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Wei Y, Zhu M, Man Y, Xiao H, Dong G, Shi X, Ji F. Clinical Study of Flumazenil Antagonizing Remimazolam on Nausea and Vomiting After Gynecologic Day Surgery. Drug Des Devel Ther 2024; 18:631-638. [PMID: 38465267 PMCID: PMC10924035 DOI: 10.2147/dddt.s444313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose To evaluate the effect of flumazenil antagonizing remimazolam on postoperative nausea and vomiting (PONV) after gynecologic day surgery. Patients and Methods 141 cases of gynaecological daycase surgery patients in Weifang People's Hospital were selected, randomized into group F (flumazenil group, 71 cases) and group C (control group, 70 cases). Dexamethasone 5 mg, flurbiprofen axetil 50 mg, and droperidol 1 mg were given intravenously before induction of anesthesia in both groups. Anesthesia induction: Remimazolam 0.25mg / kg was injected within 1 minute. After the patient fell asleep, mivacurium chloride 0.2mg / kg was injected for 30 seconds and alfentanil 20ug / kg was injected for 30 seconds. Anesthesia maintenance: Remimazolam 1mg/kg/h and alfentanil 40ug/kg/h were continuously pumped by micro pump. Stopping the injection of remimazolam and alfentanil at the end of the operation. Flumazenil 0.2 mg was given to antagonize remimazolam in group F after 1 minute. Group C was given an equal volume of saline. The incidence of PONV in the postoperative PACU and over a 24-hour period, patient awakening time, and general patient information were recorded. Results The incidence of PONV in both groups within 24 hours was 50.70% in group F was significantly higher than 32.86% in group C. The difference was statistically significant (P < 0.05). The incidence of PONV in the PACU was 5.6% in group F and 8.6% in group C. The difference was not statistically significant (p > 0.05). Conclusion Flumazenil antagonism of remimazolam increases the incidence of PONV within 24 hours in gynecologic day surgery patients and has no significant effect on the incidence of PONV in the PACU.
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Affiliation(s)
- Yaxin Wei
- School of Anesthesiology, Weifang Medical University, Weifang, 261053, People's Republic of China
| | - Min Zhu
- Department of Gynecology, Weifang People's Hospital, Weifang, 261041, People's Republic of China
| | - Yan Man
- School of Anesthesiology, Weifang Medical University, Weifang, 261053, People's Republic of China
| | - Hongyi Xiao
- Department of Anesthesiology, Weifang People's Hospital, Weifang, 261041, People's Republic of China
| | - Guimin Dong
- Department of Anesthesiology, Weifang People's Hospital, Weifang, 261041, People's Republic of China
| | - Xinyuan Shi
- School of Anesthesiology, Weifang Medical University, Weifang, 261053, People's Republic of China
| | - Fanceng Ji
- Department of Anesthesiology, Weifang People's Hospital, Weifang, 261041, People's Republic of China
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Teshome D, Hunie M, Kibret S, Mestofa M, Fenta E. Prevalence and Factors Associated with Postoperative Nausea and Vomiting in an Ethiopian Comprehensive Specialized Hospital. Adv Prev Med 2024; 2024:6699732. [PMID: 39149580 PMCID: PMC11324358 DOI: 10.1155/2024/6699732] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/19/2023] [Accepted: 02/09/2024] [Indexed: 08/17/2024] Open
Abstract
Background Postoperative nausea and vomiting (PONV) is a common and uncomfortable anesthetic and surgical consequences. It may cause severe distress to the patient and may cause the recovery process to be delayed. Identifying the reasons may aid in reducing the magnitude and problems. The purpose of this study was to determine the prevalence and risk factors for PONV after general anesthesia in an Ethiopian hospital. Methods From March 1 to May 30, 2019, a cross-sectional study was designed. A patient interview was used to obtain data on the occurrence of PONV, and a chart review was used to collect data on other demographic and clinical variables. To identify associated factors, variables with a P-value of 0.2 in binary logistic regression were transformed into a multivariable logistic regression. The strength of the association and level of significance waswere demonstrated using crude and adjusted odds ratios with 95% confidence intervals and P-values of 0.05. Results The study included 162 participants, with a remarkable 100% response rate. Within 24 hr after surgery, 51.2% of patients had nausea and vomiting. When compared to their counterparts, female patients, patients who received perioperative opioid medication, patients with a history of PONV, and patients with a history of motion sickness reported a statistically significant difference (higher incidence) in PONV. Conclusion This study only comprised ASA physical classes 1 and 2 patients who did not receive preventive antiemetics. In the research area, the total prevalence of vomiting and nausea was 51.2%. Female sex, perioperative opioid usage, a history of nausea and vomiting, and a history of motion sickness were discovered to be statistically significantly associated with a higher incidence of PONV.
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Affiliation(s)
- Diriba Teshome
- Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Metages Hunie
- Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Simegnew Kibret
- Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Marifa Mestofa
- Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Efrem Fenta
- Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Yayla A, Eskici İlgin V, Kılınç T, Karaman Özlü Z, Ejder Apay S. Nausea and Vomiting After Laparoscopic Cholecystectomy: Analysis of Predictive Factors. J Perianesth Nurs 2022; 37:834-841. [PMID: 35382962 DOI: 10.1016/j.jopan.2022.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/02/2022] [Accepted: 01/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to identify the factors predictive of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy. DESIGN This is a descriptive, cross-sectional study. METHODS In total, 172 patients completed the study. "The Questionnaire Form," "Visual Analog Scale," "Nausea Scale," and "Anxiety Specific to Surgery Questionnaire" created by the researchers were used for data collection. FINDINGS At the second postoperative hour, 55.8% of the patients had nausea, 20.3% had vomiting and 75% had severe pain. The severity of nausea, vomiting, and pain decreased with time. Age, gender, smoking, motion sickness, postoperative pain, opioid use, preoperative fasting time, time of first postoperative fluid intake and preoperative anxiety score were found to be among the factors predictive of PONV (P < .05). CONCLUSIONS High rates of postoperative nausea and vomiting were recorded. The factors predictive of PONV can be evaluated in the preoperative period, and PONV can be controlled with early interventions and treatment of patients in the risk group.
