Overall Incidence Of Nausea Research Articles

Laparoscopic cholecystectomy with or without drainage: a systematic review and meta-analysis

Background. The abdominal drainage with a prophylactic purpose was used by surgeons for decades because of the possibility to detect early signs of postoperative complications. However, the real value of routine drainage after abdominal surgery is still debated. There are discrepancies between studies supporting the drain placement only in patients with intraoperative complications and works showing a beneficial effect of prophylactic abdominal drainage on postoperative pain, nausea, and vomiting. However, there is still a lack of evidence on the use of routine abdominal drainage following laparoscopic cholecystectomy and its clinical value. Current guidelines do not mention the role of drainage after laparoscopic cholecystectomy. Objective: to evaluate whether conventional postoperative drainage is more effective than no drainage in patients with non-complicated benign gallbladder disease after laparoscopic cholecystectomy. Materials and methods. A search in the electronic databases MEDLINE, Scopus, Cochrane Library was conducted for randomized controlled trials reporting outcomes of laparoscopic cholecystectomy with and without an abdominal drainage until January 2024. The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis — using fixed and random effects models. Odds ratio (OR) with confidence interval (CI) for qualitative variables and mean difference (MD) with CI for continuous variables were calculated using IBM SPSS Statistics 29.0.2.0. Results. Forty-four randomized controlled trials invol­ving 5,185 patients (2,592 with drains vs 2,593 without them) were included in the meta-analysis. There were no statistically significant differences in the incidence of intra-abdominal fluid accumulation (OR = 0.87; 95% CI: 0.64–1.19; p = 0.39) between two groups. Abdominal drains did not reduce the overall incidence of nausea and vomiting (OR = 1.51; 95% CI: 0.85–2.70; p = 0 .16) or shoulder pain (OR = 0.90; 95% CI: 0.58–1.41; p = 0.65). The abdominal drain group reported significantly higher pain scores (MD = 0.67; 95% CI: 0.37–0.98; p < 0.001) than patients without drains. Abdominal drainage increased operative time (MD = 3.82; 95% CI: 1.93–5.70; p < 0.001) but not the length of hospital stay after surgery (MD = 0.42; 95% CI: –0.02–0.85; p = 0.06). Wound infection (OR = 3.26; 95% CI: 2.35–4.51; p < 0.001), fever (OR = 4.40; 95% CI: 2.57–7.8554; p < 0.001) and pneumonia (OR = 4.74; 95% CI: 2.25–9.97; p < 0.001) were found to be associated with the use of abdominal drains. Conclusions. Currently, there is no evidence to support the use of routine drainage after laparoscopic cholecystectomy in non-complicated benign gallbladder disease. No drainage after laparoscopic cholecystectomy is safe and associated with fewer complications. Postoperative recovery is improved if drain is not used. Further well-designed randomized clinical trials are required to confirm this finding.

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.

Anti-emetic effect of low dose metoclopramide with dexamethasone and metoclopramide alone for post-operative nausea and vomiting after thyroidectomy. A prospective cohort study

IntroductionNausea and vomiting after thyroidectomy is one of the common post-operative complications with the incidence of up to 84%. It is a challenging problem that may leads to surgical wound dehiscence, hematoma, upper airway obstruction, severe dehydration, acid base and electrolyte imbalance. The aim of this study was to compare the anti-emetic effect and safety of low dose both metoclopramide and dexamethasone versus metoclopramide alone for the prevention of nausea and vomiting after thyroidectomy. MethodA prospective cohort study was employed on 76 patients who underwent Thyroidectomy. The randomly selected study participants were grouped as either exposed or control. Patients who received both 5 mg intravenous metoclopramide and 4 mg dexamethasone were considered as exposed group while patients who received 10 mg metoclopramide alone were considered as control group. Post-operative nausea and vomiting, and side effects were recorded post operatively at 6, 12 and 24 h. Data was entered in to EPI info version 7 and then transferred to SPSS version 20 computer program for analysis. Based on their assumption the independent two sample t-test, Manny Whitney test and chi-square test were used. P- Value < 0.05 was considered as statistically significant. ResultAs compared to control group, the first 24 h overall incidence of nausea and vomiting was significantly lower in exposed group, 63% versus 24% respectively. Severity of nausea at 6th, 12th and 24th were also reduced in exposed group. Post-operative sedation was significantly higher in control group (39.47%) than exposed group (16.79%). Although the difference was statistically not significant headache was also higher (26.31%) in control group. ConclusionGiving intravenous 5 mg metoclopramide with 4 mg dexamethasone before induction of general anesthesia was effective and safer than10mg intravenous metoclopramide alone for prevention of post-operative nausea and vomiting after thyroidectomy.

