Brazilian Journal of Anesthesiology最新文献

{"title":"An update on the mechanisms and risk factors for anesthesia-related cardiac arrest in children: a narrative review","authors":"Leandro Gobbo Braz,&nbsp;Jose Reinaldo Cerqueira Braz,&nbsp;Teofilo Augusto Araújo Tiradentes,&nbsp;Daniela de Sa Menezes Porto,&nbsp;Cristiano Martins Beserra,&nbsp;Luiz Antonio Vane,&nbsp;Paulo do Nascimento Junior,&nbsp;Norma Sueli Pinheiro Modolo,&nbsp;Mariana Gobbo Braz","doi":"10.1016/j.bjane.2024.844519","DOIUrl":"10.1016/j.bjane.2024.844519","url":null,"abstract":"<div><p>The relation between surgery and anesthesia safety in children and a country's Human Development Index (HDI) value has been described previously. The aim of this narrative review was to provide an update on the mechanisms and risk factors of Anesthesia-Related Cardiac Arrest (ARCA) in pediatric surgical patients in countries with different HDI values and over time (pre-2001 vs. 2001‒2024). Electronic databases were searched up to March 2024 for studies reporting ARCA events in children. HDI values range from 0 to 1 (very-high-HDI countries: ≥ 0.800, high-HDI countries: 0.700‒0.799, medium-HDI countries: 0.550‒0.699, and low-HDI countries: &lt; 0.550). Independent of time, the proportion of children who suffered perioperative Cardiac Arrest (CA) attributed to anesthesia-related causes was higher in very-high-HDI countries (50%) than in countries with HDI values less than 0.8 (15‒36%), but ARCA rates were higher in countries with HDI values less than 0.8 than in very-high-HDI countries. Regardless of the HDI value, medication-related factors were the most common mechanism causing ARCA before 2001, while cardiovascular-related factors, mainly hypovolemia, and respiratory-related factors, including difficulty maintaining patent airways and adequate ventilation, were the major mechanisms in the present century. Independent of HDI value and time, a higher number of ARCA events occurred in children with heart disease and/or a history of cardiac surgery, those aged younger than one year, those with ASA physical status III‒V, and those who underwent emergency surgery. Many ARCA events were determined to be preventable. The implementation of specialized pediatric anesthesiology and training programs is crucial for anesthesia safety in children.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000411/pdfft?md5=feab13e976f9ba112e4cb5803daf5fd2&pid=1-s2.0-S0104001424000411-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of intranasal dexmedetomidine versus oral midazolam for premedication in pediatric patients: an updated meta-analysis with trial-sequential analysis","authors":"Eduardo Maia Martins Pereira ,&nbsp;Tatiana Souza do Nascimento ,&nbsp;Mariana Gaya da Costa ,&nbsp;Eric Slawka ,&nbsp;Carlos Galhardo Júnior","doi":"10.1016/j.bjane.2024.844520","DOIUrl":"10.1016/j.bjane.2024.844520","url":null,"abstract":"<div><h3>Background</h3><p>Midazolam is routinely used as preanesthetic medication in pediatric patients. Recently, dexmedetomidine has emerged as an alternative as a premedicant. We aimed to add more evidence about the efficacy and safety of two common routes of administration for pediatric premedication: oral midazolam versus intranasal dexmedetomidine.</p></div><div><h3>Methods</h3><p>We systematically searched Randomized Controlled Trials (RCTs) involving patients ≤ 18 years old undergoing preanesthetic medication and comparing intranasal dexmedetomidine with oral midazolam. Risk Ratio (RR) and Mean Difference (MD) with 95% Confidence Intervals (95% CI) were computed using a random effects model. Trial-sequential analyses were performed to assess inconsistency.