Prevention Of Postoperative Nausea And Vomiting Research Articles

A RANDOMIZED, DOUBLE-BLIND STUDY OF PALONOSETRON COMPARED WITH ONDANSETRON IN PREVENTING POSTOPERATIVE NAUSEA AND VOMITING AFTER MODIFIED RADICAL MASTECTOMY SURGERY.

BACKGROUND : Palonosetron is a new potent 5-hydroxytryptamine 3 antagonist. Although used for chemo induced emesis, data is lacking for PONV. The high incidence of nausea and vomiting after breast surgery is well documented. This study compared the effects of i.v.ondansetron and palonosetron administered at the time of induction for preventing postoperative nausea and vomiting (PONV) in these high-risk patients . The aim was to compare Onda METHODS : nsetron 8 mg and Palonosetron 0.075mg administered intravenously for prevention of post operative nausea and vomiting in patients undergoing modied radical mastectomy 24 hours postoperatively, by a randomised , controlled, double blind study. 70 female non smoking patients scheduled for elective modied radical mastectomy were, allocated randomly into 2 groups . Patients received either Palonosetron 0.075mg (GROUP P ) or ondansetron 8mg ( GROUP O ) intravenously, immediately before induction of general anaesthesia. The occurence of nausea, vomiting, retching, need for rescue antiemetics and side effects were monitored for a period of 24 hours after surgery. The compete response rate and overall PONV for 0 - 24 hours were calculated. The demographic prole of the patients were comparable. The RESULTS : incidence of a complete response (no PONV, no rescue antiemetics ) during 0 - 24 hours in post operative period was signicantly high in GROUP P ( 85.7% vs 62.9%, p=0.02) than GROUP O. The incidence of nausea was signicantly low in GROUP P ( 14.3% vs 37.1%). There was no statistically signicant difference between the 2 groups in vomiting, retching, side effects and need for rescue antiemetics. Thus overall PONV was low in GROUP P (14.3% vs 37.1% p = 0.02 statistically signicant.) We conclude that Palonosetron 0.075mg was more effective for preventing PONV in patients undergoing modied radical mastectomy surgery

Comparison of palonosetron with combined palonosetron and midazolam for preventing postoperative nausea and vomiting after laparoscopic cholecystectomy.

Background:Postoperative nausea and vomiting (PONV) is an undesirable complication in patients undergoing general anesthesia. Combination therapy via different mechanisms of action for antiemetic prophylaxis has been warranted for effective treatment of PONV. This study was designed to compare the prophylactic antiemetic effect between midazolam combined with palonosetron (group MP) and palonosetron alone (group P) after laparoscopic cholecystectomy surgeries.Methods:A prospective randomized controlled trial was investigated in non-smoking female. Eighty-eight patients were randomly divided into 2 groups with 44 patients each. Group MP received 0.05 mg/kg of midazolam intravenously before induction of anesthesia whereas group P received the same volume of normal saline. Immediately after anesthetic induction, 0.075 mg of palonosetron was administered to both the groups. The incidence and severity of PONV were assessed during 2 time intervals (0–2 hours, 2–24 hours), postoperatively.Results:The incidence of PONV during 24 hours after surgery was lower in group MP as compared to group P. There was also a significant difference in the use of rescue antiemetics. The severity of nausea was significantly lower in group MP as compared to group P, in the initial 2 hours after surgery. The incidence of side effects was similar between the 2 groups.Conclusion:In the prevention of PONV, midazolam combined with palonosetron, administered during induction of anesthesia was more effective as compared to palonosetron alone.

Dexamethasone versus placebo for prevention of nausea, vomiting and pain after open total abdominal hysterectomy