COVID-19, nausea, and vomiting.

Exclusion of nausea (N) and vomiting (V) from detailed consideration as symptoms of COVID‐19 is surprising as N can be an early presenting symptom. We examined the incidence of NV during infection before defining potential mechanisms. We estimate that the overall incidence of nausea (median 10.5%), although variable, is comparable with diarrhea. Poor definition of N, confusion with appetite loss, and reporting of N and/or V as a single entity may contribute to reporting variability and likely underestimation. We propose that emetic mechanisms are activated by mediators released from the intestinal epithelium by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) modulate vagal afferents projecting to the brainstem and after entry into the blood, activate the area postrema (AP) also implicated in anorexia. The receptor for spike protein of SARS‐CoV‐2, angiotensin 2 converting enzyme (ACE2), and transmembrane protease serine (for viral entry) is expressed in upper gastrointestinal (GI) enterocytes, ACE2 is expressed on enteroendocrine cells (EECs), and SARS‐CoV‐2 infects enterocytes but not EECs (studies needed with native EECs). The resultant virus‐induced release of epithelial mediators due to exocytosis, inflammation, and apoptosis provides the peripheral and central emetic drives. Additionally, data from SARS‐CoV‐2 show an increase in plasma angiotensin II (consequent on SARS‐CoV‐2/ACE2 interaction), a centrally (AP) acting emetic, providing a further potential mechanism in COVID‐19. Viral invasion of the dorsal brainstem is also a possibility but more likely in delayed onset symptoms. Overall, greater attention must be given to nausea as an early symptom of COVID‐19 and for the insights provided into the GI effects of SARS‐CoV‐2.

The efficacy of transversus abdominis plane block with or without dexmedetomidine for postoperative analgesia in renal transplantation. A randomized controlled trial.

Current options for effective postoperative analgesia after renal transplantation are limited, due to altered renal clearance and the risk of renal damage. This study compared the analgesic effect of the transversus abdominis plane block, with or without dexmedetomidine, in renal transplant recipients. This prospective randomized double-blinded clinical trial was performed from November 2014 to March 2017. Patients were randomly divided into group C (morphine intravenous patient-controlled analgesia), group R (morphine intravenous patient-controlled analgesia and transversus abdominis plane block), and group RD (morphine intravenous patient-controlled analgesia and transversus abdominis plane block with 1μg/kg dexmedetomidine). Morphine consumption, time to first request for analgesia, pain, sedation, nausea, vomiting, respiratory depression, and bradycardia were measured at 2, 4, 6, 12 and 24h after surgery. The visual analogue pain score in group C was the highest among the three groups at the 2nd and 4th hour. Morphine consumption was the highest in group C at all assessed time intervals (p<0.01). By the 12th hour and 24th hour, morphine consumption (calculated by time interval) was the lowest in group RD (p<0.05), while no statistical difference was found between groups C and R. The average time to first request of analgesia was the longest and shortest in group RD and group C, respectively (p<0.01). The overall incidence of nausea and vomiting was the highest in group C (p<0.05). The transversus abdominis plane block reduced morphine consumption in the first 24h following renal transplantation, and the addition of dexmedetomidine provided a more effective analgesic effect.

Comparison of laparoscopic cholecystectomy with and without abdominal drainage in patients with non-complicated benign gallbladder disease: A protocol for systematic review and meta analysis.

