Treatment Of Postoperative Nausea Research Articles

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.

Inhaled Peppermint Aromatherapy for Treatment of Postoperative Nausea and Vomiting: A Compliment to Traditional Pharmacological Treatments

Inhaled Peppermint Aromatherapy for Treatment of Postoperative Nausea and Vomiting: A Compliment to Traditional Pharmacological Treatments

FORMULATION OPTIMIZATION AND EVALUATION OF MOUTH DISSOLVING FILM OF APREPITANT

Objectives: The aim of the present research is to prepare mouth dissolving film of aprepitant used in the prevention and treatment of post-operative nausea and vomiting.
 Methods: The MDF was prepared using Kollicoat IR, PEG 400, and spraying technique. Formulation was optimized by central composite design. Compatibility study was carried out using Fourier-transform infrared and differential scanning calorimetry. The films were evaluated for thickness, folding endurance, weight variation, disintegration time, dissolution studies, drug content, and in vitro diffusion test.
 Results: From the results, it was found that there was no drug excipient interaction. The prepared optimized batch AP2 showed disintegration time 18 sec, highest dissolution rate 101.53%, drug diffused 39.58 mg/cm2 within 10 min and also passes all the physicochemical parameters. It was concluded that plasticizer PEG 400 plays a very much important role in the preparation of aprepitant MDF.
 Conclusion: MDF of aprepitant was found to be a better option in the prevention and treatment of post-operative nausea and vomiting by the way of fast onset of action for patient convenience and compliance. In the near future, the MDF market will expand very fastly to treat various diseases.

Impact of intra-operative dexamethasone after scheduled cesarean delivery: a retrospective study

BackgroundDexamethasone is an effective analgesic and anti-emetic in patients undergoing many surgical procedures but its effects on pain after cesarean delivery are poorly studied. The aim of this study was to evaluate if routine intra-operative administration of dexamethasone improved analgesia and decreased postoperative nausea and vomiting after scheduled cesarean delivery. MethodsElectronic medical record data for scheduled cesarean deliveries performed under neuraxial anesthesia, before and after a practice change that introduced the routine use of intravenous dexamethasone 4 mg, were obtained. Patients were analyzed based on whether they received routine care (n=182) or also received dexamethasone (n=187). The primary outcome was time to first opioid use. Secondary outcomes included postoperative opioid consumption, pain scores, incidence and treatment of postoperative nausea and vomiting, satisfaction and length of stay. ResultsThere was no significant difference between groups in median time to first postoperative opioid administration (15.8 [3.4–48.0] h routine care vs 14.7 [3.2–38.8] h routine care plus dexamethasone, P=0.08). There were no significant differences in any secondary outcomes. ConclusionsThis impact study involving more than 360 patients suggests that routine administration of intra-operative intravenous dexamethasone 4 mg does not provide additional analgesic benefit after scheduled cesarean delivery, in the context of a multimodal postoperative analgesic regimen. Studies are required to determine if a larger dose or repeated administration influence postoperative analgesia or side effects, or whether certain subsets of patients may benefit.

成人术后恶心呕吐的防治进展

成人术后恶心呕吐的防治进展

Amisulpride for the prevention and treatment of postoperative nausea and vomiting: A quantitative systematic review (meta-analysis)

Amisulpride for the prevention and treatment of postoperative nausea and vomiting: A quantitative systematic review (meta-analysis)

Comparison of Intravenous Ramosetron and Ondansetron for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Surgeries

Background: Nausea and vomiting are distressing symptoms after laparoscopic surgeries. Number of drugs is used but none is devoid of side effects. Introduction of 5-HT3 receptors antagonists heralded the major advance in the treatment of postoperative nausea and vomiting. Hence search for ideal new 5-HT3 receptors antagonists goes on. Aim: The aim of the present study was to compare the efficacy of intravenous ramosetron and ondansetron for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgeries.  Subjects and Methods: 144 patients of ASA physical status I and II, posted for elective laparoscopic surgeries under general anaesthesia were included in this prospective randomized study. Patients were randomly allocated into two groups to receive either injection Ramosetron 0.3 mg or injection Ondansetron 4 mg intravenously. Incidence of nausea, vomiting or both, need of rescue antiemetic and complete response were recorded for 24 hrs. Data was analyzed statistically. Results: Overall incidence of PONV was observed in 15.27% patients in group R and 36.11% in group O. Rescue antiemetic was used in 5.55% patients in group R compared to 22.22% in group O. Complete response was found in 84.74% patients of group R and 63.88% of group O. Conclusion: Intravenous Ramosetron with dose of 0.3 mg appears to be a promising drug for prevention of postoperative nausea and vomiting in laparoscopic surgery under general anaesthesia.

