Postoperative Nausea And Vomiting In Patients Research Articles

Comparative efficacy of prophylactic protocols in reducing perioperative nausea and vomiting during video-assisted thoracoscopic radical resection of lung cancer

Lung cancer, a global mortality leader, often necessitates Video-Assisted Thoracoscopic (VATS) surgery. However, post-operative nausea and vomiting (PONV) is common, highlighting a need for effective management and prevention strategies in this context. A retrospective case–control study at Fujian Medical University Union Hospital evaluated patients undergoing VATS radical resection of lung cancer between May and September 2022. Patients were categorized based on PONV prevention methods, and data encompassing demographics, surgical history, and postoperative adverse events s were analyzed to assess the association between prophylactic protocols and PONV incidence. The Netupitant and Palonosetron Hydrochloride (NEPA) group showed a significant reduction in PONV occurrences post-surgery compared to Ondansetron (ONDA) and Control groups, emphasizing NEPA’s efficacy in alleviating PONV symptoms (P < 0.05). Furthermore, following VATS radical resection of lung cancer, NEPA markedly reduced the intensity of PONV symptoms in patients. Both univariate and multivariate logistic analyses corroborated that NEPA independently reduces PONV risk, with its protective effect also apparent in susceptible populations like females and non-smokers. NEPA utilization markedly reduced both the incidence and severity of PONV in patients undergoing VATS radical resection of lung cancer, serving as an independent protective factor in mitigating PONV risk post-surgery.

Analysis of influencing factors and construction of prediction model for postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy: a single-center retrospective cohort study.

With the increasing number of bariatric surgeries, the high incidence of postoperative nausea and vomiting (PONV) associated with this surgery has also gradually attracted attention. Among the common bariatric surgery methods, patients undergoing sleeve gastrectomy (SG) have the highest incidence of nausea and vomiting. The mechanism of occurrence of PONV is very complex. This study aims to explore the influencing factors of PONV in patients undergoing laparoscopic sleeve gastrectomy (LSG) and construct a nomogram prediction model based on these factors. With the approval of the Ethics Committee, the electronic medical records of patients who underwent LSG from July 2022 to May 2023 were collected retrospectively. A total of 114 patients with complete medical records who underwent LSG from July 2022 to May 2023 were included in this study. Among them, 46 patients developed PONV, resulting in a PONV incidence rate of 40.4%. Multivariate logistic regression analysis revealed that female gender, the use of inhalation anesthesia, and operation time ≥ 120min were risk factors for PONV in LSG. Additionally, the use of more than two kinds of antiemetic drugs was identified as a protective factor. Based on these factors, a nomogram model was constructed. PONV in patients undergoing LSG is related to gender, type of anesthesia, duration of surgery, and combination therapy with antiemetic drugs. The nomogram prediction model constructed in this study demonstrates high accuracy and discrimination in predicting the occurrence of PONV in patients undergoing LSG.

Association between preoperative lumbar skeletal muscle index and postoperative nausea and vomiting in patients undergoing pylorus-preserving pancreatoduodenectomy: a retrospective study.

Sarcopenia is associated with postoperative complications; however, its impact on the quality of postoperative recovery, such as postoperative nausea and vomiting (PONV) and pain, remains unclear. We investigated the association of preoperative lumbar skeletal muscle mass index (LSMI) with PONV, postoperative pain, and complications. Medical records of 756 patients who underwent pylorus-preserving pancreatoduodenectomy (PPPD) were retrospectively reviewed. The skeletal muscle areas were measured on abdominal computed tomography (CT) images. LSMI was calculated by dividing the skeletal muscle area by the square of the patient's height. We analyzed the correlations between preoperative LSMI calibrated with confounding variables and PONV scores, PONV occurrence, pain scores, rescue analgesic administration, postoperative complications, and length of hospital stay. The median (1Q, 3Q) LSMI was 47.72 (40.74, 53.41) cm2/m2. The incidence rates of PONV according to time period were as follows: post-anesthesia care unit, 42/756 (5.6%); 0-6 h, 54/756 (7.1%); 6-24 h, 120/756 (15.9%); 24-48 h, 46/756 (6.1%); and overall, 234/756 (31.0%). The incidence of PONV was inversely correlated with LSMI 24-48 h post-surgery and overall. LSMI and PONV scores were negatively associated 6-24 h and 24-48 h post-surgery. There was no association between LSMI and postoperative pain scores, rescue analgesic administration, complications, or length of hospital stay. Preoperative LSMI was associated with PONV in patients undergoing PPPD. Therefore, LSMI measured on preoperative abdominal CT can be a predictive indicator of PONV. Appropriate PONV prophylaxis is necessary in patients with low LSMI before PPPD.