</p></div><div><h3>Results</h3><p>Sixteen RCTs (1,239 patients) were included. Mean age was 5.5 years old, and most procedures were elective. There was no difference in satisfactory induction or mask acceptance (RR = 1.15, 95% CI 0.97–1.37; <em>p</em> = 0.11). There was a higher incidence of satisfactory separation from parents in the dexmedetomidine group (RR = 1.40; 95% CI 1.13–1.74; <em>p</em> = 0.002). Dexmedetomidine was also associated with a reduction in the incidence of emergence agitation (RR = 0.35; 95% CI 0.14–0.88; <em>p</em> = 0.02). Heart rate and mean arterial pressure were marginally lower in the dexmedetomidine group but without clinical repercussions.</p></div><div><h3>Conclusion</h3><p>Compared with oral midazolam, intranasal dexmedetomidine demonstrated better separation from parents and lower incidence of emergence agitation in pediatric premedication, without a difference in satisfactory induction. Intranasal dexmedetomidine may be a safe and effective alternative to oral midazolam for premedication in pediatric patients.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000423/pdfft?md5=064adeaffd87c463ef99b57c94398c03&pid=1-s2.0-S0104001424000423-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141158894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determination of ED50 and ED95 of remimazolam besylate combined with alfentanil for adult gastroscopy: a prospective dose-finding study","authors":"Pingjuan Wang,&nbsp;Song Xue,&nbsp;Liufei Zhang,&nbsp;Kunkun Gao,&nbsp;Yiqiao Wang","doi":"10.1016/j.bjane.2024.844518","DOIUrl":"10.1016/j.bjane.2024.844518","url":null,"abstract":"<div><h3>Background</h3><p>To explore the median effective dose (ED50) and 95% effective dose (ED95) of remimazolam besylate combined with alfentanil for adult gastroscopy.</p></div><div><h3>Methods</h3><p>This prospective studyenrolled 31 patients scheduled to painless gastroscopy at Anhui No. 2 Provincial People's Hospital between April and May, 2022. 5 µg.kg⁻¹ of alfentanil hydrochloride was used for pre-analgesia. The initial single loading dose of remimazolam besylate was 0.12 mg.kg⁻¹, increased or reduced by 0.01 mg.kg⁻¹ for the next patient with modified Dixon sequential method. The modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S) was used to assess sedation.</p></div><div><h3>Results</h3><p>Combined with alfentanil, the ED50 of remimazolam besylate was 0.147 mg.kg⁻¹ (95% CI: 0.138-0.160 mg.kg⁻¹) and ED95 0.171 mg.kg⁻¹ (95% CI: 0.159-0.245 mg.kg⁻¹). The induction time after injection of remimazolam besylate was 70 ± 25 s, with the anesthesia recovery time and the observation time in resuscitation room 5.13 ± 2.13 min and 2.32 ± 1.6 min, respectively. Twenty nine patients’ vital signs were within acceptable limits during gastroscopy.</p></div><div><h3>Conclusions</h3><p>The ED50 of remimazolam besylate combined with alfentanil for painless gastroscopy was 0.147 mg.kg⁻¹, and the ED95 was 0.171 mg.kg⁻¹.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S010400142400040X/pdfft?md5=cc227e13125149062710d8c44aa348b6&pid=1-s2.0-S010400142400040X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative intensive care allocation and mortality in high-risk surgical patients: evidence from a low- and middle-income country cohort","authors":"Adriene Stahlschmidt ,&nbsp;Sávio Cavalcante Passos ,&nbsp;Guilherme Roloff Cardoso ,&nbsp;Gabriela Jungblut Schuh ,&nbsp;Paulo Corrêa da Silva Neto ,&nbsp;Stela Maris de Jezus Castro ,&nbsp;Luciana Cadore Stefani","doi":"10.1016/j.bjane.2024.844517","DOIUrl":"10.1016/j.bjane.2024.844517","url":null,"abstract":"<div><h3>Background</h3><p>The escalation of surgeries for high-risk patients in Low- and Middle-Income Countries (LMICs) lacks evidence on the positive impact of Intensive Care Unit (ICU) admission and lacks universal criteria for allocation. This study explores the link between postoperative ICU allocation and mortality in high-risk patients within a LMIC. Additionally, it assesses the Ex-Care risk model's utility in guiding postoperative allocation decisions.