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Deb B, Saini K, Arora S, Kumar S, Soni SL, Saini M. Olanzapine versus standard antiemetic prophylaxis for the prevention of post-discharge nausea and vomiting after propofol-based general anaesthesia: A randomised controlled trial. Indian J Anaesth 2024; 68:566-571. [PMID: 38903258 PMCID: PMC11186532 DOI: 10.4103/ija.ija_1162_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/22/2024] Open
Abstract
Background and Aims Post-discharge nausea and vomiting (PDNV) is a pertinent problem in patients undergoing ambulatory surgery. The objective of this study was to assess the efficacy of the novel drug olanzapine, which has proved its efficiency in patients undergoing highly emetogenic chemotherapy for PDNV prevention. Methods This randomised controlled trial recruited 106 adult patients (18-65 years) undergoing highly emetogenic daycare surgeries with propofol-based general anaesthesia (GA). Group O received preoperative oral olanzapine 10 mg, and Group C, acting as a control, received 8 mg of intravenous dexamethasone and 4 mg of ondansetron intraoperatively. The primary outcome was nausea (numeric rating scale >3) and/or vomiting 24 h after discharge. Secondary outcomes included nausea and vomiting in the post-anaesthesia care unit (PACU), severe nausea, vomiting and side effects. Normality was assessed using the Shapiro-Wilk test, and the independent samples t-test or the Mann-Whitney U test was used to compare continuous variables. Fisher's exact test was used to assess any non-random associations between the categorical variables. Results The incidence and severity of postoperative nausea and vomiting were similar in both groups within PACU (four patients experienced nausea and vomiting, three had severe symptoms in Group O, P = 0.057) and in the post-discharge period (three patients in Group O had nausea and vomiting compared to five patients in Group C, of which four were severe, P = 0.484). The side effects (sedation, dizziness, and light-headedness) were comparable between the two groups. Conclusion A single preoperative oral olanzapine can be an effective alternative to standard antiemetic prophylaxis involving dexamethasone and ondansetron for preventing PDNV in highly emetogenic daycare surgeries with propofol-based GA.
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Affiliation(s)
- Binayak Deb
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Kulbhushan Saini
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Suman Arora
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Sanjay Kumar
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Shiv L. Soni
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Manu Saini
- Department of Ophthalmology, PGIMER Chandigarh, India
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Taylor K, De Bruyne M, Li C, Yip M, Grant D, Tang X, Laing S, Preston B, Chand K, De Silva A, Leslie K, Darvall JN. Anaesthetist prediction of postoperative opioid use: a multicentre prospective cohort study. BJA OPEN 2023; 8:100226. [PMID: 37830104 PMCID: PMC10565679 DOI: 10.1016/j.bjao.2023.100226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023]
Abstract
Background The Apfel simplified risk score includes four risk factors: female sex, non-smoking status, postoperative nausea and vomiting or motion sickness history, and postoperative opioid use. The score is calculated preoperatively, so postoperative opioid use must be predicted. We aimed to determine whether anaesthetists can predict patients' postoperative opioid use and dose. Methods Specialist anaesthetists from eight hospitals preoperatively predicted opioid use and dose in the post-anaesthesia care unit (PACU) and for the first 24 h postoperatively, which was compared with actual opioid use and dose. Opioid doses were converted to oral morphine equivalents (MEQ). Correlations between predicted and actual opioid use and dose were analysed with Spearman's rho and linear regression. Results A total of 487 anaesthetist-patient pairs were included. Anaesthetists overpredicted opioid use (398 [82%] predicted vs 251 [52%] actual patients requiring opioids in the PACU; 396 [81%] predicted vs 291 [60%] actual in the first 24 h) (Spearman's rho [95% confidence interval] 0.24 [0.16-0.33], P<0.001 in the PACU; 0.36 [0.28-0.44], P<0.001 in the first 24 h). Anaesthetists also overpredicted opioid dose (median [inter-quartile range] 12 [8-20] mg predicted MEQ vs 4 [0-18] mg actual MEQ in the PACU; 32 [18-60] mg vs 24 [0-65] mg MEQ in the first 24 h) (Spearman's rho 0.21 [0.13-0.29], P<0.001 in the PACU; 0.53 [0.40-0.60], P<0.001 in the first 24 h). Conclusions Specialist anaesthetists cannot accurately predict opioid use or dose in the PACU or the first 24 postoperative hours. The Apfel risk criterion for postoperative opioid use may be inaccurate in clinical practice.