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Affiliation(s)
- Ayşegül Yayla
- Department of Surgical Nursing, Faculty of Nursing, Atatürk University, Erzurum, Turkey.
| | - Vesile Eskici İlgin
- Department of Surgical Nursing, Faculty of Nursing, Atatürk University, Erzurum, Turkey
| | - Tülay Kılınç
- Department of Surgical Nursing, Faculty of Nursing, Atatürk University, Erzurum, Turkey
| | - Zeynep Karaman Özlü
- Department of Surgical Nursing, Faculty of Nursing, Anesthesiology Clinical Research Office, Atatürk University, Erzurum, Turkey
| | - Serap Ejder Apay
- Atatürk University Health Science Faculty, Department of Midwifery, Erzurum, Turkey
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Majumdar JR, Assel MJ, Lang SA, Vickers AJ, Afonso AM. Implementation of an Enhanced Recovery Protocol in Patients Undergoing Mastectomies for Breast Cancer: an interrupted time-series design. Asia Pac J Oncol Nurs 2022; 9:100047. [PMID: 35647224 PMCID: PMC9133751 DOI: 10.1016/j.apjon.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/24/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jennifer R. Majumdar
- Departments of Anesthesiology and Critical Care Medicine, New York, NY, USA
- Corresponding author.
| | | | - Stephanie A. Lang
- Breast Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Anoushka M. Afonso
- Departments of Anesthesiology and Critical Care Medicine, New York, NY, USA
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Gloor Y, Czarnetzki C, Curtin F, Gil-Wey B, Tramèr MR, Desmeules JA. Genetic Susceptibility Toward Nausea and Vomiting in Surgical Patients. Front Genet 2022; 12:816908. [PMID: 35173765 PMCID: PMC8842269 DOI: 10.3389/fgene.2021.816908] [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: 11/17/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Postoperative nausea and vomiting (PONV) are frequently occurring adverse effects following surgical procedures. Despite predictive risk scores and a pallet of prophylactic antiemetic treatments, it is still estimated to affect around 30% of the patients, reducing their well-being and increasing the burden of post-operative care. The aim of the current study was to characterize selected genetic risk factors of PONV to improve the identification of at risk patients. We genotyped 601 patients followed during the first 24 h after surgery for PONV symptoms in the absence of any antiemetic prophylaxis. These patients were recruited in the frame of a randomized, placebo controlled clinical study aiming to test the efficacy of dexamethasone as a treatment of established PONV. We examined the impact of selected single nucleotide polymorphisms (SNPs) located around 13 different genes and the predicted activity of 6 liver drug metabolizing enzymes from the cytochromes P450 family (CYP) on the occurrence and recurrence of PONV. Our genetic study confirms the importance of genetic variations in the type 3B serotonin receptor in the occurrence of PONV. Our modelling shows that integration of rs3782025 genotype in preoperative risk assessments may help improve the targeting of antiemetic prophylaxis towards patients at risk of PONV.
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Affiliation(s)
- Yvonne Gloor
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Christoph Czarnetzki
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.,Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Emergency Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - François Curtin
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.,Personalized Health Programs, Swiss Federal Institute of Technology Zurich (ETHZ), Zurich, Switzerland
| | - Béatrice Gil-Wey
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Martin R Tramèr
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Jules A Desmeules
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
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Chekol B, Zewudu F, Eshetie D, Temesgen N, Molla E. Magnitude and associated factors of intraoperative nausea and vomiting among parturients who gave birth with cesarean section under spinal anesthesia at South Gondar zone Hospitals, Ethiopia. Ann Med Surg (Lond) 2021; 66:102383. [PMID: 34040769 PMCID: PMC8143994 DOI: 10.1016/j.amsu.2021.102383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/04/2021] [Accepted: 05/09/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Intraoperative nausea and vomiting are common intraoperative events by which parturient feel discomfort and disturbed after spinal anesthesia. METHODS Hospital-based cross-sectional study was conducted on mothers who underwent cesarean section with spinal anesthesia. Descriptive analysis and chi-square test were employed. Bivariable and multivariable logistic regressions were used to measure the association of factors with the outcome variable intraoperative nausea and vomiting. A p-value of ≤0.05 was used to decide statistical significance for multivariable logistic regression. RESULT A total of 246 parturients were participated in this study. The incidence of intraoperative nausea and vomiting was 40.2%. According to multivariable logistic regression, age greater than 30 years (AOR, 6.26; 95%CI, 2.2-17.78; p-value 0.001), primiparous (AOR, 3.72; 95%CI, 1.35-10.24; p-value, 0.011), having motion sickness (AOR, 7.1; 95%CI, 2.75-18.33; p-value 0.001), emergency cesarean sectin (AOR, 9.85; 95%CI, 3.19-30.38; p-value 0.001), oxygen suplimentation (AOR, 0.021; 95%CI, 0.005-0.08; p-value 0.0001) and uterotonic agent (AOR, 2.99; 95%CI 1.24-7.22; p-value 0.015) had statistically significant association with intraoperative nausea and vomiting. CONCLUSION In our study, the overall incidence of intraoperative nausea and vomiting after spinal anesthesia was 40.2%. Parturients with age greater than 30 years, having motion sickness, didn't get intraoperative supplemental oxygen, oxytocin used for the uterotonic purpose, emergency surgery, and primiparous were at increased risk of intraoperative nausea and vomiting.
