Prevention Of Postoperative Nausea And Vomiting Research Articles

Impacts of intrathecal fentanyl on the incidence of postoperative nausea/vomiting: Systematic review and meta-analysis of randomized studies.

Post-operative nausea and vomiting (PONV) is an event of multifactorial origin with an incidence of 30% in the general population. Opioids such as fentanyl are being used as adjuvant to local anesthetic for its antiemetic effect. In this context, with this study we aimed to evaluate the impact of spinal fentanyl as an adjuvant on the incidence of PONV compared with a placebo, and shivering. A systematic search of randomized controlled trials that evaluated the use of spinal fentanyl in the prevention of PONV and shivering was conducted in different databases, of which 32 studies met the inclusion criteria. A total of 2116 patients scheduled for various surgeries, including cesarean section, orthopedic surgery in the lower limb, hysterectomy, and transurethral resection of the prostate, were included in the final analysis. The meta-analysis estimated the relative risk of incidence of PONV in the first 24 hours after surgery and secondary outcomes included the shivering symptom. The use of intrathecal fentanyl was associated with lower incidence of PONV, but not statistically significant when compared to the placebo (RR: 0.74 CI95%: 0.55-1.01 P = 0.06). Subgroup analysis showed a statistically significant reduction in PONV incidences with lower doses between 10 and 15 μg (RR: 0.44 CI95%: 0.35-0.55 P < 0.00001, I2 = 0%) but not with higher doses 20-25 μg. Secondary outcomes showed a decrease in incidence with the use of fentanyl vs the placebo (RR: 0.49, CI95% 0.33-0.72 P = 0.0003). Current evidence shows that the use of spinal fentanyl decreases the incidence of PONV, an effect favored using low doses.

Postoperative Nausea and Vomiting in Female Patients Undergoing Breast and Gynecological Surgery: A Narrative Review of Risk Factors and Prophylaxis.

Postoperative nausea and vomiting (PONV) have been widely studied as a multifactorial entity, being of female gender the strongest risk factor. Reported PONV incidence in female surgical populations is extremely variable among randomized clinical trials. In this narrative review, we intend to summarize the incidence, independent predictors, pharmacological and non-pharmacological interventions for PONV reported in recently published clinical trials carried out in female patients undergoing breast and gynecologic surgery, as well as the implications of the anesthetic agents on the incidence of PONV. A literature search of manuscripts describing PONV management in female surgical populations (breast surgery and gynecologic surgery) was carried out in PubMed, MEDLINE, and Embase databases. Postoperative nausea and vomiting incidence were highly variable in patients receiving placebo or no prophylaxis among RCTs whereas consistent results were observed in patients receiving 1 or 2 prophylactic interventions for PONV. Despite efforts made, a considerable number of female patients still experienced significant PONV. It is critical for the anesthesia provider to be aware that the coexistence of independent risk factors such as the level of sex hormones (pre- and postmenopausal), preoperative anxiety or depression, pharmacogenomic pleomorphisms, and ethnicity further enhances the probability of experiencing PONV in female patients. Future RCTs should closely assess the overall risk of PONV in female patients considering patient- and surgery-related factors, and the level of compliance with current guidelines for prevention and management of PONV.

Antiemetic Efficacy of Prophylactic Ondansetron Versus Ondansetron with Dexamethasone Combination Therapies in Women Undergoing Breast Surgeries: A Randomized Controlled Trial

