Une approche préventive adaptée aux risques réduit l’incidence générale de nausées et de vomissements postopératoires en milieu hospitalier

Abstract

P Pu ur rp po os se e: : Routine prophylactic antiemetic treatment of surgical patients appears justified only in case of an increased risk of postoperative nausea and vomiting (PONV). The objective of this investigation was to assess the feasibility and efficacy of a dichotomized risk score adapted management of PONV based on ondansetron prophylaxis and treatment with respect to the overall institutional rate of PONV. M Me et th ho od ds s: :After estimating the individual PONV risk by a simplified score, 162 adult patients scheduled for elective surgery received either 4 mg ondansetron intravenously (two to four risk factors = high-risk) or no prophylaxis (zero to one risk factor = low-risk). For antiemetic treatment ondansetron was given intravenously and orally. Incidence of PONV was recorded during the first 24 hr after recovery.

Incidence and circumstances of cervical hematoma complicating thyroidectomy and its relationship to postoperative vomiting

“…10 However, when classifying patients into high-and low-risk groups for postoperative vomiting, the single use of ondansetron seems to be of limited efficacy because even with its use, the incidence of postoperative vomiting in highrisk patients is double the incidence in low-risk patients. 11 Combined administration of ondansetron with other antiemetics acting on different receptors has been suggested as capable of further reducing the postoperative vomiting rate and possibly the rate of hemorrhagic complications. 12 The endpoints of this study were the analysis of the causes of cervical hematoma and the existence of a relation between postoperative vomiting and cervical hematoma, and determination of the propriety of thyroidectomy as an ambulatory procedure.…”

Association of ABCB1 polymorphisms with the efficacy of ondansetron for postoperative nausea and vomiting

“…The incidence ranges between 20% and 30%, but is as high as 80% in high-risk patients [1] and may cause significant complications [2]. Although the exact mechanism of PONV is not clear, it is known that the chemoreceptor trigger zone in the area postrema plays an important role, in which the 5-hydroxytryptamine type-3 (5-HT 3 ) receptor is involved in the occurrence of PONV [3].Currently, 5-HT 3 receptor antagonists such as ondansetron are widely used for prevention and treatment of PONV and although these agents have a significant effect, over 35% of patients treated with ondansetron may still experience PONV [4,5]. We hypothesised that polymorphism in the adenosine triphosphate-binding cassette subfamily B member 1 (ABCB1), an encoding gene of transporter for ondansetron in the brain-blood barrier [6], would contribute to such inter-individual variation.…”

Performance and customization of 4 prognostic models for postoperative onset of nausea and vomiting in ear, nose, and throat surgery

“…Prognostic models for PONV are aimed to predict PONV and can be used as tools to aid in antiemetic therapy and prophylaxis [12,13]. Furthermore, they are used in clinical trials assessing treatment alternatives or medications to test the similarity of risks in patient groups [14,15].…”