Prevention Of Postoperative Nausea And Vomiting Research Articles

Efficacy of fosaprepitant for the prevention of postoperative nausea and vomiting in patients undergoing gynecologic surgery: a multicenter, randomized, double-blind study

Abstract Purpose This study aims to investigate whether adding fosaprepitant to palonosetron and dexamethasone is effective in preventing postoperative nausea and vomiting (PONV) in high-risk patients undergoing gynecologic surgery. Methods Eligible patients undergoing gynecological surgery were randomized into two groups (1:1). One group received fosaprepitant (150 mg) and the other (control) received a placebo infusion. Both groups received a single dose of palonosetron (0.25 mg) and dexamethasone (5 mg) together with therapeutic medication. The primary endpoint was the absence of vomiting and no use of rescue antiemetics during the first 24 h after surgery; complete response rate (CRR). Results CRR was significantly higher in the fosaprepitant group compared to the control group 0–24 h after surgery (P = 0.037; relative risk [RR], 1.116; 95% confidence interval [CI], 1.007 to 1.235). Moreover, CRR was also significantly higher during the 24–48 h (P = 0.004; RR, 1.148; 95% CI, 1.045 to 1.261) and 48–72 h (P = 0.039; RR, 1.083; 95% CI, 1.005 to 1.168) observation periods respectively. The complete control rate was higher in the fosaprepitant group than in the control group during the 0–24 h observation period (P = 0.012; RR, 1.367; 95% CI, 1.067 to 1.751). Nausea and rescue antiemetic use were comparable between the two groups. The severity of vomiting was significantly higher in the fosaprepitant group than in the control group on the second day (P = 0.016). Dynamic pain visual analog scale score was lower in the fosaprepitant group and quality of recovery-15 scores were significantly higher in the same group during 0–24 h observation period (P = 0.018 and 0.005, respectively). Conclusions The triple combination of fosaprepitant, palonosetron, and dexamethasone was superior in the prevention of PONV after gynecologic surgery in high-risk patients. We suggest that for high-risk patients, a triple combination therapy may be a better choice. Trial registration Registered at the Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=171741) with No. ChiCTR2200060890 on June 13, 2022. Principal investigator: Jingdun Xie.

Study of penehyclidine for the prevention of postoperative nausea and vomiting following laparoscopic sleeve gastrectomy under general anesthesia: a randomized, prospective, double-blind trial.

To investigate the efficacy of penehyclidine (PHC) for preventing postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG) under general anesthesia. In this prospective study, 219 patients who were scheduled to undergo LSG were randomly assigned to three cohorts: the control cohort (received normal saline), the infusion cohort (administered 0.25mg of PHC intravenously followed by an additional 0.25mg through an intravenous analgesia pump for 48h after LSG), and the bolus cohort (received a single intravenous dose of 0.5mg of PHC). The study outcomes included the incidence of PONV within the first 48h postoperatively, the severity and intensity of PONV, side effects and postoperative recovery outcomes. Univariate and multivariate logistic analyses were performed to identify independent risk factors associated with PONV. Compared with the control cohort, both the infusion and bolus cohorts presented considerably lower incidences of PONV (61.64% vs. 12.33% vs. 38.36%, P < 0.05), as well as significantly decreased PONV severities (P < 0.05) and intensities (P < 0.05). There were no significant differences in side effects and postoperative recovery outcomes among the three cohorts, with the exception of dry mouthand the administration of rescue antiemetic therapy (P < 0.05). Additionally, the Apfel risk score and PHC intervention were identified as independent risk factors associated with PONV incidence following LSG (P < 0.05). PHC effectively prevented PONV occurrence and reduced its severity in LSG patients without decreasing postoperative recovery outcomes, particularly in the infusion cohort.

