Treatment Of Postoperative Nausea Research Articles

ANESTHESIA FOR OPHTHALMIC SURGERY: PERIOPERATIVE CONSIDERATIONS

The use of anesthesia during ophthalmic surgery is crucial for ensuring patient comfort and safety. Different types of ophthalmic surgeries require different types of anesthesia techniques. Cataract surgery is the most performed ophthalmic surgery and is typically performed under local anesthesia with sedation, while glaucoma surgery can be performed using local or general anesthesia depending on the complexity of the procedure. The use of local anesthesia can reduce intraocular pressure (IOP) and is associated with fewer postoperative complications compared to general anesthesia. Three ophthalmic reexes, the oculocardiac, oculorespiratory, and oculoemetic reexes, should be recognized by the anesthesiologist. Appropriate prophylaxis and treatment of postoperative nausea and vomiting are essential for patients undergoing ophthalmic surgery.

Clinical experience with the use of inhaled isopropyl alcohol to treat nausea and vomiting: A narrative review.

Isopropyl alcohol (IA) is a colorless, flammable organic compound that has been used in the manufacturing process of a wide variety of industrial and household chemicals. Inhalation of its vapor has been noted to potentially have antiemetic effects, which may be useful in the treatment of postoperative nausea and vomiting (PONV). However, given the varied study protocols and endpoints assessing its efficacy as antiemetic, clinical trials have yielded mixed results. If effective, inhalation of IA may be a cost-effective, readily available, and inexpensive therapy that can be used for the treatment of PONV with a low risk of adverse effects. The following narrative review explores the available information regarding the mechanism of action of IA in treating PONV, presents clinical information including possible mechanism of action and clinical applications, and reviews the published literature on its efficacy to treat nausea and vomiting with a focus on its use postoperatively. While early studies suggested that inhaled IA may be successful for the short-term treatment of PONV compared with placebo, subsequent studies both in and out of the operating room (OR) have reported conflicting results. In general, studies in the perioperative setting have provided some evidence to support the use of inhaled IA in alleviating or reducing the severity of PONV in adults. In particular, inhaled IA may have a more rapid onset compared with traditional antiemetic agents, but the clinical effect has generally been found to be short-lived. The results outside of the OR and perioperative setting have been somewhat more favorable, generally showing that inhaled IA reduces nausea and vomiting of various etiologies in adults in the emergency department setting. Similarly, it has been shown to reduce the need for rescue antiemetic agents in this area and thus may be considered a cost-cutting strategy with no reported adverse effects. The available literature suggests that inhaled IA may be considered a potential therapy to achieve rapid relief of PONV and assist in the management of nausea and vomiting in adult patients outside of the perioperative setting. There remain insufficient data to determine how inhaled IA may impact PONV in children. Given the mixed results and the limitations of the current studies, additional data are needed to draw firm conclusions regarding the utility of inhaled IA.

Ondansetron: A selective 5HT3 receptor antagonist and it advances in drug delivery system

Ondansetron is a serotonin (5HT3) receptor antagonist used for the prevention and treatment of postoperative nausea and vomiting. It is available in many dosage forms in the market. Various analytical methods used for the determination of Ondansetron have been studied in this review article such as UV spectroscopy, mass spectroscopy, high-performance liquid chromatography, high-performance thin layer chromatography, a new electrospray ionization mass spectrometry etc. Ondansetron in human plasma can be estimated using this method. With time many advances have been made in the formulation aspects of Ondansetron, such as now a days it is available in floating drug delivery, transdermal as well as gastroretentive and orodispersible drug delivery system. New novel technologies are also mentioned in this review article related to 3D printing, nanofibers etc

Chewing Gum for Prevention of Nausea and Vomiting After Elective Caesarean Section: a Pilot Randomised Controlled Trial.