To evaluate whether conventional postoperative drainage is more effective than not providing drainage in patients with non-complicated benign gallbladder disease following laparoscopic cholecystectomy (LC). A search of the electronic databases MEDLINE, EMBASE, Web of science, Cochrane Library, and Chinese Biomedical Database (CBM) was conducted for randomized controlled trials (RCTs) reporting outcomes of LC surgery with and without an abdominal drain. Twenty-one RCTs involving 3246 patients (1666 with drains vs 1580 without) were included in the meta-analysis. There were no statistically significant differences in the rates of incidence of intra-abdominal fluid (RR: 1.10; 95% CI: 0.81-1.49; P = .54) or post-surgical mortality (RR: 0.44; 95% CI: 0.04-4.72; P = .50) between the two groups. Abdominal drains did not reduce the overall incidence of nausea and vomiting (RR: 1.16; 95% CI: 0.95-1.42; P = .15) or shoulder tip pain (RR: 1.03; 95% CI: 0.76-1.38; P = .86). The abdominal drain group displayed significantly higher pain scores (MD: 1.07; 95% CI: 0.69-1.46; P < .001) than the non-drainage patients. Abdominal drains prolonged the duration of the surgical procedure (MD: 5.69 min; 95% CI: 2.51-8.87; P = .005) and postoperative hospital stay (MD: 0.47 day; 95% CI: 0.14-0.80; P = .005). Wound infection was found to be associated with the use of abdominal drains (RR: 1.97; 95% CI: 1.11-3.47; P = .02). Currently, there is no evidence to support the use of routine drainage after LC in non-complicated benign gallbladder disease. Further well-designed randomized clinical trials are required to confirm this finding.

Antiemetic prophylaxis with temozolomide: an audit from a tertiary care center.

In our previous experience, a significant proportion of patients who received 5-HT3 antagonist monotherapy with adjuvant temozolomide (150-200 mg/m2) had chemotherapy-induced nausea and vomiting (CINV). This is an audit comparing the multiple antiemetic therapies in the prevention of temozolomide-associated CINV. This was a retrospective audit. Adult glioma patients treated with temozolomide at a dose of 150-200 mg/m2 between October 2017 and June 2018 were selected for this analysis. Three antiemetic prophylaxis were used in this time period: ondansetron (October 2017 to November 2017), ondansetron + domperidone (December 2017 to February 2018), and ondansetron + olanzapine (March 2018 to June 2018). The rates of nausea and vomiting were compared among the 3 cohorts using the chi-squared test with Bonferroni correction. A P value of less than .016 was considered significant. A total of 360 patients were selected for this analysis. There were 91 patients in the ondansetron prophylaxis group (25.3%), 113 (31.4%) in the ondansetron plus domperidone group, and 156 (43.3%) in the ondansetron plus olanzapine group. The overall incidence of nausea and vomiting was 25.0% (n = 90) and 7.2% (n = 26). Overall the rates of nausea (P = .052) and vomiting (P = .481) were similar in all 3 cohorts. However, the rates of grade 2 and above nausea (P = .012) and vomiting (P = .015) were significantly lower in the olanzapine group. The combination of ondansetron with olanzapine leads to a statistically significant decrease in the rate of moderate-to-severe emesis and nausea and needs to be explored in a prospective study.

In patients undergoing fast track total knee arthroplasty, addition of buprenorphine to a femoral nerve block has no clinical advantage: A prospective, double-blinded, randomized, placebo controlled trial.

Background:Several adjuvants have been proposed to prolong the effect of peripheral nerve blocks, one of which is buprenorphine. In this randomized double blinded placebo controlled trial we studied whether the addition of buprenorphine to a femoral nerve block prolongs analgesia in patients undergoing total knee arthroplasty in a fast track surgery protocol.Methods:The treatment group (B) was given an ultrasound-guided femoral nerve block with ropivacaine 0.2% and 0.3mg buprenorphine. We choose to use 2 control groups. Group R was given a femoral nerve block with ropivacaine 0.2% only. Group S also received 0.3 mg buprenorphine subcutaneously. Only patients with a successful block were enrolled in the study.Results:We found no difference in our primary outcome parameter of time to first rescue analgesic. We found lower opioid use and better sleep quality the first postoperative night in patients receiving buprenorphine perineurally or subcutaneously. Buprenorphine did not lead to any significant change in pain or mobilization. We found a high overall incidence of nausea and vomiting.Conclusion:In patients undergoing total knee arthroplasty, in the setting of a fast track surgery protocol, the addition of buprenorphine to a femoral nerve block did not prolong analgesia.

Effects of hypercapnia on postoperative nausea and vomiting after laparoscopic surgery: a double-blind randomized controlled study.

