Recomendaciones de prevención y tratamiento de las náuseas y vómitos postoperatorios y/o asociados a las infusiones de opioides

Abstract

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Española de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating Este trabajo ha sido financiado mediante la concesión de una subvención de ProStrakan Farmacéutica SL a la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor.Aceptado para su publicación en agosto de 2010.Rev. Esp. Anestesiol. Reanim. 2010; 57: 508-524. Reproducido con permiso de REDAR.

Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP)

“…La identificación del riesgo basal de los pacientes permite adoptar medidas de reducción de riesgo y aplicar la profilaxis farmacológica [158][159][160] . 60.…”

“…Nivel de evidencia alto. 158. En pacientes intolerantes al AAS, el clopidogrel se recomienda como una alternativa en el postoperatorio de cirugía coronaria.…”

Incidence of postoperative vomiting in pediatric population undergoing anesthesia: a prospective cohort study

“…anesthetic technique, opioid use doubles the risk of POV, while inhaled anesthetics are associated with increased incidence, particularly in children identified as prone to developing this complication (7). Certain procedures such as strabismus surgery, tonsillectomy, tympanoplasty, and procedures lasting >30 minutes, have been shown to increase the occurrence of POV in children (9,11).…”

“…In clinical practice, POV is one of the main causes of dissatisfaction and the primary cause of unexpected hospital readmissions (5,6). Its clinical implications include difficulty initiating oral intake of food and medications, dehydration, electrolytic imbalances, aspiration, and unfavorable surgical outcomes such as suture dehiscense, bleeding or hematoma formation (7)(8)(9). In turn, these have a negative effect on quality indicators and healthcare costs.…”

Palonosetrón comparado con ondansetrón y dexametasona en el control de náusea y vómito en el postoperatorio de colecistectomías laparoscópicas. Estudio de cohortes retrospectivas

“…En la década de los 90 se desarrolló la escala simplificada de Apfel (Tabla 1), la cual resultó ser igualmente eficaz que sus predecesoras, y al ser simplificada y darle el mismo peso a cada factor de riesgo, es fácilmente aplicable y es la más utilizada en la actualidad. 5 A pesar de existir lineamientos generales y acciones preventivas no medicamentosas profilácticas para prevenir su aparición, 4,6 en ocasiones es necesario recurrir a fármacos cuando el riesgo de su presentación es moderado, como es en las cirugías laparoscópicas. 7 En estas condiciones, la recomendación es el uso de monoterapia o biterapia anti-NVPO.…”