Early Postoperative Nausea And Vomiting Research Articles

Retrospective Study on the Incidence of Postoperative Nausea and Vomiting and Hypotension During Orthognathic Surgery Using Propofol or Remimazolam

Objective This study aimed to evaluate the incidence of early (up to 2 h) and late (2–24 h) postoperative nausea and vomiting (PONV) and hypotension in patients who underwent general anesthesia for orthognathic surgery using propofol or remimazolam along with remifentanil. Methods This retrospective chart review included healthy adult patients under the age of 60 who underwent orthognathic surgery using propofol (P group) or remimazolam (R group) from January 2021 to March 2022. Records were reviewed to gather PONV and intraoperative hypotension data as well as patient characteristics and other variables. Results Early PONV was significantly lower in the P group vs the R group (9.5% vs 34.1%, respectively; P = .002), although the difference in late PONV was insignificant (36.9% vs 51.2%, respectively; P = .13). A higher incidence of intraoperative hypotension was noted in the P group (22.6%) vs the R group (2.4%; P = .004); however, there were no differences in average intraoperative systolic blood pressure or vasopressor administration. Conclusion These results suggest that propofol is associated with a lower incidence of early PONV as compared to remimazolam; however, antiemetics are still recommended given the frequency of late PONV in both groups. Propofol also caused more episodes of intraoperative hypotension vs remimazolam, but the increase in transient hypotension is likely to be irrelevant during orthognathic surgery in healthy adults under the age of 60.

Longer oxygen administration after surgery dose not reduce postoperative nausea and vomiting: An open label, clinical controlled study

BackgroundFrom previous studies, “intraoperative” supplemental oxygen did not seem to affect postoperative nausea and vomiting (PONV). However, less attention has been directed toward the relationship between “postoperative” oxygen administration and PONV. We have experienced some cases in which PONV was suppressed after oxygen was resupplied, and others in which PONV occurred immediately after stopping oxygen. Therefore, we hypothesized that administering oxygen postoperatively should have an antiemetic effect, and that longer postoperative oxygen administration should reduce PONV. MethodsThis study is a single-center, open label, and quasi-randomized controlled trial. Participants were patients undergoing laparoscopic gynecological surgery. They were randomly allocated to either a 1 h (1H) group or 5 h (5H) group according to their hospital ID number. The 1H group received oxygen for 1 h postoperatively; the 5H group received oxygen for 5 h. We investigated whether the duration of postoperative oxygen affects the likelihood of PONV under propofol-based general anesthesia. The primary outcome was the difference in overall incidence of nausea between the two groups. ResultsAfter excluding 168 patients before and after allocation, 628 patients for 1H patients and 588 patients for 5H were followed up and analyzed. The incidence of nausea was 44.1 % in the 1H group and 45.2 % in the 5H group (p = 0.73). No significant difference in early or late PONV was observed between the groups. ConclusionsLonger-duration postoperative oxygen administration did not reduce the incidence of PONV in patients undergoing laparoscopic gynecological surgery.

Preoperative Oral Carbohydrate (CHO) Supplementation Is Beneficial for Clinical and Biochemical Outcomes in Patients Undergoing Elective Cesarean Delivery under Spinal Anaesthesia-A Randomized Controlled Trial.

Preoperative fasting and surgery cause metabolic stress, insulin resistance with ketosis, and postoperative nausea and vomiting (PONV). Oral carbohydrate loading strategy (CHO) improves outcomes in labor and general surgery. We aimed to compare the effectiveness of CHO with standard fasting in patients undergoing elective cesarean delivery (CD) under spinal anesthesia. A single-center, parallel, prospective randomized controlled trial (RCT) was conducted in a tertiary university obstetrics department at Pomeranian Medical University in Szczecin, Poland. Patients were randomly assigned (1:1 ratio) to the CHO group (oral carbohydrate 2 h before elective CD, n = 75) or the SF group (control-standard fasting, n = 73). The main outcome measures were incidence and severity of PONV at 6 and 24 h after CD, time to the first peristalsis, time to first bowel movement, and biochemical parameters indicating ketosis in mothers and their children. A total of 148 adult females with singleton pregnancies undergoing elective CD under spinal anesthesia (ASA I and II) were included in the final analysis. At 24 h after CD, 8.0% from the CHO group vs. 20.55% reported three or more episodes of vomiting or dry retching as compared to patients in the SF group (p = 0.041). Preoperative CHO supplementation decreased preoperative feelings of hunger (p < 0.001) and thirst (p < 0.001). Laboratory results in the CHO group showed higher plasma pH (p = 0.001) and glucose (p < 0.001), lower F2-isoprostane in plasma (p = 0.049) and urine (p = 0.018), lower urine F2-isoprostane/creatinine ratio (p = 0.045) than in the SF group. HOMA-IR (p < 0.001) and lactate (p < 0.001) were higher in the CHO group than in the control group. There was no significant difference in the incidence or severity of early PONV at 6 h. The incidence of vomiting or dry retching at 24 h after cesarean delivery was lower in the CHO group as compared to standard starvation, but the combined results of PONV frequency and severity on the Wengritzky scale did not differ between the two study groups. Preoperative CHO supplementation decreased preoperative feelings of hunger and thirst, enhancing the comfort of pregnant women. ClinicalTrials.gov identifier: NCT04069806.

