Eine faktorielle Studie von 6 Interventionen zur Vermeidung von �belkeit und Erbrechen nach Narkosen

Apfel, Christian C.; Bacher, Andreas; Biedler, A.; Danner, K.; Danzeisen, O.; Eberhart, Leopold; Forst, H.; Fritz, Georg; Hergert, M; Frings, G.; Göebel, Andreas; Hopf, Hans‐Bernd; Kerger, Heinz; Kranke, Peter; Lange, Martina; Mertzlufft, F.; Motsch, J.; Paura, A.; Roewer, Norbert; Schneider, Erich; Stoecklein, Katrin; Wermelt, Julius Z.; Zernak, Carmen

doi:10.1007/s00101-005-0803-8

Cited by 43 publications

(10 citation statements)

References 37 publications

(18 reference statements)

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“…However, there is some controversy concerning the effect of remifentanil on PONV. Several previous studies [ 12 , 13 ] reported that remifentanil use increased the incidence of PONV, while other studies (remifentanil vs other opioids [ 21 ] and sevoflurane with remifentanil vs sevoflurane) [ 22 ] reported that remifentanil did not increase incidence of PONV. Since remifentanil can lead to acute tolerance and hyperalgesia, [ 15 , 23 , 24 ] remifentanil use during thyroidectomy may increase postoperative pain in the immediate period after surgery, and in consequence result in higher postoperative rescue analgesic requirements after infusion of remifentanil has stopped.…”

Section: Discussionmentioning

confidence: 99%

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Effects of remifentanil versus nitrous oxide on postoperative nausea, vomiting, and pain in patients receiving thyroidectomy

Kim

Yi²,

Kang³

et al. 2016

Medicine

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Remifentanil and nitrous oxide (N2O) are 2 commonly used anesthetic agents. Both these agents are known risk factors for postoperative nausea and vomiting (PONV). However, remifentanil and N2O have not been directly compared in a published study. Remifentanil can induce acute tolerance or hyperalgesia, thus affecting postoperative pain. The objective of this retrospective study is to compare the effects of remifentanil and N2O on PONV and pain in patients receiving intravenous patient-controlled analgesia (IV-PCA) after thyroidectomy.We analyzed the electronic medical records of 992 patients receiving fentanyl-based IV-PCA after thyroidectomy at Chung-Ang University Hospital from January 1, 2010 to April 30, 2016. We categorized the patients according to anesthetic agents used: group N2O (n = 745) and group remifentanil (n = 247). The propensity score matching method was used to match patients in the 2 groups based on their covariates. Finally, 128 matched subjects were selected from each group.There were no differences between groups for all covariates after propensity score matching. The numeric rating scale for nausea (0.55 ± 0.88 vs 0.27 ± 0.76, P = 0.01) was higher and complete response (88 [68.8%] vs 106 [82.8%], P = 0.001) was lower in group N2O compared with group remifentanil on postoperative day 0. However, the visual analog scale score for pain (3.47 ± 2.02 vs 3.97 ± 1.48, P = 0.025) was higher in group remifentanil than group N2O on postoperative day 0.In patients receiving IV-PCA after thyroidectomy, postoperative nausea was lower but postoperative pain was higher in group remifentanil.

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Section: Discussionmentioning

confidence: 99%

“…[ 12 ] However, remifentanil is known to significantly increase the risk of PONV, although reports concerning the effects of this agent are inconsistent. [ 13 , 14 ] In addition, continuous infusion of remifentanil may induce acute opioid tolerance or hyperalgesia. [ 15 ]…”

Section: Introductionmentioning

confidence: 99%

Effects of remifentanil versus nitrous oxide on postoperative nausea, vomiting, and pain in patients receiving thyroidectomy