Analysis of postoperative nausea and vomiting in patients with lung cancer undergoing thoracoscopic surgery under general anesthesia and its influencing factors: a observational study

ObjectiveTo investigate the current situation and influencing factors of postoperative nausea and vomiting (PONV) in lung cancer patients undergoing thoracoscopic surgery under general anesthesia, providing a reference for developing targeted PONV prevention and management strategies.MethodsUsing a consecutive sampling method, 200 lung cancer patients who underwent their first thoracoscopic surgery under general anesthesia between November 18, 2021, and March 1, 2022, at a tertiary class A cancer hospital in Liaoning Province, China, were selected. The occurrence of PONV within 24 h post-operation was assessed using WHO Postoperative Nausea and Vomiting Rating Criteria. Patient general information, surgical and medication data were systematically collected to analyze the independent influencing factors of PONV.ResultsAmong the 200 patients undergoing thoracoscopic lung cancer surgery under general anesthesia, 75 (37.5%) experienced PONV. Logistic regression analysis indicated that being female, having a history of motion sickness, and a history of PONV were independent risk factors for the occurrence of PONV in these patients. Long-acting antiemetics such as penehyclidine hydrochloride and methylprednisolone were protective factors against PONV.ConclusionThe incidence of PONV in patients undergoing thoracoscopic lung cancer surgery under general anesthesia is relatively high. Nursing staff should focus on female patients and those with a history of motion sickness and PONV. Comprehensive preoperative assessments should be conducted, exploring multimodal analgesia and applying integrated prevention measures to reduce the occurrence of PONV and promote the rapid recovery of patients.

Prevention of postoperative nausea and vomiting after cesarean delivery under neuraxial anesthesia and postpartum analgesia in Japan: A cross-sectional study.

This study aims to investigate the clinical practice of physicians working in obstetric setting toward postoperative nausea and vomiting (PONV) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia. We conducted this online survey to all active members of the Japan Society of Obstetric Anesthesiology and Perinatology (JSOAP), where leads academic society in obstetric anesthesia in Japan. The questionnaire was developed using the Delphi method. The survey included questions about routine practices for PONV prevention, the use of neuraxial opioids, optimal practices, and perceived obstacles. The email sent three times every 2 weeks as a reminder. A total of 1046 e-mails were sent, and 307 JSOAP members responded to the survey (29.3%). More than half of responders (62.7%) used neuraxial opioids with intrathecal morphine being the most frequent. They had a higher rate of multimodal PONV prophylaxis compared with who did not use neuraxial opioids for postoperative analgesia (19.9% vs 6.7%). Metoclopramide was the commonest medication for PONV prevention, and there was a significant difference in the use of 5-hydroxytryptamine receptor antagonists (19.9% vs. 8.6%, p = 0.012). We observed that 80% of physicians reported the routine administration of prophylaxis for PONV for CD. Among these, 20% indicated the use of two or more agents. Conversely, in the cohort not administering neuraxial opioids, only 6.7% reported the use of two or more agents. The online survey showed that the physicians using neuraxial opioids for CD had a higher proportion of multimodal PONV management involving two or more agents.

Comparison of the effects of Aprepitant and Granisetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing Laparoscopic Cholecystectomy: A double-blind, randomized, controlled study

Background: Postoperative nausea and vomiting (PONV) is one of the most common findings in the first 24 hours after surgery, occurring in 30% of all patients and up to 80% of high-risk patients. We compared aprepitant (a neurokinin-1 receptor antagonist) and granisetron in preventing PONV in patients who underwent laparoscopic cholecystectomy (LC). Methods: Sixty-one patients (aged 18-90) and the American Society of Anesthesiologists (ASA) I-II class who underwent LC under general anesthesia were enrolled in the study. Our study aimed to compare the incidence of PONV between 0-6, 6-12, and 6-24 hours postoperatively and the need for additional antiemetic requirements primarily and, secondly, detecting VAS scores and additional analgesic requirements for aprepitant and granisetron. Results: Our study observed similar PONV changes in both groups at 0-6 hours. A significantly lower VDS was observed in group A at 30-60 minutes compared to group G (p=0.10). There was no significant difference between groups at other intervals until the 120th minute. Between 6 and 12 hours, Group A had a lower VDS (Verbal Descriptive Scale) than Group G, but there was no statistically significant difference (P&gt;0.05). There was no significant difference between the groups regarding VAS scores, additional analgesic requirements, and adverse effects on patients (p&gt;0.05). Conclusion: We observed that aprepitant may be more effective than granisetron in preventing PONV and can be used safely in patients undergoing LC.