Effect of Dexamethasone in Management of Postoperative Nausea, Vomiting and Pain After Tonsillectomy in Paediatric Patients

Introduction: The effectiveness of dexamethasone (DEX) in reducing complication rates following paediatric tonsillectomy is still up for debate. The incidence of postoperative nausea and vomiting (PONV) and the severity of pain following paediatric tonsillectomy were examined by comparing concentrations of DEX 0.15 and DEX 0.5 mg/kg, respectively. Aim of the study: The aim of the study is to assess the effect of Dexamethasone in management of postoperative nausea, vomiting and pain after tonsillectomy where the targeted patients are of 3 to 10 years children. Methods: This prospective cross sectional study was conducted in the Department of Paediatric Anaesthesiology and Surgical ICU in Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh during July 2019 to June 2022. This study included 123 children undergoing elective tonsillectomy. The Institutional Ethics Committee approved this study and informed parental written consent was obtained from the parents before collecting the patients’ information. Results: The prevalence of early PONV was lower in both DEX groups (DEX 0.15: 22%; DEX 0.5: 26%; placebo: 48%; P=0.001). On the second day after surgery, the DEX groups had a lower rate of severe pain (DEX 0.15: 20%; DEX 0.5: 5%; placebo: 47%; P&lt;0.001). The study was not conducted to assess a difference between the two dose groups of Dexamethasone. Conclusions: The frequency of early and late PONV and the level of pain on the second postoperative day were both reduced by an i.v injection of DEX during the induction of anesthesia. To reduce the incidence of PONV, it appeared that a dose of DEX 0.15 mg/kg was just as effective as a dose of DEX 0.5 mg/kg.

Risk factors for postoperative nausea and vomiting in patients of orthognathic surgery according to the initial onset time: a cross-sectional study.

A high incidence (40-73%) of postoperative nausea and vomiting (PONV) has been reported following orthognathic surgery, and various risk factors have been associated with it. Identifying PONV risk factors based on initial onset time will help establish preventive measures. This study aimed to identify factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. This study included 590 patients who underwent orthognathic surgery. Multivariate logistic regression analysis was performed to identify the risk factors that are significantly related to PONV. The objective variables were classified into three categories: no PONV, early PONV (initial onset time: 0-2 h after anesthesia), and late PONV (initial onset time: 2-24 h after anesthesia). The explanatory variables included relevant risk factors for PONV, as considered in previous studies. Total intravenous anesthesia with propofol was a significant depressant factor for early PONV (adjusted odds ratio [aOR] = 0.340, 95% confidence interval [CI] = 0.209-0.555) and late PONV (aOR = 0.535, 95% CI = 0.352-0.814). The administration of a combination of intraoperative antiemetics (vs. no administration) significantly reduced the risk of early PONV (aOR = 0.464, 95% CI = 0.230-0.961). Female sex and young age were significant risk factors for late PONV (aOR = 1.492, 95% CI = 1.170-1.925 and unit aOR = 1.033, 95% CI = 1.010-1.057, respectively). We identified factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. Total intravenous anesthesia with propofol significantly reduced the risk of PONV not only in the early period (0-2 h after anesthesia) but also in the late period (2-24 h after anesthesia).

Comparison of Low-Dose Promethazine and Dexamethasone against Ondansetron Monotherapy Given as Antiemetic Prophylaxis during Myomectomy Under Spinal Anesthesia: A Randomized Clinical Trial.