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Affiliation(s)
- Basazinew Chekol
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fentaye Zewudu
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Denberu Eshetie
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Netsanet Temesgen
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Eshetie Molla
- Department of Social Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Park HJ, Chang MJ, Kang SB, Hwang IU, Kim JS, Chang CB. Effects of preoperative, scheduled administration of antiemetics in reducing postoperative nausea and vomiting in patients undergoing total knee arthroplasty. Medicine (Baltimore) 2021; 100:e24143. [PMID: 33429790 PMCID: PMC7793323 DOI: 10.1097/md.0000000000024143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
There is no established protocol regarding the timing of administration of antiemetics in patients undergoing total knee arthroplasty (TKA). The purpose of this study was to determine whether preoperative, rather than postoperative administration of an antiemetic could reduce postoperative nausea and vomiting (PONV) in patients undergoing TKA, and whether there was a difference in postoperative pain, patient satisfaction and complications after TKA between the 2 different administration times.The included patients (N = 101) either received intravenous administration of the ramosetron 1 hour before surgery (N = 50) or at the end of surgery (N = 51) consecutively order. The incidence of PONV and the frequency of rescue medicine use were recorded until 48 hours postoperatively. The severity of postoperative pain and patient satisfaction were assessed using the visual analogue scale. The incidence of complications associated with use of antiemetic was assessed.Preoperative administration of ramosetron did not decrease PONV during the first 48 hours. There was no significant difference in the incidence of nausea and vomiting, use of rescue antiemetics, and the severity of nausea (P > .05). Postoperative pain, satisfaction scores, and the incidence of complications were not different between the 2 groups (P > .05).Preoperative administration of ramosetron did not show clinical advantage in reducing POVN, postoperative pain and improving patient satisfaction. However, the outcomes of complications were not inferior to those of postoperative administration. Therefore, under the current protocol of multimodal therapies, timing of administration of pre-emptive antiemetic did not have significant effect on PONV.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Il-ung Hwang
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul
| | - Jong Seop Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
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Consideration of Migraines Among Risk Factors for Postoperative Nausea and Vomiting. J Clin Med 2020; 9:jcm9103154. [PMID: 33003496 PMCID: PMC7600372 DOI: 10.3390/jcm9103154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
The impact of migraine on postoperative nausea and vomiting (PONV) is controversial, and few studies have focused on their relationship. Thus, we investigated the impact of migraine, among other risk factors, on PONV in a large retrospective study. We analyzed 10 years of clinical data from the Smart Clinical Data Warehouse of Hallym University Medical Center. PONV was defined as nausea or vomiting within the first 24 h after surgery. Patients diagnosed by a neurologist and with a history of triptan use before surgery were enrolled into the migraine group. We enrolled 208,029 patients aged > 18 years who underwent general anesthesia (GA), among whom 19,786 developed PONV within 24 h after GA and 1982 had migraine. Before propensity score matching, the unadjusted and fully adjusted odds ratios (ORs) for PONV in subjects with versus without migraine were 1.52 (95% confidence interval (CI), 1.34–1.72; p < 0.001) and 1.37 (95% CI, 1.21–1.56; p < 0.001), respectively. The OR for PONV in patients with migraine was also high (OR, 1.37; 95% CI, 1.13–1.66; p = 0.001) after matching. Our findings suggest that migraine is a significant risk factor for PONV.
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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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Ford C, McCormick D, Parkosewich J, Derycke-Chapman K, Marshall J, Mancarella J, Chepulis A. Safety and Effectiveness of Early Oral Hydration in Patients After Cardiothoracic Surgery. Am J Crit Care 2020; 29:292-300. [PMID: 32607569 DOI: 10.4037/ajcc2020841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients fast after cardiothoracic surgery because of concerns for nausea, vomiting, dysphagia, and aspiration pneumonia; fasting, however, causes thirst, a distressing symptom. To our knowledge, no studies exist to guide hydration practices in this population. OBJECTIVE To determine the effect of early oral hydration on adverse events and thirst in patients after cardiothoracic surgery. METHODS This study applied a prospective 2-group design in which 149 patients from an 18-bed cardiothoracic intensive care unit were randomized to either usual care (a 6-hour fast) or early oral hydration after extubation. The research protocol involved nurses evaluating patients' readiness for oral hydration and then offering them ice chips. If patients tolerated the ice chips, they were allowed to drink water 1 hour later. RESULTS Most patients (91.3%) had undergone coronary artery or valve surgery, or both. Demographic and clinical variables were similar in both groups. No significant between-group differences were found for the incidence of nausea, vomiting, or dysphagia, and no aspiration pneumonia occurred. Significantly more patients with a high thirst level were in the usual care group (81.2%) than in the early oral hydration group (56.5%; P = .002, r2 test). After adjustment for demographic and clinical variables by using logistic regression, early oral hydration was independently and negatively associated with a high thirst level (odds ratio, 0.30 [95% CI, 0.13-0.69]; P = .004). CONCLUSION This research provides new evidence that oral hydration (ice chips and water) soon after extubation is safe and significantly reduces thirst in particular patients.
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Affiliation(s)
- Catherine Ford
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Donna McCormick
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Janet Parkosewich
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Katrien Derycke-Chapman
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Judith Marshall
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Jessica Mancarella
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Anne Chepulis
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
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Patients' Experiences of Pain and Postoperative Nausea and Vomiting in the Early Postoperative Period After an Elective Knee Arthroplasty. J Perianesth Nurs 2020; 35:382-388. [PMID: 32340790 DOI: 10.1016/j.jopan.2019.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study is to explore patients' experience of pain and postoperative nausea and vomiting (PONV) in the early postoperative period after knee arthroplasties. DESIGN This is a retrospective cohort study with a quantitative approach. Data from patients registered in the Swedish Perioperative Registry were used. We used the Strenghtening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies. METHODS Data were collected from patients (N = 439) undergoing knee arthroplasties. The analysis was performed with descriptive and analytic statistics. FINDINGS The findings indicate that women experienced significantly higher levels of pain than men and suffered significantly more often from PONV. However, the relationship of postoperative pain and PONV was not significant. There was also no significance for the relationship among postoperative pain, PONV, and age. CONCLUSIONS Care needs to be sensitive to differences in experiencing pain and PONV depending on sex or gender bias, with a goal of increasing the equality in care.
