Risk Of Postoperative Nausea And Vomiting Research Articles

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

The effect of timing and dosing of 5% and 10% dextrose versus saline on postoperative nausea and vomiting in high-risk women following ambulatory surgeries: a randomized double-blind controlled trial

A common complication after outpatient surgeries is postoperative nausea and vomiting (PONV) which is concomitant with high levels of patient distress and dissatisfaction. Perioperative dextrose-containing fluid administration has been used as a non-pharmacologic preventive measure against postoperative nausea and vomiting (PONV). However, its efficacy remains unclear. This study aimed to compare different concentrations of dextrose solution on PONV for 24 hours after surgery. This is a randomized double-blind controlled study where 120 women were divided into three equal groups. Group C was infused with IV 0.9% saline 100 mL/h for two hours (200 mL) starting one hour before anesthesia and ending during surgery. Group D5%, was infused with dextrose 5%. Group D10%, was infused with D10%. PONV within 24 hours was compared between groups by PONV score. Other outcomes were the antiemetic drugs needed, VAS Score, total fentanyl consumption, hemodynamic data, unplanned admission, and complications. The incidence of nausea and vomiting was significantly reduced in dextrose 10% and 5% patients in comparison to the control group (five patients [12.5%], 18 [42.5%], and 39 [87.5%] respectively). The request for antiemetic drugs decreased significantly in groups D10% and 5% than in group C (36 [90%], 29 [72.5%] and 19 [47.5%] patients did not receive any antiemetics, P=0.002). Postoperative pain prevalence in patients with PONV was significantly different only at 24 h, P=0.03. There was a potential role for preoperative IV infusion of dextrose 10% solution that significantly reduces the incidence and severity of PONV and pain in patients at high risk for PONV.

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.

Preoperative reflux or regurgitation symptoms are independent predictors of postoperative nausea and vomiting (PONV) in patients undergoing bariatric surgery: a propensity score matching analysis.

Postoperative nausea and vomiting (PONV) is common side effect after gastrointestinal surgery. It causses discomfort, increase risk of incision disruption, bleeding and airway blockage. This study aimed to investigate the incidence and severity of PONV and determine whether preoperative reflux or regurgitation symptoms influence PONV in patients undergoing bariatric surgery. Patients with obesity underwent laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in our center between January 2016 and December 2018 were divided into PONV and NoPONV group and analyzed retrospectively. PONV and postoperative pain visual analogue scale (VAS) were analyzed after surgery. A 1:1 propensity score matching (PSM) method was performed, and multivariable logistic regression analyses were used to identify predictors for PONV. There were 483 patients enrolled, with a mean age of 30.19 ± 9.96years, and 134 pairs of matched patients were selected from PONV group and NoPONV group after PSM. PONV occurred in 288 (59.6%) patients after bariatric surgery (77.4% after LSG vs 21.5% after LRYGB, p < 0.001). In PONV group, 210 (72.9%) were female, preoperative reflux or regurgitation symptoms were 128 (33.6%). Multivariable analysis found that preoperative reflux or regurgitation symptoms were independent risk factors for PONV after LSG, with an OR of 2.78 (95% CI: 1.12-6.93, p = 0.028). Incidence of PONV after bariatric surgery is high. For the first time, this study valued preoperative reflux or regurgitation symptoms as risk factors that may promote PONV after bariatric surgery. Patients with preoperative symptoms undergoing LSG have a higher risk of PONV, so these patients should be carefully evaluated for the feasibility of LSG before surgery.

