Anti-emetic Drugs for Prophylaxis of Postoperative Nausea and Vomiting After Craniotomy: An Updated Systematic Review and Network Meta-Analysis

Postoperative Nausea and Vomiting in the Ambulatory Surgery Center: A Narrative Review

Postoperative nausea and vomiting (PONV) is a common complication of ambulatory surgery, leading to numerous deleterious effects such as decreased patient satisfaction, prolonged recovery unit stays, and rarely, more serious complications such as aspiration pneumonia or wound dehiscence. In this paper, we present a narrative review of the literature regarding common risk factors for PONV including patient factors, surgical factors, and anesthetic factors. We then will review anesthetic techniques and antiemetic drugs demonstrated to mitigate the risk of PONV. Finally, we discuss the potential economic benefits of PONV prophylaxis in the perioperative ambulatory setting.

Transcutaneous electrical acupoint stimulation for postoperative nausea and vomiting in patients undergoing craniotomy: A randomized controlled trial

BACKGROUND

The incidence of nausea and vomiting following craniotomy is high, and pericardium 6 (P6; Neiguan) acupoint stimulation is an important strategy for treating postoperative nausea and vomiting (PONV). Here, we aimed to evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) at P6 as an adjunct to antiemetic drugs to prevent PONV after craniotomy.

MATERIALS AND METHODS

This randomized placebo-controlled trial enrolled 120 patients scheduled for craniotomy. The enrolled patients were randomly assigned to a TEAS or sham TEAS group. The incidence of PONV, pain score, and postoperative remedial treatment with antiemetics and analgesics at 0-2, 2-6, and 6-24 h after craniotomy were assessed.

RESULTS

The patient characteristics did not significantly differ between the two groups (P > 0.05). During 0-2 and 6-24 h after craniotomy, the incidence of vomiting was not significantly different between the two groups (P > 0.05). During 2-6 h, the incidence of vomiting was higher in the sham TEAS group than in the TEAS group (29.3 % vs. 14.0 %, P = 0.047). During 0-2 and 2-6 h, the pain scores did not differ significantly between the two groups (P > 0.05). During 6-24 h after craniotomy, the pain score was significantly higher in the sham TEAS group than in the TEAS group (P = 0.001). The degree of nausea and proportion of patients requiring antiemetic drugs were not significantly different between the two groups in each period (P > 0.05).

CONCLUSION

TEAS at P6 may reduce vomiting incidence and pain scores following craniotomy.

Fosaprepitant Does Not Interfere With Commonly Used Intraoperative Neuromonitoring Modalities Under General Anesthesia: A Preliminary Study

BACKGROUND

Fosaprepitant [Emend®], a neurokinin type-1 [NK-1] receptor antagonist, is a highly effective for the prophylaxis of postoperative nausea and vomiting [PONV] after general anesthesia; it is particularly effective in patients undergoing neurosurgical procedures. Based on the widespread distribution of NK-1 receptors in the central and peripheral nervous systems, we sought to determine whether fosaprepitant administration would interfere with commonly used intraoperative neurophysiologic monitoring modalities during general anesthesia.

METHODS

Eleven patients having propofol-based general anesthesia for interventional neuroradiology procedures were administered 150 mg fosaprepitant intravenously after baseline electroencephalogram [EEG], transcranial motor evoked potential [TcMEP], and somatosensory evoked potential [SSEP] recordings were obtained. Recordings of these neuromonitoring modalities at 30, 60, and 90 min after fosaprepitant administration were compared to baseline.

RESULTS

Fosaprepitant did not have a significant effect on SSEP/TcMEP amplitudes or latencies, or on TcMEP morphology. There were also no changes in EEG voltage, frequency, or symmetry.

CONCLUSION

Fosaprepitant does not appear to markedly interfere with SSEP, TcMEP, or EEG neuromonitoring modalities during propofol-based general anesthesia.

Comparative Efficacy of Granisetron and Droperidol After Orthognathic Surgery for Prophylaxis of Postoperative Nausea and Vomiting: A Retrospective Study

BACKGROUND

In the fall of 2021, granisetron was approved for postoperative nausea and vomiting (PONV) management in Japan. However, the comparative efficacy of droperidol and granisetron in the field of orthognathic surgery has not been determined.

PURPOSE

We compare the efficacy of droperidol and granisetron for PONV prophylaxis following orthognathic surgery.

