Antiemetic Protocol Research Articles

Outcome following elective unilateral arytenoid lateralization performed in an outpatient manner is comparable to hospitalization for dogs with laryngeal paralysis.

To compare outcomes and short-term complications of dogs with laryngeal paralysis treated with unilateral arytenoid lateralization performed on an outpatient versus inpatient basis. 44 client-owned dogs. Medical records were retrospectively reviewed to identify dogs that underwent unilateral arytenoid lateralization for the treatment of laryngeal paralysis between 2018 and 2022. Signalment, surgical technique, anesthesia time, comorbidities, laryngeal examination, concurrent procedures, use of prokinetics and sedatives, episodes of vomiting, episodes of regurgitation, duration of hospitalization, postoperative complications, anxiety scores, and pain scores were recorded. Variables were compared between dogs and grouped by outpatient or inpatient management. The overall complication rate was 22.7% (10/44), with 35% (7/20) being in the inpatient group and 12.5% (3/24) being in the outpatient group. The overall mortality rate was 6.8% (3/44). The overall morbidity for hospitalized patients versus those undergoing and outpatient procedure was 5% (1/20) and 4.2% (1/24), respectively. There was no significant difference between overall rate of complications and mortality rates between the inpatient and outpatient groups. Results suggested that outpatient management of dogs with laryngeal paralysis treated with elective unilateral arytenoid lateralization is an appropriate method of postoperative management with no difference in complication or mortality rates. Further prospective studies with standardized surgical, sedative, and antiemetic protocols are warranted to evaluate more definitely.

Olanzapine versus Aprepitant as Antiemetic in Highly Emetogenic Chemotherapy - A Randomized Clinical Trial

Introduction: Chemotherapy induced nausea and vomiting is still a major problem in highly emetogenic chemotherapy protocols. Current guidelines use neurokinin 1 inhibitors, 5-hydroxytryptamine 3 receptor antagonist (5HT3) antagonist and dexamethasone for its prevention. Use of olanzapine has been shown to be effective, safe as and cheap alternative to standard antiemetic protocol. The purpose of this study was to compare effect of Olanzapine on nausea and vomiting when compared to standard antiemetic protocol. Methods: Chemotherapy naive fifty patients receiving highly emetogenic chemotherapy were enrolled. 25 patients were randomly grouped on each arm. In arm A, tab aprepitant 125 mg, inj granisetron 1mg and tab dexamethasone 12 mg on day 1, tab aprepitant 80mg day 2 and day 3, tab dexamethasone 8mg day 2, day 3 and day 4 was given. In Arm B, patients received tab olanzapine 10mg, inj granisetron 1mg and tab dexamethasone 12 mg was given on day 1 and tab olanzapine 10mg PO and tab dexamethasone 8mg day 2, day 3 and day 4 was given. Results: Complete response was 88 % for acute period (24 hours post chemotherapy) and 76% for delayed period (2-5 days post chemotherapy) in Arm A and 84 % for acute period and 72% for delayed period in Arm B, there were no grade 3 and 4 toxicities. Olanzapine containing regimen was comparable with aprepitant containing regimen in control of chemotherapy induced nausea and vomiting. Conclusion: Olanzapine when combined with dexamethasone and granisetron is very effective at controlling nausea and vomiting in patients receiving highly emetogenic chemotherapy. Olanzapine can be a safe, effective and cheaper alternative to aprepitant.

SNAPTIMED study: does the Scottish and Newcastle Antiemetic Protocol achieve timely intervention and management from the emergency department to discharge for paracetamol poisoning?

BackgroundThis study aimed to establish whether the modified 12-hour Scottish and Newcastle Antiemetic Protocol (SNAP) for paracetamol poisoning is associated with improvement in hospital length of stay (LoS), as well...

Evaluation of acupuncture and auriculotherapy in the control of chemotherapy-induced nausea and vomiting: a Pilot Study.

