Prophylaxis of Postoperative Nausea and Vomiting in Morbidly Obese Patients Undergoing Laparoscopic Gastroplasties. A Comparative Study among Three Methods

Mendes, Melissa Nespeca; Monteiro, Rosana de Souza; Martins, Fernanda P.

doi:10.1016/s0034-7094(09)70081-9

Cited by 24 publications

(10 citation statements)

References 9 publications

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“…The current study compared the frequency of postoperative nausea in morbidly obese and normal weight to mildly obese patients in 138 cases and observed significant differences concerning the study population. The frequency of PONV in the OG we observed in the current study was comparable to other investigations [11, 12]. In addition, the occurrence of PONV was more frequent in female subjects and, thus, corresponds to the results reported by Apfel et al [1, 13].…”

Section: Discussionsupporting

confidence: 92%

“…However, in the field of bariatric surgery, up to now, there is only a small number of studies focusing on PONV rates and their cause. Mendes et al and Moussaa et al reported on PONV-incidences up to 79% in bariatric patients [11, 12]. In a study published by Bataille et al , who examined PONV rates when using total intravenous anaesthesia with BIS monitoring, PONV frequency was up to 54% [17].…”

Section: Discussionmentioning

confidence: 99%

“…Concerning therapy of PONV, previous studies on severely overweight patients showed that combinations of antiemetic drugs are more efficient to successfully treat nausea and vomiting; in some studies, even a combination of two drugs seemed not to be satisfactory [11, 12, 15, 17, 19]. This was also valid if propofol instead of volatile anesthetics was used to maintain anesthesia [17].…”

Section: Discussionmentioning

confidence: 99%

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Postoperative nausea and vomiting in bariatric surgery in comparison to non-bariatric gastric surgery.

Groene¹,

Eisenlohr²,

Zeuzem³

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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IntroductionPostoperative nausea and vomiting (PONV) are complications of general anesthesia. Patient-specific factors, type of surgery and a variety of drugs determine the frequency. Clinical experience shows nausea and vomiting to be very frequent in morbidly obese patients undergoing bariatric surgery.AimTo detect the onset and extent of nausea and vomiting in the group of morbidly obese patients undergoing laparoscopic bariatric surgery.Material and methodsWe conducted a retrospective data bank analysis (since 2004) of all patients with body mass index > 35 kg/m2 undergoing laparoscopic bariatric surgery in comparison to patients with a body mass index < 35 kg/m2 undergoing gastric surgery. Propensity score matching was applied to minimize bias effects. The frequency of postoperative nausea was defined as the primary outcome parameter.ResultsOne hundred and thirty-eight patients were included. There was a significant difference between the morbidly obese group and the control group concerning the frequency of postoperative nausea (15.9% vs. 55.1%; p < 0.001). In patients receiving volatile anesthetics a significant difference between groups concerning frequency of PONV was not observed. Intravenous anesthetics were suitable to reduce PONV in the control group but not in the morbidly obese group (12.5% vs. 56.8%, p < 0.001). With given prophylaxis PONV events still occurred in 15.6% vs. 48.8% (p = 0.003).ConclusionsMorbidly obese patients undergoing laparoscopic bariatric surgery are at higher risk of suffering from PONV than non-morbidly obese patients. To reduce the PONV incidence in morbidly obese patients, further research, especially focusing on more efficient use of antiemetic drugs, seems to be necessary.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Postoperative nausea and vomiting in bariatric surgery in comparison to non-bariatric gastric surgery.

Groene¹,

Eisenlohr²,

Zeuzem³

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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“…Nausea and vomiting were n Number of patients present in 33 (41.3%) and 28 (35%) patients, consecutively. Although nausea and vomiting had been reported as ones of the presenting symptoms in leak patients after LSG [13], they are also common in up to 79% of patients in the early postoperative period [14,15].…”

Section: Discussionmentioning

confidence: 99%

Challenges in the Diagnosis of Leak After Sleeve Gastrectomy: Clinical Presentation, Laboratory, and Radiological Findings

