Prevention and Treatment of Postoperative Nausea and Vomiting

P Pu ur rp po os se e: : To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV).S So ou ur rc ce e: : Literature from randomized controlled trials, systematic reviews, logistic regression analyses and expert opinion in the management of PONV.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The etiology of PONV is multifactorial. Patient, anesthesia, and surgery related risk factors have been identified. Universal PONV prophylaxis is not cost-effective. Identification of patients at high-risk of PONV allows targeting prophylaxis to those who will benefit most from it. No prophylaxis is needed for patients at low risk for PONV. For patients at moderate risk for PONV, prophylaxis using a single antiemetic or a combination of two agents should be considered. Double and triple antiemetic combinations should be considered for patients at high risk for PONV. Furthermore, a multimodal approach should be adopted incorporating steps to keep the baseline risk of PONV low. The optimum cost-effective approach to the management of PONV will differ between an ambulatory centre and an inpatient hospital setting. For the treatment of established PONV in patients who failed prophylaxis, patients should not receive a repeat dose of the prophylactic antiemetic. Rather, a drug acting at a different receptor should be used. Beyond six hours after surgery, patients can be treated with any of the agents used for prophylaxis, except dexamethasone and transdermal scopolamine.C Co on nc cl lu us si io on n: : PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature. Objectif : Énoncer des lignes de conduite fondées sur des données probantes pour la prévention et le traitement des nausées et des vomissements postopératoires (NVPO). Source : Les publications d'essais contrôlés et randomisés, les études méthodiques, les analyses de régression logistique et l'opinion d'experts sur le traitement des NVPO. Constatations principales : L'origine des NVPO est multifactorielle. Les facteurs de risque reliés au patient, à l'anesthésie et au type de chirurgie sont connus. La prévention universelle des NVPO n'est pas rentable. L'identification des patients à haut risque de NVPO permet

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“…75,76 These compounds have, however, a higher incidence of extrapyramidal side effects compared to the aliphatic phenothiazines. 77 …”

Section: Other Older Generation Antiemeticsmentioning

confidence: 99%

Evidence-based management of postoperative nausea and vomiting: a review

Habib

Gan

2004

Can J Anesth/J Can Anesth

196

106

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“…Furthermore, many patients experience postoperative nausea and vomiting (PONV) after TKA, owing to not only anesthesia and surgery but also the various agents used for pain control [8,10,20,27]. Inadequate management of postoperative pain and PONV can lead to several systemic complications and delays recovery [13,16,34,48]. Moreover, pain and PONV are strongly associated with patient dissatisfaction [11,32,39,41,43].…”

Section: Introductionmentioning

confidence: 99%

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

Koh

Chang

Lee

et al. 2013

Clinical Orthopaedics &Amp; Related Research

119

147

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Background Dexamethasone is a potent analgesic and antiemetic. However, the benefit of dexamethasone after TKA is unclear, as is the efficacy in a current multimodal regime. Questions/purposes We determined (1) whether the addition of dexamethasone to a protocol including ramosetron further reduces postoperative emesis compared with ramosetron alone; (2) whether it reduces postoperative pain; and (3) whether it increases the risk for wound complications in a current multimodal regime after TKA. Methods We randomized 269 patients undergoing TKAs to receive dexamethasone (10 mg) 1 hour before surgery and ramosetron immediately after surgery (Dexa-Ra group, n = 135), or ramosetron alone (Ra group, n = 134). We recorded the incidence of postoperative nausea and vomiting (PONV), severity of nausea, incidence of antiemetic requirement, complete response, pain level, and opioid consumption. Patients were assessed 0 to 6, 6 to 24, 24 to 48, and 48 to 72 hours postoperatively. In addition, patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery. Results The Dexa-Ra group had a lower incidence of PONV during the entire 72-hour evaluation period and experienced less severe nausea for the first 6 hours after TKA, although not between 6 to 72 hours.

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“…Postoperative nausea and vomiting (PONV) is a common and distressing complication in patients undergoing general anaesthesia. 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].…”

mentioning

confidence: 99%

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

Choi

Lee

et al. 2010

Anaesthesia

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SummaryWe investigated whether the 2677G>T ⁄ A and 3435C>T polymorphisms of adenosine triphosphate-binding cassette subfamily B member 1 (ABCB1) affect the efficacy of ondansetron to prevent postoperative nausea and vomiting. One hundred and ninety-eight patients undergoing general anaesthesia were enrolled. Thirty minutes before the end of surgery, 0.1 mg.kgondansetron was administered intravenously. The incidence of postoperative nausea and vomiting was compared between genotypes in the 2677G>T ⁄ A and 3435C>T polymorphisms of ABCB1. The incidence of postoperative nausea and vomiting was lower in patients with the 2677TT genotype (TT vs Non-TT = 25.9% vs 53.0%, p = 0.01) and 3435TT genotype (CC + CT vs TT = 52.6% vs 21.7%, p = 0.01) during the first 2 h after surgery. There were no significant differences in the incidence of postoperative nausea and vomiting between the different genotype groupings during period between 2 and 24 h after surgery. In conclusion, ABCB1 genotypes may be a clinical predictor of responsiveness for ondansetron. Postoperative nausea and vomiting (PONV) is a common and distressing complication in patients undergoing general anaesthesia. 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.In a previous study, the 3435C>T single nucleotide polymorphism of ABCB1 was associated with the efficacy of 5-HT 3 receptor antagonists for chemotherapy-induced nausea and vomiting [7]. Therefore, we investigated whether the 2677G>T ⁄ A, and 3435C>T polymorphisms of ABCB1 affect the efficacy of ondansetron in preventing PONV in patients undergoing general anaesthesia. MethodsThis study was approved by the Institutional Review Board of Yonsei University Hospital. Written informed consent was obtained from each patient. One hundred and ninety-eight adult patients, of ASA physical status 1-2, undergoing laparoscopic cholecystectomy were enrolled in this study. Patients with a history of drug abuse, known hypersensitivity to 5-HT 3 receptor antagonist, body mass index > 30 kg.m , hepatic or renal disease or who had used antiemetics within the 24 h before the study were excluded. Before surgery, all patients were interviewed about their medical history including tobacco use, presence of PONV and motion sic...

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Prevention and Treatment of Postoperative Nausea and Vomiting

Cited by 69 publications

References 143 publications

Evidence-based management of postoperative nausea and vomiting: a review

Evidence-based management of postoperative nausea and vomiting: a review

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

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

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