To evaluate the effectiveness of acupuncture and auriculotherapy protocol in relieving chemotherapy-induced nausea and vomiting in cancer patients compared to the antiemetic protocol. Pilot study of a pragmatic two-arm clinical trial: an acupuncture group received systemic acupuncture, auriculotherapy, and antiemetic protocol; a control group used antiemetic protocol. The sample consisted of 42 patients with cancer of the gastrointestinal system or multiple myeloma. The outcome was assessed using the Chemotherapy-Induced Nausea and Vomiting Assessment Tool and the patient's diary. There was no statistically significant difference between groups according to the assessment of the patient's diary and the Assessment Tool of chemotherapy-induced nausea and vomiting. The patients were 60 years old on average and the groups were homogeneous, except for marital status. In the diary, there was no statistical difference between groups and sessions for days of nausea (p = 0.873) and vomiting episodes (p = 0.993). The protocol of acupuncture and auriculotherapy as a complementary treatment of chemotherapy-induced nausea and vomiting was ineffective, considering the limitations of the study.

Megestrol acetate dispersible tablets with a 5-HT3 receptor antagonist and dexamethasone vs. 5-HT3 receptor antagonist plus dexamethasone, can better control chemotherapy-induced nausea and vomiting: a randomized controlled study.

A reasonable and effective control of chemotherapy-induced nausea and vomiting (CINV) plays an important role in the comprehensive treatment of cancer. Megestrol belongs to the 17α-hydroxyprogesterone derivative and is a highly effective synthetic progesterone. Recorded in the instructions may improve appetite and cachexia in patients with advanced tumors. In recent years, clinical practice and small sample studies have shown that megestrol combined with chemotherapy can improve CINV. This randomized controlled trial aimed to evaluate the clinical efficacy and safety of megestrol acetate combined with a 5-Hydroxytryptamine (5-HT3) receptor antagonist and dexamethasone in patients with CINV. Patients with malignant tumors who were treated with cisplatin-containing chemotherapy in our hospital from September 2018 to December 2019 were enrolled. A total of 120 patients were selected and randomly assigned to receive either megestrol acetate dispersible tablets with a 5-HT3 receptor antagonist and dexamethasone (megestrol group) or a 5-HT3 receptor antagonist plus dexamethasone (control group). Megestrol acetate dispersible tablets: 160 mg orally every morning from the day of chemotherapy until it lasts for ten days. Abstract IV of the quality-of-life scale for cancer patients in China was used to assess the quality of life (QOL) of the participants. All adverse reactions during chemotherapy were assessed according to the CTCAE 4.03 evaluation standard issued by the National Cancer Institute and divided into five grades according to severity. For the control of nausea, the rates of complete prevention were significantly higher in the megestrol group than in the control patients during the delayed [53.3% (31/60) vs. 30.0% (18/60), P=0.012] and overall [40.0% (24/60) vs. 15.0% (9/60), P=0.002] observation periods. Moreover, the megestrol combination treatment group also achieved markedly higher rates of complete remission of vomiting than the control group during the delayed observation period [76.7% (46/60) vs. 51.7% (31/60), P=0.001], achieving an overall higher proportion of remission during the study period [68.3% (41/60) vs. 46.6% (28/60), P=0.0016]. The triple antiemetic protocol using megestrol acetate with a 5-HT3 receptor antagonist plus dexamethasone can improve CINV symptoms caused by highly emetogenic chemotherapy (HEC) with cisplatin, with an excellent control effect and few adverse reactions, especially for delayed CINV. Chinese Clinical Trial Registry ChiCTR1800017953.

EP-379 Day-case laparoscopic Nissen fundoplication. Experience from a tertiary center