</p></div><div><h3>Methods</h3><p>A secondary analysis was conducted in a cohort of high-risk surgical patients from a 800-bed university-affiliated teaching hospital in Southern Brazil (July 2017 to January 2020). Inclusion criteria encompassed 1431 inpatients with Ex-Care Model-assessed all-cause postoperative 30-day mortality risk exceeding 5%. The study compared 30-day mortality outcomes between those allocated to the ICU and the Postanesthetic Care Unit (PACU). Outcomes were also assessed based on Ex-Care risk model classes.</p></div><div><h3>Results</h3><p>Among 1431 high-risk patients, 250 (17.47%) were directed to the ICU, resulting in 28% in-hospital 30-day mortality, compared to 8.9% in the PACU. However, ICU allocation showed no independent effect on mortality (RR = 0.91; 95% CI 0.68‒1.20). Patients in the highest Ex-Care risk class (Class IV) exhibited a substantial association with mortality (RR = 2.11; 95% CI 1.54–2.90) and were more frequently admitted to the ICU (23.3% vs. 13.1%).</p></div><div><h3>Conclusion</h3><p>Patients in the highest Ex-Care risk class and those with complications faced elevated mortality risk, irrespective of allocation. Addressing the unmet need for adaptable postoperative care for high-risk patients outside the ICU is crucial in LMICs. Further research is essential to refine criteria and elucidate the utility of risk assessment tools like the Ex-Care model in assisting allocation decisions.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000393/pdfft?md5=ff56b792c16c1173127caf180eb53baa&pid=1-s2.0-S0104001424000393-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing surgical outcomes in dengue patients: strategic approaches to anesthetic management and timing of elective surgery","authors":"Marina Ayres Delgado ,&nbsp;Andre Luis Vieira Drumond ,&nbsp;André dos Santos Mendonça ,&nbsp;Camila Gomes Dall'Aqua ,&nbsp;Márcio Erlei Vieira de Sá Filho ,&nbsp;Bruno Pessoa Chacon ,&nbsp;Lais Mendes Viana","doi":"10.1016/j.bjane.2024.844514","DOIUrl":"10.1016/j.bjane.2024.844514","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000368/pdfft?md5=9d55697b367563d4841fbae6f1f2da48&pid=1-s2.0-S0104001424000368-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cannabinoid products for pain management: recommendations from the São Paulo State Society of Anesthesiology","authors":"Guilherme Antonio Moreira de Barros ,&nbsp;Alexandre Mio Pos ,&nbsp;Ângela Maria Sousa ,&nbsp;Carla Leal Pereira ,&nbsp;Cecília Daniele de Azevedo Nobre ,&nbsp;Cláudia Carneiro de Araújo Palmeira ,&nbsp;Cristina Aparecida Arrivabene Caruy ,&nbsp;Derli Conceição Munhoz ,&nbsp;Durval Campos Kraychete ,&nbsp;Esthael Cristina Querido Avelar ,&nbsp;Fernanda Bono Fukushima ,&nbsp;João Batista Santos Garcia ,&nbsp;João Nathanael Lima Torres ,&nbsp;Karenthan de Abreu Rodrigues ,&nbsp;Mariana Palladini ,&nbsp;Olympio de Hollanda Chacon Neto ,&nbsp;Maria José Carvalho Carmona","doi":"10.1016/j.bjane.2024.844513","DOIUrl":"10.1016/j.bjane.2024.844513","url":null,"abstract":"<div><p>There is growing interest in using cannabinoids across various clinical scenarios, including pain medicine, leading to the disregard of regulatory protocols in some countries. Legislation has been implemented in Brazil, specifically in the state of São Paulo, permitting the distribution of cannabinoid products by health authorities for clinical purposes, free of charge for patients, upon professional prescription. Thus, it is imperative to assess the existing evidence regarding the efficacy and safety of these products in pain management. In light of this, the São