Effect of S-Ketamine on Postoperative Nausea and Vomiting in Patients Undergoing Video-Assisted Thoracic Surgery: A Randomized Controlled Trial.

Postoperative nausea and vomiting (PONV) frequently occur in patients after surgery. In this study, the authors investigated whether perioperative S-ketamine infusion could decrease the incidence of PONV in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy. This prospective, randomized, double-blinded, controlled study was conducted a total of 420 patients from September 2021 to May 2023 at Xuzhou Central Hospital in China, who underwent elective VATS lobectomy under general anesthesia with tracheal intubation. The patients were randomly assigned to either the S-ketamine group or the control group. The S-ketamine group received a bolus injection of 0.5 mg/kg S-ketamine and an intraoperative continuous infusion of S-ketamine at a rate of 0.25 mg/kg/h. The control group received an equivalent volume of saline. All patients were equipped with patient-controlled intravenous analgesia (PCIA), with a continuous infusion rate of 0.03 mg/kg/h S-ketamine in the S-ketamine group or 0.03 μg/kg/h sufentanil in the control group. The primary outcome was the incidence of PONV. Secondary outcomes included perioperative opioid consumption, hemodynamics, postoperative pain, and adverse events. The incidence of PONV in the S-ketamine group (9.7%) was significantly lower than in the control group (30.5%). Analysis of perioperative opioid usage revealed that remifentanil usage was 40.0% lower in the S-ketamine group compared to the control group (1414.8 μg vs 2358.2 μg), while sufentanil consumption was 75.2% lower (33.1 μg vs 133.6 μg). The S-ketamine group demonstrated better maintenance of hemodynamic stability. Additionally, the visual analogue scale (VAS) scores on postoperative day 1 (POD-1) and postoperative day 3 (POD-3) were significantly lower in the S-ketamine group. Finally, no statistically significant difference in other postoperative adverse reactions was observed between the two groups. The results of this trial indicate that perioperative S-ketamine infusion can effectively reduce the incidence of PONV in patients undergoing VATS lobectomy.

Comparison of prophylaxis strategy for postoperative nausea and vomiting and its incidence before and after the implementation of 5-hydroxytryptamine 3 in surgical setting: a single-center, retrospective study.

To investigate the association between adherence to guideline-recommended risk-based postoperative nausea and vomiting (PONV) prophylaxis, the antiemetics used for PONV prophylaxis, and the incidence of PONV in patients who were underwent general anesthesia before and after 5-HT3 receptor antagonists became available. Patients (≥ 20years old) who were extubated after scheduled surgery and returned to general wards between January 2021 and February 2022 and between June 2022 and July 2023 were included. Risk factors included age < 50, female, motion sickness, nonsmoker, surgical factors, and postoperative opioid use. Two and three or more prophylaxis were recommended for patients with one or two and three or more risk factors, respectively. The primary outcome was the number of patients who received adequate prophylaxis, and the secondary outcomes were antiemetic agents used during anesthesia and the incidence of PONV on postoperative days 0 and 1. PONV was defined as documented PONV or rescue antiemetic administration. From January 2021 to February 2022 and from June 2022 to July 2023, 2342 and 2682 patients were included, respectively. Before ondansetron became available, more D2 receptor antagonists were used (p < 0.001), and after ondansetron became available, both ondansetron (p < 0.001) and propofol (p < 0.001) were given more frequently. Before and after ondansetron became available, the number of patients with adequate prophylaxis was 3.7% and 9.2%, respectively (p < 0.001), and the incidence of PONV on postoperative days 0 and 1 was 44.6% and 44.0%, respectively (p = 0.67). The availability of ondansetron increased the number of patients with adequate PONV prophylaxis, but did not decrease the incidence of PONV.