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The incidence and factors associated with intraoperative nausea and vomiting during cesarean section under spinal anesthesia, July 2019. An institution based cross sectional study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Aydin A, Kaçmaz M, Boyaci A. Comparison of ondansetron, tropisetron, and palonosetron for the prevention of postoperative nausea and vomiting after middle ear surgery. Curr Ther Res Clin Exp 2019; 91:17-21. [PMID: 31384338 PMCID: PMC6664010 DOI: 10.1016/j.curtheres.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/06/2019] [Indexed: 01/11/2023] Open
Abstract
Background Postoperative nausea and vomiting (PONV) are 2 of the most frequent adverse effects of anesthesia. PONV prolongs hospital stays and also delays the recovery of patients. Objective In this study, the effects of ondansetron, tropisetron, and palonosetron on PONV in patients who had undergone middle ear surgeries such as mastoidectomy or tympanoplasty were compared. Methods The study included 165 American Society of Anesthesiologists grade 1 and 2 patients aged 18 to 65 years. Patients were randomized into 3 groups by a closed envelope method. Neither the patients nor the nurses administering the treatments knew which patient belonged to which group. The anesthetic technique was standardized for all groups. During skin closure, 0.075 mg palonosetron, 5 mg tropisetron, and 8 mg ondansetron were administered intravenously to the palonosetron, tropisetron, and ondansetron groups, respectively. After completion of the surgery, the patients were followed for 48 hours. Diclofenac sodium (100 mg IM) was administered to patients experiencing pain and metoclopramide chloride (10 mg IM) was administered to patients with nausea or vomiting. Potential side effects such as headache and constipation were recorded in the postanesthesia care unit and ear, nose, and throat clinic. Results There was no significant difference in the effects of all 3 antiemetic agents on the severity of PONV (P = 0.081). At 48 hours postoperatively, the incidence of PONV was significantly lower in the palonosteron group (38.2%) than the ondansetron group (63.6%) and tropisetron group (61.8%) (P = 0.011). At 48 hours postoperatively, the incidence of postoperative nausea was significantly lower in the palonosetron group (32.7%) than in the ondansetron group (63.6%) and the tropisetron group (56.4%) (P = .003). The incidence of PONV between hours 12 and 24 postoperatively was significantly higher in the ondansetron group (27.3%) than in the palonosetron group (9.1%) (P = 0.013). The antiemetic requirement in the first hour after surgery was significantly higher in the tropisetron group (25.5%) than in the palonosetron group (7.3%) (P = .019). Conclusions The results of the current study support those of earlier studies that suggest that palonosetron was statistically more effective than the other 2 formulations in the prevention of PONV in patients who have undergone middle ear surgery. (Curr Ther Res Clin Exp. 2019; 80:XXXXXX).
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Affiliation(s)
- Ahmet Aydin
- Department of Anesthesiology, Training and Research Hospital, Niğde, Turkey
| | - Mustafa Kaçmaz
- Department of Anesthesiology, Ömer Halisdemir University Faculty of Medicine, Niğde, Turkey
| | - Adem Boyaci
- Department of Anesthesiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
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Wesmiller SW, Bender CM, Conley YP, Bovbjerg DH, Ahrendt G, Bonaventura M, Sereika SM. A Prospective Study of Nausea and Vomiting After Breast Cancer Surgery. J Perianesth Nurs 2017; 32:169-176. [PMID: 28527544 PMCID: PMC5453310 DOI: 10.1016/j.jopan.2015.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/04/2015] [Accepted: 12/05/2015] [Indexed: 10/21/2022]
Abstract
PURPOSE Postoperative nausea and vomiting (PONV) and post-discharge nausea and vomiting (PDNV) continue to be common and disturbing complications experienced after surgery, particularly in women and especially in women undergoing breast cancer surgery. The purpose of this study was to assess the incidence and risk factors associated with PONV and PDNV from preoperative to 48 hours postoperatively in 97 women scheduled for breast cancer surgery. DESIGN Prospective, comparative design. METHODS After informed consent was obtained, women scheduled for breast cancer surgery were evaluated for incidence of vomiting, as well as the presence and severity of nausea from the preoperative holding area for 48 hours following surgery. Vomiting was assessed as both a nominally scaled, binary variable (Yes/No) and as a continuous variable to measure separate emetic events. Nausea was measured on an 11point verbal numeric scale with 0 being the absence of nausea and 10 representing the highest level of nausea ever experienced. RESULTS Twenty-nine (29.8%) women experienced nausea, and nine (9%) women experienced nausea and vomiting while in the post-anesthesia care unit despite close attention to the need for prophylactic antiemetic medications. Women who experienced PONV had higher levels of pain and received more opioids than those women who did not experience PONV. Women who received intravenous acetaminophen did not experience less PONV in this study. PDNV occurred more frequently than PONV, with 34 women (35%) reporting occurrence after discharge. About 13 women who did not experience PONV while in the PACU subsequently experienced PDNV after leaving the hospital, evidence for the importance of patient discharge teaching regarding these symptoms. Although clinical guidelines are necessary, our observation is that nurses in the PACU setting continuously challenge themselves to individualize the combination of medications and activities for each patient to reduce PONV after surgery.
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Son J, Yoon H. Factors Affecting Postoperative Nausea and Vomiting in Surgical Patients. J Perianesth Nurs 2017; 33:461-470. [PMID: 30077290 DOI: 10.1016/j.jopan.2016.02.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 01/19/2016] [Accepted: 02/23/2016] [Indexed: 10/19/2022]
Abstract
PURPOSE This study was to identify factors affecting postoperative nausea and vomiting (PONV) and to investigate the incidence of PONV for the first 24 hours after operation. DESIGN The prospective research was performed in an 1,100-bed university hospital, from April to December, 2011. The sample consisted of 609 patients with elective surgery. METHODS Factors affecting PONV were identified by multiple logistic regression. FINDINGS Incidence of PONV was 27.1% for the first postoperative 24 hours. Insertion of nasogastric tube (OR, 4.54, P = .002), history of PONV (OR, 3.24, P < .001), general anesthesia (OR, 2.76, P = .002), history of motion sickness (OR, 2.33, P < .001), and female sex (OR, 2.05, P = .004) were high risk factors of PONV. The nonadministration of antiemetics during operation (OR, 1.70, P = .014) and nonuse of intravenous patient-controlled analgesia (OR, 1.54, P = .038) increased PONV during the first postoperative 24 hours. CONCLUSIONS Patients of female gender, history of motion sickness and PONV, general anesthesia, and nasogastric insertion are more likely to experience PONV.
