Search Results (168)

Background: Robotic deep inferior epigastric artery perforator (DIEP) flap surgery is a technique used for autologous breast reconstruction to maintain the integrity of the rectus abdominis muscle while also utilizing robotic assistance for flap harvest. This study assesses postoperative outcomes of patients undergoing robotic DIEP flap reconstruction through the measurement of postoperative pain, narcotics use, and antiemetic usage. Methods: A retrospective analysis was performed for patients undergoing robotic DIEP flap breast reconstruction between March 2024 and March 2025. Postoperative pain scores (1–10 scale), narcotics usage (measured in oral morphine equivalents), antiemetic usage, and complications were recorded. Patient outcomes were compared to a control group of 40 patients who had undergone abdominal-based free flap breast reconstruction. Results: Overall, 14 patients underwent robotic DIEP flap breast reconstruction, representing 24 breasts. The average patient age was 56.5 (range: 30–73). Ten patients underwent bilateral breast reconstruction, and four underwent unilateral breast reconstruction. The average length of stay postoperatively was 4.86 days (±1.23 days), and the return of bowel function occurred in 1.29 days (±0.47 days). No patients experienced an unplanned return to the OR or flap failure. Average pain scores on postoperative day 1 (POD1), 2 (POD2), and 3 (POD3) were 4.0 (±0.6), 3.4 (±0.6), and 2.93 (±0.5), respectively. Average antiemetic usage totalled 1.25 doses (±0.25). Average daily OME use was 27.7 (±5.0) for POD1, 25.96 (±6.3) for POD2, and 21.23 (±7.11) for POD3. This averaged to a total hospital OME use of 74.9 (±15.7) per patient. Patients undergoing robotic DIEP flap reconstruction required a significantly lower narcotics dosage, as well as a lower antiemetic dosage, during the first three days postoperatively compared to the control abdominal free flap group. Average pain scores in the robotic DIEP flap reconstruction patient group were also significantly decreased, specifically in POD2 and POD3. Conclusions: The robotic DIEP flap offers advantages in autologous breast reconstruction compared to other abdominal free flap reconstructive methods. In this limited retrospective study, the use of the robotic DIEP flap lowers chances of flap failure and complications, while also improving narcotics use, antiemetic use, and postoperative pain. Full article

Background and Objectives: Nausea and vomiting (NV) are common and distressing adverse effects among cancer patients undergoing treatment. Despite the widespread use of pharmacological antiemetics, these medications are often insufficient for controlling nausea and may cause medication interactions and side effects. Acupuncture has been proposed as a complementary therapy; however, the comprehensive analysis of its effects on NV across all emetogenic cancer treatments remains limited. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of acupuncture in managing NV in cancer patients undergoing chemotherapy, radiotherapy, or surgery. Materials and Methods: We conducted a comprehensive search across three electronic databases and two clinical registry platforms from inception to December 2024. Randomized controlled trials (RCTs) evaluating acupuncture for NV in cancer patients were included. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Safety outcomes were assessed based on the Common Terminology Criteria for Adverse Events (CTCAE). Results: Seventeen RCTs met the inclusion criteria, with twelve studies included in the meta-analysis. Acupuncture did not demonstrate significant effects on acute nausea (RR: 0.98; 95% CI: 0.84–1.15; p = 0.80) or acute vomiting (RR: 0.93; 95% CI: 0.65–1.32; p = 0.67). However, it significantly reduced delayed vomiting (RR: 0.76; 95% CI: 0.61–0.95; p = 0.02). Subgroup analysis demonstrated significant effects when acupuncture was administered for at least five days (RR: 0.56; 95% CI: 0.39–0.81; p = 0.002). The most frequently used acupoints were PC6, ST36, CV12, LI4, LR3, and ST25. No serious adverse events related to acupuncture treatments were reported, with only minor AEs such as localized bleeding and mild bruising observed. Conclusions: Acupuncture represents a safe and effective complementary therapy for managing delayed vomiting in cancer patients receiving emetogenic treatments. Clinicians can anticipate optimal benefits from at least five days of treatment, particularly using acupoints PC6, ST36, CV12, LI4, LR3, and ST25. Further high-quality studies are needed to establish standardized treatment regimens and explore its comprehensive effects on NV. Full article