Laparoscopic surgery is associated with a high incidence of postoperative nausea and vomiting (PONV). The use of CO2 pneumoperitoneum has been proposed as a potential cause of high PONV incidence. However, intraoperative hypercarbia may be related to enhanced perfusion to the main effector sites for PONV, including the brain and gastrointestinal tract. In this study, we investigated whether an increase in intraoperative CO2 partial pressure in arterial blood (PaCO2) reduces the incidence of PONV. This study enrolled 400 female patients aged 20-60years who were undergoing laparoscopic gynecologic surgery. The patients were allocated randomly to one of three groups with the following intraoperative PaCO2 levels: 36-40mmHg (Group 1), 41-45mmHg (Group 2), or 46-50mmHg (Group 3). The anesthetic regimen used a standardized total intravenous anesthesia consisting of propofol and remifentanil for all patients. The arterial blood gas analysis was performed to identify the difference in CO2 partial pressure between arterial blood and end-tidal gas. The PONV incidence was evaluated for the periods of 0-2, 2-6, and 6-24h after anesthesia. The incidence and severity of PONV and the administration of rescue antiemetics were recorded. The three groups were comparable for the patient, anesthesia, and surgical characteristics. The average PaCO2 level during surgery was 38-39, 43-44, and 47-48mmHg in Groups 1, 2, and 3, respectively. The incidence and severity of PONV and use of rescue antiemetics were not significantly different among the groups. The overall incidence of nausea during the first 24-h postoperative period was 54, 48, and 50% in Groups 1, 2, and 3, respectively (P=0.593). Our data suggest that mild to moderate intraoperative hypercapnia did not decrease the incidence and severity of PONV or the requirement for rescue antiemetics after gynecologic laparoscopic surgery.

Preliminary evaluation of a predictive blood assay to identify patients at high risk of chemotherapy-induced nausea.

The aim of this study was to test a new blood-based assay for its ability to predict delayed chemotherapy-induced nausea. Blood drawn from consented patients prior to receiving their first platinum-based therapy was tested for glutathione recycling capacity and normalized to total red cell numbers. This number was used to predict nausea and then compared to patient reported outcomes using the Rotterdam Symptom Check List and medical records. We show that the pathways involved in the glutathione recycling are stable for at least 48h and that the test was able to correctly classify the risk of nausea for 89.1% of the patients. The overall incidence of nausea was 21.9% while women had an incidence of 29.6%. This might be the first objective test to predict delayed nausea for cancer patients receiving highly emetogenic chemotherapy. We believe that this assay could better guide clinicians in their efforts to provide optimal patient-oriented care.

The Effect of a Combination Treatment Using Palonosetron, Promethazine, and Dexamethasone on the Prophylaxis of Postoperative Nausea and Vomiting and QTc Interval Duration in Patients Undergoing Craniotomy under General Anesthesia: A Pilot Study.

Postoperative nausea and vomiting (PONV) is a displeasing experience that distresses surgical patients during the first 24 h after a surgical procedure. The incidence of postoperative nausea occurs in about 50%, the incidence of postoperative vomiting is about 30%, and in high-risk patients, the PONV rate could be as high as 80%. Therefore, the study design of this single arm, non-randomized, pilot study assessed the efficacy and safety profile of a triple therapy combination with palonosetron, dexamethasone, and promethazine to prevent PONV in patients undergoing craniotomies under general anesthesia. The research protocol was approved by the institutional review board and 40 subjects were provided written informed consent. At induction of anesthesia, a triple therapy of palonosetron 0.075 mg IV, dexamethasone 10 mg IV, and promethazine 25 mg IV was given as PONV prophylaxis. After surgery, subjects were transferred to the surgical intensive care unit or post anesthesia care unit as clinically indicated. Ondansetron 4 mg IV was administered as primary rescue medication to subjects with PONV symptoms. PONV was assessed and collected every 24 h for 5 days via direct interview and/or medical charts review. The overall incidence of PONV during the first 24 h after surgery was 30% (n = 12). The incidence of nausea and emesis 24 h after surgery was 30% (n = 12) and 7.5% (n = 3), respectively. The mean time to first emetic episode, first rescue, and first significant nausea was 31.3 (±33.6), 15.1 (±25.8), and 21.1 (±25.4) hours, respectively. The overall incidence of nausea and vomiting after 24-120 h period after surgery was 30% (n = 12). The percentage of subjects without emesis episodes over 24-120 h postoperatively was 70% (n = 28). No subjects presented a prolonged QTc interval ≥500 ms before and/or after surgery. Our data demonstrated that this triple therapy regimen may be an adequate alternative regimen for the treatment of PONV in patients undergoing neurological surgery under general anesthesia. More studies with a control group should be performed to demonstrate the efficacy of this regimen and that palonosetron is a low risk for QTc prolongation. NCT02635828 (https://clinicaltrials.gov/show/NCT02635828).

