Risk-tailored prophylaxis for postoperative nausea and vomiting: still a messy issue (original) (raw)
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Colombian journal of anesthesiology
Introduction: Postoperative nausea and vomiting are frequent adverse effects of anesthesia and surgery. Impact is greater in pediatric populations compared to adults and the reported incidences are heterogeneous. Objective: To describe the incidence of postoperative vomiting in a pediatric population and to identify associated risk factors. Materials and methods: This prospective cohort study included 190 children aged 3 to 12 years undergoing surgery and anesthesia in a maternal and child health clinic in Bucaramanga (Colombia). The main outcome variable was postoperative vomiting. Data were analyzed using bivariate, multivariate analysis and logistic regression to assess the associated risk factors. Results: The overall incidence of postoperative vomiting was 18.95% (95% CI: 13.32 - 24.57), with a higher incidence at home vs. hospital (12.63% vs. 9.47%). After adjustment, associated risk factors were anesthesia time longer than 45 minutes (OR: 2.33; 95% CI: 1.10-4.90) and postoper...
Middle East journal of anaesthesiology
To investigate the impact of Endotracheal tube (ETT) vs. Laryngeal Mask Airway (LMA) on postoperative nausea and vomiting (PONV) in patients undergoing surgery with general anesthesia. Key words searching from databases such as Medline, Embase, and Cochrane library provided 14 studies focusing on the use of EET vs. LMA for general anesthesia. Pooled estimate of relative risk with 95% confidence interval using random effect model was conducted. 14 studies were selected for meta-analysis with a total of 1866 patients. 9 studies focused on the outcome of PONV in adult patients. It showed incidence of PONV with of LMA and ETT in adult of about 204/690 (30%) and 145/725 (20%) respectively with [Odds Ratio (OR) = 1.69, 95% CI, 0.76-3.75, P = 0.20]. Heterogeneity was high (I2 = 87%). Five studies focused on the outcome of PONV in pediatric patients with PONV in LMA and ETT group of 85/229 (37%) and 72/222 (32%) respectively with (OR = 1.30, 95% CI, 0.61-2.76, P = 0.50). Heterogeneity was m...
Pediatric Anesthesia, 2004
Background: Postoperative vomiting (POV) is a frequent side-effect of paediatric surgery and a leading cause of unplanned admission. Many antiemetic drugs have been studied, but less attention has been given to the effects on POV of the anaesthetic technique adopted. The aim of this study was to compare two different anaesthetic techniques in children under regional analgesia at risk for POV. Methods: We studied 135 children suffering from motion sickness or with a previous history of POV. The patients were randomized to receive inhalation anaesthesia (group S) with sevoflurane by LMA TM or intravenous (i.v.) anaesthesia with ketamine and propofol (group P). All the patients were treated with an ilio-inguinal block after induction of anaesthesia. Postoperatively, the children were followed by the nursing staff and by their parents, none of whom were aware of the anaesthesia technique used. Results: A significant decrease was observed in the incidence of early (0-6 h) and delayed (6-24 h) POV in those children who received i.v. sedation. There was no difference between the two groups in the level of analgesia either at the end of surgery or 2 h postoperatively. Conclusions: Anaesthesia based on propofol and ketamine is better than inhalation anaesthesia with sevoflurane by LMA for reducing POV in children at risk under an ilio-inguinal block. Tailoring the anaesthetic to the specific needs of children susceptible to POV should be considered before resorting to the routine use of expensive antiemetic prophylaxis.
BJA: British Journal of Anaesthesia, 2018
A non-synonymous single nucleotide polymorphism in an OPRM1 splice variant is associated with fentanyl-induced emesis in women undergoing minor gynaecological surgery. PLoS One 2012; 7: e48416 18. Zhang W, Yuan JJ, Kan QC, Zhang LR, Chang YZ, Wang ZY. Study of the OPRM1 A118G genetic polymorphism associated with postoperative nausea and vomiting induced by fentanyl intravenous analgesia.