Nausea and vomiting are common complications in patients undergoing caesarean delivery under regional anaesthesia. When experienced after surgery, they may delay recovery, reduce patient satisfaction and affect the bonding between mother and baby. Various pharmacological and non-pharmacological approaches for prophylaxis and treatment of postoperative nausea and vomiting (PONV) have been employed with different degree of efficacy. In this pilot randomised controlled trial, we aimed to determine the possible preventative effects of chewing gum on the rate of PONV in expectant mothers undergoing neuraxial anaesthesia for elective lower segment caesarean section. All participants underwent spinal anaesthesia with administration of 10-11.5mg of intrathecal heavy Bupivicaine 0.5% according to anaesthetists' preference, Morphine 100μg and Fentanyl 25μg. Postoperative analgesia regimen was also standardised. Two hundred ninety-six patients were randomised to an intervention arm to receive chewing gum in addition to standard therapy and to a non-intervention arm to receive standard therapy. After exclusions, 258 patients were followed up 24h postoperatively. Standard therapy is defined as Ondansetron 4mg IV intra-operatively. The primary outcomes were the incidences of nausea and vomiting in the first 24h postoperatively. Secondary outcomes were the number of episodes of nausea or vomiting in the recovery room and on the ward 24h postoperatively, use of anti-emetics postoperatively, severity of nausea and patient satisfaction with the intervention. Our study revealed no significant differences in rates of postoperative nausea and vomiting between the intervention and standard therapy groups (41.4% v 36.9% p = 0.461). There were no significant differences in secondary outcomes between groups. Chewing gum does not reduce the incidence of PONV after elective LSCS under spinal anaesthesia. Our trial was registered with clinicaltrials.org (NCT04191694).

Network pharma cology and GEO chip based elucidation of mechanisms underlying the use of Yi Tieqing for prevention and treatment of postoperative nausea and vomiting

Purpose: To investigate the mechanism(s) involved in the use of Yi Tieqing for the prevention and treatment of postoperative nausea and vomiting (PONV), using network pharmacology and GEO chip.
 Methods: The chemical constituents and functional targets of five traditional Chinese medicines in Yi Tieqing were obtained by searching TCMSP database. The PONV disease targets were identified through DisGeNET, GeneCards and DrugBank databases, and differential expression genes of the GEO database chip (GSE7762) were mined. From the intersections of the component targets and disease targets, the core targets of drugs and diseases were obtained. The core targets were investigated in R language using GO-biological process and KEGG enrichment analyses, and their biological activities were verified via molecular docking. Finally, the severity and incidence of PONV in control and treatment groups were determined and compared.
 Results: A total of 254 bioactive components and 301 related potential targets were obtained from the TCMSP database. There were 2092 related targets in PONV, and 6 intersecting targets were obtained from Venn diagram. The results of GO biological process and KEGG enrichment analysis showed that the incidence of PONV was strongly correlated with the negative regulation of response to wounding and nervous system. Clinical results showed that from 24 – 48 h (T2) after operation, the severity and incidence of PONV in the treatment group were significantly lower than those in the control group (p < 0.05).
 Conclusion: Yi Tieqing alleviates PONV through multi-components, multi-targets, and multi-pathways.

Intravenous amisulpride as rescue treatment of postoperative nausea and vomiting in patients undergoing oncologic surgical procedures.