Cannabinoid hyperemesis syndrome (CHS) is characterized by a pattern of cyclic vomiting and abdominal pain despite an absence of an organic cause, occurring in regular cannabis users. This syndrome was first described in 2004. Initially considered rare, with the increased use and legalization of cannabis, a growing incidence of diagnoses has been observed. Data on the pediatric population are still scant despite the high rate of cannabis consumption in young people. In this narrative review, we aim to synthesize the growing knowledge about CHS and its epidemiology, pathophysiology, diagnosis, and management in the pediatric population. Findings in this review highlight the diagnostic challenges in pediatric patients, the limited efficacy of standard anti-emetic therapies, and the central role of cannabis cessation in treatment. This review underscores the need for increased awareness of CHS in pediatric practice to ensure timely diagnosis and avoid unnecessary investigations and interventions. Full article

Neuro-oncology focuses on the diagnosis and treatment of brain tumors, which, despite their rarity, are associated with high mortality due to their invasiveness and limited treatment options. Emerging evidence suggests that dopamine (DA), a neurotransmitter crucial for cognitive and emotional processes, and its receptors may influence tumor growth and the tumor microenvironment. This study aimed to evaluate the potential anticancer effects of repurposed antipsychotic dopamine-targeting drugs (Clozapine, CLZ; Pimozide, PIM; Olanzapine, OLZ; and Risperidone, RIS) and antiemetic drugs (Domperidone, DOM; Droperidol, DRO) on neuroblastoma (SH-SY5Y) and glioblastoma (A172) cell lines, and to assess whether their efficacy is modulated by oxidative stress and DA synthesis. The drugs were first tested individually, followed by co-treatment with tyrosine (Tyr), a dopamine precursor, and hydrogen peroxide (H₂O₂), an inducer of oxidative stress. Additionally, drug activity was evaluated in the simultaneous presence of H₂O₂ and Tyr. CLZ exhibited the highest cytotoxicity in both cell lines, suggesting strong anticancer potential and also synergism among the different combinations, particularly in SH-SY5Y. Liquid chromatography of the extracellular medium showed greater Tyr consumption in SH-SY5Y compared to A172 cells, indicating a higher dependence on extracellular Tyr to mitigate drug- and/or stress-induced cytotoxicity. In summary, several of the repurposed antipsychotics demonstrated cytotoxic effects on central nervous system tumor cells, with CLZ showing the most promising activity, even under oxidative stress conditions. These findings support further investigation into dopamine-targeting drugs as potential therapeutic agents in neuro-oncology. Full article

Background: Zolbetuximab, a monoclonal antibody targeting claudin-18.2 (CLDN18.2), which was recently approved as first-line treatment for advanced gastric cancer (AGC), presents unique safety challenges, particularly infusion-related gastrointestinal toxicity and hypoalbuminemia. This study aimed to present our experience with zolbetuximab administration in patients with AGC, focusing on the safety and management effectiveness of our adapted protocol in routine clinical practice. Methods: This study presents our single-institution real-world experience implementing a proactive management protocol (“Project VYLOY”) using zolbetuximab to mitigate these toxicities. We adopted a standardized stepwise infusion protocol and antiemetic premedication to reduce infusion-related nausea and vomiting. Patients with CLDN18.2-positive advanced gastric or gastroesophageal junction adenocarcinoma who received zolbetuximab combined with chemotherapy were included. Results: Twenty-four patients were included. The median infusion duration was 215 min, with an interruption rate of 25.0%. In cycle 1, 62.5% experienced infusion-associated adverse events, primarily grade 1 nausea (54%) and vomiting (25%). Hypoalbuminemia (grade ≥ 2) occurred in 57% of first-line patients, potentially linked to zolbetuximab-induced gastritis and gastrointestinal protein loss. Proactive antiemetic support and infusion rate adjustments substantially reduced infusion interruptions in subsequent cycles (10.9%). Patients without prior gastrectomy had higher nausea and vomiting rates, confirming the stomach’s role in mediating toxicity. Conclusions: Our results suggest that proactive management can improve the safety and tolerability of zolbetuximab, especially by reducing infusion-related toxicity in real-world practice. Full article