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Semiz A, Akpak YK, Yılanlıoğlu NC, Babacan A, Gönen G, Çam Gönen C, Asıliskender M, Karaküçük S. Prediction of intraoperative nausea and vomiting in caesarean delivery under regional anaesthesia. J Int Med Res 2017; 45:332-339. [PMID: 28222642 PMCID: PMC5536580 DOI: 10.1177/0300060516680547] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objectives This study aimed to predict patients who have caesarean operations under regional anaesthesia and are at risk for intraoperative nausea and vomiting (IONV), for ultimately prompting anaesthetists and surgeons to take preventive measures. Methods This was a retrospective study on 209 patients who had caesarean section under spinal-epidural combined regional anaesthesia. The relevant medical history, such as severe nausea and vomiting in the first trimester, smoking, a history of motion sickness, and premenstrual syndrome (PMS), were obtained from the patients’ records and interviews. Results Patients who had a female neonate, a history of severe nausea and vomiting in the first trimester, and a history of PMS and motion sickness before pregnancy experienced a significantly higher rate of IONV. Smokers were less susceptible to IONV, but this was not significant. Conclusion This study shows that some factors in the medical history of a patient can help identify those who are more likely to suffer from IONV.
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Affiliation(s)
- Altuğ Semiz
- Memorial Hospital, Fetal Medicine and Perinatology Unit, Istanbul, Turkey
| | - Yaşam Kemal Akpak
- Ankara Mevki Military Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
- Yaşam Kemal Akpak, Department of Obstetrics and Gynecology, Ankara Mevki Military Hospital, Ankara 06100, Turkey.
| | | | - Ali Babacan
- GATA Haydarpasa Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Gökhan Gönen
- Necip Fazıl State Hospital, Department of Obstetrics and Gynecology, Kahramanmaraş, Turkey
| | - Canan Çam Gönen
- Necip Fazıl State Hospital, Department of Anesthesiology, Kahramanmaraş, Turkey
| | - Murat Asıliskender
- GATA Haydarpasa Training Hospital, Department of Anesthesiology, Istanbul, Turkey
| | - Selim Karaküçük
- Necip Fazıl State Hospital, Department of Anesthesiology, Kahramanmaraş, Turkey
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Wesmiller SW, Sereika SM, Bender CM, Bovbjerg D, Ahrendt G, Bonaventura M, Conley YP. Exploring the multifactorial nature of postoperative nausea and vomiting in women following surgery for breast cancer. Auton Neurosci 2016; 202:102-107. [PMID: 27729204 DOI: 10.1016/j.autneu.2016.09.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/25/2016] [Accepted: 09/26/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) are two of the most frequent and distressing complications following surgical procedures, with as many as 80% of patients considered to be at risk. Despite recognition of well-established risk factors and the subsequent use of clinical guidelines, 20-30% of women do not respond to antiemetic protocols, indicating that there may be a genetic risk. OBJECTIVE The purpose of this pilot study was to describe the incidence and explore the risk factors associated with PONV after surgery in women diagnosed with early stage breast cancer. METHODS A prospective cohort design was employed to measure PONV in women recruited prior to surgery. DNA was extracted from saliva samples collected prior to discharge. Polymorphisms for seven candidate genes with a known role in one of the neural pathways associated with PONV were included in this study; serotonin receptor (HTR3A), serotonin transport (SLC6A4), tryptophan (TPH), dopamine receptors (DRD2/ANKK and DRD3), catechol-O-methyltransferase (COMT) and histamine (H1). RESULTS Twenty-nine (29.8%) women experienced nausea and 10 (11%) experienced nausea and vomiting while in the PACU despite administration of multiple antiemetic medications. Women who experienced PONV had higher levels of pain and received more opioids than those women who did not experienced PONV. Odds ratios demonstrated that alleles for the COMT, DRD3, and TPH genes were associated with decreased PONV. CONCLUSION The understanding of the multifactorial nature of PONV and the recognition of genetic risk will ultimately lead to the development of personalized interventions to manage these frequent and often debilitating symptoms.
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Affiliation(s)
| | | | | | - Dana Bovbjerg
- University of Pittsburgh Cancer Institute, United States
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Zeraati H, Shahinfar J, Imani Hesari S, Masrorniya M, Nasimi F. The Effect of Ginger Extract on the Incidence and Severity of Nausea and Vomiting After Cesarean Section Under Spinal Anesthesia. Anesth Pain Med 2016; 6:e38943. [PMID: 27847700 PMCID: PMC5101427 DOI: 10.5812/aapm.38943] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/21/2016] [Accepted: 06/25/2016] [Indexed: 11/26/2022] Open
Abstract
Background Nausea and vomiting are one of the most common complications of cesarean sections under spinal anesthesia. Recently, the use of drugs to treat nausea and vomiting has decreased, and nonpharmaceutical and alternative traditional medicine are often preferred. Objectives This study aimed to determine the effect of ginger extract on the incidence and severity of nausea and vomiting after cesarean section under spinal anesthesia. Methods In this double-blind randomized clinical trial, 92 pregnant women, each of whom underwent a cesarean section under spinal anesthesia, were divided in two groups: a control group and an intervention group. The intervention group received 25 drops of ginger extract in 30 cc of water, and the control group received 30 cc of water one hour before surgery. The incidence and severity of nausea and vomiting were assessed during the surgery and two and four hours after the surgery using a self-report scale. Data analysis was performed using SPSS software and statistical tests. Results There was no statistically significant difference between the two groups in terms of maternal age, duration of fasting, duration of surgery, and confounding factors (P > 0.05). According to an independent t-test, there was a significant relationship between the two groups in terms of the incidence and mean severity score of nausea and vomiting during the cesarean section (P < 0.05). However, no statistically significant relationship was found between the two groups in terms of the incidence and mean severity score of nausea and vomiting two and four hours after surgery (P > 0.05). Conclusions The findings of this study showed that ginger extract can be used for the prevention of nausea and vomiting during cesarean section under spinal anesthesia.