A New Communication Tool and Process Improvement for the Recognition and Treatment of Postoperative Nausea and Vomiting in the Pediatric Patient

A pediatric surgery center’s patient satisfaction is evaluated through monthly surveys, sent quarterly in a Stoplight report. The score that assessed “Focus on helping your child with nausea or discomfort”, had decreased to 80.5%, below the average for the CHCA.

Scopolamine: a journey from the field to clinics

Tropane alkaloids are present in many different plants of the Solanaceae family and widely known for their anticholinergic properties. Among them, most valued and increasingly demanded is scopolamine, also known under the name of hyoscine, which is used as pharmaceutical active substance in the treatment of postoperative nausea and vomiting, motion sickness and gastrointestinal, renal and biliary spasms for instance. It naturally occurs in various plant genera, e.g. Anisodus, Anthocercis, Atropa, Brugmansia, Datura, Duboisia, Hyoscyamus, Mandragora and Scopolia and the purified substance has a long history of use dating back to the nineteenth century. Until today, the supply in scopolamine is mainly covered by large scale field plant cultivation of hybrids between Duboisia myoporoides and Duboisia leichhardtii. Biotechnological approaches optimising the alkaloid biosynthesis, for example the use of callus cultures or genetically transformed hairy root cultures, are not competitive by now. The aim of this review is to give a comprehensive overview regarding the current knowledge on botanical origin, pharmacology, biosynthesis as well as agricultural and biotechnological production of scopolamine.

Bradycardia Associated with Steroid Use for Laryngeal Edema in an Adult: A Case Report and Literature Review.

Steroids are used for specific indications in the perioperative period to reduce laryngeal or spinal cord edema, or for prophylaxis and treatment of postoperative nausea and vomiting. Given the other potential causes for hemodynamic alterations in the perioperative setting, it is important for physicians to be aware of cardiovascular side effects of short term steroids. Changes in blood pressure and heart rate, cardiac dysrhythmias, and even death have been described in patients receiving short term intravenous steroids. Bradycardia has been reported following short term methylprednisolone and dexamethasone therapy in both adult and pediatric patients. There are only two case reports in the literature of bradycardia following short term intravenous dexamethasone use in adult patients. This is the first case report that describes bradycardia following the use of dexamethasone in the postoperative setting for management of laryngeal edema in an adult. Telemetry and twelve lead electrocardiograms revealed sinus bradycardia and correlated directly with administration of dexamethasone in our patient. Bradycardia resolved following discontinuation of dexamethasone. We advocate for hemodynamic monitoring in patients receiving more than one dose of intravenous steroid therapy in the perioperative period, especially those with known cardiac and hepatic comorbidities and those taking medications with negative chronotropic effects.

Comparison of epidural oxycodone and epidural morphine for post-caesarean section analgesia: A randomised controlled trial.

Background and Aims:Epidural morphine after caesarean section may cause moderate to severe pruritus in women. Epidural oxycodone has been shown in non-obstetric trials to reduce pruritus when compared to morphine. We hypothesised that epidural oxycodone may reduce pruritus after caesarean section.Methods:A randomised controlled trial was conducted in pregnant women at term who underwent caesarean section with combined spinal-epidural technique initiated with intrathecal fentanyl 15 μg. Women received either epidural morphine 3 mg or epidural oxycodone 3 mg via the epidural catheter after delivery. The primary outcome was the incidence of pruritus at 24 h after caesarean section. The secondary outcomes were the pruritus scores, treatment for post-operative nausea and vomiting (PONV), pain scores and maternal satisfaction.Results:One hundred women were randomised (group oxycodone O = 50, morphine M = 50). There was no difference between Group O and M in the incidence of pruritus (n [%] 28 [56%] vs. 31 [62%], P = 0.68) and the worst pruritus scores (mean [standard deviation] 2.6 (2.8) vs. 3.3 [3.1], P = 0.23), respectively. Both groups had similar pain scores at rest (2.7 [2.3] vs. 2.0 [2.7], P = 0.16) and sitting up (5.0 [2.3] vs. 4.6 [2.4], P = 0.38) at 24 h. Pruritus scores were lower at 4–8, 8–12 and 12–24 h with oxycodone, but pain scores were higher. Both groups had a similar need for treatment of PONV and maternal satisfaction with analgesia.Conclusion:There was no difference in the incidence of pruritus at 24 h between epidural oxycodone and morphine. However, pruritus scores were lower with oxycodone between 4 and 24 h after surgery with higher pain scores in the same period.