Post-operative nausea and vomiting (PONV) is a disturbing issue. Dexamethasone has been suggested for the prevention of PONV. The aim of the present study was to evaluate the efficacy of dexamethasone as an anti-emetic and analgesic following total abdominal hysterectomy. The study was performed as a double blind, placebo-controlled randomised clinical trial on 102 women undergoing an open total abdominal hysterectomy. The intervention group received 8 mg dexamethasone 1 h before surgery, and the control group received a placebo. The total number of emesis episodes during the 24 h after surgery did not show significant difference between the two groups, however, the number of emesis episodes in hours 2 and 4 after the surgery were less in the intervention group, but not in hours 0, 6, 12 and 24. The nausea severity in hours 0, 2, 4, 6 and 12 after the surgery, was less in the intervention group. The severity of pain was not different between the two groups. IMPACT STATEMENT What is already known on this subject? Post-operative nausea and vomiting (PONV) is an important and disturbing issue. It is one of the most common problems following gynaecological surgeries including open total abdominal hysterectomy (TAH). Dexamethasone has been suggested as a prophylaxis for the prevention of PONV. What do the results of this study add? Dexamethasone 8 mg is effective for the prevention of late onset PONV (after 2 h of surgery) in the cases of open total abdominal hysterectomy. However, it has no effect on PONV immediately following surgery (hour 0) and pain. What are the implications of these findings for clinical practice and/or further research? Dexamethasone can be considered as an effective prophylaxis for PONV for the first 24 h after an open total abdominal hysterectomy, but it has limited effects on the management of early onset of PONV; between 0 and 2 h after surgery. Since the highest rates of emesis episodes and nausea severity are at this time, it is suggested to combine another rapid onset medication with dexamethasone. Also, dexamethasone, 8 mg, cannot be considered for pain relief after an open total abdominal hysterectomy. Higher amounts of dexamethasone should be evaluated for this purpose, in order to find appropriate dosages.

Efficacy of Ginger in Preventing Postoperative Nausea and Vomiting: A Systematic Review and Meta-Analysis.

We aimed to synthesize the published evidence to evaluate the preventive efficacy of ginger on postoperative nausea and vomiting (PONV). A systematic review and meta-analysis were conducted in this study. PubMed, EMBASE, Cochrane Library, and CINAHL were systematically searched from their outset to October 2020, without language limitation. Randomized controlled trials (RCTs) comparing the effects of ginger and prophylactic antiemetics or placebo on PONV were included. Data were analyzed by the fixed effects model or random effects models regarding the results of heterogeneity. A total of 14 studies involving 1417 participants were included. Compared with placebo, the ginger group had significantly lower nausea severity (MD=-0.71, 95% CI=-1.37 to -0.06, p=0.03) and lower proportion of rescue antiemetic use (RR=0.71, 95% CI=0.62-0.82, p<0.001; RR=0.71, 95% CI=0.56-0.91, p<0.001). The ginger group had significantly lower incidence of nausea and vomiting over 6h after operation (RR=0.68, 95% CI=0.55-0.85, p<0.001; RR=0.78, 95% CI=0.42-1.44, p=0.43) compared with placebo. When compared with the prophylactic antiemetic group, the ginger group had significantly lower incidence of nausea (RR=0.75, 95% CI=0.56-0.99, p=0.04), but no significant differences in the incidence of vomiting and proportion of rescue antiemetic use were found. Ginger was effective for the prevention of PONV. More RCTs comparing ginger and other prophylactic antiemetics are needed to evaluate whether ginger could replace the traditional prophylactic antiemetics. This study's results could be used as an evidence for all patients following surgery who are at risk of PONV without allergy to ginger.

Ретробульбарная блокада при энуклеации глазного яблока у детей с ретинобластомой

Introduction. Retinoblastoma (RB) is a malignant tumor of the embryonic nerve retina. Purpose. To determine the effectiveness of retrobulbar blockade (RbB) with ropivacaine 0.5% for intra- and postoperative analgesia, as well as for the prevention of oculocardial reflex (OCR), postoperative nausea and vomiting (PONV) during enucleation. Material and methods. A prospective, randomized, controlled clinical trial was performed. Eighty patients aged 0 to 10 years were included, who were randomly assigned to the RbB group (retrobulbar blockade with ropivacaine 0.5% with general anesthesia) N = 40 and the GA control group (general anesthesia) N = 40. Results. There were no complications in the RbB group caused by the methodology. In the intraoperative period, the average dose of fentanyl in the RbB group was 4.7 ± 0.7 μg / kg, which is significantly lower than in the OA group of 10.1 ± 1.9 μg / kg (P &lt;0.05). OCR in the RbB group was observed in 5% of cases versus 100% in the GA group (P = 0.002). The average VAS score was 1.8 vs. 3.7 60 minutes after surgery (P &lt;0.001). For the first time 12 hours after surgery, PONV was not observed in the RBB group, and in the control group it was observed in 45% of patients. Conclusions. The study revealed that intraoperative retrobulbar blockade with 0.5% ropivacaine solution in children with RB is effective and safe. Provides stable intraoperative hemodynamics and reduces the need for opioids. Promotes the prevention of OCD and PONV, as well as the improvement of postoperative analgesia during the operation of enucleation of the eyeball in pediatric. Key words: ropivacaine, retrobulbar block, oculocardial reflex, pain, retinoblastoma, enucleation, pediatric patients.