Preoperative dexamethasone administration in reducing the incidence of nausea and vomiting after thyroidectomy: a systematic review and meta-analysis of drug dosage.

Postoperative nausea and vomiting (PONV) are key contributors to the delay of recovery and cause patients' considerable discomfort. This study aimed to evaluate the influence of a specific dexamethasone dosage on PONV incidence, with a secondary objective of assessing its impact on postoperative pain in patients undergoing thyroid surgery. A meta-analysis was performed to examine the effects of preoperatively administering various doses of dexamethasone in combination with saline on PONV and pain relief in patients undergoing thyroidectomy. Relevant trials published before December 30, 2022, were searched in the PubMed, Embase, Cochrane Library, and Web of Science databases. The collected data were analyzed using RevMan 5.3 software (Cochrane), and a random-effects model or fixed-effects model was employed to conduct the meta-analysis. Our meta-analysis included 11 randomized controlled trials (RCTs) with a total of 1,544 participants. The results suggested that administering dexamethasone at a dosage of 8-10 mg can reduce the incidence of PONV in patients after thyroid surgery [odds ratio (OR) 0.27; 95% CI: 0.15-0.50; I2=82%; P<0.0001]. Additionally, administering dexamethasone at a dosage of 8-10 mg was found to be significantly more effective in reducing the incidence of PONV than was a dosage of 4-5 mg (OR 0.39; 95% CI: 0.19-0.80; I2=29%; P=0.01). The study also revealed that administering dexamethasone at a dosage of 8-10 mg can significantly reduce pain in patients undergoing thyroidectomy [mean difference (MD): -1.19; 95% CI: -1.97 to -0.41; I2=96%; P=0.003]. However, administering dexamethasone at a dosage of 4-5 mg did not significantly reduce pain (MD: -0.27; 95% CI: -1.00 to 0.45; I2=0%; P=0.46) according to the subgroup analysis. Our study found that the intervention of administering dexamethasone did not have a significant impact on the consumption of analgesic drugs (MD: -0.19; 95% CI: -0.45 to 0.08; I2=62%; P=0.16). A preoperative single dose of 8-10 mg of dexamethasone can significantly reduce PONV and the requirement for additional antiemetic medications, as well as alleviate postoperative pain after thyroidectomy. However, more RCTs should be conducted to determine the effects of varied dexamethasone dosages, particularly 4-5 mg, on the incidence of PONV and pain.

The Correlation Between Pre-Operative Fasting Duration and Post-Operative Nausea and Vomiting Occurrence on Patients with General Anestehesia

Background: Preoperative fasting is a procedural measure implemented before surgery or anesthesia to avert regurgitation or vomiting. PONV incidence is influenced by surgical, anesthetic, and patient-related factors. The purpose of the study is to ascertain the duration of preoperative fasting observed by participants and the prevalence of PONV according to personality traits. Purpose: Determine the correlation between the duration of preoperative fasting and the occurrence of PONV in patients undergoing general anesthesia at RSUD Dr. Soekardjo Tasikmalaya. Methods: Observatory, descriptive, and cross-sectional designs are utilized. The sampling method was with sixty respondents ranging in age from seventeen to forty-five years, ASA I to II. Data is collected via observation and evaluation. Findings: The study observed that among 37 individuals (61.7%), preoperative fasting for 6-8 hours was beneficial, while for 23 individuals (38.3%), fasting for &gt;8 hours were detrimental. At the age of 17-25 years, 10 individuals (47.6%) develop PONV, while 11 individuals (52.4%) do so between the ages of 26-45. Among women, 17 individuals (81.0%) have PONV, while 20 individuals (95.2%) have ASA I physical status, and 1 individual (4.8%) has ASA II physical status. Conclusion: There is a significant link (p &lt; 0.013) between preoperative fasting time and postoperative nausea and vomiting (PONV) in patients under general anesthesia. Fasting before surgery should be long enough to avoid PONV

The Relationship Between Pre-Anesthesia Anxiety and the Incidence of Post-Operative Nausea and Vomiting (PONV) in Patients Undergoing General Anesthesia at Islamic Hospital Purwokerto