Abstract Aim For day-case laparoscopic surgery to be successful, patient selection is of the utmost importance. This study aimed to assess the acceptability, feasibility, and results of day-case laparoscopic fundoplication for gastro-esophageal reflux disease (GERD) in a university tertiary care center. Methods A Day-case surgery for GERD was proposed routinely to all patients with proven asymptomatic, uncomplicated GERD. All of them were fulfilling predetermined inclusion criteria from January 2020 and December 2021. All patients underwent standard anesthetic, surgical, analgesic, and antiemetic protocols. Patient age, social circumstances, and other demographics were also recorded as well as any comorbidities and ASA score. The primary endpoint measured was the rate of readmission and complication rates. Results Of 23 patients undergoing laparoscopic fundoplication for GERD during the study period, 16 (69.56%) had day-case procedures. Most of them (81.6%) were discharged 6 to 8h after operation. Five patients were converted to in-patient hospitalization because of nausea (n=1), inadequate pain control (n=3), or anxiety (n=1). There were no complications and no re-admissions recorded. Conclusion Day-case laparoscopic Nissen fundoplication is a feasible, effective, and safe option for treating selected patients with gastroesophageal reflux disease (GERD) subject to careful patient selection and surgeon expertise.

SNAPTIMED study: does the Scottish and Newcastle Anti-emetic Protocol achieve timely intervention and management from the emergency department to discharge for paracetamol poisoning?

Many hospitals across the UK have instituted the modified 12-hour Scottish and Newcastle Anti-emetic Protocol (SNAP) for paracetamol poisoning but, to our knowledge, no validation has been undertaken of the SNAP for its perceived benefit of decreased length of stay (LoS). While the SNAP

Low incidence of postoperative nausea, vomiting, regurgitation, and aspiration pneumonia in geriatric dogs receiving maropitant, famotidine, and fentanyl as part of an anesthesia protocol.

To determine the incidence of and potential risk factors for postoperative regurgitation and vomiting (PORV), postoperative nausea and vomiting (PONV), and aspiration pneumonia in geriatric dogs using premedication with maropitant and famotidine, intraoperative fentanyl, and postoperative fentanyl as part of an anesthetic protocol. 105 client-owned geriatric dogs that underwent general anesthesia for a major surgical procedure between January 2019 and March 2020. Medical records were reviewed to collect data on signalment, historical gastrointestinal signs, American Society of Anesthesiologists (ASA) score, indication for surgery, duration of anesthesia and surgery, patient position during surgery, mode of ventilation, and perioperative administration of maropitant, famotidine, anticholinergics, opioids, colloidal support, NSAID, corticosteroids, and appetite stimulants. The incidence of postoperative regurgitation, vomiting, nausea, and aspiration pneumonia was calculated, and variables were each analyzed for their association with these outcomes. 2 of 105 (1.9%) dogs regurgitated, 1 of 105 (1.0%) dogs developed aspiration pneumonia, 4 of 105 (3.8%) dogs exhibited nausea, and no dogs vomited. Identified possible risk factors included older age (≥ 13 years old) for postoperative regurgitation, regurgitation for postoperative aspiration pneumonia, and high ASA score (≥ 4) for both regurgitation and aspiration pneumonia. The use of an antiemetic protocol including maropitant, famotidine, and fentanyl in geriatric dogs resulted in very low incidences of PORV, PONV, and aspiration pneumonia. Future prospective studies are warranted to further evaluate and mitigate postoperative risks.