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Affiliation(s)
- Kieran Taylor
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mihika De Bruyne
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christine Li
- Department of Anaesthesia and Pain Medicine, Footscray Hospital, Melbourne, Australia
| | - Marcus Yip
- Department of Anaesthesia, St Vincent’s Hospital, Melbourne, Australia
| | - Dominique Grant
- Department of Anaesthesia, Austin Hospital, Melbourne, Australia
| | - Xinci Tang
- Department of Anaesthesia, Northern Hospital, Melbourne, Australia
| | - Sarah Laing
- Department of Anaesthesia, Ballarat Base Hospital, Ballarat, Australia
| | - Braden Preston
- Department of Anaesthesia, Northeast Health Wangaratta, Wangaratta, Australia
| | - Kavinay Chand
- Department of Anaesthesia, Goulburn Valley Health, Shepparton, Australia
| | - Anurika De Silva
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Monash University, Melbourne, Australia
- Methods and Implementation Support for Clinical and Health Research Hub, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Melbourne, Australia
| | - Kate Leslie
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Jai N. Darvall
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
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Gan TJ, Jin Z, Meyer TA. Rescue Treatment of Postoperative Nausea and Vomiting: A Systematic Review of Current Clinical Evidence. Anesth Analg 2022; 135:986-1000. [PMID: 36048730 DOI: 10.1213/ane.0000000000006126] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although prophylactic antiemetics are commonly used perioperatively, an estimated 30% of surgical patients still suffer from postoperative nausea and vomiting (PONV). Very few prospective trials have studied rescue treatment of PONV after failure of prophylaxis, providing limited evidence to support clinical management. In patients who have failed PONV prophylaxis, administering a rescue antiemetic from the same drug class has been reported to be ineffective. For many antiemetics currently used in PONV rescue, significant uncertainty remains around the effective dose range, speed of onset, duration of effect, safety, and overall risk-benefit ratio. As prompt, effective PONV rescue after failure of prophylaxis is important to optimize postoperative recovery and resource utilization, we conduct this systematic review to summarize the current evidence available on the topic.
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Affiliation(s)
- Tong J Gan
- From the Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, New York
| | - Zhaosheng Jin
- From the Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, New York
| | - Tricia A Meyer
- Department of Anesthesiology, Texas A&M College of Medicine, Temple, Texas
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Grass N, Bundy E. Postdischarge Nausea and Vomiting Risk Assessment in Breast and Gynecologic Surgical Patients. J Perianesth Nurs 2021; 36:339-344. [PMID: 33653617 DOI: 10.1016/j.jopan.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Postdischarge nausea, vomiting, and retching often occur after the time of discharge from the postanesthesia care unit (PACU) in patients who have undergone outpatient surgeries. At a large mid-Atlantic Academic Hospital, 40% of gynecologic outpatient surgical patients had postdischarge nausea and vomiting (PDNV). The purpose of this quality improvement project was to implement and evaluate the effectiveness of and staff compliance with the Apfel Postdischarge Nausea and Vomiting Risk Assessment tool to improve PDNV risk screening in the PACU. DESIGN This quality improvement project was part of an evidence-based practice project. METHODS After identification and recruitment of key stakeholders and unit champions, a force-field analysis, as part of Lewin's change theory, was completed to identify the driving and restraining forces. All PACU registered nurses received education on the risk assessment protocol using the Apfel risk assessment tool. The Apfel risk assessment tool has been validated to identify five independent risk factors for PDNV in outpatient ambulatory surgical populations. Implementation of the tool with data collection occurred for 8 weeks on all scheduled outpatient breast and gynecologic surgical patients. Staff compliance was measured throughout implementation. FINDINGS In patients with at least three risk factors present, the Apfel tool correctly identified the risk for PDNV in 68% of patients. In patients with four and five risk factors present, the tool correctly identified the risk for PDNV in 88% and 100% of patients, respectively. Compliance with the tool was high with an average compliance rate of 92% for the 8-week data collection period. CONCLUSIONS Data analysis demonstrated that the Apfel risk assessment tool adequately predicted the risk for PDNV in outpatient surgical breast and gynecologic patients. Use of Lewin's change theory was successful in maintaining a high compliance rate throughout implementation. In addition, this quality improvement project resulted in increased compliance of the standing follow-up phone call policy. Efforts toward sustainment include expansion to all outpatient surgical populations and implementation of a PDNV prevention and management guideline.
