Postdischarge Nausea And Vomiting Research Articles

New pharmacologic findings for the treatment of PONV and PDNV

Research regarding new pharmacologic findings in regards to the treatment of postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) are discussed. PONV and PDNV have many important negative outcomes, including medical complications and financial consequences. Great strides in basic research have identified a plethora of mechanisms involved in regulating and processing the emetic reflex, and subsequent development of antiemetic treatments has lessened these burdens. The currently available antiemetic agents are not able to individually ameliorate PONV, so guidelines have been developed that recommend administering a combination of antiemetic treatments from different drug classes as prophylaxis, especially for high-risk patients. Recent research has indicated that due to the unique structural characteristics of palonosetron that impact receptor binding, this 5-HT(3) receptor antagonist has a pharmacokinetic and pharmacologic profile different from other inhibitors within the drug class. Implications of the high affinity, allosteric, and positive cooperative binding properties of palonosetron include longer and tighter binding to the 5-HT(3) receptor, making palonosetron a very efficient antagonist and less likely to be displaced by the binding of serotonin. Ongoing research is warranted in order to better prevent and manage PONV and PDNV.

Post-discharge nausea and vomiting: an overlooked aspect of ambulatory anesthesia?

uE to continuing advances in anesthetic and surgical techniques, modern ambula-tory surgical care has become remarkably safe, with very low overall mortality and morbidity. However, despite impressive pharmaco-logical developments, which allow precise tailoring of anesthetic concentrations to facilitate rapid and pre-dictable emergence and recovery, the problem of pos-toperative nausea and vomiting (PONV) remains an elusive and ongoing clinical challenge. up to the pres-ent time, anesthesiologists have focused the majority of their analgesic and antiemetic strategies on patient care, to the point of patient discharge from the hos-pital. This is reflected in the growing documentation of patients’ experiences with nausea and vomiting in the postanesthesia care unit. However, there has been relatively little research, to date, examining the prob-lem of post-discharge nausea and vomiting (PDNV) after patients have left the hospital. This is definitely an overlooked aspect of ambulatory anesthesia. Post-discharge symptoms are seldom serious or life threatening, but they can be unpleasant and distress-ing to patients. The complication of PDNV can also have a major impact on the overall functional status of the patient. Important consequences include: a) delay in the resumption of normal daily activities and readi-ness to work; b) potential economic impact for health care providers and patients themselves; and c) failure to comply with analgesic prescriptions, for fear that the analgesic medications may cause further nausea and vomiting, thus aggravating the existing distress.

We’re Tired of Waiting

We’re Tired of Waiting

Randomized comparison of two anti-emetic strategies in high-risk patients undergoing day-case gynaecological surgery

Postoperative nausea and vomiting (PONV) is a significant cause of morbidity among patients undergoing general anaesthesia. The optimal strategy for prevention of PONV, however, remains unclear. This study compared two commonly used prophylactic strategies in high-risk, day-case, gynaecological surgery patients. We conducted a randomized trial comparing sevoflurane combined with dolasetron (SD), with propofol-based total intravenous anaesthesia (TIVA) in 126 high-risk patients undergoing day-case gynaecological surgery. The primary endpoints included the incidence and severity of nausea or vomiting before discharge and the incidence of nausea or vomiting between discharge and 24 h. To identify the factors most predictive of a complete response (no PONV at any time within the 24 h period), multiple logistic regression models were fitted. Before discharge, there was no significant difference between the two treatment groups with respect to nausea and vomiting outcomes (P = 0.3). Post-discharge nausea and vomiting (PDNV), however, were significantly more common for patients in the TIVA group (nausea, P = 0.004 and vomiting, P = 0.03). Type of anaesthetic, adjusted for weight and anaesthesia duration was significantly associated with complete response (odds ratio = 2.7, 95% confidence interval = 1.15 to 6.4). Although both TIVA and dolasetron prophylaxis reduce the predicted rate of PONV in the early postoperative period, the anti-emetic effects of propofol are short-lived. A longer-acting drug such as dolasetron may therefore be necessary to prevent PDNV.