Comparison of aprepitant versus ondansetron for prevention of postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis.

Postoperative nausea and vomiting (PONV) is a common complication after surgery. Preventing PONV in high-risk patients often requires a multimodal approach combining antiemetic drugs with diverse mechanisms. While aprepitant, a neurokinin-1 receptor antagonist, is recognised as highly effective for PONV prevention, uncertainties remain regarding its effectiveness. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The analysis assessed the effectiveness of aprepitant (A), aprepitant plus ondansetron (AO) and aprepitant plus dexamethasone and ondansetron (ADO) in preventing PONV compared to ondansetron alone (O) or in combination with dexamethasone (DO). In the analysis of 12 studies involving 2729 patients, aprepitant demonstrated significant efficacy in preventing PONV compared to ondansetron alone (A versus [vs.] O: PONV incidence 12.5% vs. 28.5%, relative risk [RR] = 0.45, P < 0.001; complete response rate 55.97% vs. 50.35%, RR = 1.13, P = 0.010). The combination of aprepitant with ondansetron (AO) also showed a significantly lower incidence of PONV compared to ondansetron alone (11.3% vs. 26.8%, RR = 0.43, P < 0.001) and a higher complete response rate (38.1% vs. 26.84%, RR = 1.41, P = 0.020). In addition, ADO significantly reduced PONV incidence compared to DO (ADO vs. DO: 13.63% vs. 35.38%, RR = 0.38, P = 0.006). Aprepitant, whether used alone or in combination with ondansetron or both ondansetron and dexamethasone, consistently outperforms ondansetron in achieving a complete response as it lowers vomiting rates and reduces the need for rescue therapy during the crucial 24-48-h postoperative period.

Effect of Prophylactic Tropisetron on Post-Operative Nausea and Vomiting in Patients Undergoing General Anesthesia: Systematic Review and Meta-Analysis with Trial Sequential Analysis.

This systematic review and meta-analysis of randomized controlled trials (RCTs) with trial sequential analysis (TSA) aimed to comprehensively evaluate and compare the efficacy of the prophylactic administration of tropisetron in the prevention of the incidence of post-operative nausea and vomiting (PONV) in patients undergoing surgery under general anesthesia. This study was registered with PROSPERO (CRD42024372692). RCTs comparing the efficacy of the perioperative administration of tropisetron with that of a placebo, other anti-emetic agents, or a combination of anti-emetic injections were retrieved from the databases of Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar. The frequency of rescue anti-emetic use (RA) and the incidence of PON, POV, and PONV (relative risk [RR]: 0.718; 95% confidence interval [CI] 0.652-0.790; I2 = 0.0, RR: 0.587; 95% CI 0.455-0.757; I2 = 63.32, RR: 0.655; 95% CI 0.532-0.806; I2 = 49.09, and RR: 0.622; 95% CI 0.552-0.700; I2 = 0.00, respectively) in the tropisetron group were lower than those in the control group; however, the incidence of complete response (CR) was higher in the tropisetron group (RR: 1.517;95% CI 1.222-1.885; I2 = 44.14). TSA showed the cumulative Z-curve exceeded both the conventional test and trial sequential monitoring boundaries for RA, PON, POV, and PONV between the tropisetron group and the control group. Thus, the prophylactic administration of tropisetron exhibited superior efficacy in the prevention of PON, POV, and PONV. Furthermore, a lower incidence of RA and a higher incidence of CR were observed with its use.