Postoperative nausea and vomiting (PONV) prophylaxis is still inadequate for a significant proportion of women undergoing myomectomy under spinal anesthesia; and it substantially decreases patient's quality of postoperative recovery. Current protocol and practice favor the use of combination therapy like promethazine/dexamethasone for PONV prophylaxis with minimal side effects and cost advantages in low-resource climes. Methodology. Seventy American Society of Anesthesiologist (ASA) class I or II women aged 21-65 years scheduled for myomectomy were recruited and randomized into group A (promethazine/dexamethasone group) and group B (ondansetron group). Myomectomy was performed on each patient using spinal anesthesia. After induction of spinal anesthesia, patients in group A received intravenous promethazine 12.5 mg and dexamethasone 8 mg while group B received intravenous ondansetron 8 mg. Early (0-3 h) and late (4-24 h) PONV was assessed using the numerical scoring scale. Data analysis was done using SPSS version 20. Postoperatively, there was no significant difference in the incidence of early ansd late PONV (p value >0.05) despite the higher incidents in the ondansetron group. The proportion of patients who required rescue antiemetics was more in the ondansetron group when compared with the promethazine/dexamethasone, with minimal and statistically insignificant side effects in both groups. There was significant patient satisfaction in both groups. The study shows that the combination of low-dose promethazine and dexamethasone is comparable to ondansetron when used as prophylaxis for PONV with cost benefits in low-resource environments.

Prevention of post-operative nausea and vomiting with honey as a pre-operative oral carbohydrate: A randomised controlled pilot trial

Background Post-operative nausea and vomiting (PONV) is the secondmost common post-operative complication. Prolonged pre-operative fasting is common in Australia despite guidelines recommending reduced fasting to improve patient outcomes, such as PONV. Commercially prepared preoperative oral carbohydrate (OC) drinks may be used to reduce fasting time. In this study commercial products were replaced with honey, an inexpensive and common food item. Design Partially blinded, four parallel arms randomised controlled noninferiority trial compared pre-operative OC loading with overnight fasting. Methods Adult elective laparoscopic cholecystectomy and thyroidectomy patients having two or more risk factors for PONV were allocated into intervention and control groups by simple randomisation. The intervention group ingested 60g of honey in 100 ml of water at least two hours before surgery as pre-operative OC loading to reduce PONV. Participants and assessors to the group assignment were blinded to the study outcomes. Early PONV (0–6 hours) was measured with Rhodes index of nausea, vomiting and retching (R-INVR) and a numeric rating scale (NRS). Results The four groups (N = 142) were control and intervention groups of thyroidectomy patients (n = 72: C = 37, I = 35), and control and intervention groups of laparoscopic cholecystectomy patients (n = 70: C = 37, I = 33) and had similar distributions of variables. The estimated effect size was 140 with a 95 percent confidence interval. The PONV incidence (Pearson χ2 = 4.54; df = 1; p = 0.03) and severity were significantly lower in the laparoscopic cholecystectomy intervention group (R-INVR: Mann–Whitney U = 446.5; p = 0.01; NRS: Mann–Whitney U = 444.5; p = 0.01) and results were not conclusive in the thyroidectomy group (NRS: Mann–Whitney U = 629.5; p = 0.95; R-INVR: Mann–Whitney U = 629.5; p = 0.76). Conclusion Honey could be recommended as an inexpensive pre-operative OC to reduce PONV in adult patients receiving general anaesthesia.

Therapeutic Suggestions During General Anesthesia Reduce Postoperative Nausea and Vomiting in High-Risk Patients - A Post hoc Analysis of a Randomized Controlled Trial.

Postoperative nausea and vomiting (PONV) are one of the most adverse events after general anesthesia, a distressing experience, and pose a risk to the patient. Despite advances in drug prophylaxis and PONV treatment, the incidence remains high and additional non-pharmacological treatments are needed. In this post hoc analysis of a recently published double-blind multicenter randomized controlled trial on the efficacy of intraoperative therapeutic suggestions on postoperative opioid dosage, we analyzed the effects of intraoperative therapeutic suggestions on PONV. We focus on patients with a high risk of PONV (Apfel risk score of 3–4) and distinguished early (first two postoperative hours) and delayed PONV (2–24 h). A total of 385 patients with a moderate or high risk for PONV were included. The incidence of early and delayed PONV was reduced (22.7–18.3 and 29.9–24.1%, respectively), without statistical significance, whereas in high-risk patients (n = 180) their incidence was nearly halved, 17.2 vs. 31.2% (p = 0.030) and 20.7 vs. 34.4% (p = 0.040), corresponding to a number needed to treat of 7 to avoid PONV. In addition, there was a significant reduction in PONV severity. In a multivariate logistic regression model, assignment to the control group (OR 2.2; 95% CI: 1.1–4.8) was identified as an independent predictor of the occurrence of early PONV. Our results indicate that intraoperative therapeutic suggestions can significantly reduce the incidence of PONV in high-risk patients. This encourages the expansion of therapeutic suggestions under general anesthesia, which are inexpensive and virtually free of side effects.Clinical Trial Registration: German Clinical Trials Register, https://drks.de, registration number: DRKS00013800.