Evidence-Based Interventions for Post Discharge Nausea and Vomiting: A Review of the Literature

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) continue to be a problem for one third of all patients who require surgery and anesthesia. Very few studies have been reported that specifically target PDNV in the outpatient surgery population for interventions after discharge home. Twenty studies were identified that specifically addressed the effect of an intervention for the purpose of preventing PDNV or rescuing the patient who develops PDNV. This article presents an integrative review of the research literature to determine the best evidence for prevention of PDNV in adults or for the rescue of patients who suffer from PDNV.

Prevention and Management of Postoperative Nausea and Vomiting: A Look at Complementary Techniques

Complementary modalities, used alone or in combination with pharmacologic therapies, play an important role in the prevention and management of postoperative nausea and vomiting (PONV) and post discharge nausea and vomiting (PDNV). This article will review the evidence for the effective use of complementary modalities: acupuncture and related techniques, aromatherapy, and music therapy that may be integrated in the perianesthesia nurse's plan of care to prevent or manage PONV.

The Use of Oral Granisetron Versus Intravenous Ondansetron for Antiemetic Prophylaxis in Patients Undergoing Laparoscopic Surgery: The Effect on Emetic Symptoms and Quality of Recovery

Based on comparative studies in patients receiving emetogenic chemotherapy, it has been suggested that granisetron would be more effective than ondansetron for the prevention of postdischarge nausea and vomiting (PDNV). However, there have been no direct comparisons of these two popular 5-HT3 antagonists with respect to PDNV and quality of recovery. We designed this randomized, double-blind study to compare the antiemetic efficacy of oral granisetron (1 mg) to a standard IV dose of ondansetron (4 mg) when administered for antiemetic prophylaxis as part of a multimodal regimen in a laparoscopic surgical population. A total of 220 patients undergoing laparoscopic surgery with a standardized general anesthetic technique were enrolled in this prospective study at two major medical centers. Patients were randomly assigned to one of two prophylactic treatment groups: the control (ondansetron) group received an oral placebo 1 h before surgery and ondansetron, 4 mg IV, at the end of the surgery, and the granisetron group received granisetron, 1 mg per os, 1 h before surgery, and normal saline, 2 mL IV, at the end of the surgery. The early recovery profiles, requirement for rescue antiemetics, incidence of PDNV, and the side effects were recorded over the 48 h study period. In addition, nausea scores were assessed using an 11-point verbal rating scale at specific intervals in the postoperative period. The quality of recovery and patient satisfaction scores were recorded at 48 h after surgery. The demographic characteristics were similar in the two prophylaxis treatment groups, as well as the recovery times to patient orientation, oral intake, and hospital discharge. The incidences of PDNV, requirements for rescue antiemetics, and quality of recovery did not differ between the two study groups. The antiemetic drug acquisition costs to achieve comparable patient satisfaction with ondansetron and granisetron were US 25.65 dollars and 47.05 dollars, respectively. Therefore, ondansetron (4 mg IV) was more cost-effective than granisetron (1 mg per os) for routine antiemetic prophylaxis as part of a multimodal regimen in patients undergoing either outpatient or inpatient laparoscopic surgery.

Self-Care Activities for Postdischarge Nausea and Vomiting

Postdischarge nausea and vomiting (PDNV) is a serious threat to the recovery of ambulatory surgical patients. Pharmacological interventions available before discharge are not readily available to the patient after discharge; therefore, the activities that patients perform to manage new-onset PDNV may affect their surgical recovery. Assembled from a comprehensive study of PDNV, this paper describes the self-care activities that ambulatory patients use to manage new-onset nausea and vomiting after discharge. The findings have implications for patient education and future research.

Does the routine prophylactic use of antiemetics affect the incidence of postdischarge nausea and vomiting following ambulatory surgery?: A systematic review of randomized controlled trials.

Does the routine prophylactic use of antiemetics affect the incidence of postdischarge nausea and vomiting following ambulatory surgery?: A systematic review of randomized controlled trials.