Background: The anaesthetic method employed during surgical procedures may cause pre-anaesthesia apprehension to increase, which is strongly associated with the occurrence of post-operative nausea and vomiting (PONV), which signifies alterations in psychological and physiological responses. Purpose: To examine the correlation between pre-anaesthesia anxiety and the occurrence of post-operative nausea and vomiting among Islamic Hospital Purwokerto patients undergoing general anaesthesia. Implementing Methods: By utilising a total sampling technique and an analytical approach with a cross-sectional design, 59 patients undergoing surgery under general anaesthesia in April 2023 were included. We gathered primary data by administering pre-anesthesia and post-anesthesia PONV questionnaires to patients in the inpatient ward. Findings: Most patients analysed by patient characteristic analysis were between the ages of 36 and 45 (33.90%), female (62.71%), had completed secondary school (54.24%), and were classified as ASA 2 (84.05%). The majority (72.88%) underwent moderate surgery, and all patients received 100% family support. Panic (49.2%), severe anxiety (42.4%), and moderate anxiety (8.5%) were the most prevalent responses. Moderate (6.7%), severe-to-moderate (28.8%), and severe (64.4%) nausea and vomiting were reported by the majority. A significant relationship exists between pre-anaesthesia anxiety and the incidence of post-operative nausea and vomiting (PONV) in patients undergoing general anaesthesia at Islamic Hospital Purwokerto, as indicated by the chi-square statistic = 0.016). Conclusion: The chi-square statistic indicates a significant relationship between pre-anaesthesia anxiety and the incidence of PONV in patients undergoing general anaesthesia at Islamic Hospital Purwokerto.

Effect of 5% Dextrose Infusion on Postoperative Nausea and Vomiting in Patients undergoing Laparoscopic Cholecystectomy: A Randomised Controlled Study

Introduction: Postoperative Nausea and Vomiting (PONV) is defined as nausea, vomiting, or retching occurring in the postanaesthesia care unit within the first 24 hours of postoperative period. It is most common following laparoscopic cholecystectomy, causing postoperative discomfort and increasing patients’ stay in the postanaesthesia care unit. Aim: To evaluate the effect of a 500 mL infusion of 5% dextrose on PONV in patients undergoing laparoscopic cholecystectomy. Materials and Methods: A randomised controlled study was conducted at Department of Anaesthesiology, ESICMC PGIMSR, Bengaluru, Karnataka, India from January 2019 to June 2020, involving 90 consenting patients who were randomly assigned to two groups. One group (Group-C) received a 500 mL infusion of 5% dextrose, while the other group (Group-D) received Ringer’s lactate 30 minutes before the end of surgery. Anaesthesia and surgical techniques were standardised for all cases. Postoperatively, primary parameters such as the incidence of nausea, vomiting, and retching, and secondary parameters such as rescue antiemetic consumption and changes in blood glucose changes were recorded. The Bellville scale was used to assess PONV. Data were analysed using the Chi-square (χ2 ) test, with a significance level of 0.05. Continuous variables were reported as mean±Standard Deviation (SD), and categorical variables were reported as proportions. Results: Demographic parameters such as age (p=0.601), gender (p=0.259), weight (p=0.802), height (p=0.391), and Body Mass Index (BMI) (p=0.806) were comparable between the two study groups. A 5% dextrose infusion during laparoscopic cholecystectomy reduced nausea and vomiting during the postoperative period (p&lt;0.05), decreased the overall incidence of PONV (p&lt;0.001), and also reduced the requirement for rescue antiemetic dose (p&lt;0.004). When comparing blood sugar levels, Group-D and Group-C showed no significant difference at T1, but there was a significant difference between the both groups at T2 (T1: p=0.211, T2: p&lt;0.001). Conclusion: A 5% dextrose infusion during laparoscopic cholecystectomy reduces the incidence of PONV and decreases the need for rescue antiemetic medication. Additionally, comparing blood sugar levels, Group-D and Group-C showed a significant difference after the drug infusion. Therefore, a 5% dextrose infusion can be recommended as an effective and safe method for the prophylaxis of PONV in laparoscopic cholecystectomy.