Preventive Effect of Pretreatment with Intravenous Metoclopramide on Incidence of Post Laparoscopic Surgery Nausea and Vomiting

Introduction: Common complications following anesthesia include Postoperative nausea and vomiting (PONV), which leads to patient dissatisfaction and discomfort. The incidence of PONV after inhalational general anesthesia is up to 30% [1]. When anesthetics are used with no prophylaxis, and in certain high-risk patients, the incidence of PONV can reach up to 70% [2]. Furthermore, laparoscopic surgeries are associated with an even higher incidence of PONV (40%-75%) [3]. This makes PONV one of the most prevalent post-operational complaints [4].Methods: This case control study includes 79 patients with high PONV risk scores scheduled for laparoscopic cholecystectomy under general anesthesia in Duhok hospitals. 40 patients received 8 mg (2ml) metoclopramide intravenously as pretreatment, while 39 patients received normal saline (2ml) as the control group. After 48 hours, we called patients and asked them about the incidence and severity of PONV.Result: statically insignificant differences in the incidence of PONV between both groups (p-value 0.91). The incidence of PONV in this study was (27.8%) which correlates with the PONV risk score mean (2.48) and was statistically significant with a p-value of less than 0.01 and a 95% confidence score (2.13, 18.32).Conclusion: PONV risk score is effective in the prediction of the incidence of PONV, and Metoclopramide is ineffective as a single drug in the prevention of PONV in high-risk patients.

Comparison of the Efficacies of Dexmedetomidine and Clonidine in Preventing Postoperative Nausea and Vomiting in Paediatric Patients Undergoing Abdominal Surgeries.

Background Postoperative nausea and vomiting (PONV) is a common complication in paediatric patients undergoing abdominal surgeries. Dexmedetomidine and clonidine, both α2-adrenergic agonists, have been proposed as potential treatments for PONV due to their antiemetic properties. This study aimed to compare the efficacies of dexmedetomidine and clonidine in the prevention of PONV in paediatric patients following abdominal surgeries Methods Eighty patients, aged five to 12 years undergoing abdominal surgeries under general anaesthesia were enrolled in this study. Patients were randomly assigned to receive either a single intravenous dose of 0.5 µg/kg of dexmedetomidine (Group D; n=40) or 1 µg/kg of clonidine (Group C; n = 40) 10 minutes before extubation. PONV was recorded for the next 24 hours. Results The baseline characteristics of patients were comparable. A higher proportion of patients in the clonidine group developed PONV as compared to the dexmedetomidine group (27.5% vs 20.0%, p=0.189). The visual analogue scale (VAS) score of group C was higher than that of group D (1.38±1.55 vs 1.00±1.26) but was not statistically significant. The Paediatric Anaesthesia Emergence Delirium (PAED) scale score or emergence agitation (EA) score was higher in group C during recovery time. The mean arterial pressures and the heart rates were comparable in both groups. No significant side effects were reported. Conclusion Our study concludes that dexmedetomidine and clonidine effectively control PONV in paediatric abdominal surgery, with no significant difference in incidence or severity. Dexmedetomidine significantly reduced PAED scale scores during recovery, indicating better control of EA. The two treatments showed comparable mean arterial pressures and heart rates without significant side effects.

Influence of higher body mass index on postoperative nausea and vomiting in patients following thoracic surgery for lung cancer: a propensity score-matched cohort study