Objective: To compare the prophylactic antiemetic efficacy of ondansetron monotherapy with that of the combination of ondansetron and dexamethasone in the prevention on postoperative nausea and vomiting (PONV) in breast surgeries by observing the incidence of PONV, assess the percentage of participants requiring rescue antiemetics, know the side effects of drugs, and analyze the effect of the surgical duration of breast surgeries. Methods: The group ondansetron (O) received 0.1 mg/kg IV ondansetron and the other group (ondansetron and dexamethasone combination, OD) received 0.1 mg/kg IV ondansetron and 0.1 mg/kg of dexamethasone. The incidence of PONV in the first 24 h, percentage of population receiving rescue antiemetics, surgical duration, and hemodynamic parameters were noted. Results: In the 0 h to 6 h postoperative period, 38.9% of participants of group O had PONV, whereas only 13.9% in group OD had PONV, which was statistically significant ( P &lt; .016). About 30.6% of study population in group O and 8.3% in group OD required rescue antiemetics which was statistically significant ( P = .017). Surgical duration of more than 120 min had a statistically significant higher incidence of PONV in the O group with a P-value of .048. Conclusion: The combination of prophylactic ondansetron with dexamethasone is more efficacious than ondansetron alone for the prevention of PONV in women undergoing breast surgeries.

A Randomized Controlled Trial for Prevention of Postoperative Nausea and Vomiting after Laparoscopic Sleeve Gastrectomy: Aprepitant/Dexamethasone vs. Mirtazapine/Dexamethasone.

Background Coadministration of different antiemetics proved to decrease postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG). This trial compared aprepitant/dexamethasone (A/D) combination vs mirtazapine/dexamethasone (M/D) combination vs dexamethasone (D) alone for prevention of PONV in morbidly obese patients undergoing LSG. Methods Ninety patients scheduled for LSG were randomly allocated to receive 8 mg dexamethasone intravenous infusion (IVI) only in the D group or in addition to 80 mg aprepitant capsule in the A/D group or in addition to 30 mg mirtazapine tablet in the M/D group. Assessment of PONV was carried out at 0–2 h (early) and 2–24 h (late). The primary outcome was the complete response 0‐24 h after surgery. Collective PONV, postoperative pain, side effects and patient satisfaction score were considered as secondary outcomes. Results The A/D and M/D groups were superior to the D group for a complete response within 0–24 h after surgery (79.3% for the A/D group, 78.6% for the M/D group, and 20.7% for the D group). The D group was inferior to the A/D and M/D groups regarding collective PONV and use of rescue antiemetic 0–24 h after surgery (P < 0.001, P < 0.001, respectively). The peak nausea scores (2–24 h) were significantly reduced in the M/D group in comparison to the D group (P=0.005). Patients in the M/D group showed high sedation scores, while those in the A/D group showed low pain scores (2–24 h) and less analgesic requirements (P < 0.001, P < 0.001, P < 0.001, respectively). The A/D and M/D groups were superior to the D group with regard to the patient satisfaction score (P < 0.001). Conclusion Aprepitant/dexamethasone combination and mirtazapine/dexamethasone combination were superior to dexamethasone alone in alleviating postoperative nausea and vomiting in morbidly obese patients scheduled to undergo laparoscopic sleeve gastrectomy. Trial Registration: ClinicalTrials.gov identifier: NCT04013386.

Feasibility of day-case pediatric cochlear implantation.

Pediatric cochlear implantation is performed on an outpatient basis in an inconstant way. The aim of this study is to assess the feasibility of day-case pediatric cochlear implantation by determining the acceptability of outpatient-to-inpatient conversion rate (acceptability threshold of 5%) and to assess the safetyby comparing outpatient and inpatient postoperative events. We also want to identify conversion predictive factors. We conducted a monocentric retrospective study including 267 cases aged 6months to 18years who underwent unilateral cochlear implantation between 2016 and 2020. This population was divided into two groups: outpatient group (190 cases) and inpatient group (77 cases). Among the 190 cases scheduled as day surgery, 9 cases required conversion to conventional hospitalization which leads to an outpatient-to-inpatient conversion rate of 4.7%. Postoperative nausea and vomiting (PONV) were involved in all cases of conversion. Conversion predictive factors were the presence of an inner ear malformation at risk of gusher (OR 32.51, 95% CI [4.98-370.27], p 0.001) and the intraoperative administration of morphine (OR 8.52, 95% CI [1.38-86.84], p 0.035). There was no statistically significant difference in immediate postoperative complications (outpatient 14.2% vs inpatient 16.9% p 0.715), early-stage complications (outpatient 12.6% vs inpatient 10.4% p 0.812) and early-stage unplanned consultations (outpatient 4.7% vs inpatient 3.9% p 0.748) between outpatient and inpatient groups. Unplanned readmissions were found only in the outpatient group. Day-case pediatric cochlear implantation is a feasible and safe procedure even in infants. The outpatient-to-inpatient conversion rate of 4.7% is considered acceptable but requires anticipation of human and accommodation needs. No causes of conversion were life-threatening. The risk of postoperative complications and unplanned consultations are not influenced by the mode of hospitalization. Special attention should be paid to the prevention of PONV and the presence of inner ear malformations.

