Drugs in anesthesia: preventing postoperative nausea and vomiting

Schlesinger, Tobias; Weibel, Stephanie; Meybohm, Patrick; Kranke, Peter

doi:10.1097/aco.0000000000001010

Cited by 10 publications

(5 citation statements)

References 31 publications

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“…Some studies reported that dexamethasone and 5-HT3 receptor antagonists can reduce the risk of PONV. [50][51][52] However, this finding was not significant in the present study. This may be attributed to the small dose of dexamethasone used in our study (3-10 mg).…”

Section: Discussioncontrasting

confidence: 89%

A web‐based dynamic predictive model for postoperative nausea and vomiting in patient receiving gynecological laparoscopic surgery

Liu,

Fang,

Cheng

et al. 2024

J of Obstet and Gynaecol

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ObjectiveThe aim of this study was to develop a web‐based dynamic prediction model for postoperative nausea and vomiting (PONV) in patients undergoing gynecologic laparoscopic surgery.MethodsThe patients (N = 647) undergoing gynecologic laparoscopic surgery were included in this observational study. The candidate risk‐factors related to PONV were included through literature search. Lasso regression was utilized to screen candidate risk‐factors, and the variables with statistical significance were selected in multivariable logistic model building. The web‐based dynamic Nomogram was used for model exhibition. Accuracy and validity of the experimental model (EM) were evaluated by generating receiver operating characteristic (ROC) curves and calibration curves. Hosmer–Lemeshow test was used to evaluate the goodness of fit of the model. Decision curve analysis (DCA) was used to evaluate the clinical practicability of the risk prediction model.ResultsUltimately, a total of five predictors including patient‐controlled analgesia (odds ratio [OR], 4.78; 95% confidence interval [CI], 1.98–12.44), motion sickness (OR, 4.80; 95% CI, 2.71–8.65), variation of blood pressure (OR, 4.30; 95% CI, 2.41–7.91), pregnancy vomiting history (OR, 2.21; 95% CI, 1.44–3.43), and pain response (OR, 1.64; 95% CI, 1.48–1.83) were selected in model building. Assessment of the model indicates the discriminating power of EM was adequate (ROC‐areas under the curve, 93.0%; 95% CI, 90.7%–95.3%). EM showed better accuracy and goodness of fit based on the results of the calibration curve. The DCA curve of EM showed favorable clinical benefits.ConclusionsThis dynamic prediction model can determine the PONV risk in patients undergoing gynecologic laparoscopic surgery.

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Section: Discussioncontrasting

confidence: 89%

A web‐based dynamic predictive model for postoperative nausea and vomiting in patient receiving gynecological laparoscopic surgery

Liu,

Fang,

Cheng

et al. 2024

J of Obstet and Gynaecol

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“…There are several classes of antiemetic drugs including serotonin (5HT3) antagonists, dopamine (D2) antagonists, NK 1-antagonists, antihistamines, and corticosteroids. There is minimal harm to using most of these drugs apart from the increased risk of sedation or increasing the QTc interval [ 107 ]. Many patients in this group will be receiving steroids as part of the surviving sepsis guidelines [ 108 ] which also have antiemetic properties.…”

Section: Resultsmentioning

confidence: 99%

Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS^®) Society Recommendations Part 2—Emergency Laparotomy: Intra‐ and Postoperative Care

et al. 2023

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Background This is Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL) using an Enhanced Recovery After Surgery (ERAS) approach. This paper addresses intra‐ and postoperative aspects of care. Methods Experts in aspects of management of high‐risk and emergency general surgical patients were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and Medline database searches were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized clinical trials, systematic reviews, meta‐analyses, and large cohort studies and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations. Some ERAS® components covered in other guideline papers are outlined only briefly, with the bulk of the text focusing on key areas pertaining specifically to EL. Results Twenty‐three components of intraoperative and postoperative care were defined. Consensus was reached after three rounds of a modified Delphi Process. Conclusions These guidelines are based on best available evidence for an ERAS® approach to patients undergoing EL. These guidelines are not exhaustive but pull together evidence on important components of care for this high‐risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.