Objective: This study examines the incidence and predictors of complications following intravenous (IV) sedation in children and adults. Methods: A retrospective analysis of 1463 surgical procedures under IV sedation was conducted at the University Hospitals of Leuven (2018–2022). Patients aged 10–91 years were divided into pediatric (10–16 years, n = 731) and adult (17–91 years, n = 732) groups. Data were analyzed using multiple regression models (p < 0.05). Results: Side effects occurred more often during recovery (children: 20.1%, adults: 9.4%) than intraoperatively (children: 4.8%, adults: 2.7%). The most common side effects were nausea (children: 10.5%, adults: 8.4%) and prolonged sedation (children: 6.0%, adults: 1.8%). Younger children had higher risks of intraoperative side effects (p = 0.02), hypotension (p < 0.001), and longer recovery (p < 0.001). Ketamine increased nausea risk in children (p = 0.02). Females had a higher risk of prolonged sedation (p = 0.03) and nausea (p = 0.01). Older adults had fewer recovery-related side effects (p = 0.03) and shorter recovery times (p = 0.05). Conclusions: IV sedation is a safe alternative to general anesthesia in oral surgery when properly monitored. However, nausea and prolonged sedation remain concerns, particularly in younger children and females. Prophylactic anti-emetics and cautious Ketamine use may help mitigate risks. Full article

Neuroendoscopy is a minimally invasive surgical technique used to treat brain pathologies such as hydrocephalus, arachnoid cysts, and skull base tumors. While it offers several advantages, including reduced tissue trauma and lower morbidity, it is associated with a high risk of postoperative nausea and vomiting (PONV). This paper provides a narrative review of the literature on the incidence, pathophysiology, and management of PONV in patients undergoing neuroendoscopic procedures. The review includes several studies published between 2001 and 2024, analyzing specific risk factors such as female gender, postoperative opioid use, extended endoscopic approaches, and cavernous sinus dissection. PONV prevention strategies include a multimodal approach combining total intravenous anesthesia (TIVA) with propofol, perioperative hydration, and pharmacological prophylaxis (5-HT3 receptor antagonists, NK1 antagonists, dexamethasone, and droperidol). Despite advances in surgical and anesthetic techniques, further research is needed to develop procedure-specific protocols and optimize PONV management in neuroendoscopy. Full article

Objective: This study aimed to explore the unmet palliative care needs among young and middle-aged (YMA) Chinese patients with advanced cancer. Methods: We used the principle of maximum difference. A total of 16 YMA patients with advanced cancer from cancer hospital were recruited. Semi-structured, in-depth, and face-to-face interviews were conducted from 28 August 2023 to 23 October 2023. The recorded audio of each interview was typed into Word software with each personal code. The interview transcripts were coded using the method of inductive content analysis. Results: Four themes and 14 sub-themes were identified in participants’ descriptions of care needs: (1) symptom management needs: need for pain relief, need for anti-emetics, and need for aid in managing fatigue; (2) psychological support needs: help reducing fear of pain, help achieving a better death, and help with parents’ negative reactions; (3) social support needs: taking care of children, emotional support from family members, consultation and emotional support from other cancer patients, and company and guidance of healthcare personnel; (4) information needs: better understanding of disease trajectory and future care needs, better access to palliative care information, and more participation in medical decision-making. Conclusions: According to the results of this study, the unmet palliative care needs of YMA patients with advanced cancer are diverse, but they have not been fully recognized and met. Therefore, medical staff should develop effective management strategies and explore patients’ needs in an all-around way. Future studies will further develop the scale of unmet needs for palliative care to accurately identify needs and improve patients’ quality of life. Full article

Vomitoxin is a member of the monotrichous mycotoxin family with a complex chemical structure and significant biological activity. This toxin has strong immunosuppressive toxic effects and can cause serious damage to human and animal health. In this study, an on-site immune detection method based on an immune SiO₂@QD fluorescent probe was developed, which realized the rapid and quantitative detection of emetic toxins in grains. Polyethyleneimine (PEI) is a polymer containing a large number of amino groups, and the binding of PEI to the surface of quantum dots can serve to regulate growth and provide functionalized groups. A SiO₂@QD nanotag with good dispersibility and a high fluorescence intensity was synthesized by combining a PEI interlayer on the surface of SiO₂ nanospheres. Utilizing the electrostatic adsorption of the amino group in PEI, CdSe/ZnS QDs were self-assembled on the surface of SiO₂ nanospheres. In the stability test, the SiO₂@QDs could maintain basically the same fluorescence intensity for 90 consecutive days in the dark at 4 °C, showing a high fluorescence stability. The fluorescence-enhanced QD immune probe was formed by coupling with anti-DON monoclonal antibodies through carbodiimide chemical synthesis. For the detection of spiked wheat flour samples, the immuno-SiO₂@QD fluorescent probe showed excellent sensitivity and stability, the detection limit reached 0.25 ng/mL, and the average recovery rate was 92.2–101.6%. At the same time, the immuno-SiO₂@QD fluorescent probe is simple to operate, is capable of rapid responses, and has great potential in the rapid detection of vomitoxins in grains. Full article