Total intravenous anesthesia vs inhalational anesthesia in patients undergoing surgery under general anesthesia. Cost-minimization study

Introduction: The methods most frequently used at the present time in Colombia for the administration of general anesthesia are based on halogenated and intravenous drugs. However, in view of the lack of differential clinical outcomes, the existence of cost variations between the two is not clear.&#x0D; Objective: To determine the expected cost of the use of both techniques in patients taken to surgery, within the framework of the Colombian national health system.&#x0D; Methods: A cost minimization study was carried out using the decision tree as the analytical model. A time frame of 6 postoperative hours was used as the assumption. Only direct healthcare-related costs were included using a case study approach. An econometric model was used based on the frequency with which each technology is applied and the type of drug used, and a deterministic and probabilistic sensitivity analysis was performed.&#x0D; Results: For the case study, total intravenous anesthesia (TIVA) is more costly than the inhalational technique, with an incremental cost of $102,718 per patient. The deterministic analysis shows that both the incidence of postoperative nausea and vomiting (PONV) as well as the use of target controlled infusion (TCI) techniques are the main cost determinants. The probabilistic analysis shows that the cost difference can even be nil in more than 50% of the simulated settings, when the difference in the risk of PONV is higher.&#x0D; Conclusions: Although the total intravenous technique can be more costly than the inhalational technique, this difference is offset by a lower cost of the postanesthesia care unit, given the lower risk of postoperative nausea and vomiting.

The Impact of Acupuncture on Postoperative Nausea and Vomiting in Obese Adult Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial.

Objectives: We wanted to research the effect of acupuncture on postoperative nausea and vomiting (PONV) in morbidly obese adult patients who were scheduled for laparoscopic sleeve gastrectomy. Design: This prospective randomized controlled study included 62 American Society of Anesthesiologists physical status I-III, 18- to 60-year-old morbidly obese patients undergoing laparoscopic sleeve gastrectomy. Patients were assigned using a closed envelope method to both groups equally. Group I consisted of acupuncture and metoclopramide; Group II consisted of metoclopramide. Setting: The study was carried out in Kecioren Educational Research Hospital, University of Health Sciences, Ankara, Turkey. Interventions: Acupuncture was performed by needling PC6, LI4 acupoints bilaterally and Yin Tang acupoint in Group I. Metoclopramide was administered as an antiemetic drug in both groups. Measurements: Demographic parameters, SAMBA PONV risk, first analgesic requirement time and PONV of the patients at the recovery 0-1, 1-6, 6-12, and 12-24 hours after operation were recorded. We used the simplified PONV impact scale to determine the intensity of nausea and its effects on the patient. Results: Nausea was observed in 37.5% of patients in Group I and 63.3% of patients in Group II at the recovery. Nausea intensity was not different between the groups at the postoperative 1-6 hours, but vomiting count was found higher in Group II at the postoperative 12-24 hours. Apfel score of the patients were similar between the groups. PONV impact scale was found higher in Group II. First analgesic requirement time was found shorter and demand for additional analgesic treatment was found significantly higher in Group II. Conclusions: Combining acupuncture with antiemetic treatment reduced nausea intensity and vomiting in the postoperative follow-up period. Also, patient's first analgesic demand time was found longer and the requirement for additional analgesic treatment was found lower in the acupuncture group.

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.

Factors Associated with Postoperative Nausea and Vomiting after Breast Cancer Surgery with Inhalation Anesthesia.

The incidence and risk factors of postoperative nausea and vomiting (PONV) and early PONV (ePONV) were evaluated in patients who underwent breast surgery with volatile anesthesia. In this retrospective study, multivariate logistic regression was used to determine incidence and identify risk factors for PONV. Among 928 patients, 166 (18%) and 220 (24%) had ePONV and PONV, respectively. In multivariate analysis, anesthesia duration and use of desflurane were independent risk factors for ePONV. For PONV, anesthesia duration and Apfel score were independent risk factors. Our results indicate that desflurane was the main cause of ePONV. However, during the delayed phase, a higher Apfel score was the strongest predictor. In the early and delayed phases, long anesthesia duration was associated with high risk of PONV. Thus, prolonged anesthesia and desflurane use should be avoided for patients at high risk of PONV, particularly those with high Apfel scores.

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.

A Comprehensive Single-Center Analysis of Postoperative Nausea and Vomiting Following Orthognathic Surgery.