12111 Background: Nausea and vomiting or retching after surgery can have significant adverse impacts, including increased length of stay, worse outcomes and patient dissatisfaction. Therefore, effective management remains a high priority. While more aggressive, multimodal prophylaxis has helped, options for treating those patients who fail are limited. Intravenous (IV) amisulpride has been shown to be safe and effective for the rescue treatment of Post-Operative Nausea and Vomiting (PONV) in a large, randomized, double-blind, placebo-controlled trial in a broad surgical population (Habib AS, Kranke P, Bergese SD, Chung F, et al. Anesthesiology 2019;130:203-212). We conducted a post-hoc analysis to investigate the safety and efficacy of amisulpride specifically in those patients undergoing oncologic surgery, predominantly excision of breast, gastrointestinal, or genitourinary malignancies. Methods: This subset analysis includes data from a randomized, double-blind, placebo-controlled, multicenter phase III trial of a single 10 mg dose of IV amisulpride as rescue treatment of PONV occurring in patients failing pre/peri-operative prophylaxis, generally with ondansetron and/or dexamethasone (Habib AS, Kranke P, Bergese SD, Chung F, et al. Anesthesiology 2019;130:203-212). The subset includes only those patients identified as undergoing surgery related to a specified malignancy or a mass considered likely to be malignant. The primary efficacy outcome was complete response (CR), defined as no emetic episodes (vomiting or retching) or administration of antiemetic rescue medication in the 24 hours after dosing. Results: In total, 465 patients were treated with either 10 mg amisulpride or placebo and 112 (56 in each group) underwent oncologic surgery. Of these, 43 (38%) underwent surgery for a pelvic tumor, 37 (33%) had breast or axillary surgery, 13 (12%) had colorectal, hepatic or pancreatic surgery and 19 (17%) underwent procedures for other malignancies, such as nephrectomy or thyroidectomy. The CR rate at 24 hours in the amisulpride group was 38%, compared to 23% with placebo. This was comparable with the success rates for the whole study population (42% vs 29%). The CR rate after 2 hours was 66% in the amisulpride group and 39% in the placebo group, also in line with the overall study results (70% vs 49%). Among those patients whose PONV occurred in the post-anesthesia care unit (PACU), the mean length of PACU stay from treatment to PACU discharge was 156 minutes in the amisulpride group and 230 minutes in the placebo group. Treatment-emergent adverse effects (TEAE) were comparable in nature and incidence between amisulpride and placebo. Conclusions: Amisulpride at 10 mg IV is safe and effective as rescue treatment for PONV in cancer patients undergoing surgery and is associated with a marked reduction in PACU length of stay.

This Month in Anesthesiology

This Month in Anesthesiology

Clinical observation of acupoint application of Chinese herbal medicine in preventing postoperative nausea and vomiting after orthopaedic surgery under general anesthesia

To explore clinical effect of acupoint application of Chinese herbal medicine in preventing postoperative nausea and vomiting after orthopaedic surgery under general anesthesia. From January 2018 to December 2019, 168 patients who met inclusion criteria and were underwent selective spine surgery, were double-blind divided into two groups according to central random system, 84 patients in each group. In control group, there were 39 males and 45 females aged from 30 to 65 years old with an average of (53.83±9.17) years old, 37 patients were classified to typeⅠand 47 patients were typeⅡ according to American Society of Anesthesiologists (ASA) grading. In experiment group, there were 39 males and 45 females aged from 30 to 65 years old with an average of (54.08±9.00) years old; 32 patients were classified to typeⅠand 52 patients were typeⅡ according to ASA grading. Both of two groups were obtained acupoint application before anesthesia induction, and acupoint application were put on Zhongwan (CV 12) and bilateral Neiguan (PC 6) for 6 h, changed after 24 h, last for 2 d. The drug prescription of plasters in experimental group was consist of Rhizome Pinelliae Preparata, Ginger and Clove. The plasters in control group was consistent with drug plasters in experimental group in appearance and smell to the greatest extent. The ingredients were flour and excipients with 10% of experimental drug concentration. Incidence of nausea vomiting, visual analogue scale (VAS) of narusea degree at 24 h and 24 to 48 h after operation between two groups were compared, SF- 12 simple quality of life score before operation, 24 and 48 h after operation were also compared by using R3.6.1 Rstudio software by the third-party. There were no statistical differences in incidence of nausea vomiting, VAS of narusea degree at 24 h after operation (P>0.05), while there were no differences in incidence of nausea vomiting, VAS of narusea degree at 24 to 48 h after operation (P>0.05) . There were no statistical differences in SF-12 before operation, 24 and 48 h after opertaion (P>0.05). The curative effect of acupoint application of traditional Chinese medicine on the prevention and treatment of postoperative nausea and vomiting is not obvious.

Dopamine Receptor Antagonists for the Prevention and Treatment of Postoperative Nausea and Vomiting

Postoperative nausea and vomiting (PONV) are common postoperative adverse events that lead to patient discomfort and dissatisfaction. The incidence of PONV is estimated at 30% for the general surgical population and as high as 80% in high-risk patients.1 Patient-specific risk factors for PONV include female gender, prior history of PONV or motion sickness, nonsmoking status, and younger age, typically defined as younger than 50 years. Procedure-related risk factors include surgery type with higher risk noted for laparoscopic, bariatric, and gynecologic surgery and anesthesia type with higher risk noted for general anesthesia of a long duration or with use of volatile anesthetics or nitrous oxide.

