Preoperative Risk Assessment to Guide Prophylaxis and Reduce the Incidence of Postoperative Nausea and Vomiting

Thomas, John Stephenson; Maple, Ingrid K.; Norcross, William; Muckler, Virginia C.

doi:10.1016/j.jopan.2018.02.007

Cited by 11 publications

(8 citation statements)

References 18 publications

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“…Several effective strategies are recommended for reducing the baseline risk for PONV ( Table 6 ): (1) routine use of local anesthesia and regional anesthesia (e.g. local infiltration and/or peripheral nerve blocks); (2) propofol induction and maintenance infusion during general anesthesia and monitored anesthesia care (MAC); (3) minimization of perioperative opioid analgesics; (4) minimization of concentrations of volatile anesthetics; (5) minimization of the use of nitrous oxide and reversal drugs; and (6) ensuring adequate perioperative hydration 17 , 38 , 52 , 412 , 430 . If general anesthesia is utilized, substituting a propofol infusion for maintenance of anesthesia in place of inhaled volatile anesthetics will reduce the risk of PONV.…”

Section: Summary Of Current Recommendations For Reducing the Risk Of mentioning

confidence: 99%

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

et al. 2020

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Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.

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Section: Summary Of Current Recommendations For Reducing the Risk Of mentioning

confidence: 99%

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

et al. 2020

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“…Although we cannot assign causality to this association, it is in agreement with previous studies linking duration of hospitalization to PONV. [10][11][12][13][14][15][16] This would be a particularly important benefit of PONV reduction, as hospital capacity is frequently a major challenge in low-income settings.…”

Section: Discussionmentioning

confidence: 99%

“…7,10 Unresolved PONV may result in a prolonged postanesthesia care unit (PACU) stay and unanticipated prolonged hospital admission, which results in a significant increase in overall health care cost. [9][10][11][12][13][14][15][16] PONV scoring systems and guideline-driven prophylaxis are well established in high-income countries. Well-established risk factors include: female gender, postpubescence, nonsmoking status, history of PONV or motion sickness, childhood and young adulthood, prolonged surgery duration, type of surgery, use of volatile anesthetics, nitrous oxide, large-dose neostigmine, and intraoperative or postoperative opioid use.…”

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confidence: 99%

“…10,15 The identification of patients at risk for PONV through preoperative risk assessment, combined with prophylaxis based on predicted risk as stratified by Apfel score, has been shown to be a costeffective means to reduce the incidence of PONV. 5,[16][17][18][19] The objective of this study was to assess the association between introduction of protocolized PONV management and postoperative outcomes. We hypothesized that administering PONV prophylaxis based on the Apfel score would be associated with a decreased incidence of PONV (primary outcome).…”

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confidence: 99%

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Investigating the Association Between a Risk-Directed Prophylaxis Protocol and Postoperative Nausea and Vomiting: Validation in a Low-Income Setting

Tuyishime

Niyitegeka

Olufolabi

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND:The efficacy of postoperative nausea and vomiting (PONV) prevention protocols in low-income countries is not well known. Different surgical procedures, available medications, and co-occurring diseases imply that existing protocols may need validation in these settings. We assessed the association of a risk-directed PONV prevention protocol on the incidence of PONV and short-term surgical outcomes in a teaching hospital in Rwanda. METHODS: We compared the incidence of PONV during the first 48 hours postoperatively before (April 1, 2019-June 30, 2019; preintervention) and immediately after (July 1, 2019-September 30, 2019; postintervention) implementing an Apfel score-based PONV prevention strategy in 116 adult patients undergoing elective open abdominal surgery at Kigali University Teaching Hospital in Rwanda. Secondary outcomes included time to first oral intake, hospital length of stay, and rate of wound dehiscence. Interrupted time series analyses were performed to assess the associated temporal slopes of the outcome before and immediately after implementation of the risk-directed PONV prevention protocol. RESULTS: Compared to just before the intervention, there was no change in the odds of PONV at the beginning of the postintervention period (odds ratio [OR], 0.23; 95% confidence interval [CI], 0.05-1.01). There was a decreasing trend in the odds of nausea (OR, 0.60; 95% CI, 0.36-0.97) per month. However, there was no difference in the incidence of nausea immediately after implementation of the protocol (OR, 0.96; 95% CI, 0.25-3.72) or in the slope between preintervention and postintervention periods (OR, 1.48; 95% CI, 0.60-3.65). In contrast, there was no change in the odds of vomiting during the preintervention period (OR, 1.01; 95% CI, 0.61-1.67) per month. The odds of vomiting decreased at the beginning of the postintervention period compared to just before (OR, 0.10; 95% CI, 0.02-0.47; P = .004). Finally, there was a significant decrease in the average time to first oral intake (estimated 14 hours less; 95% CI, −25 to −3) when the protocol was first implemented, after adjusting for confounders; however, there was no difference in the slope of the average time to first oral intake between the 2 periods (P = .44). CONCLUSIONS: A risk-directed PONV prophylaxis protocol was associated with reduced vomiting and time to first oral intake after implementation. There was no substantial difference in the slopes of vomiting incidence and time to first oral intake before and after implementation. (Anesth Analg 2023;136:588-96) KEY POINTS• Question: Is implementation of risk-directed postoperative nausea and vomiting (PONV) prophylaxis based on the Apfel score associated with a decreased incidence of PONV in low-income settings? • Findings: Implementation of a protocol was associated with reduced vomiting and time to first oral intake, although longitudinal studies are needed to assess whether these effects are sustained over time. • Meaning: Despite major differences in low-income settings, implemen...

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“…Besides the malaise caused by blood loss, postoperative vomiting increases the pressure in the newly operated region and causes an increasing of the edema. In addition, due to the bleeding caused by the pressure increasing, there may be formation and/or increasing of hematomas [24][25][26].…”

Section: Blood Lossmentioning

confidence: 99%

Edema Management in Oral and Maxillofacial Surgery

Yaedú¹,

Mello²,

Silveira³

et al. 2022

Inflammation in the 21st Century

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This chapter will discuss the expected edema and intercurrences in maxillofacial surgery, which involves important anatomical structures, such as the upper airways. It will also discuss important issues such as intrinsic and extrinsic enhancers of edema and the main consequences of a severe edema setting according to physiological, functional, and psychosocial points of view. Edema assessment and measurement is still performed subjectively in the clinical routine. However, for the accomplishment of studies, more objective forms are being tested, but still not very successful for clinical applicability. It is known that the best way to deal with edema is prevention; so in elective surgeries, much is discussed about the best management forms. This way, besides edema prevention, it is important not to cause unwanted reactions for the patient or in the performed procedure. Therefore, it will also be debated about preoperative medications and their consequences. Another point discussed involves main treatments for the underdeveloping edema and the one already installed, such as manual lymphatic drainage therapy, a treatment that is well known and used in other specialties, but is still very little widespread among maxillofacial surgeons.

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Preoperative Risk Assessment to Guide Prophylaxis and Reduce the Incidence of Postoperative Nausea and Vomiting

Cited by 11 publications

References 18 publications

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

Investigating the Association Between a Risk-Directed Prophylaxis Protocol and Postoperative Nausea and Vomiting: Validation in a Low-Income Setting

Edema Management in Oral and Maxillofacial Surgery

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