Postoperative nausea and vomiting (PONV) remains a major clinical end-point for directing enhanced recovery after surgery (ERAS) protocols in facial plastic surgery. This study aimed to identify risk factors for PONV and evaluate strategies for PONV reduction in orthognathic surgery patients. A retrospective cohort study was performed among patients receiving orthognathic surgery at our institution from 2011 to 2018. Patient demographics, surgical operative and anesthesia notes, medications, and nausea/vomiting were assessed for each patient. The amount of opioid analgesia given both perioperatively and postoperatively was recorded and converted into morphine equivalents (MEQ). Stepwise regression analysis was used to identify significant risk factors for PONV. Post hoc analyses were employed to compare PONV among patients based on MEQ dosage and antiemetic prophylaxis regimes. A total of 492 patients were included; mean age was 23.0 years (range: 13-60); 54.4% were female. The majority of patients received concurrent Le Fort I osteotomy, BSSO, and genioplasty (70.1%). During hospitalization, 59.4% of patients experienced nausea requiring antiemetic medications and 28.4% experienced emesis. Stepwise regression yielded Apfel scores (P = 0.003) and postoperative opioids (P = 0.013) as the strongest predictors of PONV. Post hoc analyses showed that undertreatment with prophylactic antiemetics (based on Apfel) predicted increased PONV (+12.9%, P = 0.020), and that lower postoperative MEQs (<28.0) predicted decreased PONV (-11.8%, P = 0.01). The study findings confirm the high incidence of PONV among orthognathic surgical patients and stratify previously reported PONV risk factors. More aggressive utilization of antiemetic medications and decreased dependence on opioid analgesia may decrease nausea/vomiting following orthognathic surgery.

Relationship of Postoperative Pain and PONV after Minimally Invasive Surgery with the Serotonin Concentrations and Receptors' Gene Polymorphisms.

(1) Background: there is a steady increase in the number of procedures performed via minimally invasive surgery, which have many benefits, but post-operative nausea and vomiting (PONV) and significant pain are still a common problem (2) Methods: 300 infertile women (18–40 years old) undergoing minimal invasive surgery. Interventions: laparoscopy and hysteroscopy performing, evaluation of postoperative symptoms, serotonin concentrations assessment, identify genetic polymorphisms. (3) Results: serotonin concentrations were significantly lower among women who required opioids (p = 0.006). The presence of the GG genotype in the rs6318 polymorphism of the 5HTR2C gene had a protective effect on PONV (OR = 0.503; C.I. = [0.300–0.841]; p = 0.008), when the GG variant of the rs11214763 polymorphism of the 5HTR3B gene, when the risk of PONV was 1.65-fold higher (OR = 1.652; C.I. = [1.003–2.723]; p = 0.048). Pain intensity was significantly higher among women with GG genotype of the rs6296 polymorphism of the 5HTR1B gene (OR = 1.660; C.I. = [1.052–2.622]; p = 0.029).; (4) Conclusions: the evaluation of serotonin concentration predicts requirement for opioid pain relief medication. The polymorphisms of the serotonin receptors affect the intensity of postoperative complaints.

