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Shim JG, Ryu KH, Cho EA, Ahn JH, Cha YB, Lim G, Lee SH. Machine learning for prediction of postoperative nausea and vomiting in patients with intravenous patient-controlled analgesia. PLoS One 2022; 17:e0277957. [PMID: 36548346 PMCID: PMC9778492 DOI: 10.1371/journal.pone.0277957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a still highly relevant problem and is known to be a distressing side effect in patients. The aim of this study was to develop a machine learning model to predict PONV up to 24 h with fentanyl-based intravenous patient-controlled analgesia (IV-PCA). METHODS From July 2019 and July 2020, data from 2,149 patients who received fentanyl-based IV-PCA for analgesia after non-cardiac surgery under general anesthesia were applied to develop predictive models. The rates of PONV at 1 day after surgery were measured according to patient characteristics as well as anesthetic, surgical, or PCA-related factors. All statistical analyses and computations were performed using the R software. RESULTS A total of 2,149 patients were enrolled in this study, 337 of whom (15.7%) experienced PONV. After applying the machine-learning algorithm and Apfel model to the test dataset to predict PONV, we found that the area under the receiver operating characteristic curve using logistic regression was 0.576 (95% confidence interval [CI], 0.520-0.633), k-nearest neighbor was 0.597 (95% CI, 0.537-0.656), decision tree was 0.561 (95% CI, 0.498-0.625), random forest was 0.610 (95% CI, 0.552-0.668), gradient boosting machine was 0.580 (95% CI, 0.520-0.639), support vector machine was 0.649 (95% CI, 0.592-0.707), artificial neural network was 0.686 (95% CI, 0.630-0.742), and Apfel model was 0.643 (95% CI, 0.596-0.690). CONCLUSIONS We developed and validated machine learning models for predicting PONV in the first 24 h. The machine learning model showed better performance than the Apfel model in predicting PONV.
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Affiliation(s)
- Jae-Geum Shim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung-Ho Ryu
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Ah Cho
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Hee Ahn
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Byeong Cha
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Goeun Lim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hyun Lee
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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Risk Factors of Postoperative Vomiting in the Eye of "Real-World Evidence"-Modifiable and Clinical Setting-Dependent Risk Factors in Surgical Trauma Patients. J Pers Med 2021; 11:jpm11050386. [PMID: 34066821 PMCID: PMC8151314 DOI: 10.3390/jpm11050386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
Numerous studies on postoperative nausea and vomiting (PONV) have been carried out since the early days of contemporary surgery. The incidence of PONV has been greatly reduced in recent years and new drugs for PONV keep evolving in the market; however, a substantial number of patients are still under the threat of PONV. Female gender, non-smokers, a history of PONV/motion sickness, and postoperative opioid use are four well-recognized risk factors of PONV. Many potential risk factors reported in previous studies were not consistently presented as predictors for PONV. Two questions then arise; are risk factors clinical setting dependent and are risk factors modifiable? We attempted to answer the questions through a comprehensive review of perioperative records of surgical patients from the Trauma Department of our hospital. As nausea is subjective and no standard is applicable for its measurement, postoperative vomiting (POV) was used as an endpoint in this study. To the best of our knowledge, this is the first study to address the POV issue in surgical trauma patients. A total of 855 patients were enrolled in this study after excluding age below 20 years old, total intravenous anesthesia, desflurane anesthesia, or records with missing data. Our results showed that female gender (OR 4.89) is the strongest predicting factor, followed by a less potent predicting factor—more intraoperative opioid consumption (OR 1.07)—which favor more POV. More intraoperative crystalloid supply (OR 0.71) and a higher body weight (OR 0.9) favor less POV. Other potential risk factors did not reach statistical significance in this study as independent risk factors. Our results also showed that when the intraoperative crystalloid infusion rate is greater than 4 mL/kg/h (OR 0.20), it favors a lower rate of POV; when intraoperative opioid consumption is greater than 12 mg morphine equivalents, MME (OR 1.87), it favors a higher rate of POV. We concluded that dominance of any independent risk factor over other risk factors depends on how individual factors interact with the clinical setting. Some risk factors could be modified, and a cut-off value could be derived to facilitate a better plan for POV prevention.
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Effects of menstrual cycle on nausea and vomiting after general anesthesia. J Anesth 2020; 34:519-526. [PMID: 32342186 DOI: 10.1007/s00540-020-02781-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the impact of menstrual cycle on patients undergoing gynecological endoscopic surgery. PATIENTS AND METHODS 220 patients scheduled for gynecological endoscopic surgery under general anesthesia were selected. The patients were divided into three groups based on 3 phases of menstrual cycle which are the follicular phase (Group F), ovulatory phase (Group O) or luteal phase (Group L). It is based on their duration of menstruation and the last day of menstrual bleeding from the date of surgery. Primary outcomes were the incidences of early and late postoperative nausea and vomiting (PONV) in the three patient groups. Preoperative venous blood was taken to determine the estrogen and progesterone levels of the patients. RESULTS A total of 207 patients were enrolled. The incidence of early PONV was highest in group O (22.22% vs 43.33% vs 17.86%, P < 0.01). Multivariate logistic regression showed that menstrual cycle (P < 0.01) and sufentanil dosage (P < 0.05) were independent risk factors for early PONV, menstrual cycle (P = 0.03) and intraoperative hypotension (P = 0.03) were independent risk factors for late PONV. After the propensity matching, the incidences of early and late PONV in group O were both higher than that in other two groups (19.23% vs 44.68% vs 16.90%, P < 0.01; 53.80% vs 72.34% vs 45.07%, P = 0.01). CONCLUSION The incidence of PONV after gynecological endoscopic surgery was different in patients with different menstrual cycles, with the highest incidence in ovulation.
