Development Of Postoperative Nausea And Vomiting Research Articles

Preoperatif Durumluk-Sürekli Anksiyete Düzeyi ve Uygulanan Anestezi Tekniğinin Postoperatif Bulantı ve Kusmaya Etkisi

Objective: It was aimed to determine the effect of preoperative anxiety levels and anesthesia of the patients on postoperative nausea and vomiting (PONV). Methods: This study was a cross sectional research. It was conducted with 323 patients at a state hospital between April-June 2022. Data were collected with Sociodemographic and Clinical Characteristics Form, State-Trait Anxiety Inventory (STAI), and Rhodes Index of Nausea, Vomiting, and Retching. Descriptive statistics were applied to analyze the data. Results: The mean age of the patients were 50.5 ± 17.3 years, and 18.9% of them were treated in the general surgery ward. There was a significant difference in the development of PONV in the Trait Anxiety Inventory (STAI-T) severe anxiety group compared to the mild anxiety group (p=0.031) and in the State Anxiety Inventory (STAI-S) moderate anxiety group compared to the mild anxiety group (p=0.012). When anesthetic type was included in the model, there was a significant difference in the development of PONV between the STAI-S moderate and mild anxiety groups (p=0.006). State Anxiety Inventory scores were found to be effective in the group that received general and spinal anesthesia (p=0.013). Postoperative nausea and vomiting development was 41.2% in the moderate anxiety group and 21.7% in the mild anxiety group in the general and spinal anesthesia group. Conclusion: It was determined that undergoing general or spinal anesthesia increases the risk of developing PONV as the STAI-S score increases. Keywords: Surgery, anxiety, nausea, vomiting

Total intravenous anesthesia versus inhalational anesthesia for radiofrequency ablation of hepatic focal lesions: a comparative study

Background The aim of this study was to assess whether total intravenous anesthesia (TIVA) offers an alternative anesthetic technique to inhalational anesthesia for patients undergoing radiofrequency (RF) ablation for hepatic focal lesions. Patients and methods A total of 100 American Society of Anesthesiologist (ASA) physical status II patients were included and divided into two groups: the first group underwent RF ablation of hepatic focal lesions under sevoflurane inhalational anesthesia with a laryngeal mask airway applied, whereas the second group was under TIVA with propofol infusion and face mask was applied. The hemodynamic changes, as well as the changes in Spo 2 , were recorded during the procedure and in the recovery room. The time to speak and the occurrence of postoperative nausea and vomiting (PONV) in the recovery room were also recorded. Results The two groups were comparable as regards the changes in arterial blood pressure values from the baseline. The TIVA group showed reductions in Spo 2 values after propofol loading, which was corrected with the application of an oropharyngeal airway. The time to speak was longer in the TIVA group than in the sevoflurane group, but it did not prolong the time of discharge from the postanesthesia care unit. The sevoflurane group showed higher incidence of PONV in the recovery room. Conclusion TIVA with propofol infusion offers an alternative anesthetic technique for RF ablation of hepatic focal lesions with the advantages of hemodynamic stability, avoiding instrumentation of the airway in a day-case patient without the development of PONV with the same technical success offered by sevoflurane anesthesia.

Postoperative Nausea and Vomiting in Children undergoing Radiofrequency Catheter Ablation: a 5-Year Review of 475 Patients

Background: Postoperative Nausea and Vomiting (PONV) is an important cause of morbidity in children. Radiofrequency Catheter Ablation (RFCA) is established as a key therapy in the management of tachyarrhythmias. In children, the procedure is typically performed under general anaesthesia. The objectives of this study were to quantify the incidence of PONV in the paediatric RFCA population and to identify any factors associated with increased risk of developing PONV. Methods: Following Institutional Ethics Committee approval, a retrospective review of all patients who underwent RFCA over a 5 year period (July 2006-June 2011) was performed. We recorded 4 primary outcomes: Nausea in PACU; Vomiting in PACU; Nausea in first 24 hours post-procedure; Vomiting in first 24 hours post- procedure. In addition we collected extensive data relating to the patient, the type and duration of anaesthetic, the use of anti-emetics and to the procedure itself. The information collected was analysed in order to identify which factors, if any, influenced the development of PONV. Descriptive statistics were used to describe the sample and to calculate the incidence of nausea and vomiting after RFCA. Chi-square and t tests were used to detect factors significantly (p < 0.05) related to these complications. Logistic regression analysis was used to ascertain which of the variables were significantly and independently related to the developing nausea and vomiting. Results: In total, 475 patients scheduled for RFCA were analysed. The overall incidence of nausea in PACU and in the first 24 hours post procedure was 21.3% (101 patients) and 29.5% (140 patients), respectively, while the incidence of vomiting in PACU and in the first 24 hours overall was 26.1% (124 patients) and 35.2% (167 patients), respectively. For all 4 primary outcomes, the use of intra-operative N2O and the omission of an intra-operative anti-emetic were associated with a significant increase in the incidence of nausea and vomiting in the postoperative period. In addition, a longer duration of anaesthetic was associated with an increased incidence of vomiting. Conclusion: Our study confirms a relatively high incidence of PONV in children who undergo general anaesthesia for RFCA, and we have identified factors which significantly increase the risk of developing this significant complication.