Analysis of acupuncture prescription for treatment of postoperative nausea and vomiting based on the modern literature

Analysis of acupuncture prescription for treatment of postoperative nausea and vomiting based on the modern literature

Effect of Transdermal Scopolamine for the Prevention of Postoperative Nausea and Vomiting Associated With Robotic Gynecologic Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial

Abstract Objective: To evaluate the efficacy of transdermal scopolamine for treatment of postoperative nausea and vomiting (PONV) after robotic-assisted gynecologic surgery. Design: Prospective, randomized, double-blinded, placebo-controlled clinical trial. Method: Overall, 47 patients underwent robotic-assisted gynecologic surgery at two tertiary care hospitals, and they were randomized to receive transdermal scopolamine or placebo preoperatively. They then completed a series of questionnaires utilizing a visual analogue scale to rate their nausea and vomiting. Main outcomes were severity of nausea and vomiting till 72 hours postoperatively. Secondary outcomes were antiemetic use, time to discharge, effect on patient well-being of PONV, and patient overall well-being. Results: There was a benefit to the number of rescue antiemetics administered in the immediate postoperative period (0.30 vs. 0.70, p=0.026), but no significant reduction in incidence or severity of PONV, no overall decrease in amount of an...

Effects of Controlled Breathing, With or Without Aromatherapy, in the Treatment of Postoperative Nausea.

The purpose of this study was to compare the effectiveness of controlled breathing (CB), with and without aromatherapy (isopropyl alcohol [IPA]), in the treatment of postoperative nausea (PON) in adult females undergoing elective outpatient laparoscopic procedures. A prospective randomized two-group quasi-experimental design was used. A convenience sample was used. Patients were consented and assigned to either a control (CB) or treatment (IPA) group. Symptomatic patients rated nausea severity before and at 2 and 5minutes after receiving either CB or CB with IPA. Complete data for one episode of nausea were obtained on 82 patients (41 in each group). Results showed that although nausea severity decreased significantly over time, there was no significant difference in PON treatment effectiveness between the two groups, nor was there a difference in requests for rescue medications. Patients who experience PON should be encouraged to take slow deep breaths as an initial response to symptoms. This approach has no side effects or costs and could also aid the patient to self-manage symptoms after discharge.

Anesthesia for Middle Ear Surgeries and Cochlear Implant

ABSTRACTThe attending anesthesiologist face several challenges in safe conduction of anesthesia for middle ear and cochlear implantation surgeries. Preoperative challenges includes counseling elderly patients with impaired hearing and counseling the parents of children with congenital ear anomalies, thorough evaluation of these patient with several comorbidities. Intraoperative challenges are to provide bloodless field, head positioning, effect of nitrous oxide on middle ear, facial nerve monitoring and avoid electrical disturbances due to electrocautery during stimulation of the cochlear implant electrode assembly. Postoperative challenges includes smooth and calm recovery, prevention and treatment of postoperative nausea and vomiting (PONV) and excellent analgesia. A close understanding and cooperation between the anesthesiologist and surgeon is the key for a positive outcome.How to cite this articleMadan HK, Kosare S. Anesthesia for Middle Ear Surgeries and Cochlear Implant. Int J Otorhinolaryngol Clin 2015;7(1):1-9.

Comparison of antiemetic efficacy of palonosetron, ondansetron and granisetron in prevention of postoperative nausea and vomiting

