low-cost predictive models with adequate discriminatory power.

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 2 nd to the 6 th 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 24 th to the 48 th 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.

There is association between state-anxiety and the emotional exhaustion dimensions of burnout, burnout depersonalization, and trait-anxiety. The occurrence of anxiety can negatively influence the way the individual faces daily stressors, which may be related to the use of ineffective strategies to cope with stress.