Incidence and Management of Postoperativ Nausea and Vomiting: A Narrative Review

Background: Postoperative nausea and vomiting (PONV) is viewed as nausea and/or vomiting or retching that occurs in the Post- anesthesia care unit within the first 24–48 h after surgery. The incidence of these adverse reactions is between 30 and 80% following elective surgery based on the type of surgery and anesthesia, and predisposing patient risk factors. The most commonly used criteria in the perioperative assessment of the risk-score is Apfel which is a tool to evaluate PONV. The risk-score depends on Four variables: female gender, PONV history or motion sickness, postoperative opioids, and smoking status. &#x0D; Methods: Currently available evidence on MEDLINE, PubMed, Google scholar and Cochrane Evidence Based Medicine Reviews, in addition to the citation reviews by manual search of new anesthesia and surgical journals related to management post-operative nausea and vomiting were searched.&#x0D; Results: This review of recent studies showed incidence and management of post-operative nausea and vomiting and way to prevent or reduce its incidence by using monotherapy or combination antiemetic therapy, multimodal approach and by using optimal anesthetic technique for reducing baseline risk PONV.&#x0D; Conclusion: The causes of PONV are complex and multifaceted. Patient (gender, individual background, and medical condition); anesthesia type; and surgical procedure are all risk factors for PONV. PONV is better treated by preventing and/or minimizing PONV risk factors, as well as using prophylactic antiemetics in high-risk patients. There is no one PONV antiemetic drug or technique that is 100% appropriate for all patients at this time. If the first anti emetic is unsuccessful, a 2nd or 3rd anti emetic that targets a specific mid brain emetic receptor location may be needed. PONV prophylaxis should be considered for patients who have a low to high chance of contracting the virus, according to the scoring system. The patient may be treated with monotherapy or combination treatment of anti emetics, as well as non pharmacologic approaches and therapies to reduce baseline risk, depending on the severity of risk. A targeted multimodal solution beginning in the preoperative phase is more likely to ensure progress in the management of PONV, which increases patient care satisfaction while still being cost-effective.

Efficaciousness of dexmedetomidine in children undergoing cleft lip and palate repair: a systematic review and meta-analysis

ObjectiveTo systematically assess the efficacy and safety of dexmedetomidine as an anaesthesia adjuvant for cleft lip and palate (CLP) repair in children.DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, Cochrane, China National...

Early post-operative nausea and vomiting: A retrospective observational study of 2030 patients.

The overall risk of post-operative nausea and vomiting (PONV) after general anaesthesia is reportedly 20%-40%. The first episode of PONV may occur early in the post-anaesthesia care unit (PACU) or later at the ward or after discharge at home in an ambulatory setting. This study aimed to investigate and describe the risk of early PONV in a PACU, and we hypothesised that patients and perioperative factors were associated with early PONV. This single-centre retrospective observational study was conducted in a Swedish county hospital from January to June 2017 and included adult patients who underwent surgical procedures under general anaesthesia. Perioperative data were obtained by reviewing the local registry for surgical procedures, medical records and anaesthesia and post-operative charts. Early PONV was defined as PONV occurring up to 4hours post-operatively at the PACU. Any notification in the medical records, perioperative charts or the registry regarding nausea, vomiting or PONV treatment was regarded as PONV. Univariate and multivariate analyses were performed for factors associated with early PONV. A total of 2030 patients were included in the study, of which 9.6% (n=194) experienced early PONV. Factors associated with a high risk of early PONV were suboptimal PONV prophylaxis, need for opioids, female sex, body mass index >35kgm-2 and major surgery and anaesthesia time ≥60minutes. We found that every 10th patient under general anaesthesia experienced early PONV. Suboptimal PONV prophylaxis and previously acknowledged risk factors for PONV were associated with early PONV.

Cost-Effectiveness of Propofol (Diprivan) Versus Inhalational Anesthetics to Maintain General Anesthesia in Noncardiac Surgery in the United States

ObjectivesIt is not known whether using propofol total intravenous anaesthesia (TIVA) to reduce incidence of postoperative nausea and vomiting (PONV) is cost-effective. We assessed the economic impact of propofol TIVA versus inhalational anesthesia in adult patients for ambulatory and inpatient procedures relevant to the US healthcare system. MethodsTwo models simulate individual patient pathways through inpatient and ambulatory surgery with propofol TIVA or inhalational anesthesia with economic inputs from studies on adult surgical US patients. Efficacy inputs were obtained from a meta-analysis of randomized controlled trials. Probabilistic and deterministic sensitivity analyses assessed the robustness of the model estimates. ResultsLower PONV rate, shorter stay in the post-anesthesia care unit, and reduced need for rescue antiemetics offset the higher costs for anesthetics, analgesics, and muscle relaxants with propofol TIVA and reduced cost by 11.41 ± 10.73 USD per patient in the inpatient model and 11.25 ± 9.81 USD in the ambulatory patient model. Sensitivity analyses demonstrated strong robustness of the results. ConclusionsMaintenance of general anesthesia with propofol was cost-saving compared to inhalational anesthesia in both inpatient and ambulatory surgical settings in the United States. These economic results support current guideline recommendations, which endorse propofol TIVA to reduce PONV risk and enhance postoperative recovery.