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Wang T, Liu H, Sun JH, Wang L, Zhang JY. Efficacy of intravenous lidocaine in improving post-operative nausea, vomiting and early recovery after laparoscopic gynaecological surgery. Exp Ther Med 2019; 17:4723-4729. [PMID: 31086606 DOI: 10.3892/etm.2019.7497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/28/2019] [Indexed: 12/15/2022] Open
Abstract
Post-operative nausea and vomiting (PONV) is a major peri-operative complication. It has numerous adverse consequences that seriously affect the post-operative recovery of patients. The aim of the present study was to investigate the efficacy of intravenous lidocaine in improving PONV and recovery after laparoscopic gynaecological surgery. A total of 40 patients were randomly assigned to 2 groups: Group L (lidocaine group) and Group C (control group). The patients in Group L received intravenous lidocaine throughout the operation, while patients in Group C were given a saline infusion. Vital signs, recovery time, extubation time, dosage of remifentanil, first flatus time and defecation time of each patient were recorded. The incidence of PONV after surgery was also recorded. The recovery of the patients was evaluated by using the quality of recovery score (QoR-40). The total dose of remifentanil was significantly lower in Group L (P<0.05). However, the recovery time and extubation time were shorter in Group C (P<0.05). The first flatus time and defecation time were longer in Group C (P<0.05). The mean arterial pressure and heart rate in Group L were lower and more stable (P<0.05). At 6 h after surgery, the incidence of PONV was significantly lower in Group L vs. that in Group C (P<0.05). The QoR-40 score in Group C was significantly lower at 1 and 3 days after the operation compared with that in Group C (P<0.05). In conclusion, intravenous lidocaine administered to patients undergoing laparoscopic gynaecological surgery may reduce PONV and supports their early recovery [trial registration number in Chinese Clinical Trial Registry: ChiCTR-IOR-17010782 (March 5, 2017)].
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Affiliation(s)
- Tao Wang
- Department of Anesthesia, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Hui Liu
- Department of Endocrinology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Jian Hong Sun
- Department of Anesthesia, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Lin Wang
- Department of Anesthesia, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
| | - Jian You Zhang
- Department of Anesthesia, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, P.R. China
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Efune PN, Minhajuddin A, Szmuk P. Incidence and factors contributing to postdischarge nausea and vomiting in pediatric ambulatory surgical cases. Paediatr Anaesth 2018; 28:257-263. [PMID: 29436139 DOI: 10.1111/pan.13333] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Little is known regarding the incidence and contributing factors of postdischarge nausea and vomiting in children. AIMS The aim of this study was to determine the incidence of postdischarge nausea and vomiting in day surgery patients and to identify demographic, intraoperative, and postoperative variables that influence the risk. METHODS In this prospective observational study, a postdischarge questionnaire was administered to parents of ambulatory patients who received anesthesia and the electronic records were reviewed. RESULTS Of 1041 ambulatory patients who received general anesthesia, 143 (14%) experienced postdischarge nausea and vomiting. Patients who did not receive intraoperative opioids had a lower incidence (8%) than those who received short-acting opioids (14%) (difference of 6%, 95% CI 1.9%-10.2%, P < .001) or long-acting opioids (24%) (difference of 16%, 95% CI 8.1%-24.3%, P < .001). Patients who received short-acting opioids also had a lower incidence than those who received long-acting opioids (difference of 10%, 95% CI 2.2%-18.1%, P < .001). The incidence also differed between those patients who received postdischarge opioids at home (29%) and those who did not (13%) (difference of 16%, 95% CI 7.5%-27.6%, P < .001). There was no association with age, gender, airway management, nitrous oxide use, amount of intravenous fluids, duration of anesthesia, intraoperative antiemetic administration or dosage, length of time from recovery room discharge to first oral intake, or length of ride home from the hospital. Multivariate generalized linear regression analysis confirmed intraoperative (short-acting opioids odds ratio 1.686, 95% CI 1.020-2.787; long-acting opioids odds ratio 3.093, 95% CI 1.634-5.874) and postdischarge (odds ratio 2.037 95% CI 1.142-3.632) opioids to be independent risk factors for postdischarge nausea and vomiting. CONCLUSION We found an incidence of postdischarge nausea and vomiting of 14%. Intraoperative and postdischarge opioids increase the risk, with long-acting intraoperative opioids further accentuating the risk.