Zoubi¹,

Khidir²,

Bashah³

2020

OBES SURG

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Background The presentation of leak after laparoscopic sleeve gastrectomy (LSG) is variable. A missed or delayed diagnosis can lead to severe consequences. This study presents our experience: the clinical presentations, laboratory, and radiological findings in patients with leak after LSG. Methods A retrospective review of patients who were diagnosed and treated as leak after LSG at our center (January 2012–November 2019). Results Eighty patients developed leak: 68 (85%) after primary LSG, 6 (7.5%) after Re-LSG and 6 (7.5%) after band removal to revisional LSG. Mean age 35.9 ± 10 years. The diagnosis was within 18 ± 14 days after surgery. Five (6.3%) patients were diagnosed during the same admission. Only 29.3% of patients were diagnosed correctly from the first visit to the ER. Most were misdiagnosed as gastritis (49%) and pneumonia (22.6%). Thirty-four patients (45.3%) were diagnosed correctly at the third visit. The most common presenting symptoms were abdominal pain (90%), tachycardia (71.3%), and fever (61.3%). The mean white blood cells (WBCs) count was 14700 ± 5900 (cells/mm3), c-reactive protein (CRP) 270 ± 133 mg/L, lactic acid 1.6 ± 0.85 mmol/L, and albumin 30.3 ± 6.6 g/L. The abdominal CT scans revealed intraabdominal collection in 93.7% of patients, extravasation of contrast in 75%, and pleural effusion in 52.5%. Upper gastrointestinal contrast study (UGIC) showed extravasation of contrast in 77.5% of patients. Conclusion Abdominal pain, tachycardia, or fever after LSG should raise the suspicion of a leak. CT scan of the abdomen and UGIC study detected leaks in 75% and 77.5% consecutively. Only 29.3% of patients were diagnosed correctly as a leak from the first visit to the ER.

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“…Тошнота и рвота в послеоперационном периоде при бариатрических вмешательствах встречаются у 70-80% пациентов, если пациенты не получают антиэметическую профилактику [32,33] Применение любого из этих препаратов интраоперационно перед окончанием операции достоверно снижает частоту эпизодов тошноты и рвоты в послеоперационном периоде, однако сочетанное применение этих препаратов позволяет добиться еще более значительного снижения частоты и интенсивности этих симптомов (с 79% до 19%) [36] и уменьшить потребность в обезболивании в послеоперационном периоде [37]. В систематическом обзоре не было выявлено побочных эффектов в виде увеличения частоты послеоперационных инфекций или замедленного заживления ран после однократного болюсного введения дексаметазона [38].…”

Section: можно рекомендовать антибиотикопрофилактику цефалоспоринами unclassified

Enhanced recovery after bariatric surgery – a modern approach

Хациев¹,

Кузьминов²,

Yashkov³

et al. 2014

Obes. metabol.

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Guidelines for enhanced recovery after surgery (ERAS) are widely used and their efficiency was clearly demonstrated by numerous studies. Number of publications on this topic in bariatric surgery is significantly lower compared with other fields of surgery. However, the data accumulated allow to compose recommendations based on studies with high level of evidence. Authors review existing methods of enhanced recovery in their implementation into bariatric surgery. Enhanced recovery methods can be used to optimize all stages of perioperative care and include data on preoperative preparation, maintenance of electrolyte balance, prevention of postoperative nausea and vomiting, sufficient analgesia and safe discharge form hospital. Suggested guidelines for bariatric surgery are implied to be used by a multidisciplinary team.

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Prophylaxis of Postoperative Nausea and Vomiting in Morbidly Obese Patients Undergoing Laparoscopic Gastroplasties. A Comparative Study among Three Methods

Abstract: The incidence of postoperative nausea and vomiting in videolaparoscopic gastroplasties was more effectively reduced with the association of ondansetron and dexamethasone than with each drug separately.

Cited by 24 publications

References 9 publications

Postoperative nausea and vomiting in bariatric surgery in comparison to non-bariatric gastric surgery.

Postoperative nausea and vomiting in bariatric surgery in comparison to non-bariatric gastric surgery.

Challenges in the Diagnosis of Leak After Sleeve Gastrectomy: Clinical Presentation, Laboratory, and Radiological Findings

Enhanced recovery after bariatric surgery – a modern approach

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