The characteristics and risk factors of the postoperative nausea and vomiting in female patients undergoing laparoscopic sleeve gastrectomy and laparoscopic gynecological surgeries: a propensity score matching analysis.

The aim of this study was to compare the prevalence of postoperative nausea and vomiting (PONV) in matched patients undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic gynecological surgeries (LGS) and investigate the main cause of the high occurrence of PONV in bariatric surgeries. Medical records of female patients with a body mass index (BMI) greater than 30 kg/m2 undergoing LSG or LGS from January 1, 2016 to September 1, 2020 were reviewed for PONV episodes in the first postoperative 48 hours. A 1:1 propensity score matching (PSM) method was performed between cases subject to the two types of surgery, and PONV rates were compared. A total of 278 patients met the inclusion criteria (LSG = 101, LGS = 177), and 74 matched subjects were selected from each group after PSM. An increased occurrence of PONV was noted in female patients with LSG compared with those undergoing LGS (66.2% vs. 23.0%; p<0.001). PONV severity was significantly worse in the LSG (p<0.001), and more frequent use of rescue antiemetics was detected in the LSG group compared with the LGS group (51.4% vs. 17.6%; p<0.001). The time of the first use of rescue drugs was much earlier in the LGS group (p = 0.034). Female patients undergoing LSG are at increased risk of PONV compared with those with LGS, indicating a critical role of procedure-related alterations of gastric physiology in the high occurrence of PONV after bariatric surgery.

The next generation of antiemetics for the management of postoperative nausea and vomiting.

Postoperative nausea and vomiting (PONV) afflict approximately 30% of patients overall and up to 80% of high-risk patients after surgery. Optimal pharmacological prophylaxis of PONV is challenging as it necessitates the consideration of PONV risk, drug efficacy, and potential adverse effects. Despite significant advances in our understanding of the pathophysiology and risk factors of PONV, its incidence has remained largely unchanged. Newer antiemetics have been introduced that may have improved safety profiles, longer duration of action, and better efficacy. This review aims to summarize the recent developments pertaining to these new agents and their potential application toward the management of PONV.

Postoperative Nausea and Vomiting in Pediatric Patients.

Postoperative nausea and vomiting (PONV), postoperative vomiting (POV), post-discharge nausea and vomiting (PDNV), and opioid-induced nausea and vomiting (OINV) continue to be causes of pediatric morbidity, delay in discharge, and unplanned hospital admission. Research on the pathophysiology, risk assessment, and therapy for PDNV, OINV and pain therapy options in children has received increased attention. Multimodal pain management with the use of perioperative regional and opioid-sparing analgesia has helped decrease nausea and vomiting. Two common emetogenic surgical procedures in children are adenotonsillectomy and strabismus repair. Although PONV risk factors differ between adults and children, the approach to decrease baseline risk is similar. As PONV and POV are frequent in children, antiemetic prophylaxis should be considered for those at risk. A multimodal approach for antiemetic and pain therapy involves preoperative risk evaluation and stratification, antiemetic prophylaxis, and pain management with opioid-sparing medications and regional anesthesia. Useful antiemetics include dexamethasone and serotonin 5-hydroxytryptamine-3 (5-HT3) receptor antagonists such as ondansetron. Multimodal combination prophylactic therapy using two or three antiemetics from different drug classes and propofol total intravenous anesthesia should be considered for children at high PONV risk. "Enhanced recovery after surgery" protocols include a multimodal approach with preoperative preparation, adequate intravenous fluid hydration, opioid-sparing analgesia, and prophylactic antiemetics. PONV guidelines and management algorithms help provide effective postoperative care for pediatric patients.