Paulo State Society of Anesthesiology (SAESP) established a task force to conduct a narrative review on the topic using the Delphi method, requiring a minimum agreement of 60% among panelists. The study concluded that cannabinoid products could potentially serve as adjuncts in pain management but stressed the importance of judicious prescription. Nevertheless, this review advises against their use for acute pain and cancer-related pain. In other clinical scenarios, established treatments should take precedence, particularly when clinical protocols are available, such as in neuropathic pain. Only patients exhibiting poor therapeutic responses to established protocols or demonstrating intolerance to recommended management may be considered as potential candidates for cannabinoids, which should be prescribed by physicians experienced in handling these substances. Special attention should be given to individual patient characteristics and the likelihood of drug interactions.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000356/pdfft?md5=0634cf53eda3a5d0fb38eee4e6457350&pid=1-s2.0-S0104001424000356-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia and perioperative care management in patients with Dengue Fever: considerations and challenges","authors":"Lorena Ibiapina Mendes de Carvalho ,&nbsp;Liana Maria Tôrres de Araújo Azi ,&nbsp;Plinio da Cunha Leal ,&nbsp;Michelle Nacur Lorentz ,&nbsp;Luis Antonio dos Santos Diego ,&nbsp;André P. Schmidt","doi":"10.1016/j.bjane.2024.844511","DOIUrl":"10.1016/j.bjane.2024.844511","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000332/pdfft?md5=6427763aabd6ee0cc27ad08df4cb9a73&pid=1-s2.0-S0104001424000332-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of early feeding on optimizing gastrointestinal recovery after cesarean section: a non-randomized, open-label, clinical trial","authors":"Graziela Cyntia Silva Santos ,&nbsp;Glaucevane da Silva Guedes ,&nbsp;Alane Cabral Menezes de Oliveira ,&nbsp;Fabiana Andrea Moura","doi":"10.1016/j.bjane.2023.11.002","DOIUrl":"10.1016/j.bjane.2023.11.002","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001423001173/pdfft?md5=06bacc42755717cd4c71ca4d0315bfdb&pid=1-s2.0-S0104001423001173-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of antimicrobial use and incidence of hospital-acquired pneumonia in critically ill trauma patients with pulmonary contusion: an observational study","authors":"Estevão Bassi ,&nbsp;Camila Trevizani Merighi ,&nbsp;Carlos Issamu Tomizuka ,&nbsp;Thais Guimarães ,&nbsp;Fernando da Costa Ferreira Novo ,&nbsp;Sergio Henrique Bastos Damous ,&nbsp;Edivaldo Massazo Utiyama ,&nbsp;Luiz Marcelo Sá Malbouisson","doi":"10.1016/j.bjane.2023.07.011","DOIUrl":"10.1016/j.bjane.2023.07.011","url":null,"abstract":"<div><h3>Background</h3><p>Pneumonia occurs in about 20% of trauma patients with pulmonary contusions. This study aims to evaluate the association between empirical antibiotic therapy and nosocomial pneumonia in this population.</p></div><div><h3>Methods</h3><p>Retrospective cohort of adult patients admitted to a trauma-surgical ICU. The Antibiotic Therapy Group (ATG) was defined by intravenous antibiotic use for more than 48 h starting on hospital admission, while the Conservative Group (CG) was determined by antibiotic use no longer than 48 h. Primary outcome was microbiologically documented nosocomial pneumonia within 14 days after hospital admission. Logistic regression was used to estimate the association between group allocation and primary outcome. Exploratory analyses evaluating the association between resistant strains in pneumonia and antibiotic use were performed.