Cross-sectional Study of PONV Risk Factors for Oral Surgery After Intubated General Anesthesia With Total Intravenous Anesthesia.

The incidence of postoperative nausea and vomiting (PONV) after general anesthesia with total intravenous anesthesia (TIVA) was reported to be significantly lower than with volatile inhalational agents (13.3% vs 25%). However, no investigation of PONV risk factors associated with TIVA has ever been reported. This cross-sectional retrospective study aimed to investigate whether known risk factors influenced PONV in intubated general anesthetics utilizing TIVA for dental or oral and maxillofacial surgery. Subjects were 761 patients who underwent dental or oral and maxillofacial surgery under TIVA with propofol, fentanyl, and remifentanil. Univariate and multivariable logistic regression analyses were performed using PONV (within 24 hours) as the dependent variable and previously reported risk factors as independent variables. Age (odds ratio [OR]: 1.020 per year decrease; 95% confidence interval [CI]: 1.0002-1.0418; P = .047) and female sex (OR: 2.73; 95% CI: 1.60-4.84; P < .001) were positively associated with PONV. Sagittal split ramus osteotomy (SSRO) (OR: 2.28; 95% CI: 1.21-4.33; P = .011) and bimaxillary osteotomy (OR: 5.69; 95% CI: 2.09-15.99; P < .001) were more likely to be associated with PONV than operations that were neither bimaxillary osteotomy nor SSRO. Late PONV (2-24 hours) had an ∼2.7 times higher incidence than early PONV (0-2 hours). These findings suggest further PONV countermeasures, aside from TIVA with propofol and prophylactic antiemetics for orthognathic surgeries especially bimaxillary osteotomy, are needed.

Effect of Palonosetron on Physical Symptoms of Surgical Patients: A Systematic Review and Meta-Analysis.

Background Postoperative nausea and vomiting (PONV) is a typical and unpleasant physical symptom that occurs in patients after surgery, and it may be one of the most challenging elements of the recovery process. PONV can be caused by a variety of factors, including surgery itself, anesthesia, or medications. Palonosetron is a medication that is now licensed by the Food and Drug Administration for the treatment of this ailment. The efficacy of palonosetron in reducing physical symptoms in patients following surgery was investigated in this meta-analysis and comprehensive review. Methods Following a quick search of databases such as CENTRAL, EMBASE, CINAHL, Google Scholar, the Science quotation index's Web site, the United States clinical trial check-in, the United Kingdom clinical trial check-in, the New Zealand clinical trial check-in, and the Australia check-in, as well as outlines of major anesthesia meetings held in the previous five years, we were able to get a good start on our research. Growing adults who had surgery and were given other drugs were compared to individuals who did get palonosetron in randomized controlled trials. Results A total of 8324 participants were recruited in 10 different clinical studies. It has been shown that palonosetron may significantly reduce the 24-hour PONV incidence and 95% confidence interval (CI) 0.41–0.86. When comparing the 6-hour and 48-hour time periods, the incidences of experiencing PONV were neither statistically different (RR: 0.82, 95% confidence interval: 0.61–1.09) or considerably different (RR: 0.60, 95% confidence interval: 0.33–1.10). Following in a similar vein, there was no significant difference between the groups in the occurrence of PONV after 48 hours (RR: 0.82, 95 percent CI: 0.59–1.14). The most often reported side effects of the medicine were headaches and dizziness, which were the most common. Regardless of the drug used, the difference in adverse reactions was not statistically significant. Conclusion When it comes to the prevention of early PONV, it has been shown that palonosetron is more effective than other medications. Palonosetron, on the other hand, has been demonstrated to be more effective than other medications in preventing vomiting after laparoscopic surgery.