Postoperative Nausea and Vomiting following Endoscopic Sinus Surgery under the Guidance of Adequacy of Anesthesia or Pupillometry with Intravenous Propofol/Remifentanil.

Postoperative nausea and vomiting (PONV) constitutes an adverse event after endoscopic sinus surgery (ESS) under general anesthesia (GA) with intravenous opioids, such as remifentanil (RMF). Monitoring the nociception/antinociception balance using the surgical pleth index (SPI) or pupillary dilatation reflex (PRD) helps guide intravenous RMF infusion. We aimed to investigate whether their employment could help reduce the incidence of PONV in patients undergoing ESS. The data of 30 patients from the GA group, 31 from the SPI group, and 28 from the PRD group were analyzed. The initial RMF infusion rate of 0.25 µg/kg body weight/minute was increased by 50% when the SPI, PRD, or Boezaart Bleeding Scale (BBS) were elevated by >15, >5%, or >2 points, respectively, until they normalized. PONV was present in 7/89 patients (7.9%): 2/31 patients (6.5%) of the SPI group, 1/30 patients (3.3%) of the GA group, and 4/28 patients (14.3%) of the PRD group. Neither PRD nor SPI guidance for RMF administration reduced the incidence of PONV compared to standard practice. Further studies are required in order to investigate the possibility of PONV eradication in patients undergoing ESS under GA when it is possibly combined with paracetamol/metamizole preventive analgesia, as well as those using antiemetic prophylaxis based on the Apfel Score and premedication with midazolam.

Hipotensi Berhubungan dengan Kejadian Post Operative Nausea and Vomiting pada Pasien Pasca Anestesi General dan Anestesi Sub Arahnoid Block

This study aims to identify decreased blood pressure and postoperative nausea and vomiting (PONV) in patients post general anesthesia and sub-arachnoid block (SAB) anesthesia. The research method used is descriptive statistics. The study showed a relationship between hypotension and the incidence of PONV in patients receiving general anesthesia, as indicated by the results of the contingency coefficient test, which had a significant value of 0.018. The study's results also showed a relationship between hypotension and the incidence of PONV in patients receiving SAB anesthesia, as indicated by the results of the contingency coefficient test, which had a significant value of 0.027. In conclusion, there is a relationship between a decrease in blood pressure and the incidence of PONV in patients who received general anesthesia and SAB anesthesia at Aisyiyah Bojonegoro Hospital.&#x0D; &#x0D; Keywords: General Anesthesia, Hypotension, PONV, Sub Arachnoid Block (SAB)

IINCIDENCE OF POST-OPERATIVE NAUSEA AND VOMITING IN LAPAROSCOPIC CHOLECYSTECTOMY WITH A SINGLE DOSE OF PREOPERATIVE DEXAMETHASONE

and vomiting (PONV). Dexamethasone, a synthetic glucocorticoid with potent anti-inflammatory, immune-modulating, analgesic, and anti-emetic effects, effectively reduces the incidence of PONV after laparoscopic cholecystectomy. In this double-blind, placebo-controlled study, we aimed to investigate the efficacy of a single 8 mg dose of dexamethasone in preventing PONV in patients undergoing laparoscopic cholecystectomy. Sixty patients were randomized into two groups: group A, who received an 8 mg dexamethasone injection in a 2-ml preparation, and group B, who received normal saline during induction. Both groups received standardized anesthesia. Post-operatively, the incidence of nausea and vomiting was observed in both groups. Our study's findings indicate that no substantial variances were observed between the two cohorts in terms of medical or demographic factors. However, a lower proportion of patients in group A exhibited post-operative nausea and vomiting (PONV), while group B had a higher demand for anti-emetic medications to alleviate PONV symptoms. Thus, we can infer that administering a solitary dose of dexamethasone before laparoscopic cholecystectomy can reduce the risk of post-operative complications in patients.

A nomogram to predict postoperative nausea and vomiting in the ward following laparoscopic bariatric surgery.