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Affiliation(s)
- Hossein Zeraati
- Anesthesiology Department, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Javad Shahinfar
- Anesthesiology Department, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran
- Corresponding author: Javad Shahinfar, Anesthesiology Department, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran. Tel: +98-9157870313, Fax: +98-5832297095, E-mail:
| | - Shiva Imani Hesari
- Anesthesiology Department, Emam Ali Hospital, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mahnaz Masrorniya
- Health Department, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Fatemeh Nasimi
- School of Nursing and Midwifery, Jahrom University of Medical Sciences, Jahrom, Iran
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Smith CA, Ruth-Sahd L. Reducing the Incidence of Postoperative Nausea and Vomiting Begins With Risk Screening: An Evaluation of the Evidence. J Perianesth Nurs 2016; 31:158-71. [DOI: 10.1016/j.jopan.2015.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 03/18/2015] [Accepted: 03/26/2015] [Indexed: 12/16/2022]
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Clinical studies of the relationship between the complication of cervicofacial rhytidectomy postoperative nausea and vomiting and different rhytidectomy sites. J Craniofac Surg 2015; 26:e168-72. [PMID: 25710750 DOI: 10.1097/scs.0000000000001390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND It was demonstrated that there are many complications following cervicofacial rhytidectomy, such as hematoma, edema, seromas, ecchymosis, nerve injury, hypertrophic scarring, contour irregularities, infection, nausea, vomiting, and so on. Accordingly, there is a lot of reports about the treatment of complications following rhytidectomy; nonetheless, we find that there is a trifle of research about the complication of postoperative nausea and vomiting. Thus, this study analyzes the cause of postoperative nausea and vomiting and the relationship between it and different sites. METHODS From 2004 to 2008, 108 patients with a mean age of 52 years (range, 30-74 years) underwent cervicofacial rhytidectomy.The approach of operation is local subcutaneous undermining and superficial musculoaponeurotic system double-plication or suture. All data were recorded such as the time when postoperative nausea and vomiting occurred, the duration of the symptom, the frequency of nausea and vomiting, and the antiemetic medicine taken. All cases were grouped according to the different sites of operation. We divided the patients into group A1 and group A2 based on whether forehead rhytidectomy was performed. Meanwhile, we divided the patients into group B1 and group B2 based on whether cervical rhytidectomy was performed. The data of each group were recorded and statistically analyzed. RESULT Among 108 patients, postoperative nausea and vomiting occurred in 55 patients. The duration of symptom was about 24 hours. The frequency of vomiting was 1 to 5 times. Besides, nausea and vomiting was characteristic of time limit and the tendency of termination. The ratios of vomiting between groups A1 and A2 were significantly different (P < 0.000 l). The ratios between groups B1 and B2 are of no significant difference (P > 0.05). CONCLUSIONS The occurrence of postoperative nausea and vomiting is significantly related with forehead rhytidectomy; nonetheless, postoperative nausea and vomiting almost do not occur in the mid-inferior face and cervical rhytidectomy.
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Deitrick CL, Mick DJ, Lauffer V, Prostka E, Nowak D, Ingersoll G. A comparison of two differing doses of promethazine for the treatment of postoperative nausea and vomiting. J Perianesth Nurs 2014; 30:5-13. [PMID: 25616881 DOI: 10.1016/j.jopan.2014.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 09/10/2013] [Accepted: 01/07/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare the use of promethazine 6.25 mg intravenous (IV) (experimental group) with promethazine 12.5 mg IV (control group) among adult ambulatory surgery patients to control established postoperative nausea or vomiting (PONV). DESIGN/METHODS In a double-blind, randomized controlled trial (n = 120), 59 subjects received promethazine 6.25 mg and 61 subjects received promethazine 12.5 mg to treat PONV. Study doses were administered postoperatively if the subject reported/exhibited nausea and/or vomiting. Outcomes for experimental and control groups were compared on the basis of relief of PONV and sedation levels. FINDINGS Ninety-seven percent of subjects reported total relief of nausea with a single administration of promethazine at either dose. Sedation levels differed between groups at 30 minutes post-medication administration and at the time of discharge to home. CONCLUSIONS Promethazine 6.25 mg is as effective in controlling PONV as promethazine 12.5 mg, while resulting in less sedation.
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Roh YH, Gong HS, Kim JH, Nam KP, Lee YH, Baek GH. Factors associated with postoperative nausea and vomiting in patients undergoing an ambulatory hand surgery. Clin Orthop Surg 2014; 6:273-8. [PMID: 25177451 PMCID: PMC4143513 DOI: 10.4055/cios.2014.6.3.273] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 11/12/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patients undergoing ambulatory surgery under general anesthesia experience considerable levels of postoperative nausea and vomiting (N/V) after their discharge. However, those complications have not been thoroughly investigated in hand surgery patients yet. We investigated factors associated with postoperative N/V in patients undergoing an ambulatory hand surgery under general anesthesia and determined whether patients' satisfaction with this setting is associated with postoperative N/V levels. METHODS We prospectively evaluated 200 consecutive patients who underwent ambulatory hand surgeries under general anesthesia to assess their postoperative N/V visual analogue scale (VAS) levels during the first 24 hours after surgery and their satisfaction with an ambulatory surgery setting. Potential predictors of postoperative N/V were; age, sex, body mass index, smoking behavior, a history of postoperative N/V after previous anesthesia or motion sickness, preoperative anxiety level and the duration time of anesthesia. We conducted multivariate analyses to identify factors associated with postoperative N/V levels. We also