Perioperative dextrose infusion for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy

Background and Aims: The effect of intravenous dextrose on the prevention of postoperative nausea and vomiting (PONV) is inconclusive. We aimed to determine the role of perioperative IV dextrose in the prevention of PONV and to analyze factors affecting PONV. Methods: This randomized, double-blind study was conducted in a tertiary care hospital. Two-hundred-fifty-five nondiabetic adults undergoing laparoscopic cholecystectomy were randomized into three groups (n = 85): group NS, group D5, and group D10 to receive perioperatively 250 mL of study fluid infusion (normal saline, dextrose 5%, and dextrose 10%, respectively). Nausea visual analog scale and PONV score, early (0–2 h) and late (2–24 h) PONV and rescue antiemetic treatment were assessed postoperatively. Statistical calculations were done using SPSS 17 version program for Windows. Results: Incidence of early and late PONV was significantly less in Groups D10 (25.9% and 2.4%, respectively) and D5 (43.5% and 17.6%, respectively) compared with Group NS (61.2% and 27.1%, respectively); P < 0.001. Postoperative PONV scores and the need for rescue antiemetics were significantly less in Groups D5 and D10 compared with Group NS; P < 0.05. After study fluid infusion, blood sugar levels (mg%) were significantly higher in patients in Group D10 (242.9 ± 26.2) compared with those who received NS (129.2 ± 10.8) or dextrose 5% (197.1 ± 20.8); P < 0.001. Factors associated with PONV were age, body mass index, female gender, increased anxiety and Apfel score, postoperative opioids, previous PONV, and blood sugar. Conclusions: Perioperative intravenous dextrose 5% (250 mL) can be considered the optimal dose for reducing the incidence and severity of PONV and antiemetic requirement in adults undergoing laparoscopic cholecystectomy.

Comparison between Dexamethasone Alone and its Combination with 5-Hydroxytryptamine Receptor Antagonist for Antiemesis during Laparoscopic Surgeries: A Double-blind Randomised Clinical Study

Introduction: Post operative nausea and vomiting (PONV) are often associated with the laparoscopic surgeries under general anesthesia (GA). The PONV guidelines recommended the use of 5-hydroxytryptamine receptor antagonist (5-HT3RA) as the first-line prophylactic agents in patients categorised as high-risk for emesis perioperatively. There are very few studies comparing the efficacies of combinations of newer 5HT3 RA with dexamethasone. Aim: To compare the severity of emetic episodes as well as the complete response rate to antiemetics like dexamethasone or its combination with palonosetron or ramosetron during the first 48 hours after laparoscopic surgeries. Materials and Methods: This randomised clinical double-blind study Department of Anesthesiology at Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from November 2014 to August 2016 among 90 patients, aged between 18 to 60 years belonging to the American Society of Anesthesiology (ASA) grade I and II scheduled for elective laparoscopic surgery under general anesthesia. They were randomly allocated into three equal groups. Group D received dexamethasone 8 mg, group RD received ramosetron 0.3 mg with dexamethasone 8 mg, and group PD received palonosetron 0.075 mg with dexamethasone 8 mg. Postoperative Nausea and Vomiting (PONV), retching were recorded via direct questioning or by the spontaneous complaints from the patients at 2, 6, 24, 48 hours. A scoring system was used to assess PONV. Complete response rate was also noted i.e, percentage of patients in a group with absence of nausea, retching, vomiting and no requirement of rescue antiemetic medications within postoperative 48 hours. Results: The baseline characteristics were similar in all three groups. Early and late PONV were significantly lesser with group-PD compared to group D (p-value=0.01) and group RD (p-value=0.007). The complete response rate in group PD (86.6%) was significantly highest compared to group D (40%) and group RD (76%). Rescue anlgesics required was nil in group PD compared to group D (36.3%), and group RD (10%) over 48 hours. Conclusion: Combination of palonosetron with dexamethasone is a better alternative to combination of ramosetron with dexamethasone in preventing PONV.

Comparison of Palonosetron Versus Palonosetron and Dexamethasone for Prevention of Postoperative Nausea and Vomiting After Middle Ear Surgeries: A Randomized Controlled Study.