STUDY DESIGN, SETTING, SAMPLE

We performed a retrospective cohort study of patients who underwent orthognathic surgery at a single institution from September 2020 to December 2022. Patients who had undergone Le Fort I osteotomy with sagittal split ramus osteotomy or isolated sagittal split ramus osteotomy were included. Patients were divided into three groups; the isolated droperidol (D), isolated granisetron (G), and droperidol with granisetron (DG) groups. General anesthesia was performed using total intravenous anesthesia for all patients; however, droperidol and granisetron were administered at the anesthesiologist's discretion.

PREDICTOR VARIABLE

PONV prophylactic therapy included isolated droperidol, isolated granisetron, and droperidol with granisetron administration.

OUTCOME VARIABLES

Postoperative nausea (PON) and postoperative vomiting (POV) were determined through medical examination within 48 hours following surgery. Secondary outcomes included complications due to droperidol and/or granisetron administration.

COVARIATES

Age, sex, body mass index, Apfel's score, duration of surgery, duration of anesthesia, intraoperative blood loss, and type of surgery.

ANALYSES

Statistical analysis was conducted using Fisher exact test, Mann-Whitney U test with Bonferroni correction for univariate comparison, and modified Poisson regression for comparison of PON and POV prophylactic efficacy for multivariate analyses. P values <.05 were considered statistically significant.

RESULTS

Our study included 218 participants. There were no significant differences in covariates between groups D (n = 111), G (n = 52), and DG (n = 55). No significant difference in PON incidence was observed between groups. However, POV incidence was significantly lower in group DG than group D (relative risk, 0.21; 95% confidence interval, 0.05 to 0.86; P = .03). No significant difference in complication incidence was observed between groups.

CONCLUSIONS AND RELEVANCE

Granisetron was as effective as droperidol for PONV management, while droperidol combined with granisetron was more effective than isolated droperidol for POV management. As compared to the use of each drug separately, their combination was considered safe, with no increase in complication rates.

The Effect of Aromatherapy Administration in the Decrease of Nausea in Post-Spinal Anesthesia Patients

Objective: This study aims to know the effect of aromatherapy on reducing nausea in post spinal anesthesia patients. Method: This research is a literature study. In the strategy to find the journal framework used is PICOT. The keywords used are "Aromatherapy and nausea and vomiting and postoperative and spinal anesthesia". The data sources used are e-resources from PubMed and Google Scholar in the form of articles or journals. The inclusion criteria in this study were national and international journals from different databases and related to research variables, namely nausea, with aromatherapy inhalation intervention, as well as articles discussing the effects of inhaled aromatherapy on nausea in postoperative patients with spinal anesthesia. Deadline for publication of articles within the last 5 years (2016-2021). The exclusion criteria for this study were national and international databases and had nothing to do with the study variables, no intervention was given, there was no reflexology effect on anxiety levels in burn patients and the publication time of the article was more than 5 years. Results: In searching for articles using 2 databases, each was found from PubMed 1871 search results and Google Scholar 951 search results. After disqualification related to the year of publication, 485 articles were obtained in the last 5 years, and in the end 8 articles were obtained that matched the criteria obtained. Of the 8 articles that have been reviewed, it was found that postoperative patients with spinal anesthesia experienced nausea Conclusion: Based on a systematic review conducted on 8 articles, it can be concluded that the administration of aromatherapy is very useful for reducing nausea in postoperative patients with spinal anesthesia. There are many choices of aromatherapy that can be given to patients, ranging from lavender aromatherapy, ginger aromatherapy, peppermint aromatherapy, lemon essential oil aromatherapy and rose aromatherapy. So it is suggested that aromatherapy inhalation intervention can be applied to patients who experience postoperative nausea with spinal anesthesia.

The next generation of antiemetics for the management of postoperative nausea and vomiting

Postoperative nausea and vomiting (PONV) afflict approximately 30% of patients overall and up to 80% of high-risk patients after surgery. Optimal pharmacological prophylaxis of PONV is challenging as it necessitates the consideration of PONV risk, drug efficacy, and potential adverse effects. Despite significant advances in our understanding of the pathophysiology and risk factors of PONV, its incidence has remained largely unchanged. Newer antiemetics have been introduced that may have improved safety profiles, longer duration of action, and better efficacy. This review aims to summarize the recent developments pertaining to these new agents and their potential application toward the management of PONV.