Applicability of risk scores for postoperative nausea and vomiting in adults to paediatric patients
British Journal of Anaesthesia, 2004
Background. Scores to predict the occurrence of postoperative vomiting (PV) or nausea and vomiting (PONV) are well established in adult patients. The aim of this survey was to evaluate the applicability of risk scores developed and tested in adult patients in 983 paediatric patients (0-12 yr) undergoing various surgical procedures. Method. The predictive properties of five models were compared with respect to discriminating power (measured by the area under a receiver operating characteristic curve) and calibration (comparison of the predicted and the actual incidences of the disease by weighed linear regression analysis). Results. The cumulative incidence of PV was 33.2% within 24 h. The discriminating power was low and insufficient in all models tested (0.56-0.65). Furthermore, the predicted incidences of the scores correlated only vaguely with the actual incidences observed. Conclusion. Specialized scores for children are required. These might use the history of PV, strabismus surgery, duration of anaesthesia >45 min, age >5 yr and administration of postoperative opioids as independent risk factors.
Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and Vomiting
Anesthesia & Analgesia, 2007
The present guidelines were compiled by a multidisciplinary international panel of individuals with interest and expertise in postoperative nausea and vomiting (PONV) under the auspices of The Society of Ambulatory Anesthesia. The panel critically evaluated the current medical literature on PONV to provide an evidencebased reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. In brief, these guidelines identify risk factors for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic monotherapy and combination therapy regimens for PONV prophylaxis; recommend approaches for treatment of PONV when it occurs; and provide an algorithm for the management of individuals at increased risk for PONV. (Anesth Analg 2007;105:1615-28) Post operative nausea and vomiting (PONV) is a continuing concern in surgical patients and the management of this problem is still confusing. In the United States, more than 71 million inpatient and outpatient operative procedures are performed each year (1). Untreated, PONV occurs in 20%-30% of the
European Journal of Anaesthesiology, 1998
To investigate the incidence of post-operative nausea and vomiting following maintenance of anaesthesia with propofol, compared with inhalational agents. Searching The MEDLEY database, which contains published literature on Zeneca's pharmaceutical products, was searched. Propofol was used as a major descriptor with the subheadings 'induction' or 'maintenance'; or with 'inhalational anaesthetics' as a major descriptor, with the subheadings 'induction' or 'maintenance' together with 'comparison', 'nausea' and 'vomiting'. Studies reported in any language were considered. Study selection Study designs of evaluations included in the review The included studies were prospective randomised controlled trials (RCTs) of the maintenance of anaesthesia with propofol or an inhalational agent, for which results for nausea, vomiting or 'nausea and vomiting' were available. Duplicates were excluded. Specific interventions included in the review The interventions included the following agents used in anaesthetic regimes: maintenance of anaesthesia with propofol and inhalational agents such as isoflurane, desflurane, enflurane, halothane and sevoflurane; induction agents such as propofol, etomidate, methohexitone, thiopentone, and sufentanil analgesia including opiate narcotics; and nitrous oxide. Some comparator groups used propofol as an induction agent. Participants included in the review The participants included adults and children undergoing the following types of surgery under general anaesthesia: arthroscopy or minor orthopaedic; breast; eye; facial, oral or dental; ear, nose and throat; gynaecological laparoscopy; other gynaecological; squint; and other or unspecified surgery. Outcomes assessed in the review The outcomes assessed were nausea, vomiting, and nausea and vomiting combined. How were decisions on the relevance of primary studies made? The publications were examined individually by two independent authors.
SAGE Open Medicine
Background: The airway of an anesthetized patient should be secured with an artificial airway for oxygenation or ventilation. Pediatrics are not small adults which means they are different from adults both anatomically and physiologically. This study aims to determine the prevalence of difficult airway and its associated factors in pediatric patients who underwent surgery under general anesthesia in referral hospitals of Addis Ababa. Methods: A multi-centered cross-sectional study design was employed. The bivariable and multivariable logistic regression was used to measure the association between the dependent variable (pediatrics difficult airway) and independent variables. p-value