</p></div><div><h3>Results</h3><p>The study included 177 patients with chest trauma and pulmonary contusion on CT scan. ATG were more severely ill than CG, as shown by higher Injury Severity Score, SAPS3, SOFA score, higher rates, and longer duration of mechanical ventilation. In the multivariate analysis, ATG was associated with a lower incidence of primary outcome (OR = 0.25, 95% CI 0.09–0.64; <em>p</em> &lt; 0.01). Similar results were found in the sensitivity analysis with another set of variables. However, each day of antibiotic use was associated with an increased risk of pneumonia by resistant bacteria (OR = 1.18 per day, 95% CI 1.05–1.36; <em>p</em> &lt; 0.01).</p></div><div><h3>Conclusions</h3><p>Empiric antibiotic therapy was independently associated with lower incidence of nosocomial pneumonia in critically ill patients with pulmonary contusion. However, each day of antibiotic use was associated with increased resistant strains in infected patients.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001423000787/pdfft?md5=fe54d34b225c5ccb9d578759102859b2&pid=1-s2.0-S0104001423000787-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10027953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CYP2D6 isoenzyme and ABCB1 gene polymorphisms associated with postoperative nausea and vomiting in women undergoing laparoscopic cholecystectomy: a randomized trial","authors":"Angela Henrique Silva Ribeiro ,&nbsp;Estêvão Luiz Carvalho Braga ,&nbsp;Nathalia de Araújo Gouveia Ferreira ,&nbsp;Beni Olej ,&nbsp;Nubia Verçosa ,&nbsp;Leonardo dos Santos Antunes ,&nbsp;Ismar Lima Cavalcanti","doi":"10.1016/j.bjane.2023.02.002","DOIUrl":"10.1016/j.bjane.2023.02.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Postoperative nausea and vomiting is still a common complication. Serotonin receptor antagonists are commonly used in clinical practice for antiemetic prophylaxis. Interindividual variations in drug response, including single nucleotide polymorphisms, are related to pharmacokinetic and pharmacodynamic changes in these drugs and may lead to a poor therapeutic response. This study aimed to evaluate the influence of CYP2D6 isoenzyme and ABCB1 gene polymorphisms on the frequency of postoperative nausea and vomiting with the use of ondansetron or palonosetron.</p></div><div><h3>Methods</h3><p>A randomized, double-blind clinical trial including 82 women aged 60 years or over undergoing laparoscopic cholecystectomy was conducted. Patients were randomized to receive either ondansetron or palonosetron for postoperative nausea and vomiting prophylaxis. DNA was extracted from saliva. Genetic polymorphisms were analyzed by real-time polymerase chain reaction. The following polymorphisms were analyzed: rs3892097 C/T, rs1128503 A/G, rs16947 A/G, rs1065852 A/G, rs1045642 A/G, rs2032582 C/A, and rs20325821 C/A.</p></div><div><h3>Results</h3><p>Overall, vomiting, and severe nausea occurred in 22.5% and 57.5% of patients, respectively. In the palonosetron group, patients with the GG genotype (rs16947 A/G) experienced more severe nausea (<em>p</em> = 0.043). In the ondansetron group, patients with the AA genotype (rs16947 A/G) presented mild nausea (<em>p</em> = 0.034), and those with the AA genotype (rs1065852 A/G) experienced more vomiting (<em>p</em> = 0.034).</p></div><div><h3>Conclusion</h3><p>A low antiemetic response was observed with ondansetron in the presence of the AA genotype (rs16947 A/G) and the AA genotype (rs1065852 A/G), and a low therapeutic response was found with palonosetron in the presence of the GG genotype (rs16947 A/G) in laparoscopic cholecystectomy.</p></div><div><h3>Register</h3><p>ClinicalTrials.gov.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001423000180/pdfft?md5=81e79526d0bd8aaf7986c892d8ad8b30&pid=1-s2.0-S0104001423000180-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9097113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}