A risk score-dependent antiemetic approach effectively reduces postoperative nausea and vomiting — a continuous quality improvement initiative

Plutniak, Sébastien; Corno, Gaëlle; Benais, Hervé; Apfel, Christian C.

doi:10.1007/bf03018235

Cited by 103 publications

(56 citation statements)

References 25 publications

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“…Bei 3 oder 4 Risikofaktoren (Risiko um 60-80%) sollten mindestens 2 oder 3 antiemetische Interventionen zum Einsatz kommen [12]. Ein ähnliches, risikoadaptiertes Prophylaxeschema ist bereits klinisch erprobt und für effektiv befunden worden [58]. Welches Vorgehen im Einzelfall angezeigt erscheint, hängt zum einen von den angestrebten Zielen und zum anderen von den lokalen Gegebenheiten ab (Kollektivzusammensetzung, umgehende Verfüg-barkeit einer Rescue-Medikation; [47] …”

Section: Antiemetischer Algorithmusunclassified

Übelkeit und Erbrechen in der postoperativen Phase

et al. 2007

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There are no consensus guidelines for the management of postoperative nausea and vomiting (PONV) in German speaking countries. This meeting was intended to develop such guidelines on which individual health care facilities can derive their specific standard operating procedures (SOPs). Anesthesiologists reviewed published literature on key topics which were subsequently discussed during two meetings. It was emphasized that recommendations were based on the best available evidence. The clinical relevance of individual risk factors should be viewed with caution since even well proven risk factors, such as the history of PONV, do not allow the identification of patients at risk for PONV with a satisfactory sensitivity or specificity. A more useful approach is the use of simplified risk scores which consider the presence of several risk factors simultaneously. Most individual antiemetic interventions for the prevention of PONV have comparable efficacy with a relative risk reduction of about 30%. This appears to be true for total intravenous anesthesia (TIVA) as well as for dexamethasone and other antiemetics; assuming a sufficiently high, adequate and equipotent dosage which should be weight-adjusted in children. As the relative risk reduction is context independent and similar between the interventions, the absolute risk reduction of prophylactic interventions is mainly dependent on the patient's individual baseline risk. Prophylaxis is thus rarely warranted in patients at low risk, generally needed in patients with a moderate risk and should include a multimodal approach in patients at high risk for PONV. Therapeutic interventions of PONV should be administered promptly using an antiemetic which has not been used before. The group suggests algorithms where prophylactic interventions are mainly dependent on the patient's risk for PONV. These algorithms should provide evidence-based guidelines allowing the development of SOPs/policies which take local circumstances into account.

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Section: Antiemetischer Algorithmusunclassified

Übelkeit und Erbrechen in der postoperativen Phase

et al. 2007

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“…2 As PONV may be effectively reduced by adherence to standards, 3 it can also be used as a marker for quality of care.…”

Section: Introductionmentioning

confidence: 99%

Documentation of Post-operative Nausea and Vomiting in Routine Clinical Practice

et al. 2010

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This study investigated the quality of documentation of post-operative nausea and vomiting (PONV) by comparing incidences collected by a research team with those reported routinely by nursing personnel. A total of 560 patients passing through an interdisciplinary recovery room were included in the study. The overall recorded incidence of PONV over 24 h was 30.7%, which was in agreement with the predicted value of 32% calculated using incidences from published randomized controlled trials. Out of the total number of 86 cases of PONV in the recovery room only 36 (42%) were detected by nursing staff. Similarly, out of the total number of 129 cases of PONV on the ward over 24 h, only 37 (29%) were recognized by nursing staff during routine care. In conclusion, PONV in routine clinical care is likely to be underreported. To use PONV as a valid quality measure, patients need to be actively asked about nausea and vomiting at frequent intervals in a standardized fashion. A considerable proportion of patients experience PONV after discharge from the recovery room, so the assessment of PONV should cover at least 24 h post-operatively

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“…Interventions oriented by scores significantly reduce PONV (23 to 71%) especially in high risk patients, while they avoid high costs and potential side effects in low risk patients. (18) Simplified risk scores (only preoperative risk factors) do not have a reduced accuracy and easy to use, accuracy is equivalent or superior in relation to other more complex systems.…”

Section: How To Prevent And/or Manage Ponv?mentioning

confidence: 99%