Comparison of palonosetron and aprepitant for prevention of post operative nausea and vomiting in females undergoing laparoscopic hysterectomy under general anesthesia

Background: Postoperative nausea and vomiting (PONV) is the second most common complaint following pain after surgery. In this era of daycare and outpatient-based surgery, PONV is the cause of delayed recovery and discharge from hospital settings. This study was designed to compare Palonosetron and Aprepitant for the prevention of PONV in patients undergoing laparoscopic hysterectomy under general anesthesia. Methods: 70 patients were included in this randomized double-blind study. Each group was allocated to receive either 0.075 mg of intravenous Palonosetron or 40mg of oral Aprepitant for PONV prophylaxis. A standard regimen of general anesthesia was administered to both groups for surgery. The primary outcome was the PONV impact severity scale (PISS) score at 48 hours following surgery in both groups. Secondary outcomes were the incidence of clinically significant PONV in both groups and the requirement of rescue antiemetics. Results: Mean PISS score at 48 hours was significantly lower (0.91±0.13 vs 3.43±0.2) in the Palonosetron group than in the Aprepitant Group. Incidence of PONV (16/35 vs 33/35) was significantly lower with Palonosetron. Incidence of clinically significant PONV and requirement of rescue antiemetics was significantly lower (2/35 vs 13/35) in the Palonosetron group.

Antiemetic effect of intravenous palonosetron and ondansetron for the prevention of postoperative nausea and vomiting following laparoscopic surgeries under general anaesthesia, a randomised observational study

Post-operative nausea and vomiting(PONV) is one of the common complications in patients undergoing laparoscopic surgeries under general anaesthesia. This study compares efficacy of prophylactic palonosetron and ondansetron in the prevention of PONV. After obtaining the approval of institutional ethical committee, a prospective randomised study was conducted on 60 patients belonging to American Society of Anaesthesiologists Grade I and II, patients of either sex, aged between 18 to 60 years, fulfilling the inclusion criteria were divided into two groups receiving inj. ondansetron 8 milligrams i.v. or inj. palonosetron 75 micrograms i.v. Incidence of PONV and need of rescue antiemetic was recorded post operatively. Data were evaluated statistically using Graph Pad Prism computer software version 6.04.It was found that inj. palonosetron 75mcg i.v. was more efficient in the prevention of PONV and required lesser rescue antiemetic when compared inj. ondansetron 8mg i.v. At conclusion of the study it was found that the prophylactic usage of inj. palonosetron 75 mcg i.v. is more effective than inj. ondansetron 8mg i.v. in the prevention of PONV in patients undergoing laparoscopic surgery (p value &lt; 0.05).

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.