Implementation of a risk-stratified approach to prevent postoperative nausea and vomiting in an institution with high baseline rates of prophylaxis.

Background and Aims:Although a risk-adjusted approach to preventing postoperative nausea and vomiting (PONV) is generally recommended, the successful implementation of such practice without mandated protocols remains elusive. To date, such a strategy has never been adapted to curb high baseline rates of prophylaxis.Material and Methods:We conducted an observational study on a cohort of patients undergoing elective surgery before and after the implementation of a quality improvement initiative including a risk-stratified approach to prevent PONV. The primary outcome was the number of prophylactic interventions administered. Secondary outcome included the repetition of ineffective medications and the need for rescue medication in the post-anesthesia care unit (PACU).Results:A total of 636 patients were included; 325 patients during the control period and 311 after the intervention. The educational program failed to reduce the amount of prophylactic antiemetics administered (2.0 vs. 2.6, P < 0.001) and the repeat administration of ineffective medications for rescue (16% vs. 20%, P = 0.15). More patients in the intervention group required rescue medication compared to the control group (16.9% vs. 9.7%; P = 0.04).Conclusion:Implementation of best practices to combat PONV remains elusive. Our results indicate that difficulties in changing provider behavior also apply to institutions with high prophylactic antiemetic administration rates.

Comparative study of palonosetron with metoclopramide and ondansetron in prevention of PONV in laparoscopic cholecystectomy a randomized controlled trial

Background: Post-operative nausea and vomiting (PONV) is a ‘big little’ problem especially after laparoscopic surgeries. Palanosetron is a new potent 5 hydroxy tryptamine 3 antagonists. In this randomized double blind clinical study we compared the effects of i.v. palanosetron, ondansetron and metoclopramide administered at the end of surgery in preventing post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy under general anesthesia.Methods: 90 ASA I/II patients of both sexes in the age group of 20-60 years over a period of 18 months undergoing laparoscopic cholecystectomy were included. The enrolled patients were randomised into three groups, Group G1 (Metoclopramide), Group G2 (Ondansetrone) and Group G3 (Palanosetron). The incidence of nausea and vomiting were monitored immediately during 0-2 h, 2-6 h, 6-24 h and 24-72 h according to the VAS.Results: Both palonosetron and ondansetron have comparable efficacy clinically and statistically in preventing nausea and were highly superior to metoclopramide in preventing nausea. Palonosetron had a better antiemetic effect than both ondansetron and metoclopramide in patients who underwent laparoscopic cholecystectomy. The number of complete responders was 8/30 (26.66%) in group G1, 20/30 (66.66%) in group G2 and 22/30 (73.33%) in group G3.Conclusion: Palonosetron has a better profile of antiemetic action, and a lesser need for rescue antiemetic postoperatively and a comparable side-effects profile as compared to ondansetron and metoclopramide

A Comparison between Intravenous Ondansetron and Granisetron in the Preventive Management of Postoperative Nausea and Vomiting in Patients Undergoing Cesarean Section under Spinal Anesthesia