Introduction: Methadone is an opioid-sparing opioid and it is increasingly used in children undergoing surgery due to its beneficial effects on postoperative pain scores, decreased opioid requirements, and fewer adverse effects compared to other opioids. Intraoperative methadone is not well studied in pediatric cardiac surgery. We hypothesized that intraoperative methadone-based analgesia would provide comparable effectiveness in pain management to non-methadone-based analgesia, including caudal morphine, following pediatric cardiac surgery. Methods: We conducted a retrospective cohort study of 287 children undergoing cardiac surgery using single institutional electronic health records with Society of Thoracic Surgeons database outcomes. Patients were administered intravenous opioids plus caudal morphine (≤6 years) or intravenous opioids in the non-methadone group versus intravenous methadone (two 0.1 mg/kg doses given intraoperatively) with or without additional intraoperative opioids. The primary outcome was postoperative opioid use in morphine milligram equivalents (MME)/kg. Results: This study included 287 pediatric cardiac surgical patients with a mean age of 3.8 years, 59% male, and 72% White. Among 287 patients, 67 (23%) received intraoperative methadone. Unadjusted analysis showed the methadone group had lower postoperative opioid use on the day of surgery (median = 0.3 vs. 0.5 MME/kg, p = 0.005). Adjusted analyses showed there were no significant differences in postoperative opioid use, average pain, maximum pain, antiemetic use, reintubation, and use of naloxone between methadone and non-methadone groups. Hospital length of stay was 2.62 times longer (95% CI: [1.55, 4.41] p < 0.001) in the methadone group vs non-methadone group, but this was only shown in the younger children (≤6 years), who also had higher max pain scores in the methadone group. All outcomes were similar between analgesia groups in older children (>6 years). Conclusions: Intraoperative methadone-based analgesia had comparable effectiveness in postoperative opioid use, pain, and antiemetic use compared to non-methadone-based intraoperative pain management for pediatric cardiac surgery. Large prospective studies of perioperative methadone are needed to examine methadone’s analgesic benefits in children undergoing cardiac surgery. Full article

This study aimed to assess the efficacy of a veterinary enhanced recovery after surgery (Vet-ERAS) protocol in dogs undergoing emergency laparotomy (EL). The protocol, adapted from human medicine, encompassed a multidisciplinary approach and interventions such as early goal-directed fluid resuscitation, antibiotic prophylaxis, anti-emetic therapy, multimodal analgesia, and early enteral nutrition. A prospective observational study compared outcomes between dogs managed with the Vet-ERAS protocol (n = 59) and historical controls (n = 82). Implementation of the Vet-ERAS protocol resulted in a significant reduction in perioperative complication rates (p = 0.003) and 15-day mortality (5% vs. 20.7%). Intraoperative complications, including tachycardia and hypothermia, were significantly lower in the Vet-ERAS group. Compliance with the protocol improved over time (p = 0.01). These findings suggest that integrating the Vet-ERAS protocol into perioperative management can improve outcomes in dogs undergoing EL. Full article

Background/Objectives: Obstetric patients undergoing elective cesarean section (CS) with combined spinal–epidural (CSE) anesthesia often experience intraoperative nausea and vomiting (N&V). While prophylactic treatment with antiemetic drugs can be effective, it may also carry potential adverse effects for both the mother and the baby. To address this, we designed a randomized clinical trial to assess the effectiveness of transdermal scopolamine patches and electrical P6 stimulation as preventive measures for N&V in patients scheduled for elective CS under CSE anesthesia. Methods: Following the Institutional Review Board approval and informed consent, a total of 240 patients were randomly allocated into three groups: (1) transdermal scopolamine, (2) P6 stimulation (via a peripheral nerve stimulator), and (3) combined transdermal scopolamine and P6 stimulation, with 80 parturients in each group. The primary outcome was defined as the presence or absence of intraoperative nausea and vomiting during the procedure. Results: The incidences of intraoperative nausea and vomiting were similar across all three treatment groups, with no significant differences observed at any point during the surgery. Additionally, there were no notable differences in overall satisfaction with anesthetic care among the three study groups. Conclusions: These findings indicate that while both transcutaneous P6 acupoint stimulation and transdermal scopolamine are straightforward, safe, and effective methods, combining these two antiemetic strategies does not offer additional benefits in reducing nausea and vomiting. Nevertheless, both approaches may be particularly appealing to patients and obstetric anesthesiologists who prioritize treatments with fewer potential side effects. Full article