Postoperative nausea and vomiting (PONV) is a common and distressing complication of laparoscopic bariatric surgery (LBS). However, there is a lack of effective integrated prediction models for preventing and treating PONV in patients after LBS. Based on a randomized controlled trial conducted between November 1, 2021, and May 13, 2022, we included 334 participants who underwent LBS according to the inclusion criteria. The database was divided randomly into training and validation cohorts in a ratio of 7:3. Least absolute shrinkage and selection operator plus multivariable logistic regression were used to identify independent predictors and construct a nomogram. The performance of the nomogram was assessed and validated by the area under the receiver operating characteristic curve (AUC), the concordance index (C-index), calibration plots, and a decision curve analysis (DCA). We also explored specific risk factors for PONV in patients with diabetes. The subjects were divided randomly into training (n = 234) and validation (n = 100) cohorts. Age, history of diabetes, type of surgery, and sugammadex use were incorporated to construct a nomogram prediction model. In the training cohort, the AUC and the optimism-corrected C-index were 0.850 [95% confidence interval (CI) 0.801-0.899] and 0.848, while in the validation cohort they were 0.847 (95%CI 0.768-0.925) and 0.844, respectively. The calibration plots showed good agreement between the predicted and actual observations. The DCA results demonstrated that the nomogram was clinically useful. The type of surgery, sugammadex use, and insulin level at 120min were predictors of PONV in patients with diabetes with an AUC of 0.802 (95%CI 0.705-0.898). We developed and validated a prediction model for PONV in patients after LBS. A risk factor analysis of PONV in patients with diabetes provides clinicians with a more precise prophylactic protocol.

A COMPARATIVE STUDY OF ONDANSETRON WITH RAMOSETRON IN PREVENTION OF POST-OPERATIVE NAUSEA AND VOMITING IN PATIENTS UNDERGOING GENERAL ANESTHESIA

Objective: Post-operative nausea and vomiting (PONV) is an unpleasant, distressing, and exhausting experience for patients. PONV may prolong recovery, delay patient discharge, and increase hospital costs. Prevention and treatment of PONV help to accelerate post-operative recovery and increase patient satisfaction. In this study, we compared the efficacy of Ondansetron and Ramosetron to prevent PONV in patients undergoing elective surgeries under general anaesthesia and also to study their side effects. Methods: Eighty patients (American Society of Anesthesiologists [ASA] I and II) between the age group of 18 and 65 years scheduled to undergo elective surgeries under general anaesthesia were randomly allocated into two groups. Group O received Ondansetron 4 mg and Group R received Ramosetron 0.3 mg intravenously before induction of anaesthesia. Episodes of nausea, vomiting, and retching were determined and noted in first 24 h after surgery at time intervals of 0–3 h, 3–6 h, 6–12 h, and 12–24 h. The incidence of adverse effects and the use of rescue anti-emetics were also noted in the post-operative period. At the end of the surgery, results were compiled and statistical analysis was done using Student’s “t” test and Chi-square test. p&lt;0.05 was considered as significant. Results: The incidence of nausea was lower in patients receiving Ramosetron when compared to patients receiving Ondansetron especially in the 0–3 h period (p=0.032). This was statistically significant. The incidence nausea was lower in Group R during 3–6 h, 6–12 h, and 12–24 h period which was not statistically significant (p=1.000, p=0.359, p=1.000 respectively). The incidence of vomiting was lower in patients receiving Ramosetron when compared to patients receiving Ondansetron in the 0–3 h, 3–6 h, 6–12 h, and 12–24 h period, but it was not statistically significant (p=0.712, p=1.000, p=0.241, and p=0.116, respectively). The use of rescue anti-emetics and the incidence of adverse side effects were more in patients receiving Ondansetron when compared to patients receiving Ramosetron with no significance. Conclusion: Our study concludes that ramosetron was more effective than ondansetron in the prevention of post-operative nausea and was associated with fewer side effects comparatively.

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.

Is the reduced risk of post-operative nausea and vomiting in low flow anesthesia applications associated with pre-operative neutrophil/lymphocyte ratio values?