conducted multivariate logistic regression analyses to determine whether the N/V levels are associated with the patients' satisfaction with this setting. Here, potential predictors for satisfaction were sex, age, postoperative pain and N/V. RESULTS Postoperative N/V were associated with a non-smoking history, a history of motion sickness and a high level of preoperative anxiety. Twenty-two patients (11%) were dissatisfied with the ambulatory setting and this dissatisfaction was independently associated with moderate (VAS 4-7) and high (VAS 8-10) levels of postoperative N/V and with a high level (VAS 8-10) of postoperative pain. CONCLUSIONS Although most of the patients were satisfied with the ambulatory surgery setting, moderate to high levels of N/V were associated with dissatisfaction of patients with this setting, suggesting a need for better identifying and managing those patients at risk. The information regarding risk factors for N/V could help in preoperative patient consultation regarding an ambulatory hand surgery under general anesthesia.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hwan Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Pyo Nam
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Bergese S, Viloria A, Uribe A, Antor A, Fernandez S. Aprepitant versus ondansetron in preoperative triple-therapy treatment of nausea and vomiting in neurosurgery patients: study protocol for a randomized controlled trial. Trials 2012; 13:130. [PMID: 22862827 PMCID: PMC3475143 DOI: 10.1186/1745-6215-13-130] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 07/16/2012] [Indexed: 11/14/2022] Open
Abstract
Background The incidence of postoperative nausea and vomiting (PONV) is 50% to 80% after neurosurgery. The common prophylactic treatment for postoperative nausea and vomiting is a triple therapy of droperidol, promethazine and dexamethasone. Newer, more effectives methods of prophylaxis are being investigated. We designed this prospective, double-blind, single-center study to compare the efficacy of ondansetron, a neurokinin-1 antagonist, and aprepitant, as a substitute for droperidol, in the prophylactic treatment of postoperative nausea and vomiting after neurosurgery. Methods After obtaining institutional review board approval; 176 patients, 18 to 85 years of age with American Society of Anesthesiologists (ASA) classifications I to III, who did not receive antiemetics 24 h before surgery and were expected to undergo general anesthesia for neurosurgery lasting longer than 2 h were included in this study. After meeting the inclusion and exclusion criteria and providing written informed consent, patients were randomly assigned in a 1:1 ratio to one of two treatment groups: aprepitant or ondansetron. The objective of this study was to conduct a randomized, double-blind, double-dummy, parallel-group and single-center trial to compare and evaluate the efficacies of aprepitant versus ondansetron. Patients received oral aprepitant 40 mg OR oral dummy pill within 2 h prior to induction. At induction, a combination of intravenous dexamethasone 10 mg, promethazine 25 mg, and ondansetron 4 mg OR dummy injection was administered. Therefore, all patients received one dummy treatment and three active PONV prophylactic medications: dexamethasone 10 mg, promethazine 25 mg, and either aprepitant 40 mg OR ondansetron 4 mg infusion. The primary outcome measures were the episodes and severity of nausea and vomiting; administration of rescue antiemetic; and opioid consumption for 120 h postoperatively. Standard safety assessments included adverse event reports, physical and laboratory data, awakening time and duration of recovery from anesthesia. Discussion The results of this comparative study could potentially identify an improved treatment regimen that may decrease the incidence and severity of postoperative nausea and vomiting in patients undergoing neurosurgery. Also, this will serve to enhance patient recovery and overall satisfaction of neurosurgical patients in the immediate postoperative period. Trial registration Registered at The Ohio State University Biomedical Sciences Institutional Review Board: Protocol Number: 2007 H0053
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Affiliation(s)
- Sergio Bergese
- Ohio State University Medical Center, Columbus, OH 43210, USA.
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Dienemann J, Hudgens AN, Martin D, Jones H, Hunt R, Blackwell R, Norton HJ, Divine G. Risk Factors of Patients With and Without Postoperative Nausea (PON). J Perianesth Nurs 2012; 27:252-8. [DOI: 10.1016/j.jopan.2012.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 06/14/2011] [Accepted: 05/29/2012] [Indexed: 11/16/2022]
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Wesmiller SW, Henker RA, Sereika SM, Donovan HS, Meng L, Gruen GS, Tarkin IS, Conley YP. The association of CYP2D6 genotype and postoperative nausea and vomiting in orthopedic trauma patients. Biol Res Nurs 2012; 15:382-9. [PMID: 22718526 DOI: 10.1177/1099800412449181] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The CYP2D6 gene encodes for an enzyme that is involved in the metabolism of more than 25% of all medications, including many opioids and antiemetics. It may contribute to the risk of postoperative nausea and vomiting (PONV), a common surgical complication. However, little research has been conducted in this area. The purpose of this study was to explore the association of CYP2D6 genotypes with PONV in adult surgical trauma patients. Data from 112 patients (28% female) with single extremity fractures, aged 18-70 years, were analyzed. PONV was defined as present if patients reported nausea, were observed vomiting, or received medication for PONV. Saliva samples collected for DNA extraction and Taqman(®) allele discrimination and quantitative real time polymerase chain reaction (qRT-PCR) were used to collect genotype data that were then used to assign CYP2D6 phenotype classification. The incidence of PONV was 38% in the postanesthesia care unit and increased to 50% when assessed at 48 hr. CYP2D6 classification results were 7 (6%) poor metabolizers, 34 (30%) intermediate metabolizers, and 71 (63%) extensive metabolizers. No ultrarapid metabolizers were identified. Patients who were classified as poor metabolizers had less PONV and higher pain scores. Gender and history of PONV, but not smoking, were also significant risk factors. Findings suggest variability in CYP2D6 impacts susceptibility to PONV.