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“…Preoperative supplementation with carbohydrates and/or electrolytes has been shown to reduce PONV and acute phase response in pediatric patients undergoing general surgical or endoscopic procedures; this is currently being investigated in the AIS population 52-54 . A wide range of antiemetics can be used for PONV with some of them being used in PSF surgery as part of enhanced recovery pathways, but their effects have not been evaluated in isolation in this population 16,43,55 . Use of antiemetics, PONV prophylactic measures, and preoperative status needs further evaluation in PSF surgery.…”

Section: Discussionmentioning

confidence: 99%

Nausea and Vomiting After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis

Syed,

Baghdadi,

Muhly

et al. 2024

JBJS Reviews

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Background: Postoperative nausea and vomiting (PONV) affects patient satisfaction, health care costs, and hospital stay by complicating the postoperative recovery period after adolescent idiopathic scoliosis (AIS) spinal fusion surgery. Our goal was to identify recommendations for optimal management of PONV in AIS patients undergoing posterior spinal fusion (PSF). Methods: We performed a systematic review in June 2022, searching the PubMed and Embase electronic databases using search terms “(Adolescent idiopathic scoliosis) AND (Postoperative) AND (Nausea) AND (Vomiting).” Three authors reviewed the 402 abstracts identified from January 1991 to June 2022. Studies that included adolescents or young adults (<21 years) with AIS undergoing PSF were selected for full-text review by consensus. We identified 34 studies reporting on incidence of PONV. Only 6 studies examined PONV as the primary outcome, whereas remaining were reported PONV as a secondary outcome. Journal of Bone and Joint Surgery Grades of recommendation were assigned to potential interventions or clinical practice influencing incidence of PONV with respect to operative period (preoperative, intraoperative, and postoperative period) on the basis that potential guidelines/interventions for PONV can be targeted at those periods. Results: A total of 11 factors were graded, 5 of which were related to intervention and 6 were clinical practice-related. Eight factors could be classified into the operative period—1 in the intraoperative period and 7 in the postoperative period, whereas the remaining 3 recommendations had overlapping periods. The majority of grades of recommendations given were inconclusive or conflicting. The statement that neuraxial and postoperative systemic-only opioid therapy have a similar incidence of PONV was supported by good (Grade A) evidence. There was fair (Grade B) and poor evidence (Grade C) to avoid opioid antagonists and nonopioid local analgesia using wound catheters as PONV-reducing measures. Conclusion: Although outcomes after spinal fusion for AIS have been studied extensively, the literature on PONV outcomes is scarce and incomplete. PONV is most commonly included as a secondary outcome in studies related to pain management. This study is the first to specifically identify evidence and recommendations for interventions or clinical practice that influence PONV in AIS patients undergoing PSF. Most interventions and clinical practices have conflicting or limited data to support them, whereas others have low-level evidence as to whether the intervention/clinical practice influences the incidence of PONV. We have identified the need for expanded research using PONV as a primary outcome in patients with AIS undergoing spinal fusion surgery.

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Drugs in anesthesia: preventing postoperative nausea and vomiting

Cited by 10 publications

References 31 publications

A web‐based dynamic predictive model for postoperative nausea and vomiting in patient receiving gynecological laparoscopic surgery

A web‐based dynamic predictive model for postoperative nausea and vomiting in patient receiving gynecological laparoscopic surgery

Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS^®) Society Recommendations Part 2—Emergency Laparotomy: Intra‐ and Postoperative Care

Nausea and Vomiting After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis

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Drugs in anesthesia: preventing postoperative nausea and vomiting

Cited by 10 publications

References 31 publications

A web‐based dynamic predictive model for postoperative nausea and vomiting in patient receiving gynecological laparoscopic surgery

A web‐based dynamic predictive model for postoperative nausea and vomiting in patient receiving gynecological laparoscopic surgery

Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2—Emergency Laparotomy: Intra‐ and Postoperative Care

Nausea and Vomiting After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis

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Product

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Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS^®) Society Recommendations Part 2—Emergency Laparotomy: Intra‐ and Postoperative Care