A better way to prevent surgical complications after laryngectomy

Introduction: 1. Understanding the implications of post-operative vomiting on the rate of salivary leak amongst patients undergoing laryngectomy. 2. Developing a better way to prevent post-operative vomiting through creation of a departmental policy to minimise risk of vomiting. Methods: We carried out a retrospective study of 24 patients who underwent primary or salvage laryngectomies. A Microsoft Excel sheet data containing the age, sex, smoking status, medical comorbidities, laryngectomy type, reconstructive method and the complications were all recorded. vomiting and the antiemetics particularly in the initial 48 hour period was documented. Results: 19 were male and 5 were female . Age varied from 51-86 and 14 of these patients were smokers. 8 patients had radiotherapy and this was within the 3 year period prior to laryngectomy in all patients. 16 patients had primary and 8 underwent salvage. Reconstructive methods included pectoralis major regional flap in 10 and ALT free flap in 6 patients. 8 patients had direct closure. 4 patients who developed a salivary leak had the post-op vomiting in the first 48 hours contrasting with 7 of the 18 who didn’t have the salivary leak but had post-operative vomiting.The average length of stay amongst those receiving regular anti-emetics was 16 days compared to thenon anti emeticgroup of 23 days. Conclusions: Standardisation of the post-operative anti-emetic protocol would likely reduce the risk of post-operative vomiting with the aim to reduce the rate of salivary leak. We are developing a policy of the prescription of anti-emetics on regular side of drug chart for all laryngectomy patients. Introduction: 1. Understanding the implications of post-operative vomiting on the rate of salivary leak amongst patients undergoing laryngectomy. 2. Developing a better way to prevent post-operative vomiting through creation of a departmental policy to minimise risk of vomiting. Methods: We carried out a retrospective study of 24 patients who underwent primary or salvage laryngectomies. A Microsoft Excel sheet data containing the age, sex, smoking status, medical comorbidities, laryngectomy type, reconstructive method and the complications were all recorded. vomiting and the antiemetics particularly in the initial 48 hour period was documented. Results: 19 were male and 5 were female . Age varied from 51-86 and 14 of these patients were smokers. 8 patients had radiotherapy and this was within the 3 year period prior to laryngectomy in all patients. 16 patients had primary and 8 underwent salvage. Reconstructive methods included pectoralis major regional flap in 10 and ALT free flap in 6 patients. 8 patients had direct closure. 4 patients who developed a salivary leak had the post-op vomiting in the first 48 hours contrasting with 7 of the 18 who didn’t have the salivary leak but had post-operative vomiting.The average length of stay amongst those receiving regular anti-emetics was 16 days compared to thenon anti emeticgroup of 23 days. Conclusions: Standardisation of the post-operative anti-emetic protocol would likely reduce the risk of post-operative vomiting with the aim to reduce the rate of salivary leak. We are developing a policy of the prescription of anti-emetics on regular side of drug chart for all laryngectomy patients.

Establishment of an antiemetic protocol for chemotherapy-induced nausea and vomiting evaluated using the Multinational Association of Supportive Care in Cancer Antiemesis Tool in colorectal cancer

Establishment of an antiemetic protocol for chemotherapy-induced nausea and vomiting evaluated using the Multinational Association of Supportive Care in Cancer Antiemesis Tool in colorectal cancer

P124 Implementing an anti-emetic protocol improves morbidity associated with intravenous therapy for Mycobacterium abscessus in children

P124 Implementing an anti-emetic protocol improves morbidity associated with intravenous therapy for Mycobacterium abscessus in children

Neutropenic sepsis rates in patients receiving bleomycin, etoposide and cisplatin chemotherapy using olanzapine and reduced doses of dexamethasone compared to a standard antiemetic regimen.

To investigate whether the use of a steroid-sparing antiemetic protocol (substituting dexamethasone with olanzapine) affects the incidence of neutropenia and associated hospital admissions in patients receiving bleomycin, etoposide and cisplatin (BEP) chemotherapy. Records from 108 patients who received BEP at St Bartholomew's Hospital, London were divided into two groups according to antiemetic regimen. Group 1 (treated 2008-2013) were treated with a steroid-containing antiemetic protocol and group 2 (treated 2014-2017) were treated according to a steroid-sparing protocol, i.e. using olanzapine. Outcomes included incidence of neutropenia at nadir blood count, severity of neutropenia, hospital admissions attributable to febrile neutropenia (FN) and baseline risk factors associated with FN. Statistical analyses were performed using two-sided chi-squared tests. The baseline characteristics of the two groups were balanced with regard to age, gender, histology, and proportion of patients with International Germ Cell Cancer Collaborative Group poor-risk disease. The incidence of neutropenia of any grade (group 1, 96.2%; group 2, 98.1%) was similar, although group 2 had more patients with severe neutropenia than group 2 (77.7% vs 88.8%). There was a significant difference in FN incidence (group 1, 22%; group 2 7.5%; P=0.030). Most cases of FN occurred in cycle 1. Two baseline characteristics were over-represented in patients who developed FN: female sex and age ≥50years. By comparing two cohorts who received prophylactic antibiotics, our audit suggests that rates of FN-related admissions were lower in the cohort of patients in whom we employed a steroid-sparing antiemetic protocol.