Preoperative Administration of Aprepitant to Prevent Postoperative Nausea and Vomiting in Children

Background: Aprepitant (Emend ® ), a neurokinin-receptor antagonist, has seen increased use in the treatment of nausea and vomiting in various clinical scenarios. To date, there are limited data regarding its use in the pediatric population. We retrospectively reviewed our experience with aprepitant after its addition to the operating room formulary for prevention of postoperative nausea and vomiting (PONV). Methods: The anesthetic records of patients who received aprepitant were retrospectively reviewed. Demographic, surgical, medication, and efficacy data were retrieved. Results: The study cohort included 144 patients ranging in age from 7 to 17 years and in weight from 24.7 to 208.9 kg. The most common surgical procedures included gastrointestinal surgery, orthopedic surgery, and otolaryngologic procedures. Reasons for the administration of aprepitant included PONV prophylaxis due to risk factors such as type of surgery, duration of surgery, previous history of significant PONV, female gender, and family history of PONV. The majority of the patients (98.6%) received aprepitant in capsule form in a dose of 40 mg (97.9%). Seventeen patients (11.8%) had PONV or received antiemetic agents postoperatively. There were no unplanned admissions related to PONV. No adverse effects related to aprepitant were noted. Conclusions: Aprepitant was effectively introduced to the preoperative regimen as an additional agent for the prevention of PONV. The overall tolerability and efficacy of aprepitant was similar to previous studies, even in a patient population at high risk for PONV. J Curr Surg. 2022;12(1):1-6 doi: https://doi.org/10.14740/jcs457

Assessment of post-operative nausea and vomiting prophylaxis usage for cesarean section, 2021: A cross sectional study

BackgroundPost-operative nausea and vomiting (PONV) are common and distressing to patients. This common anesthetic and surgical side effect has been reported to increase patient dissatisfaction and can be more distressing to patients than post-operative pain. It has multi-factorial causes: patient, anesthesia and surgery related risk factors have been identified. Prevention of PONV is important since it has psychological and physical effects, and it can also cause severe complications. ObjectiveTo determine the level of practice of PONV prophylaxis usage for caesarean section. MethodsThis clinical perspective study was conducted at all pregnant mothers scheduled for caesarean section under anesthesia from March 1 to March 30, 2021 consecutively. The standards were directly changed into question forms with two integral checking components, “Yes”, and “No”. Data were entered and analyzed by statistical package of social sciences (SPSS) version 20. ResultsA total of 100 parturients scheduled for caesarean section were included with a response rate of 100%. Based on the standards, Anti-emetic treatment to patients with post-operative nausea and vomiting (PONV), adherence of anesthetists to local evidence based guideline for PONV prevention and more importantly no prophylactic administration to patients at low risk for PONV were implemented with a percentage of 17%,47%, and 14% respectively. Conclusionsand recommendations: There was a significant performance gap in the clinical practice of prevention of post-operative nausea and vomiting. We strongly suggest that adherence to a Protocol to reduce baseline risk and the adoption of a multimodal approach will highly likely ensure success in the management of PONV. The usage of appropriate anti-emetic prophylaxis to the right patient is necessary to have a good outcome after surgery and anesthesia.

Comparison of efficacy of palonosetron-dexamethasone combination with palonosetron alone or dexamethasone alone for prophylaxis against post-operative nausea and vomiting in patients undergoing laparoscopic cholycystectomy

Post-operative nausea and vomiting (PONV) is highly distressing and unpleasant symptom. Palonosetron and dexamethasone are effective antiemetics with minimal side effect profile. This study compared the efficacy of palonosetron dexamethasone combination with palonosetron alone and dexamethasone alone for prevention of PONV after laparoscopic cholecystectomy.This prospective, randomised, double-blind study was done on 150 adults, American Society of Anesthesiologists Grade I and II patients, aged 18-60 years undergoing laparoscopic cholecystectomy. They were allocated to three groups which were to receive either of the three treatment regimens: Group A, (n = 50) Dexamethasone 8 mg plus Palonosetron 0.075 mg OR GroupB (n = 50) Palonosetron 0.075 mg Alone OR Group C (n = 50) Dexamethasone 8 mg Alone. The primary outcome was incidence of PONV in 24 h and the secondary outcome was a number of rescue antiemetic required. One-way ANOVA test was used to compare the means amongst three groups. To compare the proportions in the groups, Chi-square test/Fisher's exact test/Two proportions Z-test was applied as appropriate.Overall incidences of PONV in the study 24 h postoperatively were 22% in group A, 42% in group B and 86% in group C in 24 h postoperatively (P &amp;#60; 0.001). Requirement of rescue antiemetic was more in dexamethasone group than other two groups.Palonosetron alone and palonosetron-dexamethasone combination were equally effective in the prevention of PONV. Dexamethasone alone was least effective amongst the three groups. There is no difference between palonosetron and palonosetron-dexamethasone for PONV prevention.

