Postoperative and Postdischarge Nausea and Vomiting After Ambulatory Surgery: An Update

Abstract

Patients undergoing ambulatory surgery have similar, but also different nausea and vomiting stimuli and mechanisms than inpatients. As the emphasis on ''street readiness'' and discharge home is a unique and important concern for outpatients, various medications, formulations, techniques, risk scores, and guidelines have been introduced to help improve the care of patients having ambulatory surgery. Additional research and data have been obtained regarding the effects of postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) on ambulatory anesthesia. More effective antiemetic combination techniques and new long-acting antiemetics have been introduced for PONV and PDNV prevention. Antiemetic drug selection for ambulatory surgery depends on efficacy, cost, adverse effects, and ease of dosing. Safety concerns include adverse events such as the ECG QTc prolongation effects of antiemetics. To help guide antiemetic drug selection, techniques, and therapy, the PONV consensus guidelines were updated in 2014.

Rescue Treatment of Postoperative Nausea and Vomiting: A Systematic Review of Current Clinical Evidence

“…70 Elderly patients may also have increased the risk of developing side effects such as sedation, extrapyramidal effects, hypotension, light-headedness/headache, and ECG QTc prolongation and should be carefully reviewed before administering the agent. 67,70…”

“…55,65 Another aspect to consider is the adverse effect profile of the antiemetics that could lead to prolonged PACU stay or readmission after discharge (Table 3). 66–69…”

“…55,65 Another aspect to consider is the adverse effect profile of the antiemetics that could lead to prolonged PACU stay or readmission after discharge (Table 3). [66][67][68][69] More than half of all surgical procedures are performed on patients aged over 65, 70 and the overall incidence of adverse events during surgery is considerably higher in the elderly. 71 Furthermore, the risk of adverse drug events (ADEs) increases with agerelated changes in pharmacokinetics and pharmacodynamics, comorbidities, and polypharmacy.…”

“…70 Elderly patients may also have increased the risk of developing side effects such as sedation, extrapyramidal effects, hypotension, lightheadedness/headache, and ECG QTc prolongation and should be carefully reviewed before administering the agent. 67,70 The incidence of PONV in children is estimated to be twice that in adults, and it is a cause of significant morbidity. [73][74][75] On the other hand, not all antiemetics are Food and Drug Administration (FDA)-approved for use in children.…”

Management of postdischarge nausea and vomiting

“…Peri-anesthesia period including recovery is the mostly used time for pharmacological intervention to reduce or prevent PONV [33,34]. Well established risk-weighted algorithms are available through the latest published consensus guidelines by an international panel of experts [12].…”