A modified olanzapine-based anti-emetic regimen for the control of nausea and vomiting in patients receiving weekly cisplatin.

Background There is limited data on specific antiemetic protocols for control of chemotherapy-induced nausea/vomiting (CINV) caused by weekly cisplatin regimens. Olanzapine is an active agent against CINV and may offer better control of nausea compared to aprepitant/fosaprepitant-based regimens. The usual antiemetic dose of olanzapine (10mg for four days) causes problems with drowsiness. A lower dose may be as effective with lesser side effects in patients receiving weekly cisplatin. Objective To assess the control of nausea, vomiting, and occurrence of side effects with a modified olanzapine-based antiemetic regimen among patients with carcinoma of the cervix receiving concurrent cisplatin with pelvic radiotherapy. Setting Tertiary cancer hospital in Southern India. Methods We used a modified regimen "mini-OPD", oral olanzapine (5mg) days 1 and 2, intravenous palonosetron (0.25mg) and dexamethasone (12mg) on day 1 of cisplatin administration in patients with carcinoma of the cervix receiving concurrent chemoradiotherapy with weekly cisplatin (40mg/m2/week). At our centre, these patients remained inpatients throughout chemoradiotherapy. CINV-related outcomes were captured in the patients' records by the treating physician in the subsequent week (up to 6 times per patient depending on the number of cycles). We audited these records to calculate the complete response (CR defined as no emetic episodes and no use of rescue medication) rate. Main outcome measure Grades of nausea, vomiting, and drowsiness as per CTCAE v4.0. Results Data of 65 patients (median age: 48years) who received mini-OPD regimen (median doses of cisplatin/patient: 4) was available. The CR rate was 55%. Considering all cycles together (217 weekly assessment points), "no nausea" target was attained in 125 (58%) assessments and "no vomiting" in 168 (77%). There were no significant side effects. Conclusions The mini-OPD regimen is an inexpensive, non-toxic and effective regimen for the prevention of CINV in patients receiving weekly cisplatin concurrent with pelvic radiotherapy.

The compliance with antiemetic guidelines of Turkish medical oncologists. A survey study of Turkish Oncology Group

PurposeWe aimed to investigate the compliance of Turkish Medical Oncologists to antiemetic guidelines for treatment of acute and delayed chemotherapy-induced nausea and vomiting (CINV) in patients receiving high (HEC), moderate (MEC), and low (LEC) emetogenic chemotherapy. MethodA covering electronic mail letter with an online questionnaire link was sent to e-mail and mobile application groups including all 599 members of the Turkish Society of Medical Oncology in January 2018. The online survey has consisted of twelve questions. ResultsQuestionnaire form was responded by 146 of Turkish Medical Oncologists. The most of the participants were following up more than one antiemetic guideline (53%). While compliance with the antiemetic guidelines was higher in acute CINV prophylaxis for HEC and MEC, it was significantly lower in the delayed CINV treatment of HEC and LEC. The highest and lowest compliance rate was found in the prophylaxis of acute and delayed CINV of HEC (92% and 15%, respectively). The incidence of noncompliance for delayed CINV in HEC was statistically significantly higher in those who worked for ≤ five years in an oncology department, under 39 years of age, and non-academicians (p = 0.004, p = 0.042, p = 0.005, respectively). ConclusionsNoncompliance with the antiemetic guidelines is continue to be a big problem in Turkish Medical Oncologists. The use of standardized antiemetic protocols in chemotherapy order forms or a computerized decision-support system is now seen as a better tool to enhance compliance with the guidelines.

Efficacy of an antiemetic therapeutic interchange protocol driven by a medically integrated pharmacy.