Background: Postoperative nausea and vomiting (PONV) was termed “the big little problem” nearly a quarter century ago in an editorial .The past decade has witnessed the introduction of several significant innovations to combat PONV, but it still remains as big a problem as before because newer choices and confusions over standardization added side by side . The aim of this study is to compare the efficacy of palonosetron with that of granisetron and ondansetron in the treatment and prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Methods: This randomized prospective comparative clinical study was carried out in the NIMS Medical College & Hospital, NIMS University, Jaipur, during the period of January 2013 to December 2013 amongst female patients of ASA grade I and II (ASA = American Society of anesthesiology) , scheduled for laparoscopic cholecystectomy under general anesthesia. A total number of 90 patients were selected and randomized into three groups of 30 patients each. Group-I was given inj. palonosetron (0.25 mg), Group-II was given inj. granisetron (1 mg) and Group–III was given inj. ondansetron (8 mg). One way analysis of variance (ANOVA) and Pearson’s Chi-square test were done as the tests of significance whenever applicable to compare the mean of different groups. Results: The incidence of nausea was 10% in Palonosetron-group while it was found to be 60% in Ondansetron-group. The incidence of vomiting was 6.7% in group-I, 26.6% in group-II & 53.3% in group-III respectively. The difference was statistically significant between group I vs group II (p <0.05). 13.3% of patients in Palonosetron-group required rescue antiemetic, while in Ondansetron-group, it was 46.7%. Conclusions: To conclude, palonosetron greatly reduced the incidence of postoperative nausea and vomiting, and also the requirement of rescue antiemetic in postoperative period than granisetron and ondansetron. Patients were satisfied by using this drug. Palonosetron is more effective in comparison to granisetron and ondansetron in the prevention and treatment of postoperative nausea and vomiting after laparoscopic cholecystectomy.

Effectiveness of ondansetron as an adjunct to lidocaine intravenous regional anesthesia on tourniquet pain and postoperative pain in patients undergoing elective hand surgery: a systematic review protocol.

Review question/objective The objective of this quantitative systematic review is to determine the effects of ondansetron as an adjunct to lidocaine on the tourniquet pain and postoperative pain of American Society of Anesthesiologists class 1 or 2 adult patients undergoing elective hand surgery with intravenous regional anesthesia. Inclusion criteria Types of participants This quantitative systematic review will consider studies that included American Society of Anesthesiologists 1 or 2 patients aged 18 years or older who used ondansetron as an adjunct to lidocaine for intravenous regional anesthesia in elective hand surgery. Types of intervention(s)/phenomena of interest This quantitative systematic review will consider studies that evaluated the analgesic effectiveness of ondansetron admixed to lidocaine for intravenous regional anesthesia in patients undergoing elective hand surgery. Patients treated with the admixture of ondansetron and lidocaine for Intravenous regional anesthesia will be compared to those who were treated with lidocaine alone. Types of outcomes This quantitative systematic review will consider studies that include the following outcome measures: 1: Tourniquet pain as measured by time to onset of tourniquet pain; 2: Postoperative pain relief as measured by first analgesic requirement time. The first analgesic requirement time is defined as the time which has elapsed after tourniquet release to the first request by the patient for analgesic and is assessed via visual analogue score in two to six hour intervals up to 24 hours postoperatively.

Examining the Effectiveness of Controlled Breathing, With or Without Aromatherapy, in the Treatment of Postoperative Nausea in Female Patients Undergoing Outpatient Laparoscopic Procedures

Examining the Effectiveness of Controlled Breathing, With or Without Aromatherapy, in the Treatment of Postoperative Nausea in Female Patients Undergoing Outpatient Laparoscopic Procedures

A survey on inhalation effect of essence of peppermint on nausea and vomiting after abdominal surgery in patients who have been admitted to Besaat and Tohid hospitals in Sanandaj