This study aimed to quantify the association between body mass index (BMI) and postoperative nausea and vomiting (PONV) within the initial 48 h following thoracic surgery for lung cancer. We then explored whether changes in serum inflammatory factor concentrations were related to BMI during the early postoperative period. We conducted a propensity score-matched (PSM), retrospective cohort study at a specialized tertiary medical center. A total of 194 patients aged 18–80 years who underwent thoracic surgery for lung cancer at Shanghai Pulmonary Hospital between January and June 2021 were enrolled. The primary outcome was the incidence of PONV during the first 48 h after surgery. Nausea, vomiting or retching at different time periods, severe pain, and concentrations of perioperative serum inflammatory factors including CRP, IL-6, IL-12, and IFN-γ were also assessed. Patients in the high BMI group (BMI ≥ 25 kg/m2) had a lower incidence of PONV than those in the normal BMI group (18.5–25 kg/m2) within the first 48 h after surgery (22 vs. 50%, p = 0.004). The incidence of nausea was lower at 0–12 h (14.5 vs. 37.1%, p = 0.004) and 12–24 h (8.1 vs. 22.6%, p = 0.025) in the high BMI group after surgery, and the incidence of vomiting was lower at 0–12 h (12.9 vs. 30.6%, p = 0.017) in higher BMI after surgery. We found no significant difference in the incidence of severe pain [severe static pain (p = 0.697) and severe dynamic pain (p = 0.158)]. Moreover, higher concentrations of IL-12 (2.24 ± 2.67 pg/ml vs. 1.48 ± 1.14 pg/ml, p = 0.048) and IFN-γ [1.55 (1.00) pg/ml vs. 1.30 (0.89) pg/ml, p = 0.041] were observed in patients with normal BMI on the first day after surgery. Given this finding, patients with a normal BMI should receive more attention for the prevention of PONV than those with a high BMI following thoracic surgery for lung cancer.Trial registration: http://www.chictr.org.cn and ChiCTR2100052380 (24/10/2021).

Comparative Study of the Preemptive Dexmedetomidine Versus Ondansetron Effect in Post-Operative Nausea and Vomiting after Middle Ear Surgery

Background: Nausea and vomiting after operation has high prevalence and cause adverse effect. The aim of this study was to compare the effect of dexmedetomidine with ondansetron in prevention of post-operative nausea and vomiting (PONV) after middle ear surgery under general anesthesia.and saliva gas in traumatic patients under mechanical ventilation. Methods: This in this double-blinded clinical trial study, one hundred and sixty-two patients undergoing middle ear surgery under general anesthesia were randomly divided into three groups of 55 each: ondansetron (O), dexmedetomidine (D) and control (C). Group O received 0.1 mg/kg of ondansetron, Group D received 1 μg/kg/min of dexmedetomidine and Group C received 10 cc of normal saline 15 to 20 minutes before surgical incision. After that, the patients were examined in post-anesthesia care unit (PACU) and up to 24 hours after the operation in terms of PONV and other study variables. Results: The severity of nausea after operation based on VAS (visual analog scale) was significantly different between Group O (2.2±0.7) and Group D (3.9± 0.7) and Group C (5.15±1.3) (P= 0.04). The incidence of vomiting in the first 24h postoperatively was 14.8% in Group O, 46.3% in Group D and 88.8% in Group C (P= 0.003). Conclusion: Our study showed that ondansetron was better than dexmedetomidine for prevention of PONV after middle ear surgery.

The Efficacy of Aprepitant in Preventing Post-bariatric Surgery Nausea and Vomiting: Evidence from Clinical Trials.

This study aims to evaluate the effectiveness of aprepitant in preventing postoperative nausea and vomiting (PONV) following metabolic bariatric surgery (MBS). Clinical trials meeting the inclusion criteria were identified through searches of PubMed, Embase, and the Cochrane Library databases, as well as clinical trials registered at clinicaltrials. gov. These trials compared aprepitant with the control or placebo groups among patients who underwent MBS. Meta-analysis was performed using StataSE 17.0 software to calculate the pooled risk ratio (RR) and its 95% confidence interval (CI) to assess the effectiveness of aprepitant in preventing PONV following MBS. A total of five articles comprising six studies including 929 patients undergoing MBS were included. Meta-analysis revealed a significant reduction in the incidence of PONV among patients receiving aprepitant (pooled RR = 0.51, 95% CI: 0.38-0.68, P < 0.05). Subgroup analysis indicated that aprepitant effectively reduced PONV incidence at 0, 6, and 12h postoperatively in patients with MBS, but did not decrease PONV occurrence at 24 and 48h postoperatively. Aprepitant demonstrated significant clinical efficacy in preventing PONV following MBS, effectively reducing patient discomfort, and improving postoperative recovery. Therefore, aprepitant should be considered a preventive measure in patients undergoing MBS to enhance patient satisfaction and recovery rates. Additionally, to maintain an effective drug concentration, aprepitant should be administered within the first 24h postoperatively. CRD 42024528154.