133 Background: Control of chemotherapy induced nausea and vomiting (CINV) remains an unmet need. An antiemetic therapeutic interchange protocol was developed to enhance control of CINV. This abstract reports the efficacy results of patients treated with highly emetogenic regimens as defined by NCCN guidelines. Methods: Medically integrated pharmacists imbedded within 2 centers of a community oncology practice evaluated each new chemotherapy order and adjusted antiemetics including a 5HT3 antagonist, steroids, olanzapine and an NK1 inhibitor using an NCCN based protocol. Exact medications depended on insurance coverage and copays. Medications were adjusted for patient comorbidities, drug interactions and patient refusal. All patients were given prochlorperazine and ondansetron for breakthrough nausea and vomiting. Medication education to increase adherence was provided by the pharmacist, nurse and advance practice provider. Patients were evaluated by nursing or pharmacist calls on day 2 and 3 and as needed to characterize CINV using the Multinational Association of Supportive Care in Cancer (MASCC) antiemesis tool that scores CINV on a Likert scale. Based on review of the literature, a score of 3 or higher reflected symptom management failure. Additionally, due to drowsiness as the most commonly reported side effect of olanzapine, each center sought to characterize the risk of drowsiness. Results: 367 consecutive patients treated with highly emetogenic chemotherapy regimens were identified at two centers by pharmacists and followed by nursing or pharmacy calls over a 9-month timeframe: November 2016 to August 2017. 89% of patients had complete control of nausea with only 11% reporting nausea greater than a 3. Additionally, 11% of patients reported drowsiness greater than a 3. Conclusions: Administering a pharmacist driven antiemetic protocol is an effective way to control CINV. While CINV did occur, evaluation shows CINV was mild. We have shown that utilizing an antiemetic therapeutic interchange protocol with a collaborative care team including medically integrated pharmacists facilitates excellent control of CINV.

Olanzapine as antiemetic drug in oncology: a retrospective study in non-responders to standard antiemetic therapy

Background The role of olanzapine in the treatment of chemotherapy-induced nausea and vomiting (CINV) in addition to the antiemetic therapeutic combination with aprepitant, setrons, and corticosteroids has not been well defined. Objective To investigate the effectiveness of the addition of olanzapine to a standard triplet therapy for the prevention of CINV in patients who experienced CINV during their first chemotherapy course, despite receiving a well-managed prevention protocol. Setting One comprehensive cancer centre in France. Method In a retrospective study with comparator, patients with a high risk of emesis were assigned to two groups during two different 6-month periods, before and after the introduction of olanzapine in clinical practice, respectively. In the olanzapine group, the antiemetic protocol for the second course of chemotherapy was reinforced by the addition of olanzapine at 5mg/day from day 1 to 5 in contrast with the control group. Main outcome measure The proportion of patients who experienced neither nausea nor emesis during the delayed phase (24-120h). Results The 25 patients in each group exhibited comparable characteristics and emetic chemotherapy level. During the first course, no significant difference was observed. During the second course, nausea and vomiting were ameliorated in 12 patients in the olanzapine group and 4 patients in the control group (p < 0.05). Nausea (12 vs. 4, p < 0.05) and vomiting (18 vs. 11, p < 0.05) also significantly improved. In the OLZ group, no adverse event was linked to olanzapine use. Conclusion The addition of olanzapine was observed to effectively restore CINV prevention in patients who did not respond to standard antiemetic therapy.

Emesis and nausea related to single agent trabectedin in ovarian cancer patients: a sub-study of the MITO15 project.

The MITO 15 was a prospective, single-arm trial, evaluating trabectedin monotherapy in patients with recurrent ovarian cancer (OC) who were BRCA mutation-carriers or had a BRCAness phenotype. It is largely reported that trabectedin may induce nausea and vomiting but the real emetogenic potential of the drug, in the different schedules, has never been fully described; furthermore, OC patients are known to have an enhanced risk of developing nausea and vomiting due to female gender, abdominal spreading of the disease, and major surgery experienced by most of them. We thought to carry on a sub-study in the MITO 15 context focused on chemotherapy-induced nausea and vomiting (CINV) associated with trabectedin single agent. For all patients enrolled in the trial, we evaluated the antiemetic regimen at the first cycle, acute and delayed CINV, any rescue therapy, any change in the prophylactic antiemetic regimen, and the potential relationship between dexamethasone dosage and incidence of CINV. Overall, our findings were consistent with literature and confirmed that trabectedin can be classified as moderately emetogenic. We observed slightly higher rates of both nausea and vomiting compared to previous experiences with trabectedin monotherapy, probably due to intrinsic features of our population: all females and suffering from ovarian cancer. It seems that in preventing acute CINV, the combination of three drugs was more effective than the doublet; however, the difference did not reach statistical significance; further studies are required to verify such hypothesis. Given the extreme heterogeneity of the antiemetic regimens used, it appears that a standard antiemetic protocol does not exist and more specific guidelines for clinicians are needed.

