Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review (original) (raw)
Related papers
Therapeutics and Clinical Risk Management
Postoperative nausea and vomiting is one of the most frequent adverse events after surgery and anesthesia. It is distressing for the patient and can lead to other postoperative complications. Management of PONV involves a framework of risk assessment, multimodal risk reduction, and prophylactic measures, as well as prompt rescue treatment. There has been a significant paradigm shift in the approach towards PONV prevention. There have also been several emerging therapeutic options for PONV prophylaxis and treatment. In this review, we will discuss the up-to-date PONV management guidelines and highlight novel therapeutic options which have emerged in the last few years.
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.
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.
Prevention and treatment of postoperative nausea and vomiting
Revista Brasileira de terapia intensiva, 2009
Postoperative nausea and vomiting are common and can be prevented. Complications of this condition cause higher rates of morbidity and mortality. A review of literature was carried out on MEDLINE, with focus on controlled clinical trials. Pathophysiology is complex, with many afferent and efferent pathways, and its comprehension facilitate the choice of medication. Risk factors are presented, with a stratified score of chance to develop postoperative nausea and vomiting. An algorithm for identification of higher risk patients was elaborated and classified the level of prevention/treatment recommended to avoid excessive use of drugs and their side effects. Postoperative nausea and vomiting must be prevented, because of the involved complications and discomfort for patients. A systematic approach with analysis of preoperative risk factors and prescription of medication can be effective for prevention.
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.
IP Innovative Publication Pvt. Ltd., 2018
Postoperative nausea and vomiting (PONV) is a common complication after anaesthesia. Although self limiting and non fatal, it can cause significant morbidity and delay discharge. The intention of doing this study was, to evaluate the accuracy of three risk scores in predicting PONV and to evaluate the efficacy of different therapeutic regimens based on the risk score in the reduction of PONV. Materials and Methods: In this prospective, randomized, double blinded study, 180 patients between 18-60 years age group, belonging to ASA 1 and ASA 2 categories coming for elective surgeries under general anaesthesia of 1-4hrs duration irrespective of the type of surgery were scored preoperatively for postoperative nausea and vomiting using APFEL, KOIVURANTA, PALAZZO and EVANS scoring systems into low risk and high risk groups. Low risk group (i.e., Group O) consisting of 60 patients - inj. ondansetron 4mg was given intravenously 30 minutes before administration of reversal agent. High risk group was further categorized into Group M and Group D consisting of 60 patients each, based on the intervention to assess the efficacy of the drugs used in these two groups. Group M patient received inj.ondansetron 4mg+inj.metoclopramide 10mg intravenously (IV) 30 minutes before administration of reversal agent. Group D patient received inj. dexamethasone 4mg IV at induction and inj.ondansetron 4mg IV 30 minutes before administration of reversal agent. After the procedure, patients were observed for any retching, nausea or vomiting in postanaesthesia care unit and up to 24 hours. Rescue treatment from a drug of different pharmacological group was administered if required. Results: Area under the curve (AUC) and the corresponding 95% confidence intervals for the scores drawn from Receiver operator characteristic (ROC) curves were: Apfel: 0.6154 (0.50470-0.72618); Koivuranta: 0.6154 (0.50470-0.72618); Palazzo & Evans: 0.6443 (0.54096-0.74764). And, a complete response of 71.67% was observed in Group O, 76.67% in Group M and 90% in Group D. Thus we concluded that, all the three scores had moderate accuracy in predicting the risk of PONV and ondansetron-dexamethasone combination was found to be superior to ondansetron- metoclopramide combination in high risk patients. Keywords: General anaesthesia, Scoring systems, Ondansetron, Dexamethasone, Metoclopromide.
Postoperative Nausea and Vomiting Prophylaxis From an Economic Point of View
American Journal of Therapeutics, 2012
Patients report that avoidance of PONV is of greater concern than avoidance of postoperative pain. [4] Among high-risk patients, the incidence of PONV can be as frequent as 70-80%. [5] Patients with PONV may develop medical complications, consume more resources, increased pain at the surgical site and delayed discharge from hospital. There are a number of other contributing factors. [6] These include patient related factors, surgical and post-operative condition. Patient related factors include increased body weight, [7] female gender [8,9] history of motion sickness or previous PONV, [10] perioperative opioid use [11] and nonsmoking status. [12,13] Current medical practice entails the use of a combination of antiemetic acting on multiple receptor sites to reduce the risk of PONV in high-risk pts. A recent meta-analysis
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
Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting: Erratum
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.