Background/Aim: Post-operative nausea and vomiting (PONV) are defined as nausea and/or vomiting occurring within the first 24 h after surgery and are often observed in the first 2 h after surgery. Only a few previous studies on the use of low fresh gas flow that reduces inhaler agent consumption in laparoscopic cholecystectomy patients at high risk of PONV have been published. Our study aimed to determine the incidence of PONV in the first 30 min and again at 24 h in cases of laparoscopic cholecystectomy in which we applied low fresh gas flow (1 L/min). In addition, we wanted to predict whether the pre-operative neutrophil/lymphocyte ratio (NLR) ≥2 is a risk factor for PONV in our patients to whom we applied low fresh gas flow. Methods: For our prospective cohort study, 80 cases between the ages of 18 and 65, had American Society of Anesthesiologists (ASA) scores of I and II, and who had been scheduled to undergo elective laparoscopic cholecystectomy were included in the study. The NLR limit (calculated by dividing the neutrophil count obtained from the complete blood count before surgery by the lymphocyte count) calculated in the pre-operative period after a patient’s informed consent was obtained was accepted as 2 [5]. Patients were classified into two groups: (1) NLR-I with NLR &lt;2 and (2) NLR-II with NLR ≥2. Premedication was not used in either group. Results: A total of 80 patients were included in the study. They were divided into two groups for classification purposes: (1) NLR-I (n=40) and (2) NLR-II (n=40). The characteristics of the patients in both groups, such as gender distribution, ASA scores, smoking status, mean age, and body mass index (BMI) values, were not different. Sevoflurane consumption in the groups was similar (P=0.169). The time required to complete surgery was longer in the NLR-II group (P=0.025). Nausea/vomiting and antiemetic use were similar in the NLR-I and NLR-II groups in which low fresh gas flow was applied in the first 30 min and 24 h (P=0.500). Although nausea/vomiting was more common in the female and non-smoking group in the first 30 min and 24 h, it was not statistically significantly different from males and smoking groups (P=0.325). However, nausea/vomiting was more common and significantly different in the ASA II versus the ASA I group (P=0.046). The time required to complete surgery was longer, and sevoflurane consumption was higher in patients with nausea and vomiting (P=0.001). Conclusions: Pre-operative NLR as classified by the two groups was not associated with an increase in the risk of PONV in patients to whom we applied low fresh gas flow. A decrease in sevoflurane consumption due to low fresh gas flow may lead to a reduction in the risk of PONV in at-risk patients.

Evaluation of the Role of Preoperative Oral Amisulpride as Part of a Multimodal Antiemetic Prophylaxis Regime on Postoperative Nausea and Vomiting in Patients Undergoing Craniotomy: A Prospective, Double-Blind, Randomized, Placebo-controlled Study.

Patients undergoing craniotomy are at high risk for postoperative nausea and vomiting (PONV) despite the use of prophylactic antiemetics. We hypothesized that a single preoperative oral dose of amisulpride as part of a multimodal antiemetic regimen would decrease the incidence of PONV in patients undergoing craniotomy for intracranial tumor surgery. Adult patients scheduled for elective craniotomy requiring general anesthesia were enrolled and randomized to receive either oral amisulpride 25mg or placebo 2 hours before surgery in addition to our institution's usual antiemetic regimen. The primary outcome of the study was the incidence of nausea and/or vomiting during the first 24 hours postoperatively. Secondary outcomes included severity of nausea, use of rescue antiemetic medications, and treatment-related adverse events. A total of 100 patients were included in the analysis. More patients in the amisulpride group had no episodes of nausea (90% vs. 40%; P<0.001) and no episodes of vomiting (94% vs. 46%; P<0.001) compared with the placebo group. The severity of nausea was lower in the amisulpride group than in the control group in the first 4 hours after surgery (P<0.05), and fewer patients receiving amisulpride required rescue antiemetics (P<0.001). The incidence of treatment-related adverse events was similar between groups. A single preoperative oral dose of amisulpride 25mg as a component of a multimodal antiemetic regimen decreased the incidence and severity of PONV in patients undergoing craniotomy for intracranial tumor surgery, with no adverse effects.

The use of aprepitant for the prevention of postoperative nausea and vomiting in endoscopic transsphenoidal pituitary surgery.