Background:Postoperative nausea and vomiting (PONV) are one of the common distressing conditions after anesthesia. The PONV are related to several potential risk factors are patient related, anesthesia related, and surgery related. In surgery-related risk, middle ear surgery is associated with a high incidence of PONV.Aims:This study aimed to compare the efficiency of palonosetron versus palonosetron with dexamethasone in the prevention of PONV in middle ear surgeries.Settings and Design:This was a prospective, randomized, double-blind study.Statistical Analysis:The data were presented as descriptive statistics for continuous variables and percentages for categorical variables and were subjected to Z-test/Chi-square test/Fisher's exact test. The value of P < 0.05 was considered statistically significant.Results:Demographic parts in comparison to age, duration of surgery, and duration of anesthesia were similar in both the groups. Our study showed that the incidence of PONV during 0–6 h was 38% (n = 19) in Group A and 12% (n = 6) in Group B and the incidence during 6–12 h postoperatively was 14% (n = 7) in Group A and 8% (n = 4) in Group B. During 12–24 h, the incidence was 8% (n = 4) and 6% (n = 3) in Group A and B, respectively. Hence, the difference of total early PONV in Group A was 60% (n = 30) and in Group B, it was 26% (n = 13) which was statistically significant (P < 0.03).Conclusions:The above result proves that palonosetron and dexamethasone group is superior in the prevention of PONV in middle ear surgery.

Differences in Postoperative Pain, Nausea, and Vomiting After Elective Laparoscopic Cholecystectomy in Premenopausal and Postmenopausal Mexican Women.

Postoperative symptoms and pain after laparoscopic cholecystectomy (LC) are common in women. However, there is no evidence of differences in incidence and severity among different age groups. We evaluated whether adverse postoperative symptoms were more common in younger than in older women after LC. One hundred and fifty premenopausal (mean age 37.6 ± 3.6 y) and 145 postmenopausal women (59 ± 5.2 y) were included in this retrospective cohort study. Clinical and anthropometric parameters were analyzed. Study endpoints were the incidences of postoperative nausea and vomiting (PONV) and pain, and the additional analgesics and antiemetics needed after surgery. Body mass index was normal in 42.7% of patients in the younger group and 64.8% in the older group (P < 0.001). Reported pain was more frequent and intense in the younger group throughout the study period (P < 0.01). Additional narcotics were required in 18% of premenopausal versus 7.6% of postmenopausal women (P = 0.001), and the doses used to reduce pain were higher for premenopausal women (P = 0.02). PONV was more frequent in the younger group at 1 and 6h after surgery (P < 0.005). Rescue antiemetics were required in 29 premenopausal and 13 postmenopausal women (P = 0.01). Hospital stay was shorter for the older patients (P = 0.01). Minor morbidity was observed in both groups (0.7% and 2.1%). There was no mortality. Early PONV and pain after LC were more frequent in premenopausal women, who also required more rescue analgesic and antiemetic medication.

Factors Associated with Postoperative Nausea and Vomiting after Breast Cancer Surgery with Inhalation Anesthesia.

The incidence and risk factors of postoperative nausea and vomiting (PONV) and early PONV (ePONV) were evaluated in patients who underwent breast surgery with volatile anesthesia. In this retrospective study, multivariate logistic regression was used to determine incidence and identify risk factors for PONV. Among 928 patients, 166 (18%) and 220 (24%) had ePONV and PONV, respectively. In multivariate analysis, anesthesia duration and use of desflurane were independent risk factors for ePONV. For PONV, anesthesia duration and Apfel score were independent risk factors. Our results indicate that desflurane was the main cause of ePONV. However, during the delayed phase, a higher Apfel score was the strongest predictor. In the early and delayed phases, long anesthesia duration was associated with high risk of PONV. Thus, prolonged anesthesia and desflurane use should be avoided for patients at high risk of PONV, particularly those with high Apfel scores.

Comparison of palonosetron and ondansetron in preventing postoperative nausea and vomiting in renal transplantation recipients: a randomized clinical trial