Intraoperative dexamethasone is associated with a lower risk of respiratory failure in thoracic surgery: Observational cohort study (SURTHODEX)

BackgroundPostoperative complications, particularly respiratory complications, are of significant clinical concern in patients undergoing elective thoracic surgery. Dexamethasone (DXM), commonly administered to prevent postoperative nausea and vomiting (PONV), has potential anti-inflammatory effects that might be beneficial in reducing these complications. We aimed to investigate whether intraoperative DXM administration could mitigate the occurrence of respiratory complications following elective thoracic surgery. MethodsWe conducted a single-center observational study, including patients who underwent elective thoracic surgery from 2012 to 2020. The primary outcome was the onset of acute respiratory failure within 7 days post-surgery. Secondary outcomes encompassed other postoperative complications, duration of hospital stay, and mortality within 30 days post-surgery. An overlap propensity score analysis was employed to estimate the treatment effect. ResultsWe included 1,247 adult patients, 897 who received dexamethasone (DXM) and 350 who served as controls. Intraoperative dexamethasone administration was associated with a significant reduction in respiratory complications with an adjusted relative risk (RR) of 0.65 (95% CI: 0.43−0.97). There was also a significant decline in composite infectious criteria with an adjusted RR of 0.76 (95% CI: 0.63−0.93). Cardiac complications were also assessed as a composite criterion, and a significant reduction was observed (adjusted RR, 0.68; 95% CI, 0.51−0.9). However, there were no association with mechanical complications, mortality within 30 days (adjusted RR of 0.43, 95% CI: 0.17–1.09) or in the length of hospital stay (adjusted RR of 0.85, 95% CI: 0.71–1.02). ConclusionsDexamethasone administration was associated with a reduction in postoperative respiratory complications. Further prospective studies are needed to confirm these findings.

Laparoskopik Kolesistektomi Sonrası Bulantı ve Kusmanın Önlenmesinde Deksametazon ve Gabapentinin Etkinliği ve Karşılaştırılması

Objective: Postoperative nausea and vomiting (PONV) is a common postoperative complication. The aim of this study was to investigate the efficacy of gabapentin and dexamethasone as new treatment strategies in the treatment of PONV. Methods: This retrospective study included a total of 136 ASA I-II patients aged 18-70 years who underwent elective cholecystectomy. Group D (n=66) received 4 mg intravenously dexamethasone after anesthesia induction and Group G (n=70) received 600 mg gabapentin oral treatment. Standard DII and V5 lead ECG, automatic non-invasive blood pressure and peripheral oxygen saturation monitoring was applied to all patients in the general operating room, anesthesia maintenance was provided with total intravenous anesthesia after orotracheal intubation and at the end of surgery, patients were transferred to the postoperative care unit. Nausea and vomiting symptoms, pain scores and the time and dose of additional antiemetic/analgesic requirements in the first 24 hours were monitored. Results: There were no statistically significant demographic differences between the groups and the results showed that both dexamethasone and gabapentin were effective in preventing PONV. The need for rescue antiemetic therapy was similar in both groups (p=0.2). Significantly less postoperative analgesic was required in the gabapentin group than in the dexamethasone group. Conclusion: Antiemetic drug prophylaxis should be administered to patients at high risk of PONV and treatment with different groups of antiemetic drugs should be considered. Dexamethasone and gabapentin can be considered effective drugs for the prevention of PONV. Keywords: Postoperative nausea and vomiting, dexamethasone, gabapentin, laparoscopic surgery, laparoscopic cholecystectomy

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.

Implementation of updated enhanced recovery after bariatric surgery guidelines: adapted protocol in a single tertiary center.

