Übelkeit und Erbrechen in der postoperativen Phase

Abstract

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.

Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems

“…Vomiting is contrasted with regurgitation, which is the effortless passage of gastric contents into the mouth [46]. In ICU patients the forcefulness of the act is often not detectable; therefore, regurgitation and vomiting should be assessed together. Management Several guidelines for prevention and management of postoperative nausea and vomiting are available [47–51]. However, no studies have addressed management of vomiting in mechanically ventilated ICU patients; therefore, no specific recommendation can be given.…”

“…Management Several guidelines for prevention and management of postoperative nausea and vomiting are available [47–51]. However, no studies have addressed management of vomiting in mechanically ventilated ICU patients; therefore, no specific recommendation can be given.…”

Fast Track in der Gefäßchirurgie

“…fol zur Einleitung und Aufrechterhaltung der Narkose sowie ggf. die Gabe von Serotoninantagonisten empfohlen [25] [26]. Die im Rahmen des Fast-Track-Programms zum Einsatz kommenden veränderten perioperativen Nüchternheits-zeiten können signifikant das Auftreten postoperativer Organfunktionsstörungen vermindern.…”

“…Dieses Phänomen ist nicht auf abdominelle Eingriffe beschränkt, sondern wird ebenso bei peripher-vaskulären Rekonstruktionen beobachtet. Jeder Patient sollte daher entsprechend seines Risikos für das Auftreten postoperativer Übelkeit und Erbrechen (PONV) evaluiert werden[25][26]. Nach derzeitig gültigen Empfehlungen sollten Patienten mit mäßigem PONV-Risiko Dexamethason nach der Einleitung erhalten, bei hohem PONV-Risiko wird zusätzlich Propo-Tab.…”

Postoperative nausea and vomiting and opioids in children

“…For acute pain therapy a regular basic medication with non-opioids and an analgesic on demand (usually opioids) for the management of breakthrough pain of ≥ 4 is provided postoperatively [1]. There are several studies and risk scores concerning postoperative nausea and vomiting (PONV) related to opioid-treatment in adults [2][3][4][5][6]. We performed a study about this topic in children.…”