BackgroundEnd-stage renal diseases patients have a high risk of postoperative nausea and vomiting (PONV), which is multifactorial and need acute attention after renal transplantation for a successful outcome in term of an uneventful postoperative period. The study was done to compare the efficacy of palonosetron and ondansetron in preventing early and late-onset PONV in live donor renal transplantation recipients (LDRT). MethodsThe prospective randomized double-blinded study was done on 112 consecutive patients planned for live donor renal transplantation. Patients of both sexes in the age group of 18...60 years were randomly divided into two groups: Group O (Ondansetron) and Group P (Palonosetron) with 56 patients in each group by computer-generated randomization. The study drug was administered intravenously (IV) slowly over 30.ßseconds, one hour before extubation. Postoperatively, the patients were accessed for PONV at 6, 24, and 72.ßhours using the Visual Analogue Scale (VAS) nausea score and PONV intensity scale. ResultsThe incidence of PONV in the study was found to be 30.35%. There was significant difference in incidence of PONV between Group P and Group O at 6.ßhours (12.5% vs. 32.1%, p.ß=.ß0.013) and 72.ßhours (1.8% vs. 33.9%, p.ß<.ß0.001), but insignificant difference at 24.ßhours (1.8% vs. 10.7%, p.ß=.ß0.113). VAS-nausea score was significantly lower in Group P as compared to Group O at a time point of 24.ßhours (45.54.ß...ß12.64 vs. 51.96.ß...ß14.70, p.ß=.ß0.015) and 72.ßhours (39.11.ß...ß10.32 vs. 45.7.ß...ß15.12, p.ß=.ß0.015). ConclusionPalonosetron is clinically superior to ondansetron in preventing early and delayed onset postoperative nausea and vomiting in live-related renal transplant recipients.

Early post-operative nausea and vomiting: A retrospective observational study of 2030 patients.

The overall risk of post-operative nausea and vomiting (PONV) after general anaesthesia is reportedly 20%-40%. The first episode of PONV may occur early in the post-anaesthesia care unit (PACU) or later at the ward or after discharge at home in an ambulatory setting. This study aimed to investigate and describe the risk of early PONV in a PACU, and we hypothesised that patients and perioperative factors were associated with early PONV. This single-centre retrospective observational study was conducted in a Swedish county hospital from January to June 2017 and included adult patients who underwent surgical procedures under general anaesthesia. Perioperative data were obtained by reviewing the local registry for surgical procedures, medical records and anaesthesia and post-operative charts. Early PONV was defined as PONV occurring up to 4hours post-operatively at the PACU. Any notification in the medical records, perioperative charts or the registry regarding nausea, vomiting or PONV treatment was regarded as PONV. Univariate and multivariate analyses were performed for factors associated with early PONV. A total of 2030 patients were included in the study, of which 9.6% (n=194) experienced early PONV. Factors associated with a high risk of early PONV were suboptimal PONV prophylaxis, need for opioids, female sex, body mass index >35kgm-2 and major surgery and anaesthesia time ≥60minutes. We found that every 10th patient under general anaesthesia experienced early PONV. Suboptimal PONV prophylaxis and previously acknowledged risk factors for PONV were associated with early PONV.

A comparative clinical study of methylprednisolone with ondansetron versus methylprednisolone with ramosetron in preventing postoperative nausea and vomiting in patients undergoing middle ear surgeries

Background: Postoperative nausea and vomiting (PONV) is one of the most unpleasant complications of anaesthesia and is more common following middle ear surgeries. Ondansetron, a 5-HT3 (5-hydroxytryptamine type 3) receptor antagonist provides significant reduction in early PONV. The other 5-HT3 antagonist ramosetron, with long duration of action, has been found to be more effective than ondansetron in reducing the early as well as delayed PONV. The antiemetic effects of glucocorticoids (dexamethasone and methylprednisolone) are well documented. So, the present study was designed to compare the efficacy of the combination of intravenous methylprednisolone and ondansetron with combination of intravenous methylprednisolone and ramosterone in preventing postoperative nausea and vomiting in patients undergoing middle ear surgeries. Methods: Sixty patients in the age group of 18-60 years, with American Society of Anaesthesiologists (ASA) physical status classification I or II, undergoing middle ear surgery were randomly allocated to receive a combination of methylprednisolone 40 mg (given at the beginning of surgery) and ondansetron 4 mg (given near the end of surgery) (group MO, n=30) or combination of intravenous methylprednisolone 40 mg and ramosetron 0.3 mg (near the end of surgery) (group R, n=30), by a computer-generated randomization table. Incidence of PONV in the both groups were studied and compared. Results: There was no significant difference in PONV between the groups in the first 2 h after the surgery. Between 2 and 24 h, the incidence of nausea was significantly lower in the methylprednisolone and ondansetron group compared to the methylprednisolone and ramosetron group (P=0.01). Between 24 and 48 h, there was no difference between the two groups with respect to incidence of nausea and vomiting. Conclusion: The combination of methylprednisolone and ondansetron is superior to combination of methylprednisolone and ramosetron for prevention of PONV after middle ear surgery especially in treatment of early PONV. Therefore, we recommend combination of methylprednisolone and ondansetron for prophylaxis for PONV in middle ear surgeries.