The aim of this study isto evaluate the effects of an adapted protocol of enhanced recovery after bariatric surgery (ERABS) on outcomes. This is asingle-center observational study comparing patients managed according to adapted ERABS protocol (March-May 2022) with a control group of old method (January 2021-February 2022). Totally, 253 bariatric patients were included in the study (n = 68) and control (n = 185) groups. Patients were mostly females (57.3% vs 70.2%; p = 0.053), of mean age 38.8 years and body mass index 41 ± 6.53 vs. 44.60 ± 7.37kg/m2 (p = 0.007) in study and control groups, respectively. The majority (90.5%) underwent primary bariatric surgery. Adapted ERABS protocol compliance was 98.5%. The study group had shorter hospital stay (mean 2.86 ± 0.51 vs. 4.03 ± 0.28 days; p < 0.001), similar rates of total (3% vs. 2.7%, p = 0.92) and major complications (1.5% vs. 0, p = 0.10). Readmission rates were similar (1.5% vs 1.6%, p = 0.92). Applied only in the study group, early ambulation (p < 0.001), opioid restriction, and preventing postoperative nausea and vomiting (PONV), resulted in satisfactory scores (mean total visual analogue score 1.93 ± 0.80, morphine milligram equivalent 34.0 ± 14.5, and mean total PONV grade 0.17 ± 0.36). In conclusion,implementing adapted ERABS guidelines improved patients' postoperative care, raising awareness to pain management. Length of stay was shortened without safety compromise. Efforts to abandon old-school routines seem worthwhile, even if ERABS is partially implemented.

Which 5-HT3 antagonist prevents nausea and vomiting in cesarean section more effectively: a network meta-analysis.

Selective 5-hydroxytryptamine 3 receptor (5-HT3) antagonists are commonly used to prevent nausea and vomiting (NV) after cesarean section, but the comparative efficacy of different 5-HT3 antagonists remains unclear. This network meta-analysis aimed to determine which 5-HT3 antagonists might be the preferred choice for preventing NV in parturient scheduled for elective cesarean delivery under spinal anesthesia. PubMed, EMBASE, Cochrane library, and Web of Science were searched for relevant randomized controlled trials (RCTs) published before August 24, 2023. Random network meta-analysis was performed using Stata 14.0 to estimate the efficacy of different 5-HT3 antagonists in preventing intra- and post-operative NV. Twenty-eight studies involving seven dosing regimens of three 5-HT3 antagonists were included. Pooled results showed that ondansetron 12 mg was superior to other six dosing regimens in the prevention of postoperative NV (PONV), PON, and POV, with the ranking probability of 80.2%, 95.8%, and 87.7%, respectively, followed by granisetron two mg. Ondansetron 4 mg might be the first choice for preventing intraoperative NV (IONV) (92.8%), with the least use of postoperative rescue antiemetics (90.6%). Granisetron 3 mg and tropisetron 2 mg might be the best options for preventing ION and IOV, respectively. Based on available data, ondansetron 12 mg may have the best efficacy in preventing PONV, PON, and POV. Additionally, more studies are warranted to compare the safety of ondansetron 12 mg versus granisetron two mg.

Comparison of oral olanzapine versus oral ondansetron for prevention of postoperative nausea and vomiting in female patients undergoing laparoscopic cholecystectomy under general anaesthesia