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Affiliation(s)
- Proshad N Efune
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
| | - Abu Minhajuddin
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter Szmuk
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA.,Outcome Research Consortium, Cleveland Clinic, OH, USA
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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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Stallings-Welden LM, Doerner M, Ketchem EL, Benkert L, Alka S, Stallings JD. A Comparison of Aromatherapy to Standard Care for Relief of PONV and PDNV in Ambulatory Surgical Patients. J Perianesth Nurs 2017; 33:116-128. [PMID: 29580591 DOI: 10.1016/j.jopan.2016.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/29/2016] [Accepted: 09/04/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine effectiveness of aromatherapy (AT) compared with standard care (SC) for postoperative and postdischarge nausea and vomiting (PONV/PDNV) in ambulatory surgical patients. DESIGN Prospective randomized study. METHODS Patients (n = 254) received either SC or AT for PONV and interviewed for effectiveness of PDNV. Machine learning methods (eight algorithms) were used to evaluate. FINDING Of patients (64 of 221) that experienced PONV, 52% were in the AT group and 48% in the SC group. The majority were satisfied with treatment (timely, P = .60; effectiveness, P = .86). Of patients that experienced PDNV, treatment was 100% effective in the AT group and 67% in the SC group. The cforest algorithm was used to develop a model for predicting PONV with literature-based risk factors (0.69 area under the curve). CONCLUSIONS AT is an effective way to manage PONV/PDNV. Gender and age were the most important predictors of PONV.
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Oh H, Kim BH. Comparing Effects of Two Different Types of Nei-Guan Acupuncture Stimulation Devices in Reducing Postoperative Nausea and Vomiting. J Perianesth Nurs 2016; 32:177-187. [PMID: 28527545 DOI: 10.1016/j.jopan.2015.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/22/2015] [Accepted: 12/05/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the effects of a relief band using transcutaneous electrical nerve stimulation with a wrist band using acupressure on the Nei-Guan acupuncture point to relieve postoperative nausea and vomiting (PONV) in patients who had undergone gynecologic surgery. DESIGN A double-blinded randomized controlled trial. METHODS In total, 54 patients scheduled for gynecologic surgery under general anesthesia were included in this study. Assessments of PONV were performed 0, 2, 6, and 24 hours after discharge from the postanesthesia care unit. The severity of PONV was measured using the Rhodes' Index of Nausea, Vomiting and Retching and by recording the frequency of patient-requested antiemetic administration that is used to treat severe cases of PONV. FINDINGS The relief band reduced the severity of PONV and the need for antiemetic administration within the first 24 hours postsurgery. CONCLUSIONS The results of this study support the use of a relief band when compared with a wrist band and with a control group to reduce PONV in women after gynecologic surgery.
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Smith CA, Haas RE, Zepp JC, Klein M. Improving the quality of post-anesthesia care: An evidence based initiative to decrease the incidence of postoperative nausea and vomiting in the post-anesthesia care unit. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.pcorm.2016.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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Oh CS, Jung E, Lee SJ, Kim SH. Effect of nefopam- versus fentanyl-based patient-controlled analgesia on postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery: a prospective double-blind randomized controlled trial. Curr Med Res Opin 2015; 31:1599-607. [PMID: 26047392 DOI: 10.1185/03007995.2015.1058251] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study comparatively evaluated the effect of patient-controlled analgesia (PCA) regimens using equipotent doses of nefopam or fentanyl during laparoscopic gynecological surgery on postoperative nausea and vomiting (PONV). RESEARCH DESIGN AND METHODS Patients undergoing gynecological laparoscopic surgery were randomly allocated to receive either nefopam- (non-opioid; N group) or fentanyl-based (F group) PCA. PONV and postoperative pain were assessed during the 72 hours following discharge from the post-anesthetic care unit (PACU). The adverse effects of nefopam were also evaluated. CLINICAL TRIAL REGISTRATION Cris.nih.go.kr ID KCT0000783. RESULTS In total, 94 patients were included in the final analysis. The PONV incidence and scale and the Rhodes index scores were significantly lower in the N group than the F group at all measured times. The N group exhibited a significantly lower incidence of PONV (15/47 [31.9%] vs. 27/47 [57.4%], respectively; P = 0.022) and severity of PONV (0 [1] vs. 1 [2], respectively; P = 0.005) 24 hours after PACU discharge and a significantly lower Rhodes index score (0 [3] vs. 5 [9], respectively; P = 0.002) from 30 minutes after PACU arrival to 24 hours after PACU discharge than did the F group. There was no significant difference in postoperative pain at any time between the two groups. Dry mouth on PACU arrival was significantly more frequent in the N group. However, the frequency of dry mouth decreased after PACU arrival in the N group, resulting in a significantly lower incidence 24 hours after PACU discharge. CONCLUSIONS Use of a PCA regimen with nefopam for analgesia was associated with a similar degree of pain control and superior PONV outcomes 24 hours after PACU discharge and no adverse events compared with a PCA regimen using an equipotent dose of fentanyl.