Dexamethasone and post-adenotonsillectomy pain in children: Double-blind, randomized controlled trial.

Objective:To assess the impact of intraoperative intravenous dexamethasone on the reduction of postoperative morbidity in children undergoing adenotonsillectomy.Methods:A double blind randomized controlled trial conducted among children undergoing adenotonsillectomy at a tertiary hospital in Korea from November 2018 to June 2019. Children were randomly assigned to receive dexamethasone (0.5 mg/kg, maximum dose 24 mg) or placebo intravenously after induction of anesthesia. The primary endpoint was the reduction of postoperative pain and postoperative nausea and vomiting (PONV); secondary endpoints were adverse effects like postoperative hemorrhage.Results:The study included 105 children, and 67 were male. Their mean age was 6.2 ± 2.1 years. There was no significant difference between the groups in terms of demographic data or the operation time. The pain scores of the dexamethasone group were lower than those of the control group, but no significant difference was found (all P > .05). The average pain visual analog scale (VAS) during the study period (day 0–7) was 3.67 ± 1.59 and 4.40 ± 2.01 in the dexamethasone group and control group, respectively (P-value = .107). When we compared early pain VAS (day 0–2) and late pain VAS (day 5–7), the dexamethasone group showed significantly lower early mean VAS compared to the control group (4.55 ± 1.78 vs 5.40 ± 2.05, P-value = .046). The mean VAS for PONV was significantly lower in the dexamethasone group than in the control group (1.89 ± 2.22 vs 3.00 ± 2.37, P value = .044).Conclusion:In children undergoing adenotonsillectomy, dexamethasone decreased the early postoperative pain and PONV without increasing postoperative hemorrhage.

Prophylactic antiemetic effects of dexamethasone versus 5-HT3 receptor antagonists in ear surgery: a systematic review and meta-analysis.

Background The optimal strategy for reducing the high incidence of postoperative nausea and vomiting (PONV) after otologic surgical procedures remains inconclusive. Aim of the review This study compared the prophylactic antiemetic effects of dexamethasone with 5-hydroxytryptamine 3 receptor antagonists (5-HT3-RAs) in ear surgery. Method PubMed, Embase, and Cochrane Library were searched up to October 31, 2020 for randomized controlled trials that used dexamethasone either singly or in combination with 5-HT3-RAs for PONV prophylaxis in adults undergoing ear surgery. Studies in languages other than English and those without a control group of 5-HT3-RAs were excluded. Random effects meta-analyses were performed, and risk of bias was assessed using the version 2 of the Cochrane risk-of-bias tool. Main outcome measures include incidences of early (< 6h) and overall (0-48h) PONV, the overall requirement for rescue antiemetics, and the occurrence of adverse events. Results Eight trials of 733 adults were included, and the overall risks of bias were generally low. Pooled risk ratios (RRs) of early and overall PONV of dexamethasone versus 5-HT3-RAs were 2.0 (95% CI 0.8-5.1, I2 = 82%), and 1.3 (95% CI 0.6-2.6, I2 = 86%). In studies comparing dexamethasone plus 5-HT3-RAs with 5-HT3-RAs alone, pooled RRs of early and overall PONV were 0.8 (95% CI 0.4-1.4, I2 = 30%), and 0.5 (95% CI 0.3-0.6, I2 = 0%), respectively. Pooled RRs of the overall need for rescue antiemetics comparing 5-HT3-RAs with dexamethasone alone and in combination with 5-HT3-RAs were 1.2 (95% CI 0.4-3.9, I2 = 73%) and 0.4 (95% CI 0.1-1.4, I2 = 61%), respectively. Common adverse events reported were headache and dizziness, and the incidences range from 0 to 10% without significant differences between the groups. Conclusion The prophylactic antiemetic effects of dexamethasone versus 5-HT3-RAs in ear surgery did not significantly differ in the early and overall postoperative phases. The combination of dexamethasone with 5-HT3-RAs showed superior overall PONV prophylactic effects to 5-HT3-RAs alone in ear surgery, but their differences in the need for rescue antiemetics remained non-significant.