Postoperative Nausea and Vomiting in Regional Anesthesia

Borgeat, Alain; Ekatodramis, Georgios; Schenker, Carlo A.

doi:10.1097/00000542-200302000-00036

Cited by 217 publications

(157 citation statements)

References 266 publications

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“…While regional anesthesia procedures are ever-increasing in popularity, 22 there remain a limited number of evaluation tools available to formally assess competency with regional techniques. Training programs are becoming more accountable to regulatory bodies in evaluating physicians in training against accepted standards which continue to be developed and validated.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Imperial College Surgical Assessment Device (ICSAD) for labour epidural placement

Hayter

Friedman

Bould

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Technical proficiency in anesthesia has historically been determined subjectively. The purpose of this study was to establish the construct validity for the Imperial College Surgical Assessment Device (ICSAD), a measure of hand motion efficiency, as an objective assessment tool for technical skill performance, by examining its ability to distinguish between operators of different levels of experience performing a labour epidural. Concurrent validity for the ICSAD was investigated by comparison to a validated task specific checklist (CL) and global rating scale (GRS). Methods A single blinded, prospective, controlled study design compared three groups of subjects: novice residents (\30 epidurals), experienced residents ([100 epidurals), and staff anesthesiologists ([500 epidurals). Performance was measured using the ICSAD (number of movements, path length, time) and scores from a CL and GRS graded by examiners blinded to the level of training. Data were analyzed by multivariate analysis of variance (MANOVA). Results Twenty-nine subjects were recruited. Novice residents had longer path lengths compared to experienced residents (P = 0.031) and staff anesthesiologists (P = 0.0004), made more movements (P = 0.012) and took more time than staff (P = 0.009). Novice residents scored significantly worse on the GRS compared to experienced residents (P = 0.029) and staff (P = 0.01) and had significantly lower CL scores compared to staff (P = 0.003). Conclusions Construct and concurrent validity for the ICSAD was established for a regional anesthesia technique by demonstrating that it can distinguish between operators of different levels of experience and by comparing it to the current standards of technical skill assessment. RésuméObjectif La compe´tence technique en anesthe´sie est traditionnellement e´value´e de façon subjective. L'objectif de cette e´tude e´tait d'e´tablir la validite´de la me´thode soustendant le dispositif d'e´valuation chirurgicale de l'Imperial College (ICSAD -Imperial College Surgical Assessment Device), une mesure de l'efficacite´des mouvements de la main, en tant qu'outil d'e´valuation objectif de la performance des compe´tences techniques. Pour ce faire, nous avons examine´la capacite´du dispositif a`faire la distinction entre les ope´rateurs de diffe´rents niveaux d'expe´rience re´alisant une pe´ridurale pour le travail Résultats Vingt-neuf sujets ont e´te´recrute´s. Les re´sidents novices avaient des parcours plus longs comparativement aux re´sidents expe´rimente´s (P = 0,031) et aux anesthe´si-ologistes traitants (P = 0,0004), faisaient plus de mouvements (P = 0,012) et ont pris plus de temps que les anesthe´siologistes traitants (P = 0,009). Les re´sidents novices ont eu des scores conside´rablement moins bons sur l'e´chelle GRS comparativement aux re´sidents expe´rimente´s (P = 0,029) et aux anesthe´siologistes traitants (P = 0,01) et des scores sur la LC conside´rablement plus bas par rapport aux anesthe´siologistes traitants (P = 0,003). Conclusion La validite´de la me´tho...

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Section: Discussionmentioning

confidence: 99%

Validation of the Imperial College Surgical Assessment Device (ICSAD) for labour epidural placement

Hayter

Friedman

Bould

et al. 2009

Can J Anesth/J Can Anesth

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“…This is very frequent in gynaecological surgery leading to recommendation of routine prophylactic administration of antiemetics. 7,22 In the present prospective, randomized, open-labelled study, the efficacy and safety of granisetron was compared with that of ondansetron for the prevention of IONV and PONV in patients undergoing abdominal hysterectomy under S.A. Granisetron 2 mg dose was selected as our study dose because it has been shown to be as effective as higher doses in preventing and treating PONV and is not associated with any significant side effects. The same dose was used in studies conducted by Bhattacharya et al Chidambaram et al 17,23 The dose of ondansetron 4 mg was selected, as it is the standard dose routinely used for prevention of PONV and the same dose was used in the previous studies.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of granisetron as an antiemetic in patients undergoing abdominal hysterectomy under spinal anaesthesia

2017

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Background: PONV most common complications related to surgery and anaesthesia despite major advances in spinal, epidural and combined spinal-epidural anesthesia techniques IONV are still present in a significant number of patients. Ondansetron, used for controlling PONV induced by chemotherapy or radiation. Recently 5HT3 receptor antagonist granisetron has more potent, selective and longer acting activity than ondansetron. Granisetron is more active for control of PONV in cisplatin induced vomiting than ondansetron. It also reduces PONV in strabismus repair, tonsillectomy, and general surgeries, it has less side effects as compared to ondansetron. Objective of the study was to study efficacy and safety of granisetron and compare it with ondansetron for prevention of IONV and PONV.Methods: 80 ASA grade I and II women undergoing abdominal hysterectomy under spinal anaesthesia were studied. Patients in group A received injection granisetron 2 mg and group B injection ondansetron 4 mg,10 minutes prior to induction of spinal anaesthesia. Main outcome measures were occurrence of nausea, retching or vomiting in intraoperative and postoperative period at 6, 12, 18 and 24 hours’ post-surgery. The response of patient to therapy and side effects were evaluated in both groups. The results were analyzed by ‘z’ test (p<0.5) considered significant.Results: Demographic characteristics of both groups were comparable patients in granisetron (80%) had more complete response as compared to ondansetron (47.5%). Adverse effects were lower in granisetron group.Conclusions: Granisetron 2 Mg has better efficacy and safety profile than ondansetron 4 Mg.