Postoperative nausea and vomiting (PONV) are adverse effects after surgery, which may increase the risk of complications. Aprepitant is a neurokinin-1 receptor blocker and has been shown to reduce chemotherapy-related nausea and vomiting and PONV. However, its role in endoscopic skull base surgery remains unclear. The purpose of this study was to evaluate the effect of aprepitant in reducing PONV in endoscopic transsphenoidal (TSA) pituitary surgery. A retrospective chart review between July 2021 and January 2023 of 127 consecutive patients who underwent TSA was performed at a tertiary academic institution. Patients were divided into 2 groups based on preoperative aprepitant use. Two groups were matched based on known risk factors of PONV (age, sex, nonsmoking, and history of PONV). The primary outcome was the incidence of PONV. Secondary outcome measures included the number of anti-emetic use, length of stay, and postoperative cererebrospinal fluid (CSF) leak. After matching, 48 patients were included in each group. The aprepitant group demonstrated a significantly lower incidence of vomiting than the non-aprepitant group (2.1%vs 22.9%, p=0.002). The number of nausea episodes and anti-emetic use decreased with aprepitant use (p<0.05). There was no difference in the incidence of nausea, length of stay, or postoperative CSF leak. Multivariate analysis demonstrated that aprepitant decreased the incidence of postoperative vomiting with odds ratio of 0.107. Aprepitant may serve as a useful preoperative treatment to reduce PONV in patients undergoing TSA. Further studies are needed to evaluate its impact in other arenas of endoscopic skull base surgery.

Impact of Emend on Perioperative Bariatric Surgery Antiemetic Utilization, Patient Satisfaction, and Costs.

Postoperative nausea and vomiting (PONV) is one of the most common adverse effects of anesthesia and surgery, resulting in patient discomfort and dissatisfaction. Latest research has demonstrated the efficacy of NK-1 receptor antagonists in PONV management and its use in chemotherapy nausea prophylaxis. The authors of this article would like to provide evidence to support the use fosaprepitant, as monotherapy, in postoperative care, replacing a polypharmacological standard of care regimen. This was a retrospective chart review of 400 patients who received standard of care antiemetic regimen or received fosaprepitant (No-Fosaprepitant vs. Fosaprepitant groups, respectively). The primary outcome of this study is to evaluate the impact of fosaprepitant (administered intravenously) on perioperative antiemetic use, treatment cost, and patient satisfaction. Total PONV medication cost decreased with the replacement of standard of care regimen for fosaprepitant, from 46.47±20.54 United States Dollars in the no-Fosaprepitant group to 25.69±14.84 United States Dollars in the Fosaprepitant group. There was a significant reduction in antiemetic doses between groups; 0.37±0.745 versus 7.61±5.202 for ondansetron (P=0.001), 92±1.279 versus 2.21±2.399 for promethazine (P=0.001), 0.25±0.685 versus 1.41±0.577 for scopolamine patch (P=0.001), and 0.05±0.218 versus 1.14±0.398 for dexamethasone (P=0.001). Patient satisfaction, measured by a questionnaire, was a 11.6% higher in the Fosaprepitant group. Fosaprepitant is a relevant alternative in preventing and treating PONV in patients who underwent bariatric/metabolic surgical procedures.

The risk factors of postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy and laparoscopic distal gastrectomy: a propensity score matching analysis

Postoperative nausea and vomiting (PONV) is a common side effect after laparoscopic surgery. The aim of the study is to investigate the variables that could predict PONV in patients who underwent laparoscopic gastrectomy. We divided patients who underwent laparoscopic gastrectomy into PONV and No-PONV groups. Propensity score matching (PSM) was applied to adjust confounding factors for further validation, and ordinal logistic regression analysis was used to identify predictors for PONV. In the ordinal logistic regression analysis, the preoperative neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR]: 3.19, 95% confidence interval [CI]: 1.38–7.38; p < 0.01) was identified as an independent risk factor for the presence of PONV and a predictor of the severity of PONV (OR: 3.44, 95% CI: 1.67–5.20; p < 0.01) in 94 PSM patients. Besides, NLR was positively correlated with the PONV score (r = 0.534, p < 0.001). In the receiver-operating characteristic (ROC) curve analysis, an NLR with an optimal cutoff value of 1.59 predicted severe PONV with a sensitivity of 72% and specificity of 81%. The NLR was an independent risk factor for the presence of PONV, and a high NLR tends to be positively associated with the severity of PONV after laparoscopic gastrectomy.