Postoperative Nausea and Vomiting: A Comprehensive Update Review (original) (raw)

The Management of Postoperative Nausea and Vomiting: Current Thoughts and Protocols

Aesthetic Plastic Surgery, 2013

Without prophylaxis, about 30% of patients undergoing general anesthesia are likely to experience postoperative nausea and vomiting (PONV). 1-3 In a patient population with multiple risk factors, the incidence is up to 80%. 3 PONV has a significant negative effect on patient satisfaction with anesthesia 4 and is one of the most common causes for unplanned hospital admissions in day-case surgery. 5 Even though rare, there can be severe complications following PONV, such as Boerhaave syndrome, airway compromise, and emphysema. 6-11 Considering these facts, it should be essential for every anesthesiologist to aim for a PONV-free recovery. 12,13

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

Consensus Guidelines for the Management of Postoperative Nausea and Vomiting

The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) and an update on the 2 previous sets of guidelines published in 2003 and 2007. These guidelines were compiled by a multidisciplinary international panel of individuals with interest and expertise in PONV under the auspices of the Society for Ambulatory Anesthesia. The panel members critically and systematically evaluated the current medical literature on PONV to provide an evidence-based reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. These guidelines identify patients at risk for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic single therapy and combination therapy regimens for PONV prophylaxis, including nonpharmacologic approaches; recommend strategies for treatment of PONV when it occurs; provide an algorithm for the management of individuals at increased risk for PONV as well as steps to ensure PONV prevention and treatment are implemented in the clinical setting.

Postoperative nausea and vomiting (PONV): A cause for concern

2013

Postoperative shivering and feeling of cold associated with it is rated as worse than pain by some patients. It has been a problem not only after general anesthesia, but also during and after spinal anesthesia. This editorial compliments an original article in this issue of ‘Anesthesia, Pain & Intensive Care’ on comparison of three different drugs for the treatment of postoperative shivering, and draws attention towards pathogenesis of shivering and its control. Shivering is not a point in time event and its cessation with pharmacological intervention does not guarantee against its recurrence. Citation: Taqi A. Can you stop this shivering doctor? Anaesth Pain & Intensive Care 2013;17(1):4-5

Prevention and Management of Postoperative Nausea and Vomiting in Adults

AORN Journal, 2009

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.

Some Considerations about Postoperative Nausea and Vomiting

Zenodo (CERN European Organization for Nuclear Research), 2022

Postoperative nausea and vomiting (PONV) are disturbing and show adverse events in anesthesia and surgery. These effects prolong recovery time, delay patient discharge, and increase hospital costs. PONV is one of the 2 main disadvantages of general anesthesia after the surgery in the first 24 hours. The origin of postoperative nausea and vomiting after surgery performed under general anesthesia is not entirely clear, but it is probably multifactorial. PONV is influenced by the patient's own factors (age, gender, obesity, diabetes, pregnancy), preoperative (premedication, anxiety, diet), intraoperative (anesthetics, intubation, aerophagia, intraoperative dehydration, high doses of neostigmine, use of N2O, time of surgery) and using of opiates. The effectiveness of various antiemetics has been studied for the prevention and treatment of PONV in surgical patients. Glucocorticoids are well known for their analgesic, anti-inflammatory, immune-modulating, and antiemetic effects. Ondansetron is the most prophylactic serotonin subtype 3 antagonists in our daily clinical practice for the prevention of PONV after surgery.

POSTOPERATIVE NAUSEA: CAUSES AND MANAGEMENT

Advances in medicine and biology, 2019

Postoperative nausea and vomiting (PONV) are common and distressing side effects following surgery and anesthesia. Despite modern antiemetic agents, short-acting anesthetics and minimally invasive surgery, PONV still affects around 30% of surgical patients, with certain high-risk patients experiencing PONV up to 80%. The etiology of PONV comprises independent risk factors such as female sex, history of PONV and motion sickness, non-smoking status, younger age, general vs regional anesthesia, use of volatile anesthetics and nitrous oxide, postoperative opioids, duration of anesthesia and the type of surgery (cholecystectomy, laparoscopic, gynecological). According to these risk factors, scoring systems have been developed to identify patients at risk. Given the multifactorial origin of PONV, a multimodal approach (pharmacological and non-pharmacological) has been developed as well.

Management of the patient at high risk for postoperative nausea and vomiting

Middle East journal of anaesthesiology

Postoperative nausea and vomiting continue to be problematic areas in anesthesia as evidenced by frequent reports of therapies in the literature. No single therapy has been proven curative for all cases, in part because of the several emetic centers, all of which may be blocked by different classes of drugs and the diverse risk factors which act alone or in combination to cause vomiting. Identification of the patient most at risk allows for cost effective prophylactic management. An appropriate anesthetic technique can be planned that, relying on evidence based medicine, will decrease if not prevent the incidence of this most troubling complication.

Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting

Anesthesia & Analgesia, 2020

This consensus statement presents a comprehensive and evidence-based set of guidelines for the care of postoperative nausea and vomiting (PONV) in both adult and pediatric populations. The guidelines are established by an international panel of experts under the auspices of the American Society of Enhanced Recovery and Society for Ambulatory Anesthesia based on a comprehensive search and review of literature up to September 2019. The guidelines provide recommendation on identifying high-risk patients, managing baseline PONV risks, choices for prophylaxis, and rescue treatment of PONV as well as recommendations for the institutional implementation of a PONV protocol. In addition, the current guidelines focus on the evidence for newer drugs (eg, second-generation 5-hydroxytryptamine 3 [5-HT 3 ] receptor antagonists, neurokinin 1 (NK1) receptor antagonists, and dopamine antagonists), discussion regarding the use of general multimodal PONV prophylaxis, and PONV management as part of enhanced recovery pathways. This set of guidelines have been endorsed by 23 professional societies and organizations from different disciplines (Appendix 1). What Other Guidelines Are Available on This Topic? Guidelines currently available include the 3 iterations of the consensus guideline we previously published, which was last updated 6 years ago 1-3 ; a guideline published by American Society of Health System Pharmacists in 1999 4 ; a brief discussion on PONV management as part of a comprehensive postoperative care guidelines 5 ; focused guidelines published by the Society of Obstetricians and Gynecologists of Canada, 6 the Association of Paediatric Anaesthetists of Great Britain & Ireland 7 and the Association of Perianesthesia Nursing 8 ; and several guidelines published in other languages. 9-12 Why Was This Guideline Developed? The current guideline was developed to provide perioperative practitioners with a comprehensive and up-to-date, evidence-based guidance on the risk stratification, prevention, and treatment of PONV in both adults and children. The guideline also provides guidance on the management of PONV within enhanced recovery pathways. How Does This Guideline Differ From Existing Guidelines? The previous consensus guideline was published 6 years ago with a literature search updated to October 2011. Several guidelines, which have been published since, are either limited to a specific populations 7 or do not address all aspects of PONV management. 13 The current guideline was developed based on a systematic review of the literature published up through September 2019. This includes recent studies of newer pharmacological agents such as the second-generation 5-hydroxytryptamine 3 (5-HT 3) receptor antagonists, a dopamine antagonist, neurokinin 1 (NK1) receptor antagonists as well as several novel combination therapies. In addition, it also contains an evidence-based discussion on the management of PONV in enhanced recovery pathways. We have also discussed the implementation of a general multimodal PONV prophylaxis in all at-risk surgical patients based on the consensus of the expert panel.