Exploring the multifactorial nature of postoperative nausea and vomiting in women following surgery for breast cancer.

Postoperative nausea and vomiting (PONV) are two of the most frequent and distressing complications following surgical procedures, with as many as 80% of patients considered to be at risk. Despite recognition of well-established risk factors and the subsequent use of clinical guidelines, 20-30% of women do not respond to antiemetic protocols, indicating that there may be a genetic risk. The purpose of this pilot study was to describe the incidence and explore the risk factors associated with PONV after surgery in women diagnosed with early stage breast cancer. A prospective cohort design was employed to measure PONV in women recruited prior to surgery. DNA was extracted from saliva samples collected prior to discharge. Polymorphisms for seven candidate genes with a known role in one of the neural pathways associated with PONV were included in this study; serotonin receptor (HTR3A), serotonin transport (SLC6A4), tryptophan (TPH), dopamine receptors (DRD2/ANKK and DRD3), catechol-O-methyltransferase (COMT) and histamine (H1). Twenty-nine (29.8%) women experienced nausea and 10 (11%) experienced nausea and vomiting while in the PACU despite administration of multiple antiemetic medications. Women who experienced PONV had higher levels of pain and received more opioids than those women who did not experienced PONV. Odds ratios demonstrated that alleles for the COMT, DRD3, and TPH genes were associated with decreased PONV. The understanding of the multifactorial nature of PONV and the recognition of genetic risk will ultimately lead to the development of personalized interventions to manage these frequent and often debilitating symptoms.

Multimodal antiemetic protocol reduces prevalence of post-operative nausea and vomiting in patients undergoing Lefort I osteotomy, but fails to reduce post-discharge nausea and vomiting

Multimodal antiemetic protocol reduces prevalence of post-operative nausea and vomiting in patients undergoing Lefort I osteotomy, but fails to reduce post-discharge nausea and vomiting

Postoperative nausea and vomiting in the post-anesthetic care unit, a 5-year survey of a quality assurance program in surgical cancer patients

PostOperative Nausea and Vomiting (PONV)is a major side effect related to surgery and anesthesia. Our institution is equipped with Anesthesia Information Management System (AIMS). We used this database to assess and follow the effect of our quality assurance program for PONV. Our AIMS system permits automatic storage of vital signs while other information are indexed by anesthesia providers and PACU personnel. Intra-operative and PACU events were extracted from a database by sequential query language (SQL) interrogation from year 2005 to 2010. A new prophylactic antiemetic protocol was issued for high-risk patients in our institution (dexamethasone, droperidol in the operating room and odansetron in the PACU) and initiated in 2006; in parallel, adjuvant measures influencing PONV were taken for anesthetic interventions. PONV scores and related medications, intra- and postoperative opioids and inhalational anesthetics consumption were extracted, and results were regularly shared with anesthesia providers and PACU personnel as part of quality assurance program. The study concerned 40,045 patients, exhaustivity or completeness was 70% in 2005 but reached 90% in 2010. PONV scores significantly improved during the years after the instauration of the new protocol (31% in 2005 vs. 13% in 2010). Concomitantly, morphine consumption and intra-operative nitrous oxide showed a steady decrease. No significant difference was noticed in the use of inhalational anesthetics. Using our AIMS database, we indirectly monitored the effectiveness of our PONV protocol but also other possible component of a multimodal approach toward these side effects.