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Affiliation(s)
- Chung-Sik Oh
- a a Department of Anesthesiology and Pain Medicine , Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea
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Kim SH, Oh CS, Lee SJ. Efficacy of palonosetron and ramosetron on postoperative nausea and vomiting related to intravenous patient-controlled analgesia with opioids after gynecological laparoscopic surgery (double-blinded prospective randomized controlled trial). J Anesth 2015; 29:585-92. [PMID: 25735497 DOI: 10.1007/s00540-015-1981-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The study was designed to assess the efficacy of palonosetron and ramosetron in preventing postoperative nausea and vomiting (PONV) related to intravenous (IV) patient-controlled analgesia (PCA) with opioids after gynecological laparoscopic surgery. METHODS Patients were randomly allocated to 4 groups-C, P, R0.3 and RPCA. At the end of surgery, group C received an infusion of 50 ml normal saline, group P received palonosetron 75 μg mixed in 50 ml normal saline, and groups R0.3 and RPCA received ramosetron 0.3 mg mixed in 50 ml normal saline. A PCA pump containing fentanyl was connected for all groups; however, ramosetron 0.6 mg was mixed with the PCA regimen for the RPCA group. PONV and postoperative pain were assessed. RESULTS PONV incidence and scale, and Rhodes index in RPCA group between 24 and 72 h after discharge from the post-anesthetic care unit (PACU) showed significantly lower values, compared with the other groups. PONV incidence and scale, and Rhodes index in P group and R0.3 group were lower than the corresponding values in C group at all times, without statistical significance. CONCLUSION A single dose of palonosetron 75 μg or ramosetron 0.3 mg was unable to prevent PONV related to IV PCA with opioids in patients undergoing gynecological laparoscopic surgery. The combination of a single dose of ramosetron 0.3 mg, followed by ramosetron 0.6 mg mixed with PCA, significantly decreased PONV compared with a single dose of palonosetron 75 μg or ramosetron 0.3 mg.
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Affiliation(s)
- Seong-Hyop Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1, Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea,
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Hwang Y, Park S. Effects of Preoperative Dehydration on Postoperative Nausea and Vomiting in Gynecological Surgery Patients. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2015; 21:23-31. [PMID: 37684809 DOI: 10.4069/kjwhn.2015.21.1.23] [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: 02/09/2015] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 09/10/2023] Open
Abstract
PURPOSE The purpose of this study was to investigate the effect of dehydration from preoperative fasting on postoperative nausea and vomiting in patients who underwent gynecologic surgeries. METHODS Study design was a prospective descriptive study. A total of 75 patients in a university hospital were selected. Data were collected from March 17 to May 16, 2014 using self-report questionnaires and clinical electronic chart. RESULTS Factors influencing the development of postoperative nausea and vomiting were type of surgery (t=3.44, p=.001), use of PCA (t=-2.16, p=.034), and preoperative dehydration level (t=5.93, p<.001), and these variables accounted for 51.7% of postoperative nausea and vomiting. Among these variables, preoperative dehydration amount (beta=.56) showed the largest influence in the difference in postoperative nausea and vomiting. CONCLUSION Reducing dehydration during preoperative fasting can prevent occurrence of postoperative nausea and vomiting. Development of a clinical guideline is necessary to give directions for the prevention of dehydration during preoperative fasting and to ensure the proper duration of fasting according to patient characteristics, type of surgery and time of surgery.
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Affiliation(s)
| | - Somi Park
- Wonju Severance Christian Hospital, Wonju, Korea
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Effectiveness of tranexamic acid on intraoperative blood loss in isolated Le Fort I osteotomies – A prospective, triple blinded randomized clinical trial. J Craniomaxillofac Surg 2014; 42:1221-4. [DOI: 10.1016/j.jcms.2014.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 12/28/2013] [Accepted: 03/10/2014] [Indexed: 11/21/2022] Open
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Choi JB, Shim YH, Lee YW, Lee JS, Choi JR, Chang CH. Incidence and risk factors of postoperative nausea and vomiting in patients with fentanyl-based intravenous patient-controlled analgesia and single antiemetic prophylaxis. Yonsei Med J 2014; 55:1430-5. [PMID: 25048507 PMCID: PMC4108834 DOI: 10.3349/ymj.2014.55.5.1430] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE We evaluated the incidence and risk factors of postoperative nausea and vomiting (PONV) in patients with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and single antiemetic prophylaxis of 5-hydroxytryptamine type 3 (5 HT₃)-receptor antagonist after the general anesthesia. MATERIALS AND METHODS In this retrospective study, incidence and risk factors for PONV were evaluated with fentanyl IV-PCA during postoperative 48 hours after various surgeries. RESULTS Four hundred-forty patients (23%) of 1878 had showed PONV. PCA was discontinued temporarily in 268 patients (14%), mostly due to PONV (88% of 268 patients). In multivariate analysis, female, non-smoker, history of motion sickness or PONV, long duration of anesthesia (>180 min), use of desflurane and intraoperative remifentanil infusion were independent risk factors for PONV. If one, two, three, four, five, or six of these risk factors were present, the incidences of PONV were 18%, 19%, 22%, 31%, 42%, or 50%. Laparoscopic surgery and higher dose of fentanyl were not risk factors for PONV. CONCLUSION Despite antiemetic prophylaxis with 5 HT₃-receptor antagonist, 23% of patients with fentanyl-based IV-PCA after general anesthesia showed PONV. Long duration of anesthesia and use of desflurane were identified as risk factors, in addition to risk factors of Apfel's score (female, non-smoker, history of motion sickness or PONV). Also, intraoperative remifentanil infusion was risk factor independent of postoperative opioid use. As the incidence of PONV was up to 50% according to the number of risk factors, risk-adapted, multimodal or combination therapy should be applied.