Abstract Background: Efforts are still conducted to reduce side effects of anesthesia, such as postoperative nausea and vomiting (PONV). This study was performed to compare the effectiveness of prophylactic use of intravenous Ondansetron (4 mg) and Granisetron (2 mg) in the preventive management of postoperative nausea and vomiting in women undergoing elective lower (uterine) segment cesarean section (LSCS). Patients and Methods: A total of 100 patients belonging to the American Society of Anesthesiologists (ASA) Grade I and II posted for elective LSCS were included in the study. 100 patients were further divided into two groups (n = 50), i.e., Group O (ondansetron) and Group G (granisetron). This study was conducted from November 2017 to August 2019 on 100 ASA I and ASA II patients, aged from 18 to 35 years who underwent elective LSCS under the subarachnoid block. Results: Both drugs Ondansetron and Granisetron showed prevention of PONV (Granisetron showed 80% response and Ondansetron showed 44% response). Both drugs have shown promising results for a shorter duration in postoperative care but Ondansetron showed a higher number of PONV incidences than Granisetron in long duration. Conclusion: Granisetron is effective than Ondansetron in preventing nausea and vomiting in the late postoperative period with fewer side effects.

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

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

Impact of extending prevention of postoperative nausea and vomiting for cancer surgical patients in the PACU: a before and after retrospective study

BackgroundsProcedures for Postoperative Nausea and Vomiting (PONV) prevention are mostly based on identification of the risk factors before administering antiemetic drugs. The purpose of this study was to evaluate the impact of the extended use of antiemetic on the PONV in the Postanesthetic Care Unit (PACU). MethodsTwo separate 4-year periods (2007...2010, P1, and (2015...2018, P2) were evaluated. During P1, the protocol consisted of dexamethasone and droperidol for patients with a locally adapted high PONV score, followed by ondansetron for rescue in the PACU. For Period 2, dexamethasone (8 mg) and ondansetron (4 mg) were administered in patients under general or regional anesthesia, or sedation longer than 30 minutes, while droperidol (1.25 mg) in rescue was injected in cases of PONV in the PACU. An Anesthesia Information Management System was used to evaluate the intensity score of PONV (1 to 5), putative compliance, sedation, and perioperative opioid consumption upon arrival in the PACU. ResultsA total of 27,602 patients were assessed in P1 and 36,100 in P2. The administration of dexamethasone and ondansetron increased several fold (p < 0.0001). The high PONV scores were more improved in P2 than in P1, with scores (3+4+5) for P1 vs. P2, p < 0.0001. Overall, 99.7% of the patients in P2 were asymptomatic at discharge. Morphine consumption decreased from 6.9..1.5 mg in P1 to 3.5 .. 1.5 mg in P2 (p < 0.0001). DiscussionThe extension of pharmacological prevention of PONV was associated with a decrease in the intensity of severe PONV. However, uncertainty regarding confounding factors should not be ignored. IRBn.. 92012/33465

Comparative study of ondansetron, granisetron and granisetron with dexamethasone for prevention of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy

An assortment of drugs are being used for managing postoperative nausea and vomiting after laparoscopic surgeries. Combination anti-emetic therapy using 5HT3 antagonists with dexamethasone as an adjunct is being tried owing to its improved efficacy for prevention or treatment of PONV. This was a prospective, randomized, double blind, comparative study conducted on 150 patients aged between 18 to 65 years scheduled for laparoscopic cholecystectomy. Group O received 0.1 mg/Kg IV ondansetron upto a maximum dose of 8 mg, Group G received 0.04 mg/kg IV granisetron upto a maximum dose of 3mg, Group G+D will receive 0.04mg/kg IV granisetron and 8mg Dexamethasone. The three groups were comparable in terms of demographic data. Our results showed that the patients who had received combination of granisetron and Dexamethasone showed a better complete response as compared to patients who received ondansetron and patients who received granisetron alone. This was seen in all three time periods of 2-6 hours, 6-12 hours and 12-24 hours postoperatively with a p value less than 0.001 making it statistically significant. : Combination therapy with granisetron and dexamethasone IV used as prophylactic antiemetic is better than granisetron or ondansetron given IV alone. IV granisetron and dexamethasone combination has fewer side effects compared to ondansetron or granisetron. Need for the rescue antiemetic was least in the patients receiving granisetron and dexamethasone combination as compared to in patient receiving ondansetron and granisetron alone.

