PONV Prophylaxis Failure Disproportionately Affects Female Patients, Despite Intraoperative Computerized Decision Support Guidance

doi:10.32873/unmc.dc.gmerj.2.1.091

Cited by 2 publications

(1 citation statement)

References 21 publications

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“…There is sufficient documentation showing that women undergoing breast and gynecological surgery have a reported incidence of postoperative nausea and vomiting up to 80% to 95% within the first 24 h after surgery when they received insufficient or no prophylactic antiemetic therapy (34)(35)(36). Conversely, the occurrence of PONV in this subset of surgical patients can dramatically decrease after the systematic implementations of PONV guidelines (37).…”

Section: Incidence Of Ponv In Patients Undergoing Breast and Gynecolo...mentioning

confidence: 99%

Postoperative Nausea and Vomiting in Female Patients Undergoing Breast and Gynecological Surgery: A Narrative Review of Risk Factors and Prophylaxis

2022

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Postoperative nausea and vomiting (PONV) have been widely studied as a multifactorial entity, being of female gender the strongest risk factor. Reported PONV incidence in female surgical populations is extremely variable among randomized clinical trials. In this narrative review, we intend to summarize the incidence, independent predictors, pharmacological and non-pharmacological interventions for PONV reported in recently published clinical trials carried out in female patients undergoing breast and gynecologic surgery, as well as the implications of the anesthetic agents on the incidence of PONV. A literature search of manuscripts describing PONV management in female surgical populations (breast surgery and gynecologic surgery) was carried out in PubMed, MEDLINE, and Embase databases. Postoperative nausea and vomiting incidence were highly variable in patients receiving placebo or no prophylaxis among RCTs whereas consistent results were observed in patients receiving 1 or 2 prophylactic interventions for PONV. Despite efforts made, a considerable number of female patients still experienced significant PONV. It is critical for the anesthesia provider to be aware that the coexistence of independent risk factors such as the level of sex hormones (pre- and postmenopausal), preoperative anxiety or depression, pharmacogenomic pleomorphisms, and ethnicity further enhances the probability of experiencing PONV in female patients. Future RCTs should closely assess the overall risk of PONV in female patients considering patient- and surgery-related factors, and the level of compliance with current guidelines for prevention and management of PONV.

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Section: Incidence Of Ponv In Patients Undergoing Breast and Gynecolo...mentioning

confidence: 99%

Postoperative Nausea and Vomiting in Female Patients Undergoing Breast and Gynecological Surgery: A Narrative Review of Risk Factors and Prophylaxis

2022

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Hyperoxia therapy for prevention of postoperative nausea and vomiting after breast cancer surgery

Mihalek,

Radovanovic,

Starcevic

et al. 2024

VOJNOSANIT PREGL

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Background/Aim. Postoperative nausea and vomiting (PONV) is one of the most common causes of patient dissatisfaction in the postoperative period after general anaesthesia. Hyperoxia may prevent PONV after abdominal surgery, but the effectiveness of intraoperative and early postoperative hyperoxia in preventing PONV after breast cancer surgery has not been adequately studied so far. Methods. Forty female patients with breast cancer were recruited, all of whom underwent surgical treatment of breast cancer with axillary sentinel node sampling or axillary lymph node dissection. Balanced general anaesthesia with propofol induction and sevofluran maintenance was administered. Twenty patients received a volatile mixture with inspiratory fraction of inspired oxygen (FiO2) of 0.8 intraoperatively and 3 L/min oxygen via face mask for two hours after surgery. The other 20 patients received a FiO2 of 0.4 during the intervention, without further administration of oxygen in the early postoperative period. The presence and severity of PONV was assessed at 30 minutes, 4/24/32/48/56 hours after surgery and a numerical PONV Intensity Scale by Wengritzky was applied to evaluate clinically significant PONV in the first 6 hours after surgery. Data were collected in Excel spreadsheet and analysed using the independent Student's t-test. Results. The overall incidence of PONV 30 minutes after the intervention was 17.5% (15% in the group of patients receiving FiO2 of 0.8 intraoperatively and 20% in the group of patients receiving volatile mixture with FiO2 of 0.4). There was no statistically significant difference (p?0.05) between the two groups in the frequency and severity of PONV, as well as in the values of PONV Intensity Score by Wengritzky. Conclusion. We found no benefit of intraand postoperative hyperoxia in reducing the incidence of PONV. The data do not support routine administration of hyperoxia in addition to antiemetics in patients undergoing breast cancer surgery for the prevention of PONV.

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PONV Prophylaxis Failure Disproportionately Affects Female Patients, Despite Intraoperative Computerized Decision Support Guidance

Cited by 2 publications

References 21 publications

Postoperative Nausea and Vomiting in Female Patients Undergoing Breast and Gynecological Surgery: A Narrative Review of Risk Factors and Prophylaxis

Postoperative Nausea and Vomiting in Female Patients Undergoing Breast and Gynecological Surgery: A Narrative Review of Risk Factors and Prophylaxis

Hyperoxia therapy for prevention of postoperative nausea and vomiting after breast cancer surgery

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