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Affiliation(s)
- Jong Bum Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yon Hee Shim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Youn-Woo Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Soo Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Rim Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Ho Chang
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Woo JH, Kim YJ, Baik HJ, Han JI, Chung RK. Does intravenous ketamine enhance analgesia after arthroscopic shoulder surgery with ultrasound guided single-injection interscalene block?: a randomized, prospective, double-blind trial. J Korean Med Sci 2014; 29:1001-6. [PMID: 25045235 PMCID: PMC4101767 DOI: 10.3346/jkms.2014.29.7.1001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 04/30/2014] [Indexed: 01/13/2023] Open
Abstract
Ketamine has anti-inflammatory, analgesic and antihyperalgesic effect and prevents pain associated with wind-up. We investigated whether low doses of ketamine infusion during general anesthesia combined with single-shot interscalene nerve block (SSISB) would potentiate analgesic effect of SSISB. Forty adult patients scheduled for elective arthroscopic shoulder surgery were enrolled and randomized to either the control group or the ketamine group. All patients underwent SSISB and followed by general anesthesia. During an operation, intravenous ketamine was infused to the patients of ketamine group continuously. In control group, patients received normal saline in volumes equivalent to ketamine infusions. Pain score by numeric rating scale was similar between groups at 1, 6, 12, 24, 36, and 48 hr following surgery, which was maintained lower than 3 in both groups. The time to first analgesic request after admission on post-anesthesia care unit was also not significantly different between groups. Intraoperative low dose ketamine did not decrease acute postoperative pain after arthroscopic shoulder surgery with a preincisional ultrasound guided SSISB. The preventive analgesic effect of ketamine could be mitigated by SSISB, which remains one of the most effective methods of pain relief after arthroscopic shoulder surgery.
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Affiliation(s)
- Jae Hee Woo
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Youn Jin Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hee Jung Baik
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jong In Han
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Rack Kyung Chung
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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17
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Abstracts of a joint meeting of the Anaesthetic Research Society and the Chinese Society of Anesthesiologists. Br J Anaesth 2013. [DOI: 10.1093/bja/aes343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Apfel C, Heidrich F, Jukar-Rao S, Jalota L, Hornuss C, Whelan R, Zhang K, Cakmakkaya O. Evidence-based analysis of risk factors for postoperative nausea and vomiting †. Br J Anaesth 2012; 109:742-53. [DOI: 10.1093/bja/aes276] [Citation(s) in RCA: 400] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Kim GH, Ahn HJ, Kim HS, Bang SR, Cho HS, Yang M, Kim JA. Postoperative nausea and vomiting after endoscopic thyroidectomy: total intravenous vs. balanced anesthesia. Korean J Anesthesiol 2011; 60:416-21. [PMID: 21738844 PMCID: PMC3121088 DOI: 10.4097/kjae.2011.60.6.416] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 11/29/2010] [Accepted: 11/30/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endoscopic thyroidectomy was recently introduced and has been rapidly accepted by surgeons and patients. The present study was conducted to estimate and compare the incidences of postoperative nausea and vomiting (PONV) after endoscopic thyroidectomy using two different anesthetic methods: sevoflurane based balanced anesthesia; total intravenous anesthesia (TIVA). METHODS Ninety nine female patients that were scheduled to undergo elective endoscopic thyroidectomy under general anesthesia were enrolled. These patients were randomly allocated to receive sevoflurane based balanced anesthesia (BA group) or propofol-remifentanil anesthesia (TIVA group). PONV was evaluated using a 4-point Likert scale, and pain using a visual analogue scale (VAS; range 0 to 100) for 0-2, 2-6, and 6-24 hours postoperatively. At 24 hours postoperatively, overall patient satisfaction regarding PONV and pain were recorded. RESULTS The incidence of PONV was 14.6% in the TIVA group and 51.3% in the BA group. The incidence of nausea at 0-2 and 2-6 hours postoperatively was lower in the TIVA group than in the BA group (4.2% vs. 35.9%, 6.3% vs. 23.1%, respectively), but no between-group difference was observed at 6-24 hours postoperatively (8.3% vs. 5.1%). Antiemetic usage at 0-2 and 2-6 hours was lower in the TIVA than the BA group (4.2% vs. 38.5%, 6.3% vs. 23.1%), but no between-group difference was observed for 6-24 hours (6.3% vs. 7.7%). There were no differences in pain or in patient satisfaction. CONCLUSIONS After endoscopic thyroidectomy, total intravenous anesthesia with propofol-remifentanil is associated with less PONV during the early postoperative period (0-6 hours) than sevoflurane based balanced anesthesia.