An Observational Study of Intravenous Granisetron Vs Oral Gabapentin in Preventing Postoperative Nausea and Vomiting after Middle Ear Surgery

Background- Postoperative nausea and vomiting (PONV) is one of the most unpleasant complications after middle ear surgery. Several studies have demonstrated use of gabapentin as antiemetic. This study aims at comparison of intravenous granisetron vs oral gabapentin in preventing PONV. Methods - 64 patients of ASA I or II between the ages of 18 and 65 years were divided equally into two groups. Patients in group I received 3mg granisetron iv 2 minutes and patients in group II received 300 mg gabapentin orally 1 hour prior to surgery. Patients were premedicated with inj. glycopyrrolate and inj. midazolam. Anaesthesia was induced, maintained and reversed in usual manner. Haemodynamic changes and number of episodes of nausea and vomiting were recorded upto 24 hours postoperatively. No statistically significant difference was observed in both the groups at 0 and 1 hour in preventing PONV (p&lt;0.05). Next 24 hours postoperatively neither group showed PONV. No significant haemodynamic changes were observed and there were noside effects in either of the groups.Conclusion- There was no statistically significant difference in prevention of PONV in the patients who had either received inj granisetron 3mg i.v. 2 minutes prior to surgery or oral Gabapentin 300mg 1hour prior to surgery after middle ear surgery without any side effects.

Transcutaneous Electrical Acupoint Stimulation Combined with Dexamethasone and Tropisetron Prevents Postoperative Nausea and Vomiting in Female Patients Undergoing Laparoscopic Sleeve Gastrectomy: a Prospective, Randomized Controlled Trial

Despite the administration of prophylactic antiemetics, some patients who undergo laparoscopic sleeve gastrectomy (LSG) remain at high risk for postoperative nausea and vomiting (PONV). Although many trials have been conducted, the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) on the prevention of PONV remains unknown. Sixty-two female patients undergoing elective LSG were randomly assigned to the TEAS combined with dexamethasone and tropisetron (TEAS group, n = 31) or dexamethasone and tropisetron (control group, n = 31) groups. The incidence and severity of PONV, as well as the need for rescue antiemetics, were collected within 48h after surgery. The patients in both groups had similar clinical characteristics and underwent the same surgical procedure. In the TEAS group, 13 patients (41.9%) had PONV within 48h after LSG compared to 24 patients (77.4%) in the control group (P = 0.004, relative risk: 0.39 [0.19, 0.80]). The severity of PONV differed significantly between groups, with five patients (16.1%) in the TEAS group and 15 patients (48%) in the control group experiencing clinically important PONV (P = 0.007, relative risk: 0.62 [0.42, 0.90]). Moreover, fewer patients required antiemetic rescue medication in the TEAS group compared with the control group (29.0% vs. 58.1%, P = 0.021). Multimodal antiemetic prophylaxis consisting of TEAS and antiemetics was effective in reducing PONV incidence and intensity in high-risk patients undergoing LSG.

Amisulpride: A Review in Post-Operative Nausea and Vomiting.

Amisulpride intravenous (IV) injection (Barhemsys®; hereafter referred to as IV amisulpride), a selective dopamine receptor antagonist, is approved in the USA as a single IV infusion for the prevention and treatment of post-operative nausea and vomiting (PONV) in adults. Results from placebo-controlled phase III trials showed that IV amisulpride is efficacious both in the prevention of PONV (used either alone or in combination with an antiemetic of a different class) and in the treatment of PONV (irrespective of prior antiemetic prophylaxis status). When administered as a single IV infusion, amisulpride had a tolerability profile that was generally similar to that of placebo, with no significant safety concerns identified. Thus, IV amisulpride is a useful additional option in the prevention and treatment of PONV in adults, particularly for patients who have failed previous antiemetic prophylaxis and for whom effective treatment options may be limited.

Amisulpride: A New Drug for Management of Postoperative Nausea and Vomiting.