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Does ramosetron reduce postoperative emesis and pain after TKA? Clin Orthop Relat Res 2012; 470:1718-27. [PMID: 22161082 PMCID: PMC3348324 DOI: 10.1007/s11999-011-2208-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 11/22/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current pain management protocols involving many anesthetic and analgesic drugs reportedly provide adequate analgesia after TKA. However, control of emetic events associated with the drugs used in current multimodal pain management remains challenging. QUESTIONS/PURPOSES We determined (1) whether ramosetron prophylaxis reduces postoperative emetic events; and (2) whether it influences pain levels and opioid consumption in patients managed with a current multimodal pain management protocol after TKA. METHODS We randomized 119 patients undergoing TKA to receive either ramosetron (experimental group, n = 60) or no prophylaxis (control group, n = 59). All patients received regional anesthesia, preemptive analgesic medication, continuous femoral nerve block, periarticular injection, and fentanyl-based intravenous patient-controlled analgesia. We recorded the incidence of emetic events, rescue antiemetic requirements, complete response, pain level, and opioid consumption during three periods (0-6, 6-24, and 24-48 hours postoperatively). The severity of nausea was evaluated using a 0 to 10 VAS. RESULTS The ramosetron group tended to have a lower incidence of nausea with a higher complete response and tended to have less severe nausea and fewer rescue antiemetic requirements during the 6- to 24-hour period. However, the overall incidences of emetic events, rescue antiemetic requirements, and complete response were similar in both groups. We found no differences in pain level or opioid consumption between the two groups. CONCLUSIONS Ramosetron reduced postoperative emetic events only during the 6- to 24-hour postoperative period and did not affect pain relief. More efficient measures to reduce emetic events after TKA should be explored. LEVEL OF EVIDENCE Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Collins AS. Postoperative nausea and vomiting in adults: implications for critical care. Crit Care Nurse 2012; 31:36-45. [PMID: 22135330 DOI: 10.4037/ccn2011470] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Postoperative nausea and vomiting is a dreaded, uncomfortable, and unpleasant patient experience that is also a factor contributing to adverse outcomes in postoperative recovery. The key to management of this concern is to identify high-risk patients and to develop a systematic method of assessment, intervention, and evaluation within the perianesthesia care continuum. This discussion outlines the wide range of pharmacological and alternative therapies that are available in clinical practice with a case study to illustrate incorporation of these interventions in critically ill patients.
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Sussanne B, Arweström C, Baker A, Berterö C. Nurses’ experiences in the relief of postoperative nausea and vomiting. J Clin Nurs 2010; 19:1865-72. [DOI: 10.1111/j.1365-2702.2009.03176.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Conway B. Prevention and management of postoperative nausea and vomiting in adults. AORN J 2009; 90:391-413. [PMID: 19735762 DOI: 10.1016/j.aorn.2009.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 06/15/2009] [Indexed: 12/20/2022]
Abstract
In early 2007, patients at our small community hospital's outpatient surgery center experienced postoperative nausea and postoperative nausea and vomiting (PONV) at a rate of 27% to 35%. Many record reviews and a written survey of nurses in the postanesthesia care unit and same day surgery center revealed that little or no risk assessment and no consistent prophylaxis or treatment were in use by nurses, physicians, or anesthesia care providers. After a review of the literature and discussions with anesthesia care providers, we developed and put into practice a risk assessment tool and perioperative care path. A formal evaluation to assess the effectiveness of the plan was performed one year after implementation. We found that the rates of PONV had decreased to 16%. AORN J 90 (September 2009) 391-413. (c) AORN, Inc, 2009.
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Neufeld SM, Newburn-Cook CV, Drummond JE. Prognostic models and risk scores: can we accurately predict postoperative nausea and vomiting in children after craniotomy? J Perianesth Nurs 2008; 23:300-10. [PMID: 18939320 DOI: 10.1016/j.jopan.2007.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Postoperative nausea and vomiting (PONV) is a problem for many children after craniotomy. Prognostic models and risk scores help identify who is at risk for an adverse event such as PONV to help guide clinical care. The purpose of this article is to assess whether an existing prognostic model or risk score can predict PONV in children after craniotomy. The concepts of transportability, calibration, and discrimination are presented to identify what is required to have a valid tool for clinical use. Although previous work may inform clinical practice and guide future research, existing prognostic models and risk scores do not appear to be options for predicting PONV in children undergoing craniotomy. However, until risk factors are further delineated, followed by the development and validation of prognostic models and risk scores that include children after craniotomy, clinical judgment in the context of current research may serve as a guide for clinical care in this population.
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Affiliation(s)
- Susan M Neufeld
- Canadian Child Health Clinician Scientist Program, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
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Abstract
Postoperative nausea and vomiting (PONV) is a significant problem in the ambulatory surgical setting. PONV results in delayed discharge, increased cost, and decreased patient satisfaction. Treating patients at risk for PONV preemptively before surgery can minimize these negative outcomes. Nurses play a key role in preventing PONV by first identifying patients at risk. Administering medication and fluids, providing comfort measures, and assessing the patient throughout the postoperative course are crucial nursing functions in the treatment of PONV. However, successful patient outcomes require a multidisciplinary approach. There have been great advances in the treatment of this common postoperative complication with improved anesthesia techniques and newer antiemetic drugs. Future research is needed to determine optimal combinations and timing of medications. Effective prevention and treatment of PONV improve patient outcomes and provide a more pleasant postoperative experience for the patient.
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Nunley C, Wakim J, Guinn C. The effects of stimulation of acupressure point p6 on postoperative nausea and vomiting: a review of literature. J Perianesth Nurs 2008; 23:247-61. [PMID: 18657760 DOI: 10.1016/j.jopan.2008.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 06/20/2007] [Accepted: 05/15/2008] [Indexed: 10/21/2022]
Abstract
Postoperative nausea and vomiting (PONV) can complicate and delay patient recovery from general and neuraxial anesthesia. Even with a new generation of anesthetic drugs and antiemetics, a high number of patients are affected by PONV. PONV has a multifactor etiology, but there are ways to reduce its occurrence. Although it is not a traditionally recognized method, stimulation of acupressure points, specifically P6, has been identified as a potentially effective method of reducing PONV. This study is a state of the science paper reviewing research on both pharmacologic and nonpharmacologic prophylaxis and various methods of acupressure. It was conducted to add information to the currently available knowledge regarding PONV in hopes of stimulating the use of acupressure for treatment of PONV. The study is divided into six categories: pathophysiology of PONV, background studies of PONV, nonpharmacologic prophylaxis, pharmacological prophylaxis, acupressure and related techniques, and benefits of routine antiemetic prophylaxis.
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Villars PS, Veazie MQ, Berger JS, Vu QM, Campbell-McAdory AA, Frenzel JC, Kee SS. Adaptation of the OODA Loop to Reduce Postoperative Nausea and Vomiting in a High-Risk Outpatient Oncology Population. J Perianesth Nurs 2008; 23:78-86. [DOI: 10.1016/j.jopan.2007.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 07/11/2007] [Accepted: 11/15/2007] [Indexed: 12/12/2022]
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