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Affiliation(s)
- Gunn Hee Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
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20
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Jee YS, Yoon HJ, Jang CH. Prophylactic antiemetic effects in gynecologic patients receiving fentanyl IV-patient controlled analgesia: comparison of combined treatment with ondansetron and dexamethasone with metoclopramide and dexamethasone. Korean J Anesthesiol 2010; 59:335-9. [PMID: 21179296 PMCID: PMC2998654 DOI: 10.4097/kjae.2010.59.5.335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 04/14/2010] [Accepted: 06/24/2010] [Indexed: 11/10/2022] Open
Abstract
Background This study was conducted to compare the efficacy of a combination of ondansetron and dexamethasone with that of metoclopramide and dexamethasone for prevention of postoperative nausea and vomiting (PONV) in gynecologic patients receiving fentanyl IV-patient controlled analgesia. Methods One hundred patients were divided into two groups at random. In Group O, 5 mg of dexamethsone was administered after tracheal intubation, while 4 mg of ondansetron was administered at the end of surgery. In Group M, 5 mg of dexamethsone was administered after tracheal intubation and 20 mg metoclopromide was administered at the end of surgery. During the experiment, the PONV was evaluated at regular intervals. In addition, the incidence of nausea, and vomiting and the numerical rating scale (NRS) of nausea was measured (range, 0-10). Results The overall incidence of PONV in Group O was 22/50 (44%) while that in Group M was 19/50 (38%). There were no significant differences in the incidence of nausea, moderate to severe nausea (NRS of nausea, 4-10), or vomiting between groups. Conclusions Treatment with a combination of 20 mg metoclopramide and 5 mg dexamethasone is an effective, safe, and inexpensive way to prevent PONV when compared to treatment with 4 mg ondansetron and 5 mg dexamethasone.
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Affiliation(s)
- Young Seok Jee
- Department of Anesthesiology and Pain Medicine, Cheil General Hospital and Women Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
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Kim NC, Yoo JB, Cho MS, Shin EJ, Hahm TS. [Effects of Nei-Guan acupressure on nausea, vomiting and level of satisfaction for gynecological surgery patients who are using a patient-controlled analgesia]. J Korean Acad Nurs 2010; 40:423-32. [PMID: 20634633 DOI: 10.4040/jkan.2010.40.3.423] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was done to examine effects of Nei-Guan acupressure on nausea, vomiting and level of satisfaction for gynecological surgery patients who were using a patient-controlled analgesia (PCA). METHODS For this study, 51 patients were assigned to one of three groups, a control group (17 patients), experimental group 1 (finger acupressure group) (17 patients), and experimental group 2 (relief band group) (17 patients). The data were collected for 24 hr in the recovery room of a university hospital located in Seoul. The 6 hr-intervals including the time of leaving the recovery room were taken into consideration. RESULTS The occurrence of nausea between the experimental group with Nei-Guan acupressure treatment and the control group was different. However, there was no difference in nausea and vomiting control or level of patient satisfaction between the finger acupressure group and the relief band group. CONCLUSION Nei-Guan acupressure is recommended for nursing practice as a way for alleviating the opioid-induced nausea and accelerating the recovery of patients who are using PCA after surgery.
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Affiliation(s)
- Nam Cho Kim
- College of Nursing, The Catholic University of Korea, Seoul, Korea.
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22
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Rüsch D, Eberhart LHJ, Wallenborn J, Kranke P. Nausea and vomiting after surgery under general anesthesia: an evidence-based review concerning risk assessment, prevention, and treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:733-41. [PMID: 21079721 DOI: 10.3238/arztebl.2010.0733] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 04/13/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND The German-language recommendations for the management of postoperative nausea and vomiting (PONV) have been revised by an expert committee. Major aspects of this revision are presented here in the form of an evidence-based review article. METHODS The literature was systematically reviewed with the goal of revising the existing recommendations. New evidence-based recommendations for the management of PONV were developed, approved by consensus, and graded according to the scheme of the Scottish Intercollegiate Guidelines Network (SIGN). RESULTS The relevant risk factors for PONV include female sex, nonsmoker status, prior history of PONV, motion sickness, use of opioids during and after surgery, use of inhalational anesthetics and nitrous oxide, and the duration of anesthesia. PONV scoring systems provide a rough assessment of risk that can serve as the basis for a risk-adapted approach. Risk-adapted prophylaxis, however, has not been shown to provide any greater benefit than fixed (combination) prophylaxis, and PONV risk scores have inherent limitations; thus, fixed prophylaxis may be advantageous. Whichever of these two approaches to manage PONV is chosen, high-risk patients must be given multimodal prophylaxis, involving both the avoidance of known risk factors and the application of multiple validated and effective antiemetic interventions. PONV should be treated as soon as it arises, to minimize patient discomfort, the risk of medical complications, and the costs involved. CONCLUSION PONV lowers patient satisfaction but is treatable. The effective, evidence-based measures of preventing and treating it should be implemented in routine practice.