Efficacy of Intravenous Glucose for Preventing Postoperative Nausea and Vomiting after Abdominal Hysterectomy under General Anesthesia

Objective: This study aimed to evaluate the ability of intravenous glucose administration during the maintenance of anesthesia as an alternative method for diminishing the incidence of postoperative nausea and vomiting (PONV) in patients undergoing total abdominal hysterectomy (TAH).Material and Methods: This was a prospective, double-blind randomized placebo-controlled trial. One hundred and ten patients who were 18 - 65 years old, American Society of Anesthesiology (ASA) 1 or 2 and required general anesthesia for TAH, were divided randomly to receive 5% DNSS (Group D) or normal saline (Group N) as a maintenance fluid at a rate of 2 mL/kg/hr. The primary outcome was the incidence of PONV at the arrival time in post-anesthetic care unit (PACU). The secondary outcomes were severity of PONV, time to first dose of an antiemetic drug, amount of antiemetic dose, and length of stay in the hospital.Results: The incidence of PONV in group N was 5.5% and in group D was 10.4% (p-value = 0.360). There were no statistically significant differences regarding the VRS scores, time to the first dose of antiemetic drug, the amount of antiemetic drug, and length of hospital stay between the 2 groups.Conclusions: There was no significant difference in efficacy between intravenous glucose administration and placebo in the prevention of PONV in patients undergoing abdominal hysterectomy under general anesthesia.

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.

ОБЗОР 4-Й РЕДАКЦИИ РУКОВОДСТВА ПО ВЕДЕНИЮ ПОСЛЕОПЕРАЦИОННОЙ ТОШНОТЫ И РВОТЫ

In 2020, the 4th edition of the guidelines for the management of postoperative nausea and vomiting (PONV) was released, prepared by an international panel of experts under the auspices of the American Society of Enhanced Recovery and the Society of Ambulatory Anesthesia based on a comprehensive search and review of literature up to September 2019. This guide includes 7 blocks of advice for the prevention and treatment of PONV in children and adults. This document contains recommendations for identifying patients at high risk of PONV development, management of the underlying risks of PONV, the choice of preventive and pathogenetic treatment for PONV, as well as recommendations for the state implementation of the PONV protocol. In addition, the latest revision of the guidelines focuses on data on new drugs, discussions on the use of general multimodal prophylaxis and management of PONV as part of the fast track concept.

A Comparative Clinical Study of Methylprednisolone with Ondansetron versus Ramosetron in Preventing Postoperative Nausea and Vomiting in Patients Undergoing Middle-Ear Surgeries.

Background:One of the most troublesome complications after middle-ear surgeries has been postoperative nausea and vomiting (PONV). A notable decrease in PONV has been observed with the use of 5-hydroxytryptamine type 3 receptor antagonists and glucocorticoids.Aim:This study aimed to evaluate the effectiveness of the combination of intravenous methylprednisolone and ondansetron with ramosetron alone in preventing PONV in patients undergoing middle-ear surgeries.Settings and Design:This was a prospective, randomized, double-blind study that comprised sixty patients in the age group of 18–60 years belonging to the American Society of Anesthesiologists (ASA) physical status classification I or II and undergoing middle-ear surgery.Materials and Methods:With the help of computer-generated randomization table, sixty patients in the age group of 18–60 years belonging to ASA physical status classification I or II and undergoing middle-ear surgery were randomly allotted 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 ramosetron 0.3 mg (near the end of surgery) (Group R, n = 30). In both the groups, the incidence of PONV was studied.Statistical Analysis:Chi-square test or Fisher's exact test was utilized to analogize the categorical variables. Independent t-test was utilized to analogize the continuous variables.Results:In the first 2 h after the surgery, the difference between the two groups regarding the incidence of PONV was insignificant. Between 2 h and 24 h, the incidence of nausea was lowered significantly in the group MO compared to the group R (P = 0.01). Between 24 h and 48 h, the incidence of nausea was more in group R compared to the combination therapy group, which was statistically significant.Conclusion:The combination therapy is better than ramosetron alone for the prevention of PONV after middle-ear surgery. Therefore, we advocate a combination of methylprednisolone and ondansetron for prophylaxis for PONV in middle-ear surgeries.