This study aimed to evaluate the efficiency and sensitivity of real-time video capsule endoscopy (RT-VCE) when detecting surgical and nonsurgical gastric lesions in dogs that presented with acute vomiting. Additionally, the patient tolerance and the utility of the RT-VCE data for clinical decision-making were assessed. Eleven client-owned dogs with an acute onset of vomiting were included. Each dog received an antiemetic and antacid before undergoing an RT-VCE (MC1200, MiroCam^®, Intromedic, Seoul, Republic of Korea). We independently reviewed the RT-VCE images to assess the image quality, detect gastric lesions, and make clinical decisions. The time taken to reach a diagnosis and the inter-clinician agreement were evaluated. RT-VCEs were successfully completed in all the dogs, with a mean time to diagnosis of 21.82 ± 15.26 min (range: 1–48 min). Both clinicians reached unanimous agreement on the RT-VCE findings. Five dogs were diagnosed with gastric foreign bodies and underwent surgical removal, while the remaining six were diagnosed with gastritis, a gastric ulcer or erosion, or hemorrhages, which were managed medically. No adverse effects, including vomiting, were observed after the capsule administration. RT-VCE proved to be an effective, accurate, and well-tolerated diagnostic method for evaluating gastric conditions in dogs with acute vomiting. Its rapid diagnostic capability and non-invasive nature make it a valuable modality in emergency veterinary settings. Full article

Background/Objectives: Remimazolam, a short-acting benzodiazepine, promotes quick and consistent recovery from anesthesia. However, flumazenil’s rapid antagonistic effects on benzodiazepines during the emergence from anesthesia are thought to increase the risk of postoperative nausea and vomiting (PONV). This study aimed to compare the rate of PONV in monitored anesthesia care (MAC) with remimazolam versus conventional MAC with dexmedetomidine. Methods: This single-center retrospective study included all cases with transcatheter aortic valve replacements (TAVR) performed using MAC at our institution between January 2019 and April 2023. The patients were divided into remimazolam and dexmedetomidine–propofol groups based on the anesthetic method used. We used propensity score matching at a 1:1 ratio to account for the patient backgrounds. The primary outcome measure was the rate of PONV within 48 h. Secondary outcome measures included the severity of PONV and the number of antiemetics administered. Results: This study included 177 subjects. Following propensity score matching, 61 patients were allocated to each group. The incidence of PONV within 48 h after surgery was 4.92% in the remimazolam group and 3.28% in the dexmedetomidine–propofol group, with no significant difference between the two groups (p = 0.817). There was no significant difference between the two groups in terms of the secondary outcomes, including the severity of PONV (p = 0.190) and the use of antiemetics (p = 0.690). Conclusions: In TAVR with MAC and remimazolam, the incidence of PONV within 48 h was comparable to that of dexmedetomidine. Full article

Background/Objectives: Cancer pain is prevalent across all stages of the disease, significantly impacting patients’ lives. Despite the availability of guidelines, its assessment and management remain suboptimal in many clinical settings. This study aimed to explore how healthcare professionals in Italy assess and manage cancer pain, identifying gaps and educational needs to improve adherence to best practices. Methods: A multidisciplinary Scientific Board designed an online survey comprising 28 items addressing demographics, pain assessment tools, perception of pain, pharmacological management, adverse effects, and barriers to care. The survey targeted oncologists, nurses, radiotherapists, and surgeons within the Italian Network of Supportive Care in Oncology. Data were collected from March to May 2024 and analyzed descriptively. Results: Eighty-five professionals participated, predominantly oncologists (63.5%). Most respondents utilized pain scales, with the Numerical Rating Scale (60.3%) being the most frequent. However, specific tools like the Edmonton Symptom Assessment System (ESAS) were underutilized, possibly due to limited training and time constraints. Factors influencing analgesic choice included patient comorbidities (30.3%) and polypharmacy (28.0%). The main barriers to effective pain management included inadequate training (85.5%) and poor communication between patients and caregivers (40.6%) and within care teams (31.9%). Preventive measures for opioid-induced adverse events were widely employed, with laxatives (52.7%) and antiemetics (40.5%) being the most common. Conclusions: Findings underscore the need for structured training programs, improved communication, and integration of validated assessment tools. A multidisciplinary, proactive approach to cancer pain assessment and management is essential to optimize care and reduce its burden across all disease stages. Full article