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Affiliation(s)
- Dirk Rüsch
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Gießen und Marburg GmbH
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23
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Ugochukwu O, Adaobi A, Ewah R, Obioma O. Postoperative nausea and vomiting in a gynecological and obstetrical population in South Eastern Nigeria. Pan Afr Med J 2010; 7:6. [PMID: 21954406 PMCID: PMC3172643 DOI: 10.4314/pamj.v7i1.69111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 10/10/2010] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To determine the incidence of Postoperative nausea and vomiting (PONV) in a high risk surgical group following studies in other predominately black populations that showed a lower rate of postoperative nausea and vomiting than that reported from Caucasian and Oriental populations. METHODS A retrospective observational survey was conducted in the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria to determine the incidence of PONV within forty-eight hours of anesthesia in an obstetrical (caesarean sections only) and gynecological population that underwent regional and general anesthesia. The study took place from December 2007-April 2009 (16 months) for the gynecological population and from May 2008 to May 2010 (25 months) for the obstetrical population. The folders of 300 patients were randomly reviewed for demographics, anesthetic technique, diagnosis and documented records of PONV within 48 hours of anesthesia. RESULTS A total of 300 obstetrical and gynecological patients were used in this study. Twelve women vomited within forty-eight hours of anesthesia (12/300 or 4.0%). Nine patients vomited in the gynecological population (9/112) or 8% of the gynecological population and (3/186) or 1.6% in the obstetric population. All patients were American Society of Anesthesiologists (ASA) 1-4 including surgical emergencies. CONCLUSION The incidence of PONV in this surgical population is lower than that from most of the studies reviewed. This might be due to an inherent ethnic/racial variation. The economic implication of spending on expensive anti-emetics means more money can diverted to other needs.
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Affiliation(s)
- Okafor Ugochukwu
- Department of Anesthesia, University of Nigeria, Enugu Campus, Enugu, Nigeria
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Ruiz JR, Kee SS, Frenzel JC, Ensor JE, Selvan M, Riedel BJ, Apfel C. The Effect of an Anatomically Classified Procedure on Antiemetic Administration in the Postanesthesia Care Unit. Anesth Analg 2010; 110:403-9. [DOI: 10.1213/ane.0b013e3181a9d076] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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25
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Nam M, Yoon H. [Effect of ondansetron combined with dexamethasone on postoperative nausea & vomiting and pain of patients with laparoscopic hysterectomy]. J Korean Acad Nurs 2009; 39:44-52. [PMID: 19265311 DOI: 10.4040/jkan.2009.39.1.44] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to compare the effects of ondansetron combined with dexamethasone on Post-Operative Nausea and Vomiting (PONV) and pain with ondansetron alone in patients with laparoscopy assisted vaginal hysterectomy under general anesthesia. METHODS Data were collected from April 1 through September 30, 2005 using a double blind method. Ondansetron 4 mg and dexamethasone 10 mg were administered to the experimental group (25 patients), and ondansetron 4 mg only to the control group (25 patients). The medications were administered through an intravenous line at the beginning peritoneum suture. PONV by Index of Nausea Vomiting and Retching (INVR), nausea by Visual Analogue Scale (VAS), and pain (VAS) were assessed at postoperative 1 hr, 3 hr, 6 hr, 24 hr, and 48 hr. Data were analyzed using repeated measures ANOVA, and Bonferroni methods. RESULTS The experimental group that received ondansetron combined with dexamethasone had less PONV (p=.048), and nausea (p=.012) than control group that received ondansetron alone. However, there was no difference in pain (p=.557) between the patients in the two groups. CONCLUSION We conclude that the administration of ondansetron combined with dexamethasone is more effective than the administration of ondansetron alone to reduce PONV in patients with laparoscopic hysterectomy.
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Affiliation(s)
- Miok Nam
- Department of Nursing, Gil Medical Center, Gachon University of Medicine & Science, Incheon, Korea
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26
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Hirst B, Noble B. Migraine as a cause of persistent nausea or vomiting in palliative care: a case series. J Pain Symptom Manage 2009; 37:918-22. [PMID: 19041219 DOI: 10.1016/j.jpainsymman.2008.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 05/06/2008] [Accepted: 05/17/2008] [Indexed: 10/21/2022]
Abstract
Migraine is common, underdiagnosed, and frequently inadequately treated in the general population. Nausea and vomiting are common reasons for patients to be referred for symptom control. Nausea can be the most prominent feature of migraine; the International Classification of Headache Disorders (ICHD) recognizes cyclical vomiting syndrome as a migraine variant in children, and there is increasing evidence for a similar entity in adults. We present three patients with troublesome nausea uncontrolled by conventional antiemetic therapy. On questioning, all three had other symptoms suggestive of migraine, and two had a family history. Their symptoms settled with the use of various antimigraine therapies. Amitriptyline appears to be particularly useful. A therapeutic trial of prophylaxis may be indicated for patients whose nausea and vomiting may be attributed to migraine.
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Affiliation(s)
- Becky Hirst
- Academic Unit of Supportive Care, University of Sheffield, Sheffield, United Kingdom.
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27
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Lee MY, Min HS. [Effects of the Nei-Guan acupressure by wrist band on postoperative nausea and vomiting after middle ear surgery]. ACTA ACUST UNITED AC 2008; 38:503-12. [PMID: 18753802 DOI: 10.4040/jkan.2008.38.4.503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was to identify the effects of Nei-Guan acupressure using a wrist band on postoperative nausea and vomiting after middle ear surgery. METHODS The study design was a nonequivalent control group non-synchronized posttest design. Forty patients were assigned into two groups of 20 patients, the wrist band group and the control group. In the wrist band group, acupressure was applied with a wrist band on the P6 point at both wrists from 30 min before to 24 hr after anesthesia. RESULTS The 1st hypothesis 'Applied wrist band groups will have a greater reduction in the nausea & vomiting grades by INVR than the control group' was accepted (t=2.303, p=.028). The 2nd hypothesis 'The Applied wrist band groups will have a greater reduction in the occurrence of nausea & vomiting than the control group' was partly accepted. The 3rd hypothesis 'The applied wrist band group will have a greater reduction in injection of antiemetics for 24 hr. post anesthesia than the control group' was rejected. CONCLUSION Acupressure on the P6 point using a wrist band is effective to alleviate nausea for middle ear surgery patients.