Effects of perioperative dextrose infusion on preventing postoperative nausea and vomiting in patients undergoing laparoscopic surgery: a meta-analysis of randomized controlled trials.

ObjectiveThe aim of this study was to systematically examine the literature and assess the effects of perioperative dextrose infusion on the prevention of postoperative nausea and vomiting (PONV) in patients following laparoscopic surgery under general anesthesia.MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Studies were eligible for inclusion if they evaluated the prevention of PONV with perioperative intravenous dextrose. Studies listed in PUBMED, Web of Science, and EMBASE databases published up to December 2020 were identified. Data were extracted and analyzed independently using a fixed-effects or random-effects model according to the heterogeneity.ResultsSix RCTs involving 526 patients were included. Our results showed that perioperative dextrose infusion not only reduced the incidence of PONV (risk ratio [RR] = 0.61, 95% confidence interval [CI]: 0.39–0.95; I2 = 59%) but also decreased the requirement for antiemetics compared with the control (RR = 0.53, 95% CI: 0.42–0.66; I2 = 32%). Furthermore, perioperative glucose infusion did not increase blood glucose levels compared with the control (mean difference [95% CI] = 74.55 [−20.64 to 169.73] mg/dL; I2 = 100%).ConclusionOur study reveals that perioperative dextrose infusion may reduce the risk of PONV after laparoscopic surgery. However, additional population-based RCTs are needed to confirm this finding.

Dexamethasone Versus Ondansetron in Preventing Postoperative Nausea and Vomiting In Laparoscopic Surgery

Objective: To compare the efficacy of dexamethasone 8mg versus ondansetron 4mg in preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy Methodology: This quasi-experimental study was conducted at the Department of Anaesthesia and Intensive Care, Holy Family Hospital from 29th July 2018 to 28th January 2019. Anesthesia was induced with propofol (2mg/kg IV) and Atracurium (0.5 mg/kg IV) was given to facilitate tracheal intubation. Nalbuphine (0.2mg/kg) was used as analgesic.Patients were randomly divided into two groups. Patients in Group A received 4mg ondansetron at end of surgery and Group B received 8mg dexamethasone at induction. Results: A total of 90 patients were included according to the inclusion criteria of the study. The mean age (years) in the study was 37.11+10.60 years. Frequency and percentage of nausea (up to 24 hours) among both the groups was 28 (62.2) and 28 (62.2) respectively (p-value = 1.0) while the frequency and percentage of vomiting (within 24 hours after extubation) was 28 (62.2) and 27 (60.0) respectively (p-value = 0.829) Conclusion: The study concluded that there was no significant difference dexamethasone and ondansetron in preventing postoperative nausea and vomiting.