Dexmedetomidine in Postoperative Analgesia in Patients Undergoing Hysterectomy: A CONSORT-Prospective, Randomized, Controlled Trial.

Both dexmedetomidine and sufentanil modulate spinal analgesia by different mechanisms, and yet no human studies are available on their combination for analgesia during the first 72 hours after abdominal hysterectomy.This CONSORT-prospective, randomized, double-blinded, controlled trial sought to evaluate the safety and efficacy of the combination of dexmedetomidine and sufentanil in intravenous patient-controlled analgesia (PCA) for 72 hours after abdominal hysterectomy.Ninety women undergoing total abdominal hysterectomy were divided into 3 equal groups that received sufentanil (Group C; 0.02 μg/kg/h), sufentanil plus dexmedetomidine (Group D1; 0.02 μg/kg/h, each), or sufentanil (0.02 μg/kg/h) plus dexmedetomidine (0.05 μg/kg/h) (Group D2) for 72 hours after surgery in this double-blinded, randomized study. The primary outcome measure was the postoperative sufentanil consumption, whereas the secondary outcome measures were pain intensity (visual analogue scale), requirement of narcotic drugs during the operation, level of sedation, Bruggrmann comfort scale, and concerning adverse effects.The postoperative sufentanil consumption was significantly lower in Groups D1 and D2 than in Group C during the observation period (P < 0.05), but lower in Group D2 than in Group D1 at 24, 48, and 72 hours after surgery (P < 0.05). The heart rate after intubation and incision was lower in Groups D1 and D2 than in Group C (P < 0.05). On arrival at the recovery room, Groups D1 and D2 had lower mean blood pressure than Group C (P < 0.05). The intraoperative requirement of sevoflurane was 30% lesser in Groups D1 and D2 than in Group C. The sedation levels were greater in Groups D1 and D2 during the first hour (P < 0.05). Compared with Groups C and D1, Group D2 showed lower levels of the overall incidence of nausea and vomiting (P < 0.05).Among the tested PCA options, the addition of dexmedetomidine (0.05 μg/kg/h) and sufentanil (0.02 μg/kg/h) showed better analgesic effect and greater patient satisfaction without other clinically relevant side effects for patients undergoing hysterectomy during the first 72 hours after abdominal hysterectomy.

Postoperative Nausea and Vomiting Following General Anaesthesia: A Prospective Study on Surgical Patients in the University of Calabar Teaching Hospital, Calabar, Nigeria

Introduction: Postoperative nausea and vomiting remains a significant problem in our clinical setting. This study at the University of Calabar Teaching Hospital, Calabar in Nigeria aims to investigate the incidence of postoperative nausea and vomiting among gynaecological and nongynaecological patients undergoing surgery under general anaesthesia, compare the incidence as it affects males and females, identify predisposing factors and recommend preventive measures. Methodology: One hundred and sixty six(166) adult patients aged 18 years and above were recruited prospectively excluding cases of full stomach, patients with nasogastric tubes and those who could not be followed up for 24 hours. The past history of motion sickness and postoperative nausea and vomiting was obtained and documented. General anaesthesia was induced with either Original Research Article Kalu et al.; BJMMR, 9(12): 1-12, 2015; Article no.BJMMR.18030 2 sodium thiopentone or ketamine hydrochloride. Maintenance was inhalational with or without a relaxant technique. Intravenous pentazocine and subanaesthetic doses of ketamine were used for intraoperative analgesia. The patients were observed postoperatively and questioned at two hourly intervals for nausea or vomiting and pain was scored using the categorical rating scale. A data sheet was completed at the end of 2 and 24 hours. The data was entered on a microcomputer for analysis with aid of EPI INFO version 6 software. The level of significance was set at 95% confidence interval with P value less than 0.05. Results: The overall incidence of nausea was 11.45% and vomiting 13.35% in the 166 patients studied. There was no significant difference in incidence between the gynaecological and non gynaecological patients. Female patients experienced more postoperative nausea and vomiting than male patients with 11.4% and 18.42% nausea and vomiting. Sodium thiopentone induction, muscle relaxant use and reversal as well as moderate to severe postoperative pain increased the incidence of PONV Conclusion: The use of prophylactic “balanced antiemesis” in high risk patients, avoidance of muscle relaxant reversal and adequate postoperative analgesia are recommended as preventive measures.

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.