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Affiliation(s)
- Myung Yun Lee
- Department of Nursing, Dong-A University Medical Center, Busan, Korea
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28
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Lee JW, Kim SK, Kim DC, Han YJ, Ko SH. The Effects of Female Hormones on Postoperative Nausea and Vomiting. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.54.1.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jeong-Woo Lee
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Seong-Kyu Kim
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Dong-Chan Kim
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Young Jin Han
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Seong-Hoon Ko
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea
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Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS, Hooper VD, Kovac AL, Kranke P, Myles P, Philip BK, Samsa G, Sessler DI, Temo J, Tramèr MR, Vander Kolk C, Watcha M. Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg 2007; 105:1615-28, table of contents. [DOI: 10.1213/01.ane.0000295230.55439.f4] [Citation(s) in RCA: 467] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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30
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Kim EJ, Ko JS, Kim CS, Lee SM, Choi DH. Combination of antiemetics for the prevention of postoperative nausea and vomiting in high-risk patients. J Korean Med Sci 2007; 22:878-82. [PMID: 17982239 PMCID: PMC2693857 DOI: 10.3346/jkms.2007.22.5.878] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
It was previously reported that the Korean predictive model could be used to identify patients at high risk of postoperative nausea and vomiting (PONV). This study investigated whether PONV in the high-risk and very high-risk patients identified by the Korean predictive model could be prevented by multiple prophylactic antiemetics. A total of 2,456 patients were selected from our previous PONV study and assigned to the control group, and 374 new patients were recruited consecutively to the treatment group. Patients in each group were subdivided into two risk groups according to the Korean predictive model: high-risk group and very high-risk group. Patients in the treatment group received an antiemetic combination of dexamethasone 5 mg (minutes after induction) and ondansetron 4 mg (30 min before the end of surgery). The incidences of PONV were examined at two hours after the surgery in the postanesthetic care unit and, additionally, at 24 hr after the surgery in the ward, and were analyzed for any differences between the control and treatment groups. The overall incidence of PONV decreased significantly from 52.1% to 23.0% (p< or =0.001) after antiemetic prophylaxis. Specifically, the incidence decreased from 47.3% to 19.4% (p< or =0.001) in the high-risk group and from 61.3% to 28.3% (p< or =0.001) in the very high-risk group. Both groups showed a similar degree of relative risk reductions: 59.0% vs. 53.8% in the high-risk and very high-risk groups, respectively. The results of our study showed that the antiemetic prophylaxis with the combination of dexamethasone and ondansetron was effective in reducing the occurrence of PONV in both high-risk and very high-risk patients.
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Affiliation(s)
- Eun Jin Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Justin Sang Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung Su Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Min Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duck Hwan Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee YY, Kim KH, Yom YH. Predictive models for post-operative nausea and vomiting in patients using patient-controlled analgesia. J Int Med Res 2007; 35:497-507. [PMID: 17697527 DOI: 10.1177/147323000703500409] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study identified predictive factors for post-operative nausea and vomiting (PONV) in patients using patient-controlled analgesia (PCA) and developed five predictive model pathways to calculate the probability of PONV using decision tree analysis. The sample consisted of 1181 patients using PCA. Data were collected using: a specifically designed check-off form to collect patient-, surgery-, anaesthesia- and post-operation-related data; the Beck Anxiety Inventory to measure pre-operative anxiety; and a visual analogue scale, to measure post-operative pain. The incidence of PONV was 27.7%. Nine factors were highly predictive of PONV in our five model pathways: gender, obesity, anxiety, history of previous PONV, history of motion sickness, inhalation of nitrous oxide during operation, use of inhalational agents, starting oral fluid/food intake after operation, and post-operative pain. With these five predictive model pathways, we can predict the probability of PONV in an individual patient according to their individual characteristics.
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Affiliation(s)
- Y Y Lee
- Postanaesthetic Care Unit, Asan Medical Centre, Songpa-Gu, Seoul, Korea
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32
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Affiliation(s)
- Randolph W Evans
- University of Pittsburgh Medical Center, Pittsburgh, PA 15206, USA
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33
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Kim MS, Lee SY, Kim JS, Min SK, Park YD, Park HJ. The Effect of Ondansetron or Dolasetron for the Prevention of Postoperative Nausea and Vomiting in Patients with Intravenous Patient-controlled Analgesia. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.5.624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Min Suk Kim
- Department of Anesthesiology and Pain Medicine, Seoul Veterans Hospital, Seoul, Korea
| | - Sook Young Lee
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ajou University, Suwon, Korea
| | - Jin Soo Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ajou University, Suwon, Korea
| | - Sang Kee Min
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ajou University, Suwon, Korea
| | - Young Duk Park
- Department of Anesthesiology and Pain Medicine, Seoul Veterans Hospital, Seoul, Korea
| | - Hyung Joo Park
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ajou University, Suwon, Korea
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