Abstract Background and aim: Nausea and vomiting is among the most common complications in patients recovering from general anaesthesia , 30-70 of patients experience nausea and vomiting after surgery. Although variety of medications have been used to control this complication, it still remains as a problem. Armothpy a non pharmacologic intervention is suggested for treatment of many conditions and Pepprmint may be effectivein treatment of common digestive conditions. This aim of this study was to examine the efficacy of inhaling peppermint essence for prevention of nausea and vomiting after abdominal surgery in patients admitted in Beasssat and Tohid hospitals in Sanandaj in 2011. Method and materials: randomized clinical trial was conducted to examine the efficacy of Peppermint essence inhalation for prevention of post- surgical nausea and sample of the study consisted of 90 patients, which were randomly allocated to receive peppermint inhalation or saline normal. 2 × 2 gauze pad saturated with two drops of pure pharmacy-grade peppermint essence was used for 1 minute in intervention group. For patients in control group a 2 × 2 gauze pad saturated with 0. 9% normal saline was used. visual analog scale was used to rate Patients were followed in recovery and surgical ward for occurrence of nausea and Data were analyzed by SPSS software, version 17. Findings: There was not statistical difference between two groups in terms of confounding variables such as body mass index, length of anesthesia as well as type of anesthesia. 6. 7% of patients in peppermint group and 0% of patients in control group experienced mild Manwitney statistical test, showed no significant difference between the two groups in terms of nausea in recovery room. results indicated there was significant difference between the two groups in the 1392 ناتسمز ،83 هرامش ،23 هرود / 34 ناراکمه و یفجن هراهب severity of nausea in surgical ward. There was not a significant difference between two groups in term of numbers of Conclusion: findings of the study showed no diferrence between peppermint and saline in terms of prevetion of nausea and One reason can either be ineffective breathing patterns of patients after anesthesia or insufficient dose of peppermint which has affected the results of this study. It seems more studies with various shapes and amounts of peppermint are required in this regard. Keywords: Aromaterapy, Nausea & Vomiting, Peppermint REFERENCES Anderson L , Gross B (2004); Aromathrapy with peppermint isopropelalchol ,or placebo is equally effective in reliving post operative nausea. Journal of peri Anesthesia Nursing . 19(1) 35-29. Chadhary S et al (2008); Preoperation intravenous fluid therapy with crystalloid or colloid on post operativenauseav Incidence of post operative nausea and vomiting in patients at a university hospital. Biomed Pap med Fac Unit PalackyOlomuc Czech Repub . 157(1) 69-79. Ferruggiari L et al (2012); The effect of aromatherapy on post operative nausea in women undergoing surgical procedures. Journal of Perianesthesia Nursing . 27(4(246-251. Gan T G et al (2003); Consenus guid lines for managing post operative nausea and vomiting. International Anesthesia Research Society . 97(16) 2-71. Gan T G et al (2007); Societyfor ambulatory anesthesia guid lines for the management of post operative nausea and vomiting. Anesthesia & Analagesia . 105(1)16-25. Hunt R et al (2012); Aromatrapy as treatment for post operative randomized tril. International Anesthisia Analagesia Research Socity . 1(1)1-8. Pellegrin J et al (2009); Comparison of inhalation of isopropyl alcholvsprometazin in the treatment of post operative nausea and vomiting(ponv) in patients identified as at high risk for developing ponv. AANA Journal . 77(4) 293-299. Salehisormaghi MH (2008); Herb and Herbal Therapy . Second ed. Tehran: Doniaetaghzie. Smeltzer S Bare B (2011); Textbook of Medical- Surgical Nursing, Operating Room . Translated by Khachian 1392 ناتسمز ،83 هرامش ،23 هرود / 32 ناراکمه و یفجن هراهب A. Tehran Jameae Negar. (Persian). Shaha PP , Kundnani PKM (2004); A review of medicinal uses and pharmacological effects of menthe pipprita. Natural Product Radiance . 3(4) 214-224. Tate S (1997); Peper mint oilatreatment for postoperative nausea. Journal of Advanced Nursing . 26(1) 584-590.

A prospective, randomized, double-blind, multicenter trial to evaluate the therapeutic efficacy and safety of palonosetron in the treatment of postoperative nausea and vomiting over a 72-h period.

We performed a multicenter, randomized, double-blind trial to assess the efficacy and safety of a single, fixed, intravenous dose of palonosetron (0.075 mg) in the treatment of established postoperative nausea and vomiting (PONV). Three hundred and eighty-four patients who had at least one risk factors of PONV and underwent surgery under general anesthesia were screened. Those who developed PONV were randomized to receive either 0.075 mg intravenous palonosetron or a placebo. The incidence of nausea and vomiting, severity of nausea, requirements for rescue anti-emetics, and adverse effects at 2, 24, and 72 h after drug administration were evaluated. Complete response (CR) and complete control (CC) rate were compared for 24 and 72 h. Among the 384 patients, 152 (39.6 %) developed PONV and were randomized to either the palonosetron (n = 75) or placebo (n = 77) group. The number of patients with CR at 24 and 72 h was higher in the palonosetron group than the placebo group [0-24 h: n = 49 (68.1 %) vs. n = 30 (40.5 %), p < 0.001; 0-72 h: n = 47 (65.3 %) vs. n = 28 (37.8 %), p < 0.001]. The incidence of PONV at 2, 24, and 72 h periods was lower in the palonosetron group than the placebo group (29.2, 45.8, and 50.0 % in the palonosetron group vs. 50.0, 62.2, and 66.2 % in the placebo group, p = 0.010, 0.048, 0.047, respectively). The incidence of adverse events was not different between the groups. A single 0.075 mg IV dose of palonosetron effectively increased the CR rates at 24 and 72 h in these moderate-risk patients with established PONV.