Effect of pharyngeal packing during nasal surgery on postoperative nausea and vomiting

Objective The aim of this study was to evaluate the efficacy of pharyngeal packing in reducing postoperative nausea and vomiting (PONV) after nasal surgery by taking into consideration the surgery types. Study Design A prospective, randomized, controlled trial. Setting A tertiary referral center. Subjects and Methods After the study was approved by the local ethics committee, this study was conducted in the Otorhinolaryngology clinic with the collaboration of the Anesthesiology clinic. The development of PONV within 24 hours after surgery was evaluated in patients who were applied a pharyngeal pack (Group 1) or not (Group 2) during nasal surgery. Results There were 104 adult patients for routine nasal surgery included in the current study, yielding 100 (group 1, n = 50; group 2, n = 50) evaluable subjects. No significant difference was found in the incidence of PONV between the two groups at two ( P = 0.41), four ( P = 0.54), eight ( P = 0.51), and 24 hours. According to surgery type, the incidence of PONV after two hours was 71 percent in septorhinoplasty, 68 percent in endoscopic sinus surgery, and 50 percent in septoplasty; after four hours it was 59 percent in septorhinoplasty, 53 percent in endoscopic sinus surgery, and 37 percent in septoplasty; and after eight hours it was 35 percent in septorhinoplasty, 39 percent in endoscopic sinus surgery, and 21 percent in septoplasty. PONV was not seen at 24 hours. Compared to the septoplasty group for which pharyngeal packing was used, significantly lower rates of PONV at four and eight hours were found in the septoplasty group in which pharyngeal packing was not used ( P = 0.02). Conclusion Pharyngeal packing in nasal surgery has no impact on PONV.

The Role of Smoking History in the Development of Postoperative Nausea and Vomiting

We congratulate Dr. Arnberger et al. 1on their recent work using nerve stimulation at the P6 acupuncture site to reduce the incidence of postoperative nausea and vomiting (PONV). This is obviously an important clinical work that could influence the management and multimodal approach to PONV. However, we are concerned about the validity of the conclusions secondary to the disproportionately higher number of smokers in the treatment group. The reasons for this concern are as follows.According to the recently published guidelines from the Society for Ambulatory Anesthesia, the risk factors for PONV fall into four criteria. These include patient risk factors, anesthesia risk factors, surgical risk factors, and type of surgery.2The three most important patient risk factors are female gender, prior history of PONV or motion sickness, and nonsmoking status. In Arnberger et al. ,1they controlled very well for the gender (all patients female, as mentioned in the editorial) and the history of motion sickness risk factors (P = 0.37). Of particular concern is the higher percentage of smokers in the treatment P6 group. Any descriptive statistics with a P value less than 0.15 should be accounted for as a potential confounder, especially if the variable is known to influence the dependent variable. It has been demonstrated in multiple randomized controlled studies that smoking decreases the incidence of PONV and having a higher percentage in the treatment group has a strong possibility of affecting the conclusion. A stratified random sample procedure would have been a much better option to achieve equal numbers of smokers in each group. Given that this was not the case, to account for this potential confounder, a logistic regression analysis should have been used to ensure that the higher percentage of smokers didn’t affect the clinical outcome in this study.Several studies have shown that smoking is an important risk factor in the development of PONV. A Canadian study retrospectively reviewed the charts for 16,000 patients postoperatively for over 2 yr in four teaching hospitals using a multiple logistic regression analysis to show that nonsmokers were 1.79 times more likely to develop PONV.3Stadler et al. 4had a sample size three times higher than Arnberger et al. ,1and showed that nonsmoking status was highly significant for both nausea and vomiting (P = 0.0070 and 0.0074). In a Korean model derived from more than 5,000 patients, a multiple regression analysis showed that smoking status reduced PONV with an odds ratio of 2.0.5The exact mechanism of smoking reducing the incidence of PONV is not fully explained; however, there are several potential explanations. Chronic exposure to one of the chemicals in tobacco may desensitize the patient to anesthetic gas or may a have direct antiemetic effect.6Another explanation is that the cytochrome p450 may be up-regulated in chronic smokers, which may increase metabolism of anesthetic agents and result in less PONV.7In conclusion, we believe that the results of this study may be hampered by the uneven distribution of smokers in the treatment group. Our intent is to encourage further studies in the area and/or further statistical analysis performed to truly elucidate if this amazing effect is caused by this seemingly simple maneuver.*The Ohio State University, Columbus, Ohio. hamdy.elsayed-awad@osumc.edu

Comparison of two instruments for assessing risk of postoperative nausea and vomiting