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“…However, most studies focus only on the effects on the fetus and not on possible advantages for the parturient, which could justify the routine use of oxygen. Women undergoing cesarean section have an increased risk of PONV than non-pregnant patients undergoing other types of surgeries 25,26 . This risk can be related to the physiological changes of pregnancy, but also with other factors such as uterine handling, aortocaval compression leading to Induction-fetal extraction time (min) 36 ± 10 37 ± 11 33 ± 8 37 ± 12 36 ± 12 37 ± 11…”

Section: Discussionmentioning

confidence: 99%

“…26 , including our hospital. The first study designed to test the efficacy of supplemental oxygen in reducing the incidence of PONV in neuro axis block for cesarean section did not observe any benefits of administering 70% oxygen after fetal extraction when compared with 21%, both on the incidence and in the severity of postoperative nausea and vomiting 25 . The present study was designed before the publication of that study and it has some differences in the study population: we used subarachnoid block instead of comparing subarachnoid and epidural blocks; lower dose of opioids (60 μg of morphine vs. 10 μg of fentanyl + 150 μg of morphine); unlike to other study, our patients did not receive any antiemetic prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Oxigênio suplementar e incidência de náuseas e vômitos perioperatórios no parto cesariano sob anestesia subaracnoidea

Pécora¹,

Malbouisson²,

Torres³

2009

Rev. Bras. Anestesiol.

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Rev Bras AnestesiolARTIGO CIENTÍFICO 2009; 59: 5: 558-569 SCIENTIFIC ARTICLE RESUMO Pécora FST, Malbouisson LMS, Torres MLA -Oxigênio Suplementar e Incidência de Náuseas e Vômitos Perioperatórios no Parto Cesariano sob Anestesia Subaracnoidea. JUSTIFICATIVA E OBJETIVOS:Oxigênio suplementar pode reduzir a incidência de náuseas e vômitos pós-operatórios em pacientes submetidos à anestesia geral. O objetivo deste estudo foi testar a eficácia do oxigênio suplementar durante a cesariana eletiva sob anestesia subaracnoidea em diminuir a incidência de náuseas e vômitos perioperatórios. MÉTODO:Após indução de anestesia subaracnoidea padronizada, noventa e quatro parturientes submetidas ao parto operatório foram distribuídas de forma aleatória para receberem, através de cateter nasal tipo óculos, 4 L.min -1 de oxigênio (Grupo O) ou ar comprimido (Grupo S) até o final do procedimento. As pacientes foram inquiridas acerca da ocorrência de náuseas e vômitos durante a operação e nas primeiras seis e 24 horas de pós-parto. RESULTADOS:Os dois grupos mostraram-se comparáveis quanto às variáveis demográficas, perioperatórias e quanto aos dados do recém-nascido. No Grupo O, a incidência de náusea durante a operação nas primeiras 6 horas de pós-operatório e entre 6 e 24 horas de pós-operatório foi de 35%, 20% e 13%, respectivamente, enquanto no Grupo S foi de 35%, 30% e 19%, respectivamente. A incidência de vômito no Grupo O foi de 9%, 11% e 6% nos perío-dos correspondentes e no Grupo S 21%, 7% e 7%, respectivamente. Essas diferenças não foram significativas.CONCLUSÕES: Na população estudada, a oxigenoterapia suplementar desde a indução da anestesia até o término da operação não reduziu a incidência de náuseas ou vômitos intraoperatórios e pós-operatórios em mulheres submetidas ao parto cesariano sob anestesia subaracnoidea.Unitermos: CIRURGIA, Obstétrica: cesariana; COMPLICAÇÕES: náusea e vômito; TÉCNICAS ANESTÉSICAS, Regional: subaracnoidea. SUMMARY BACKGROUND AND OBJECTIVES:Supplemental oxygen can reduce the incidence of postoperative nausea and vomiting in patients under general anesthesia. The objective of the present study was to determine the efficacy of supplemental oxygen to reduce the incidence of perioperative nausea and vomiting in elective cesareans under subarachnoid block. METHODS:After induction of standardized subarachnoid block, 94 parturients undergoing surgical delivery were randomly divided to receive 4 L.min -1 of oxygen (Group O) or medical air (Group S) under nasal cannula throughout the procedure. Patients were questioned on the development of nausea and vomiting during the surgery and in the first six and 24 hours after the procedure. RESULTS:Demographic and perioperative parameters, as well as the data on the newborn, were comparable in both groups. In Group O, the incidence of nausea during the surgery, in the first 6 hours afterwards, and between 6 and 24 hours was 35%, 30%, and 19%, respectively, while in Group S, it was 35%, 30%, and 19%, respectively. In Group O, the incidence of vomiting was 9%...

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Postoperative Nausea and Vomiting in Regional Anesthesia

Cited by 217 publications

References 266 publications

Validation of the Imperial College Surgical Assessment Device (ICSAD) for labour epidural placement

Validation of the Imperial College Surgical Assessment Device (ICSAD) for labour epidural placement

Evaluation of granisetron as an antiemetic in patients undergoing abdominal hysterectomy under spinal anaesthesia

Oxigênio suplementar e incidência de náuseas e vômitos perioperatórios no parto cesariano sob anestesia subaracnoidea

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