An analysis of the management and incidence of postoperative nausea and vomiting.

Postoperative nausea and vomiting significantly increases recovery time, reduces patient satisfaction, and increases time to discharge. Consensus guidelines for the management of postoperative nausea and vomiting highlight effective methods for prophylaxis and treatment. Implications of adherence to these guidelines include both improved patient outcomes and reduced healthcare costs. This study aimed to assess the incidence, contributing factors, and current prescribing practices for prophylaxis and treatment of postoperative nausea and vomiting. Electronic medical records were assessed for adult patients who had an elective gastrointestinal or gynaecologic surgical procedure over a one-year period. Patient demographics and perioperative data were collected to assess risk factors and the incidence of postoperative nausea and vomiting. The appropriateness of prophylaxis and treatment was assessed according to current guidelines. The incidence of postoperative nausea and vomiting was consistent with previously noted findings. The average time spent under anaesthesia was significantly higher in patients who experienced postoperative nausea and vomiting. Appropriate evidence-based rescue therapy was administered in a minority of the cohort experiencing postoperative nausea and vomiting. There is substantial opportunity for provider education and adherence to best prescribing practices. Enhanced adherence to evidence-based rescue therapy prescribing may improve patient outcomes and satisfaction.

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.

The acupoint herbal plaster for the prevention and treatment of postoperative nausea and vomiting after PLIF with general anesthesia: study protocol for a multicenter randomized controlled trial

BackgroundPostoperative nausea and vomiting (PONV) are common in posterior lumbar intervertebral fusion (PLIF) patients undergoing general anesthesia. The previous clinical observation has shown that a traditional acupoint herbal plaster (AHP) is beneficial to patients with PONV. This trial aims to assess the effect of the AHP for the prevention and treatment of PONV after PLIF in patients with general anesthesia.MethodsA multicenter, parallel, randomized controlled trial (RCT) will be conducted. A total of 166 participants will be randomized to either a treatment group receiving an AHP or a control groups receiving an acupoint placebo plaster (APP) in a 1:1 ratio. The primary outcomes are the first occurrence and frequency of nausea and vomiting. The secondary outcomes include the severity grading of nausea and vomiting using a visual analog scale (VAS) measurement system, quality of life, and serological indicators. The safety evaluation is mainly about adverse events and skin reactions’ observation. Assessments will be carried out at the baseline, day 1, and day 2 (the end of the intervention). The central randomization system in the clinical trial (http://124.205.181.142:8082/xwtf/) will be used to conduct random allocation.DiscussionThis scientific methodology design of the trial is expected to provide clinical evidence to support the AHP for the prevention and treatment of PONV.Trial registrationThis study is retrospectively registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn) on 19 April 2018. ID: ChiCTR1800015768.

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.

Acupuncture PC6 for postoperative nausea and vomiting at different times: A protocol for systematic review and meta analysis.

Postoperative nausea and vomiting (PONV) is a condition that commonly following anesthesia and surgery, antiemetics can lead to some side effects in treating PONV. Acupuncture PC6(Neiguan) has been widely used in the prevention and treatment of postoperative nausea and vomiting. However, there still exists controversy towards its effectiveness, appropriate, and effective intervention time. We, therefore, design this meta-analysis to assess the effectiveness and confirm the optimal time of acupuncture PC6 point for PONV. The following electronic databases will be searched from their inception to April 2020, including PubMed, Cochrane Library, EMBASE, Web of Science, WHO International Clinical Trials Registry Platform, Chinese National Knowledge Infrastructure, WanFang Database, Chinese Biomedical Literature Database, the Chongqing VIP Chinese Science, and Technology Periodical Database. All randomized controlled trials in English or Chinese involving acupuncture PC6 for patients with PONV will be included. Two reviewers will independently responsible for the data extraction, study selection, risk of bias assessment and assessment of study quality. The primary outcome was the number of postoperative nausea, postoperative vomiting and PONV during 0 to 6 hours and after 6 hours of the postoperatively. The secondary outcome is the number of people with side effects and the use of rescue therapy. The meta-analysis will be conducted using RevMan V.5.3.5 statistical software. This systematic review will evaluate the efficacy and appropriateness time of acupuncture PC6 in the treatment of PONV. This study will provide high-quality current evidence of the effectiveness and optimal time of acupuncture PC6 point for the patient with PONV. Ethical approval is not required; this review will not involve individuals' information. The results will be published in a peer-reviewed publication or disseminated in relevant conferences. DOI 10.37766/inplasy2020.4.0012.