Gabapentin and Prevention of Post-Operative Nausea and Vomiting (PONV)

Background: Postoperative nausea and vomiting (PONV) is a major complication after abdominal surgery. Gabapentine has versatile role in case of convulsion and neuropathic pain management. Recently it has been used for the prevention of PONV. Objective: To evaluate the action of prophylactic gabapentin in preventing PONV in Laparoscopic cholecystectomy patients. Methods: It was a randomized placebo-controlled, double-blind study conducted in the Department of Anesthesiology, Dhaka Medical College Hospital from August 2016 to January 2017. A total number of 220 patients were selected by purposive sampling. They were divided into 2 Each group 110. After obtaining a detailed history, General physical and systemic examinations were done for all enrolled patients, after obtaining a detailed history and relevant investigations were done. The results were tested by chi-square test to see their level of significance level at &lt;0.05. Results: Of the 220 patients, 51.81% male and 48.18% were female patients respectively belonged to the study group whereas 55.45% and 44.54% were male and female patients. The mean age of the study group and control group were 45.31±13.63 and 47.03±15.51. The mean BMI in both groups was 23.69±3.12 and 24.17±4.73. The mean arterial pressure in both groups was 96.73±8.19 and 93.35±6.37. The total mean of intravenous fluid study and control group were 1233.7±29.5 and 1139.83±55.69. The total duration of surgery in the study group was 51.77±3.95 and the control group was 46.63±7.89. From the point of view of PONV, gabapentine has shown significantly higher efficacy than placebo (P=&lt;0.05). Out of 53 patients affected by PONV in the study group 13(24.52%), 30(56.60%), and 10(18.86%) patients were categorized as mild-moderate and severe PONV whereas 29(26.36%) 71(64.54%) and 20(18.18%) were upholder as their counterpart in the control group. In severe grade, there was no statistically significant difference found between the groups but in mild...........

Penehyclidine for prevention of postoperative nausea and vomiting following bimaxillary orthognathic surgery: a randomized, double-blind, controlled trial

PurposeTo investigate the efficacy and safety of low-dose bolus plus continuous infusion of penehyclidine in preventing postoperative nausea and vomiting (PONV) following bimaxillary surgery.MethodsThree hundred fifty-four patients were randomly allocated into three groups. In the Control group, placebo (normal saline) was injected before anesthesia and infused over 48 h after surgery; in the Bolus group, 0.5 mg penehyclidine was injected before anesthesia, whereas placebo was infused after surgery; in the Infusion group, 0.25 mg penehyclidine were injected before anesthesia, another 0.25 mg penehyclidine was infused after surgery. The primary endpoint was the incidence of PONV within 72 h.ResultsA total of 353 patients were included in intention-to-treat analysis. The PONV incidence was 61.0% (72/118) in the Control group, 40.2% (47/117) in the Bolus group, and 28.0% (33/118) in the Infusion group. The incidence was significantly lower in the Bolus group than in the Control group (RR 0.66; 95% CI 0.51–0.86; adjusted P = 0.003) and in the Infusion group than in the Control group (RR 0.46; 95% CI 0.33–0.63; adjusted P < 0.001); the difference between the Infusion and Bolus groups was not statistically significant (RR 0.70; 95% CI 0.48–1.00; adjusted P = 0.144). Emergence agitation occurred more frequently in the Bolus group than in the Control group (36.8% [43/117] vs. 21.2% [25/118], adjusted P = 0.027), but did not differ significantly between the Infusion and Control groups.ConclusionsA low-dose bolus plus continuous infusion of penehyclidine was effective in preventing PONV without increasing emergence agitation.Trial registrationClinicaltrials.gov. Identifier: NCT04454866.

Management of postoperative nausea and vomiting in adults: current controversies.

Postoperative nausea and vomiting (PONV) continue to plague the surgical patient population with an adverse impact on postoperative outcomes. The aim of this review is to critically assess current evidence for PONV management, including studies evaluating baseline risk reduction and antiemetic prophylaxis, to provide a pragmatic approach to prevention and treatment of PONV in routine clinical practice. Multiple recent reviews and guidelines have been published on this topic with some limitations. In the current ERAS era, all patients irrespective of their PONV risk should receive two to three antiemetics for prophylaxis. Patients at a high risk of PONV [i.e. prior history of PONV, history of motion sickness, high opioid requirements after surgery (e.g. inability to use nonopioid analgesic techniques)] should receive three to four antiemetics for prophylaxis. This review provides a practical approach to PONV prevention based on recent literature.