To review the pharmacology, efficacy, and safety of amisulpride and determine its role in the management of postoperative nausea and vomiting (PONV). A PubMed search (1946 to November 2020) using the terms amisulpride and APD421 was conducted. Relevant reports on intravenous amisulpride were included. Six clinical trials were evaluated. In 4 trials on the prevention of PONV, a greater percentage of patients who received amisulpride 5 mg compared with placebo experienced a complete response (44%-60% vs 31%-33%, respectively, when used as monotherapy; 58% vs 47%, respectively, when used in combination with another antiemetic). In 2 trials on the treatment of PONV, a significantly greater percentage of patients who received amisulpride 10 mg compared with placebo experienced a complete response (31.4% vs 21.5%, respectively, in patients who had not received prophylaxis; 41.7% vs 28.5%, respectively, in patients who had received prophylaxis). Adverse effects included infusion site pain, chills, hypokalemia, procedural hypotension, and abdominal distension. Amisulpride is effective for the management of PONV and may be less likely to cause QT prolongation and extrapyramidal symptoms than other dopamine antagonists. Additional information is needed on its use for chemotherapy-induced nausea and vomiting and in children. Amisulpride is an important new option for the multimodal management of PONV in adults, and it may be the preferred dopamine antagonist because of the more favorable safety profile that results from its unique pharmacological properties.

Granisetron vs. Granisetron and Dexamethasone on The Reduction of Postoperative Nausea and Vomiting (PONV) After Caesarean Section With Intrathecal Morphine: A Randomised Controlled Trial

ABSTRACT Background Intrathecal morphine (ITM) has proven to be excellent in reducing postoperative pain. However, its use is associated with the occurrence of postoperative nausea and vomiting (PONV). In this study, we wish to compare the efficacy between the combination therapy of granisetron and dexamethasone versus granisetron alone on the occurrence of postoperative nausea and vomiting (PONV) in parturients undergoing elective Caesarean delivery. Method This is a prospective double-blinded, randomised controlled trial (RCT) involving 126 parturients of American Society of Anesthesiologist (ASA) physical status I and II undergoing elective Caesarean deliveries. Subjects were randomly allocated into 2 groups (n = 63), to either receive a combination of 1 mg intravenous (IV) granisetron plus 4 mg IV dexamethasone (Group A) or to receive 1 mg IV granisetron (Group B). They were assessed at 1, 4, 8, 12 and 24-hour postoperatively. Episodes of nausea, retching, vomiting and the requirement of rescue antiemetics at these time intervals were recorded. Results There are no statistically significant differences in the occurrence of nausea, retching and vomiting between both groups at 1, 4, 8, 12 and 24 h postoperatively. The usage of rescue antiemetics were similar in both groups of subjects. Conclusion The use of granisetron is comparable with the use of granisetron and dexamethasone in the prevention of PONV in parturients receiving intrathecal morphine for elective Caesarean section.

A Comparative Study of Efficacy and Safety of Ondansetron, Glycopyrrolate and Dexamethasone for Post Operative Nausea and Vomiting Following General Aneasthesia

Postoperative nausea and vomiting (PONV) is a common distressing problem in patients undergoing surgery under general anaesthesia which requires frequent medical interventions. This was a prospective, randomized study conducted in Victoria hospital, Bengaluru. Study subjects were randomly assigned into four groups of twenty patients in each. Group A received inj. Ondansetron 8 mg i.v, Group B received inj Glycopyrrolate 0.2 mg i.v, Group C received inj Dexamethasone 10 mg i.v and Group D received 1ml normal saline i.v, just before induction of anaesthesia with inj fentanyl and inj propofol. Number of patients having nausea &amp; vomiting was assessed for 24 hrs after surgery. Out of eighty patients 47 (58.7%) patients had nausea and vomiting in the postoperative period. Six (30%) patients in group A, eleven (55%) in group B, thirteen (65%) in group C and seventeen (85%) patients in group D. Use of rescue antiemetic was higher in normal saline group followed by dexamethasone group. Headache was reported as an adverse effect in less than 10% of the patients. Our study showed that prophylactic use of ondansetron is more effective for prevention of PONV with lesser requirement of rescue medication and fewer side effects, followed by glycopyrrolate and dexamethasone.

Prevention and Treatment of Postoperative Nausea and Vomiting (PONV): A Review of Current Recommendations and Emerging Therapies.

Postoperative nausea and vomiting is one of the most frequent adverse events after surgery and anesthesia. It is distressing for the patient and can lead to other postoperative complications. Management of PONV involves a framework of risk assessment, multimodal risk reduction, and prophylactic measures, as well as prompt rescue treatment. There has been a significant paradigm shift in the approach towards PONV prevention. There have also been several emerging therapeutic options for PONV prophylaxis and treatment. In this review, we will discuss the up-to-date PONV management guidelines and highlight novel therapeutic options which have emerged in the last few years.