Kim

Yi²,

Kang³

et al. 2016

Medicine

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“…So konnte gezeigt werden, dass neben anderen Pharmaka auch spezifische Antagonisten am serotoninergen HT-3-Rezeptor [11,24] einsetzbar sind. HT-3-Antagonisten sind jedoch kostenintensive Substanzen, sodass ein genereller Einsatz dieser Pharmaka zur alleinigen Prophylaxe von postoperativer Übelkeit und Erbrechen ("postoperative nausea and vomiting", PONV) aus Kostengründen derzeit nicht empfohlen wird [2].…”

Section: Trends Und Medizinökonomieunclassified

“…Weitere Kosten-Effektivitäts-Analysen aus dem anästhesiologischen Versorgungsbereich betreffen Schemata zur Behandlung und Prophylaxe von PONV [2] und perioperativer Hypothermie. So hat die Erhaltung der perioperativen Normothermie bei Laparotomien eine kostenrelevante Verkürzung der Verweildauer im Aufwachraum zur Folge [10,20].…”

Section: Tab 2 Demographische Datenunclassified

Dolasetron und „shivering“

et al. 2007

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“…There is debate surrounding the use of multimodal prophylactic therapy based on risk factors [7–10]. Multiple studies have been done on multimodal prophylactic antiemetic therapy; particularly regimens containing phenothiazines [11–13] and 5-hydroxytryptamine type 3 (receptor) antagonists (5HT3) [14–17]. While Apfel et al [18] submit that prophylactic antiemetic interventions (specifically: droperidol, ondansetron and dexamethasone in doses used in their study) have roughly similar effects in reducing the incidence of PONV, comparisons between phenothiazines and 5HT3 antagonists are few and equivocal.…”

Section: Introductionmentioning

confidence: 99%

Phenothiazine vs 5HT3 Antagonist Prophylactic Regimens to Prevent Post‐Anesthesia Care Unit Rescue Antiemetic: An Observational Study

Ruíz

Ensor

Lim

et al. 2015

OJAnes

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Purpose Our practitioners are asked to consider a patient’s postoperative nausea and vomiting (PONV) risk profile when developing their prophylactic antiemetic strategy. There is wide variation in employed strategies, and we have yet to determine the most effective PONV prophylactic regimen. The objective of this study is to compare prophylactic antiemetic regimens containing: phenothiazines to 5HT3 antagonists for effectiveness at reducing the incidence of Post-Anesthesia Care Unit (PACU) rescue antiemetic administration. Methods This is an observational study of 4,392 nonsmoking women who underwent general anesthesia for breast surgery from 1/1/2009 through 6/30/2012. Previous history of PONV or motion sickness (HxPONV/MS) and the use of PACU opioids were recorded. Prophylactic antiemetic therapy was left to the discretion of the anesthesia care team. We compared phenothiazines and 5HT3 antagonists alone and with a glucocorticoid to determine the most effective treatment regimen in our practice for the prevention of the administration of PACU rescue antiemetics. Results Patients who received a phenothiazine regimen compared to a 5HT3 antagonist regimen were less likely to have an antiemetic administered in the PACU (p=0.0100) and this significant difference in rates holds in a logistic regression model adjusted for HxPONV/MS and PACU Opioid use (p=0.0103). Conclusions Based on our findings our clinicians are encouraged to administer a combination of a phenothiazine and a glucocorticoid in female, nonsmoking surgical breast patients for the prevention of PACU rescue antiemetic administration.

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Eine faktorielle Studie von 6 Interventionen zur Vermeidung von �belkeit und Erbrechen nach Narkosen

Cited by 43 publications

References 37 publications

Effects of remifentanil versus nitrous oxide on postoperative nausea, vomiting, and pain in patients receiving thyroidectomy

Effects of remifentanil versus nitrous oxide on postoperative nausea, vomiting, and pain in patients receiving thyroidectomy

Dolasetron und „shivering“

Phenothiazine vs 5HT3 Antagonist Prophylactic Regimens to Prevent Post‐Anesthesia Care Unit Rescue Antiemetic: An Observational Study

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