Incidence and predictors of postdischarge nausea and vomiting in a 7-day population

Study Objective1) To quantify the incidence and severity of postdischarge nausea and vomiting (PDNV) for 7 days in adults undergoing outpatient surgeries with general anesthesia; 2) to evaluate whether a risk model previously developed for the first two postoperative days may be used to predict the patient’s risk of PDNV for 7 days; and 3) to verify whether the same risk factors are applicable in the 3 to 7 day period. DesignProspective study. SettingTwo university-affiliated centers. Patients248 adult (>18 years) surgical outpatients undergoing ambulatory surgical procedures with general anesthesia between 2007 and 2008. MeasurementsThe incidence and severity of PDNV and a simplified risk score for PDNV was assessed prospectively from discharge up to 7 postoperative days. Main ResultsThe overall incidence of nausea was 56.9% and of emesis was 19.4%. The incidence of PDNV was highest on the day of surgery (DOS), with PDNV of 44.8% and decreasing over time to 6.0% on day 7. Using the simplified risk score for PDNV the area under the receiver operating characteristic (ROC) curve was 0.766 (0.707, 0.825). A previous history of postoperative nausea and vomiting (PONV; OR 3.51, CI 1.70 - 7.27), operating room time (odds ratio [OR] 2.19, 95% CI 1.34 - 3.60), use of ondansetron in the Postanesthesia Care Unit (PACU; OR 6.39, CI 1.65-24.79), and pain during days 3–7 (OR 1.67, CI 1.30 - 2.14) were the strongest predictors of PDNV on days 3–7. ConclusionsPDNV affects a significant number of patients after ambulatory surgery, and our simplified PDNV score may be applied to a 7-day population. Pain appears to be a factor in late PDNV. It is possible that the presence of PDNV during days 3–7 has different origins from the PDNV that resolved over the first 48 hours.

Does dexamethasone prevent subarachnoid meperidin-induced nausea, vomiting and pruritus after cesarean delivery?

Background:Opioid-induced side effects such as nausea and vomiting and pruritus are common and may be more debilitating than pain itself. We performed a study to assess the efficacy of dexamethasone in reducing postoperative nausea, vomiting, and pruritus in patients receiving neuraxial anesthesia with meperidine.Methods:Fifty-two women undergoing cesarean section were enrolled in the study. The control group and dexamethasone group received intravenously normal saline and dexamethasone, respectively, before spinal anesthesia. The occurrence of postoperative nausea, vomiting, and pruritus was assessed for 24 h in both groups.Results:The overall incidence of nausea and vomiting during the 24 h follow-up period was 37% and 22.2% for group saline and 20% and 12% for group dexamethasone, respectively (P=0.175, 0.469). The incidence of pruritus was not significantly different between the two groups. Pruritus severity was significantly less in the dexamethasone group than in the saline group (P=0.019).Conclusion:Prophylactic dexamethasone does not reduce the incidence of subarachnoid meperidine-induced nausea, vomiting, and pruritus in women undergoing cesarean delivery.

Efficacy comparison of ramosetron with ondansetron on preventing nausea and vomiting in high-risk patients following spine surgery with a single bolus of dexamethasone as an adjunct

BackgroundDespite the development of a new class of antiemetics, postoperative nausea and vomiting (PONV) still remains a frequent and distressing complication. We compared the prophylactic antiemetic effect of administering dexamethasone 5 mg as an adjunct to ramosetron and ondansetron in patients at high-risk for PONV following lumbar spinal surgery.MethodsIn this randomized, double-blind study, 120 female non-smoking patients with intravenous patient-controlled analgesia (PCA) received ramosetron 0.3 mg plus dexamethasone 5 mg (group R + D) or ondansetron 4 mg plus dexamethasone 5 mg (group O + D) intravenously. Fentanyl-based PCA was administered for 48 hr postoperatively; ramosetron 0.3 mg or ondansetron 12 mg was added to the PCA regimen according to the allocated group. The incidence of PONV and rescue antiemetic were assessed for 48 hr postoperatively at 0-6, 6-24, and 24-48 hr.ResultsThe overall incidence of PONV did not differ between the groups (50% vs. 60%, in groups R + D and O + D, respectively). The overall incidence of nausea was similar between groups (47% vs. 60%, in groups R + D and O + D, respectively). The overall frequency of vomiting was also similar between groups (8% vs. 12%, in groups R + D and O + D, respectively). The severity of nausea and the overall use of rescue antiemetic were not different between groups.ConclusionsThe antiemetic efficacy of ramosetron plus dexamethasone was similar to that of ondansetron plus dexamethasone on preventing PONV in high-risk patients undergoing lumbar spinal surgery.

