Incidence and factors contributing to postdischarge nausea and vomiting in pediatric ambulatory surgical cases

Efune, Proshad N.; Minhajuddin, Abu; Szmuk, Peter

doi:10.1111/pan.13333

Cited by 31 publications

(32 citation statements)

References 27 publications

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“…Anesthesia-related risk factors ( Table 1 – Table 3 ) include the use of opioids, volatile agents, nitrous oxide (which increases the risk for postoperative vomiting), and high doses of neostigmine for the reversal of residual neuromuscular blockade 32 , 38 , 47 – 51 . General anesthesia is associated with a higher incidence of PONV compared with regional anesthesia 35 , 52 , 53 secondary to the greater requirement for opioid medication to control postoperative pain after general anesthesia in both adults and children 35 , 54 .…”

Section: Risk Factors For Ponv and Pdnvmentioning

confidence: 99%

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

et al. 2020

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Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.

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Section: Risk Factors For Ponv and Pdnvmentioning

confidence: 99%

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

et al. 2020

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“…However, their use is associated with a high risk of postoperative nausea and vomiting, as well as risks of urinary retention, respiratory depression, and delayed emergence from anesthesia. [16,17] Therefore, many studies have explored ketorolac, acetaminophen, and midazolam as alternatives to opioid to attenuate emergence agitation. [18] Some studies found that children premedicated with midazolam were less agitated after surgery while others reported that airway sensitivity to midazolam delayed discharge from the recovery room.…”

Section: Discussionmentioning

confidence: 99%

Effect of esmolol and lidocaine on agitation in awake phase of anesthesia among children

Park

Kim

et al. 2019

Chinese Medical Journal

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Background: Sevoflurane is widely used to anesthetize children because of its rapid action with minimal irritation of the airways. However, there is a high risk of agitation after emergence from anesthesia. Strabismus surgery, in particular, can trigger agitation because patients have their eyes covered in the postoperative period. The aim of this study was to determine whether or not esmolol and lidocaine could decrease emergence agitation in children. Methods: Eighty-four patients aged 3 to 9 years undergoing strabismus surgery were randomly assigned to a control group (saline only), a group that received intravenous lidocaine 1.5 mg/kg, and a group that received intravenous esmolol 0.5 mg/kg and lidocaine 1.5 mg/kg. Agitation was measured using the objective pain score, Cole 5-point score, and Richmond Agitation Sedation Scale score at the end of surgery, on arrival in the recovery room, and 10 and 30 min after arrival. Results: The group that received the combination of esmolol and lidocaine showed lower OPS and RASS scores than the other two groups when patients awoke from anesthesia (OPS = 0 (0–4), RASS = –4 [(–5)–1]) and were transferred to the recovery room (OPS = 0 (0–8), RASS = –1 [(–5)–3]) ( P < 0.05). There was no significant difference in the severity of agitation among the three groups at other time points ( P > 0.05). Conclusions: When pediatric strabismus surgery is accompanied by sevoflurane anesthesia, an intravenous injection of esmolol and lidocaine could alleviate agitation until arrival in the recovery room. Trial registration: Clinical Research Information Service, No. KCT0002925; https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=11532

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“…The incidence of PDNV in our study (32.9%) was higher than the 14.1% rate reported in another paediatric study. 3 This increased incidence may be explained by differences in patient selection and the criteria used for PDNV. Efune and colleagues 3 studied a cohort of patients and did not measure the severity of nausea, but recorded the parent's response to the question about nausea.…”

Section: Discussionmentioning

confidence: 99%

“…20 We planned to obtain data on 19 subjects with emesis to allow for missing data because of emergence delirium, delayed recovery, lack of cooperation from pain-related behaviours, or for other reasons. Assuming the incidence of emesis in the PACU was 10% in subjects receiving current standard perioperative care, 3…”

Section: Sample Sizementioning

confidence: 99%

Validation of the pictorial Baxter Retching Faces scale for the measurement of the severity of postoperative nausea in Spanish-speaking children

Watcha

Medellin

Lee

et al. 2018

British Journal of Anaesthesia

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Background: As the intensity of nausea, a subjective symptom, is difficult to estimate in children, vomiting is used as the objective clinical endpoint in managing paediatric postoperative nausea and vomiting. The pictorial Baxter Retching Faces (BARF) scale is a validated quantitative measure of paediatric nausea, but versions in languages other than English have not been validated. Methods: Healthy Spanish-speaking children aged 7e18 yr (n¼184) undergoing elective ambulatory surgery rated perioperative pain and nausea using visual analogue (VAS) and pictorial Faces Pain Scale-Revised and BARF scales, along with a Likert scale measurement of symptom changes. Parents kept a post-discharge diary. Results: Postoperative BARF scores were significantly higher in patients receiving anti-emetics {mean [standard deviation (SD)]: 4.6 (3.4) vs 0.9 (1.6); P<0.001}. Nausea scores obtained prior to rescue anti-emetics were higher than preoperative values [mean (SD) increase: 4.0 (3.6); P<0.001], and decreased after therapy [decrease: 2 (2.4); P¼0.03]. The Spearman correlation [95% confidence interval (CI)] between the BARF and VAS nausea scores was 0.72 (0.64e0.78), and significantly stronger than BARF and pain score correlation [0.3 (0.1e0.4)]. The minimum (SD) clinically relevant difference was 1.2 (1.7) for both BARF and VAS nausea scales. The intra-class coefficient (95% CI) of BARF scores was 0.88 (0.76e0.94). The BARF scale had excellent performance in predicting patient-perceived need for anti-emetics (area under the curveereceiver operating characteristic: 0.899; 95% CI: 0.82e0.98). Conclusions: The BARF scale has construct, convergent, discriminant, and testeretest validity in measuring nausea severity in Spanish-speaking children, and may be a useful instrument in the management of paediatric postoperative nausea and vomiting. Clinical trial registration: NCT02007109.

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Incidence and factors contributing to postdischarge nausea and vomiting in pediatric ambulatory surgical cases

Abstract: We found an incidence of postdischarge nausea and vomiting of 14%. Intraoperative and postdischarge opioids increase the risk, with long-acting intraoperative opioids further accentuating the risk.

Cited by 31 publications

References 27 publications

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

Effect of esmolol and lidocaine on agitation in awake phase of anesthesia among children

Validation of the pictorial Baxter Retching Faces scale for the measurement of the severity of postoperative nausea in Spanish-speaking children

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