Intraoperative systemic vascular resistance is associated with postoperative nausea and vomiting after laparoscopic hysterectomy.

BACKGROUNDThe incidence of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic hysterectomy is very high compared with other surgeries, even when many prophylactic measures have been taken. However, the pathogenesis of PONV is multifactorial. Female sex, a history of motion sickness or PONV, nonsmokers, and perioperative opioid use are the most closely related factors. Among the multiple risk factors, suboptimal gastrointestinal (GI) perfusion may be attributed to some cases of PONV, and increased systemic vascular resistance (SVR) may lead to GI ischemia. The hypothesis of this research was that SVR is related to PONV.AIMTo investigate the relationship between SVR and PONV in patients undergoing laparoscopic hysterectomy.METHODSA total of 228 patients who underwent elective laparoscopic hysterectomy were included in this prospective observational study. SVR was monitored using a noninvasive hemodynamic monitoring system. Four indices of SVR, the baseline, mean, area under the curve (AUC), and weighted AUC, were used for analysis. The incidence and severity of nausea and vomiting were evaluated while patients were awake and throughout the intervals from 0 to 2 h, 2 to 6 h, and 6 to 24 h starting upon arrival at the post-anesthesia care unit. The associations between various SVR indices and PONV were investigated by logistic regression. P < 0.05 was considered statistically significant.RESULTSThe incidence of PONV in the study was 56.14% (128/228), and PONV tended to appear within 6 h after surgery. Five variables were significant in univariate analyses, however, only SVR mean [odds ratio (OR) = 1.015, 95%CI: 1.005-1.109, P = 0.047] and duration of surgery (OR = 1.316, 95%CI: 1.003-2.030, P = 0.012) were associated with PONV after logistic regression analysis. Furthermore, patients with high SVR mean were more likely to suffer from PONV after laparoscopic hysterectomy. On average, patients who developed PONV needed more time to tolerate diet and demonstrated poorer sleep quality on the first night after surgery. CONCLUSIONIn this study, PONV was a common complication after laparoscopic hysterectomy. SVR was associated with PONV, and high SVR mean was associated with a significantly increased risk of PONV.

Relationship between dexamethasone added to periarticular anesthetic infiltration and postoperative nausea and vomiting following total knee arthroplasty under general anesthesia: a retrospective observational study

BackgroundPeriarticular anesthetic infiltration (PAI) with a corticosteroid is a modality for pain control following total knee arthroplasty (TKA). Systemic corticosteroids are an established antiemetic for the prophylaxis of postoperative nausea and vomiting (PONV). The purpose of this retrospective observational study was to elucidate the relationship between dexamethasone added to PAI and PONV in patients who underwent TKA.MethodsData from 435 patients who received PAI using ropivacaine with or without dexamethasone were reviewed. The primary outcome was the incidence of PONV within 24 h following TKA. The incidence of deep incisional and organ/space surgical site infection (SSI) within the first year was also assessed.ResultsThe overall incidence of PONV was 23.2%. A multivariate logistic regression analysis showed that dexamethasone added to PAI was independently associated with a reduced incidence of PONV (adjusted odds ratio, 0.23; 95% confidence interval, 0.12–0.44, P < 0.001). The incidence of PONV and rescue analgesic requirements within 24 h were lower in patients who received PAI with dexamethasone than in those who received PAI alone (19.5% vs 49.1%, P < 0.001, 7.9% vs 29.1%, P < 0.001, respectively). SSI developed in one out of the 55 patients who received PAI alone, but in none of those who received PAI with dexamethasone.ConclusionsDexamethasone added to PAI for postoperative pain management was independently associated with a lower risk of PONV within 24 h of TKA.