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Affiliation(s)
- Nicole Grass
- Nurse Anesthesia Practice Program, Georgetown University, Washington, DC.
| | - Elaine Bundy
- Nurse Practitioner program, University of Maryland School of Nursing, Baltimore, MD
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Dziadzko M, Aubrun F. Management of postdischarge nausea and vomiting. Best Pract Res Clin Anaesthesiol 2020; 34:771-778. [PMID: 33288126 DOI: 10.1016/j.bpa.2020.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
Postdischarge nausea and vomiting (PDNV) occurs in at least 30% of patients leaving hospital, especially after day-case surgery. A significant number of ambulatory patients may develop PDNV associated with the use of analgesics for postsurgical pain. A validated PDNV prediction score and international evidence-based consensus guidelines for PONV/PDNV management are available. High-risk patients benefit from a predischarge PDNV risk assessment and the use of adapted pharmacological intervention (combination of long- and short-acting antiemetics and access to antiemetics at home). Patient education is often overlooked in this context. All clinicians involved in the ambulatory surgery care process should participate in the development of institutional protocol for PONV/PDNV management. Constant quality control and patients' feedback should be integrated as part of an efficient implementation strategy.
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Affiliation(s)
- Mikhail Dziadzko
- Service Anesthésie Réanimation Douleur, Université Lyon 1, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 LYON Cédex 04, France.
| | - Frédéric Aubrun
- Service Anesthésie Réanimation Douleur, Université Lyon 1, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 LYON Cédex 04, France.
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Gecit S, Ozbayir T. Evaluation of Preoperative Risk Assessment and Postoperative Nausea and Vomiting: Importance for Nurses. J Perianesth Nurs 2020; 35:625-629. [PMID: 32778493 DOI: 10.1016/j.jopan.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 04/11/2020] [Accepted: 04/17/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Postoperative nausea and vomiting (PONV) continues to be one of the most common postoperative complications affecting one of four patients. The aim of this study was to assess the importance of preoperative risks and PONV, and to determine the significance for nurses. DESIGN This was a descriptive study. METHODS The study was carried out with 242 patients in the surgical clinics of a university hospital. The data of the study were evaluated via a "Patient Information Form" and "Patient Evaluation Form," including Apfel and Koivuranta Nausea Vomiting Risk Scores, before and after surgery. FINDINGS At the end of the study, 45.9% of the patients were found to have nausea and 23.6% suffered vomiting. The average Apfel risk score of patients was 1.88 ± 1.16, and the Koivuranta risk score was 2.35 ± 1.07. CONCLUSIONS The study found that more patients had nausea than vomiting in the postoperative period. We recommend that the risk scores used in the early determination of PONV should be evaluated by nurses and health care workers in the preoperative period. Furthermore, nursing care planning is recommended for patients identified as at risk of PONV.
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Affiliation(s)
- Sinem Gecit
- Nursing Faculty, Surgical Nursing Department, Ege University, Izmir, Turkey.
| | - Turkan Ozbayir
- Nursing Faculty, Surgical Nursing Department, Ege University, Izmir, Turkey
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