Introduction: Postoperative nausea and vomiting is one of the significant problem in anaesthesia practice The incidence is even high following laparoscopic surgeries. 5HT3 receptor antagonists are routinely used to prevent postoperative nausea and vomiting (PONV). Olanzapine, an atypical antipsychotic drug with its activity on multiple receptor sites particularly at D2 and 5HT3 receptors, has potential antiemetic properties. This study aimed to compare the efficacy of ondansetron with olanzapine in prevention of PONV following laparoscopic cholesystectomy under general anaesthesia. Materials and methods: This randomized double blind controlled study was done by recruiting 120 female patients belonging to ASA I/II posted for laparoscopic cholecystectomy under general anaesthesia. Patients were assigned to one of the two groups. Group A received tablet Olanzapine 5mg, 4 hrs before surgery and Group B received tablet ondansetron 16mg 1hr before surgery. Postoperatively nausea, retching, vomiting complete response and sedation were assessed for 24hrs at the interval of 0-4hrs, 4-8hrs, 8-12hrs and 12-24hrs. Results: There was no statistical difference in the incidence of postoperative nausea, retching and vomiting between the groups at 0-4hrs, 4-8hrs. Statistical difference between the groups were seen at 8-12hr interval (nausea p=0.048, retching=0.042, vomiting p=0.042) and at 12-24 hr (nausea p=0.028, retching p=0.001, vomiting p=0.006). There was a significant difference in the use of rescue drug at 8-12hrs (6.7% patients required rescue drug in Group B whereas none required in Group B). Conclusion: Olanzapine 5 mg can be used safely and effectively for prophylaxis against PONV and is more effective in preventing PONV during the late postoperative period compared to ondansetron.

Molecular and Circuit Mechanisms Regulating Nausea and Vomiting: Recent Advances and Future Perspectives

Nausea and vomiting are closely related but distinct physiologic and psychological phenomena that are often experienced together. The incidence of nausea and vomiting are high but our understanding of the molecular and circuit mechanisms is limited. Currently, the drug treatments for nausea and vomiting are not very effective but are often accompanied by unpleasant side effects. Therefore, nausea and vomiting remain a crucial factor affecting early recovery of patients and urgent measures are needed to enhance prevention and treatment efforts, alleviate patient suffering, improve healthcare outcomes, and promote rapid recovery. The mechanism underlying nausea and vomiting is complex and involves multiple different receptors and neural pathways, all of which have important roles. Herein we reviewed the recent advances involving the molecular and neural circuit mechanisms regulating nausea and vomiting as well as the clinical factors and research status of postoperative nausea and vomiting (PONV). Understanding nausea and vomiting circuitry and cellular mechanisms is crucial for developing PONV prevention and treatment strategies.

Hyperoxia therapy for prevention of postoperative nausea and vomiting after breast cancer surgery

Background/Aim. Postoperative nausea and vomiting (PONV) are one of the most common causes of patient dissatisfaction in the postoperative period after general anesthesia. Hyperoxia may prevent PONV after abdominal surgery, but the effectiveness of intraoperative and early postoperative hyperoxia in preventing PONV after breast cancer surgery has not been fully elucidated. The aim of this study was to assess if the application of intraoperative hyperoxia during surgery could prevent PONV. Methods. Forty female patients with breast cancer were recruited for the study, all of whom underwent surgical treatment of breast cancer with axillary sentinel node sampling or axillary lymph node dissection. A balanced general anesthesia was conducted, which was induced with propofol and maintained with sevofluran. Out of the 40 patients, 20 (in-tervention group) received a volatile gas mixture with a fraction of inspired oxygen (FiO2) of 0.8 L/min intraoperatively and, afterward, 3 L/min of oxygen via face mask for two hours after surgery. The other 20 patients (control group) received a FiO2 of 0.4 L/min during the surgery without further administration of oxygen in the early postoperative period. The presence and severity of PONV were assessed at 30 min, 4, 24, 32, 48, and 56 hrs after surgery with the use of the PONV numerical Intensity Scale by Wengritzky for evaluating clinically significant PONV in the first six hours after surgery. Data were collected in an Excel spreadsheet and analyzed using the independent Student?s t-test. Results. The overall incidence of PONV during the 30 min after the surgery was 17.5% (15% in the group of patients receiving FiO2 of 0.8 L/min and 20% in the group of patients receiving FiO2 of 0.4 L/min intraoperatively). There was no statistically significant difference between the two groups in the frequency of PONV, as well as in the severity of PONV, measured with the PONV Intensity Scale by Wengritzky (p ? 0.05). Conclusion. We found no benefit of intra- and post-operative hyperoxia in reducing the incidence of PONV. The data do not support routine administration of hyperoxia, in addition to antiemetics, for the prevention of PONV in patients undergoing breast cancer surgery.