Two instruments for assessing patients' risk of postoperative nausea and vomiting (PONV) were compared. The existing protocol (protocol 1) assessed PONV risk using 16 weighted risk factors and was used for both adults and pediatric patients. The new protocol (protocol 2) included a form for adults and a pediatric-specific form. The form for adults utilized the simplified risk score, calculated using a validated, nonweighted, 4-point scale, and categorized patients' risk of PONV as low, moderate, or high. The form for pediatric patients used a 7-point, non-weighted scale and categorized patients' risk of PONV as moderate or high. A list was generated of all patients who had surgery during August 2005, for whom protocol 1 was used, and during April 2006, for whom protocol 2 was used. Fifty patients from each time period were randomly selected for data analysis. Data collected included the percentage of the form completed, the development of PONV, the number of PONV risk factors, patient demographics, and the appropriateness of prophylaxis. The mean +/- S.D. number of PONV risk factors was significantly lower in the group treated according to protocol 2 ( p = 0.001), but fewer patients in this group were categorized as low or moderate risk and more patients were identified as high risk (p < 0.001). More patients assessed by protocol 2 received fewer interventions than recommended (p < 0.001); however, the frequency of PONV did not significantly differ between groups. Implementation of a validated and simplified PONV risk-assessment tool appeared to improve form completion rates and appropriate risk assessment; however, the rates of PONV remained similar and fewer patients received appropriate prophylaxis compared with patients assessed by the existing risk-assessment tool.

Blood‐borne factors possibly associated with post‐operative nausea and vomiting: an explorative study in women after breast cancer surgery

The pathophysiology behind post-operative nausea and vomiting (PONV) is still not fully understood, especially with respect to gender. According to PONV risk scores, female gender is the strongest predictor for PONV. The risk for PONV after general anaesthesia for breast cancer surgery is 50-80%. The aim of the present explorative study was to identify blood-borne factors that might be associated with the development of PONV in women undergoing breast cancer surgery as a basis for further studies. Fifty patients were enrolled prospectively in the study. A standardized sevoflurane-based anaesthetic was used. Blood samples for the analysis of vasopressin, gastrin, cholecystokinin, epinephrine, norepinephrine, dopamine, serotonin, platelet count and blood glucose were taken at six pre-determined time points peri-operatively, and PONV was assessed during 24 h. PONV was found in 27 of 47 patients completing the study. Patients with PONV had a larger variability of the platelet count (P = 0.001), a reduced platelet count on the first post-operative day (P = 0.02) and a less pronounced relationship between the platelet count and whole blood serotonin (P = 0.004) compared with non-PONV patients. A lack of a decrease in epinephrine levels in response to the induction of anaesthesia (P = 0.03) and increased levels of vasopressin (P < 0.001), epinephrine (P = 0.005) and blood glucose (P = 0.004) were observed in the early post-operative period in PONV patients. Three different platelet-associated factors and an altered epinephrine pattern were found to be associated with the occurrence of PONV after breast cancer surgery.

A Comparison of the Efficacy and Safety of Tropisetron and Tropisetron Plus Dexamethasone as Antiemetics for Elective Thyroidectomy

Background: Thyroidectomy is associated with a relatively high incidence of postoperative nausea and vomiting (PONV) ranging from 63% to 84%. In this study, we evaluated the safety and the antiemetic effects of tropisetron 30μg/kg or tropisetron 30μg/kg plus dexamethasone 5 mg in patients undergoing thyroidectomy under a standard anesthetic technique without narcotics. Methods: Sixty-eight patients undergoing thyroidectomy were randomized to receive a placebo (Group C, n = 28), tropisetron 30μg/kg (Group T, n = 23) or tropisetron 30μg/kg plus dexamethasone 5 mg (Group T + D, n = 17) IV over 2-5 minutes immediately before the induction of anesthesia. The effects of these regimens on the development of PONV, adverse events and need for rescue antiemetics were analyzed for the 0 to 1 hour and 1 to 24 hours postoperative periods. Results: In the 0 to 1 hour postoperative periods, the incidence of PONV in group C, T and T + D was 35.7%, 17.4% and 17.6% respectively, which showed no significant difference among the three groups (P > 0.05). In the same period, the incidence of retching or vomiting in Group C, T and T + D was 14.3%, 0% and 0% respectively, which showed a significantly lower incidence in Group T and T + D than Group C (P 0.05). During the first 24 hours postoperatively, the overall incidences of PONV was 67.9% for group C, 60.9% for group T and 58.8% for group T + D, which showed no siginificant difference among the three groups (P > 0.05). Group T + D patients had more headache compared to other groups, but there was no significant difference in the

The management of post-operative nausea and vomiting.

Despite the advent of new technology and pharmacological agents, post-operative nausea and vomiting (PONV) continues to have an incidence of 20-30% today. Development of PONV can lead to serious complications such as aspiration, dehydration, electrolyte disturbances and disruption of the surgical site. PONV leads to increased cost of treatment, and may be associated with increased anxiety, dissatisfaction with the surgical experience and anticipatory nausea in the future. The mechanisms of PONV are examined with associated risk factors. A review of the literature of PONV management is included covering pharmacological, dietary and behavioural interventions; culminating in the development of assessment and management guidelines and identification of areas for further study.