The effectiveness of PC6 acupuncture in the prevention of postoperative nausea and vomiting in children: A systematic review and meta-analysis.

A growing number of studies have demonstrated the effectiveness of acupuncture in preventing and treating postoperative nausea and vomiting. Here, we used meta-analysis to confirm these benefits in children and to determine the optimal time to perform this treatment. Four databases (MEDLINE, EMBASE, CENTRAL, and Chinese Database of Biology and Medicine) were searched from inception until January 16, 2019. We included randomized controlled trials for evaluating the effectiveness of acupuncture in the prevention and treatment of postoperative nausea and vomiting during the early stage (0-4hours) and within 24hours postoperatively in pediatrics. Control groups received standardized care control or standardized care combined with sham control. Sixteen literatures and 1773 patients undergoing general anesthesia were included in the study. The results indicated that acupuncture was effective in reducing postoperative vomiting, both during the first 4hours (RR=0.47, 95% CI 0.26, 0.84; low quality) and within 24hours postoperatively (RR=0.74, 95% CI 0.60, 0.91; low quality). Stratifying by the timing of acupuncture, acupuncture was effective in reducing the first 4hours (RR=0.34, 95% CI 0.18, 0.64; moderate quality), and 0-24hours postoperative vomiting (RR=0.81, 95% CI 0.70, 0.93; moderate quality) when performed before and during anesthesia, respectively. Further, the RR value was more robust when acupuncture was performed before anesthesia. Acupuncture was also effective in treating 0-24hours postoperative nausea (RR=0.73, 95% CI 0.60, 0.88; moderate quality) and in reducing the utilization of remedies during the first 4hours (RR=0.64, 95% CI 0.45, 0.89; moderate quality). Acupuncture reduces the incidence of postoperative nausea and vomiting as well as the utilization of antiemetic remedies, particularly during the first 4hours following the operation. Acupuncture performed before anesthesia was demonstrated to be the most ideal intervention time for children.

A pharmacological profile of intravenous amisulpride for the treatment of postoperative nausea and vomiting

ABSTRACT Introduction The issue of postoperative nausea and vomiting (PONV) remains important in surgical practice, contributing to patient distress, slower recovery, and increased use of healthcare resources. Many surgical patients report it to be a worse problem than the pain. New antiemetics of different classes are still needed to help manage PONV effectively, especially the treatment of established PONV after the failure of common prophylactic antiemetics such as 5-HT3-antagonists and corticosteroids. Intravenous amisulpride, a drug with a long history of safe use in oral form as an antipsychotic, has recently been approved in the US (trade name: Barhemsys) as an intravenous antiemetic for the prevention and treatment of PONV. Areas covered This review article summarizes the published data on the clinical pharmacology, safety, and efficacy of intravenous amisulpride as an antiemetic, supplemented by published data on oral amisulpride, where relevant to the intravenous form. Literature was obtained via the PubMed search terms ‘intravenous amisulpride’ and ‘amisulpride AND safety.’ Both primary and secondary pharmacology are covered, along with clinical pharmacokinetics (distribution, metabolism, and excretion). The review of clinical safety and efficacy includes data from four studies in the prevention of PONV, two in the treatment of PONV and two investigating effects on the QT interval of the electrocardiogram in healthy volunteers. Expert opinion Given the importance of sufficient PONV prevention for patients and the healthcare system, the availability of intravenous amisulpride is helpful, restoring the dopamine-antagonist class as a potential mainstay in both combination prophylaxis and treatment.