Effect of 2% dextrose in ringer lactate on incidence of nausea and vomiting in laparoscopic cholecystectomy-Prospective randomized control study

Post-operative nausea and vomiting (PONV) is the distressing situation for patients &amp; caregivers. Various groups of pharmalogical agents are used for prophylaxis in high risk patients for PONV but they have their own advantage and disadvantages. Recent metaanalysis on intravenous use of 5% dextrose showed conflicting results with risk of hyperglycemis. So in this study we plan to use intravenous 2% dextrose in ringer lactate for prevention of PONV in laparoscopic cholecystectomy patients.This prospective randomized double-blind controlled study was conducted in 60 American Society of Anaesthesiologist 1 &amp; 11 patients, age 20-55 years undergoing elective laparoscopic cholecystectomy under general anaesthesia. Patients were randomly divided into two groups: group DRL received 2% dextrose in ringer lactate and group RL received ringer lactate. Allocate fluid was started at induction of anaesthesia and continued post-operatively up to 6hr. Incidence and severity of PONV was measured as a primary outcome. Secondary outcome includes comparison of blood sugar level, requirement of rescue antiemetic, time of oral acceptance of food &amp; time of discharge between two groups. Mean between two groups were compared with student t test. The critical value of ‘p’ indicating the probability of significant difference was taken as&amp;#60;0.05 for comparison.Incidence and severity of PONV was less in group DRL than group RL. Blood sugar level was higher in group DRL but within the normal range. Time of oral feed and time to discharge was early in group DRL.Intravenous 2% dextrose in ringer lactate reduces the incidence and severity of PONV in laparoscopic cholecystectomy patients.

Comparison of different end-tidal carbon dioxide levels in preventing postoperative nausea and vomiting in gynaecological patients undergoing laparoscopic surgery

The aim of this study was to compare different end-tidal carbon dioxide (EtCO2) levels to prevent postoperative nausea and vomiting (PONV) caused by increased intracranial pressure due to pneumoperitoneum and Trendelenburg position in gynaecological laparoscopic surgery. A total of 60 female patients aged 25–50 years who would undergo laparoscopic gynaecological surgery under general anaesthesia were randomised into two groups: group A (EtCO2: 26 − 35 mmHg, n = 30) and group B (EtCO2: 36 − 45 mmHg, n = 30). In both groups, ONSD and EtCO2 of the patients were measured at baseline after anaesthesia induction (T b), at 5 min after pneumoperitoneum (T PP5), and at 10 min intervals after Trendelenburg position (T PP10, T PP20, T PP30). At 5 (T D5) and 10 min (T D10) after deflation, ONSD measurements were repeated. The incidence and severity of PONV of the patients, and antiemetic drugs used in both groups were assessed in the postoperative period. In the intraoperative follow-up periods, T PP5 and subsequent EtCO2 values, as well as T PP10 and subsequent ONSD values, were significantly higher in group B and the incidence of nausea, the PONV scores and the incidence of rescue antiemetic use significantly lower in group A than in group B (p<.001 for all). This result indicates that low EtCO2 levels have beneficial effects on ICP and PONV in laparoscopic gynaecological operations. Impact statement What is already known on this subject? Laparoscopic gynaecologic surgery has been a more preferred technique. The incidence of postoperative nausea and vomiting (PONV) after laparoscopic gynaecologic surgery is remarkably high. In the prevention of PONV after gynaecologic laparoscopic surgery, single and multiple drug therapies and methods have been used. What the results of this study add? Postoperative nausea and vomiting caused by intracranial pressure (ICP) increase due to carbon dioxide pneumoperitoneum and Trendelenburg position in gynaecologic laparoscopic surgeries were decreased in the early postoperative period by low end-tidal carbon dioxide levels in the intraoperative period. It was shown that low end-tidal carbon dioxide levels have beneficial effects on ICP and PONV in laparoscopic gynaecologic operations. What the implications are of these findings for clinical practice and/or further research? This result indicates that low end-tidal carbon dioxide levels have beneficial effects on ICP and PONV in laparoscopic gynaecologic operations.