Is Fasting Necessary for Elective Cerebral Angiography?

In order to prevent unexpected events such as aspiration pneumonia, cerebral angiography has been performed under fasting in most cases. We investigated prospectively the necessity of fasting before elective cerebral angiography. The study is an open-labeled clinical trial without random allocation. In total, 2554 patients who underwent elective cerebral angiography were evaluated on development of nausea, vomiting, and pulmonary aspiration during and after angiography. Potential risks and benefits associated with fasting were provided in written documents and through personal counseling to patients before the procedure. The patients chose their fasting or nonfasting option. No restriction in diet was given after angiography. The patients were observed for 24 hours. Nausea and vomiting during and within 1 hour after angiography was considered as a positive event associated with cerebral angiography. The overall incidence of nausea and vomiting during and within 1 hour after angiography was 1.05% (27/2554 patients). There was no patient with pulmonary aspiration. No statistical difference in nausea and vomiting development between the fasting and the diet groups was found. The incidence of nausea and vomiting associated with cerebral angiography is low and not affected by diet or fasting. Pulmonary aspiration had no difference between the diet and the fasting group. Our study suggests that fasting may not be necessary for patients who undergo elective cerebral angiography.

The effect of combining dexamethasone with ondansetron for nausea and vomiting associated with fentanyl‐based intravenous patient‐controlled analgesia*

We investigated whether combined dexamethasone and ondansetron is more effective than ondansetron alone in preventing postoperative nausea and vomiting in patients with fentanyl-based intravenous patient-controlled analgesia. One hundred and thirty patients undergoing video-assisted thoracoscopic surgery were assigned to either an ondansetron group or a dexamethasone and ondansetron group. In all patients, ondansetron 4 mg was administered at the end of surgery and 12 mg was added to the patient-controlled analgesia solution. The dexamethasone and ondansetron group received dexamethasone 8 mg at the induction of anaesthesia. The overall incidence of nausea and vomiting during the first 48 h postoperatively did not differ between groups (34/61 (56%) vs 28/62 (45%) in the ondansetron group and dexamethasone and ondansetron groups, respectively). The incidence of severe nausea and vomiting (≥ 7 nausea on an 11-point verbal numerical rating scale, retching or vomiting) was higher in the ondansetron group than in the dexamethasone and ondansetron group (15/61 (25%) vs 6/62 (10%, respectively, p=0.028). Combined dexamethasone and ondansetron is more effective in reducing severe nausea and vomiting than ondansetron alone in patients receiving fentanyl-based intravenous patient-controlled analgesia.

Ondansetron, ramosetron, or palonosetron: Which is a better choice of antiemetic to prevent postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy?

Background:Postoperative nausea and vomiting (PONV) is a serious concern in patients undergoing laparoscopic cholecystectomy (LC), with an incidence of 46 to 72%. The purpose of this study was to compare the antiemetic efficacy of intravenous (iv) ondansetron 8 mg, ramosetron 0.3 mg, and palonosetron 0.075 mg for prophylaxis of PONV in high-risk patients undergoing LC.Materials and Methods:In this prospective, randomized, double-blinded study, 87 female patients, 18 to 70 years of age (ASA I and II) and undergoing elective LC under general anesthesia were randomly allocated into three equal groups, the ondansetron group (8 mg iv; n=29), the ramosetron group (0.3 mg iv; n=29), and the palonosetron group (0.075 mg iv; n=29), and the treatments were given just after completion of surgery before extubation. The incidence of complete response (patients who had no PONV and needed no other rescue antiemetic medication), nausea, vomiting, retching, and need for rescue antiemetics over 24 hours after surgery were evaluated.Results:The number of complete responders were 19 (65.5%) for ramosetron, 11 (37.9%) for palonosetron, and 10 (34.5%) for ondansetron, representing a significant difference overall (P=0.034) as well as between ramosetron and ondansetron (P=0.035). Comparison between ramosetron and palonosetron also showed a clear trend favoring the former (P=0.065).Conclusion:Ramosetron 0.3 mg iv was more effective than palonosetron 0.075 mg and ondansetron 8 mg in the early postoperative period, but there was no significant difference in the overall incidence of nausea suffered.