An overview of intravenous amisulpride as a new therapeutic option for the prophylaxis and treatment of postoperative nausea and vomiting

ABSTRACT Introduction Current therapies of postoperative nausea and vomiting (PONV) are based on a combination of antiemetics from different pharmacological classes. Dopamine receptor antagonists are one of the cornerstones of such multimodal antiemetic approach, with droperidol being the best studied representative of this group. Droperidol’s use has significantly declined after the FDA’s black-box warning in 2001 due to its QT-prolonging properties. Amisulpride is a promising antiemetic agent which could fill this gap. Areas covered In this review, the authors discuss the pharmacological profile as well as clinical safety and efficacy of intravenous amisulpride and its relevance in the management of PONV. The article is based on a Medline, ClinicalTrials.gov, and Cochrane Library search for studies on amisulpride conducted so far. Expert opinion Promising clinical results on Barhemsys®, an intravenous formulation of amisulpride, make it a potential future drug of choice from the dopamine receptor antagonist group, replacing droperidol after its safety concerns. Amisulpride’s success on the market will mostly be determined by its cost-effectiveness and it will likely find a brighter use on the US-market, where the black-box warning led to droperidol’s withdrawal, while in many European countries, droperidol is still being used as an antiemetic.

Chapter 19 - Anesthesia for meningioma surgery

Patients receiving treatment for a meningioma require anesthesia when undergoing open craniotomy and, in some cases, during preoperative tumor embolization and radiosurgery. Adequate anesthesia management is integral to patients' perioperative care, which consists of the three phases of preoperative assessment and optimization, intraoperative care, and postoperative recovery. The preoperative anesthesia evaluation focusses on the cardiorespiratory and neurologic systems, as well as the airway, but also extends to ensure the optimal treatment of significant comorbidities before surgical intervention. The goals of intraoperative care are maintenance of brain physiology, facilitating surgery, and correcting any adverse effects of surgery and underlying pathology to preserve general patient homeostasis. This requires adequate intraoperative patient monitoring, cardiorespiratory support, management of infusion therapy, and application of knowledge about the effects of anesthetic agents on brain physiology. The anesthesiologist's responsibilities for patient care extend well into the postoperative recovery period, with a focus on pain control, prevention, and treatment of postoperative nausea and vomiting (PONV), and, in some patients, intensive care therapy.

Perioperative dexamethasone

Dexamethasone is asynthetic steroid that has been used for many years in the clinical routine due to its anti-inflammatory, anti-allergic and immunosuppressive properties. Furthermore, dexamethasone has been used for along time for prophylaxis and treatment of chemotherapy-induced nausea and vomiting. In the meantime dexamethasone has been approved as standard for the prophylaxis and treatment of postoperative nausea and vomiting (PONV). This review article outlines the indications and side effects of the perioperative administration of dexamethasone.

The impact of nausea on post-operative outcomes in bariatric surgery patients.

The evaluation and treatment of post-operative nausea in bariatric surgery patients has not been standardized. In this patient population, nausea can have a significant impact on quality outcomes. The primary objective of this study was to determine the impact of nausea on post-operative outcomes in bariatric surgery patients. A retrospective chart review was conducted of adult patients who underwent a primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (LSG) between 2014 and 2017 at a single institution. Patients with post-operative nausea were identified. Post-operative nausea was defined as patients who had nausea that was documented by multiple providers, and which interfered with their oral intake. Demographic variables were identified for patients with and without documented nausea. Univariate analyses were performed to determine the impact of post-operative nausea on patients' length of stay, readmissions, reoperations, and overall complications. There were 449 primary bariatric surgery patients in the study period, 197 (43.9%) LRYGB and 252 (56.1%) LSG. Of these patients, 160 (35.6%) had documented post-operative nausea. Demographic factors that contributed to post-operative nausea included African-American race and undergoing a LSG (p = 0.004 and p = 0.01, respectively). Patients who underwent a LSG had a 2.0 times increased risk of post-operative nausea compared to LRYGB (p = 0.01). Patients with documented nausea had a statistically significant increased length of stay (2.4 ± 1.9days vs. 1.6 ± 1.0days; p ≤ 0.01). Documented nausea patients had an increased incidence of Emergency Department visits within 30days post-operatively (p = 0.02). Post-operative nausea was more likely in patients who underwent a sleeve gastrectomy. Gastric bypass and sleeve gastrectomy patients with documented nausea had an increased length of stay and Emergency Department visits. These results highlight the need for a metric to more accurately measure post-operative nausea, as well as a standardized anti-emetic treatment pathway to improve quality outcomes.