Postoperative Nausea And Vomiting (PONV)

Postoperative nausea and vomiting (PONV) is one of the most common side effects of general anaesthesia [10]. The commonly reported incidence is between 1 and 43% [10-14]. This study reports the incidence of nausea of 11.45% while that of vomiting is 13.25%. This is lower than the 14.6% for nausea and 19.6% for vomiting reported by Soyannwo and others in Ibadan-Nigeria [15]. The lower incidence may be attributed to the anaesthetic agents used and the selection of patients. Most patients who vomited in the series were given nitrous oxide and pethidine as part of their general anaesthesia. A meta-analysis by Hartung [16] concisely summarized the results of several studies that convincingly argues for a positive association between nitrous oxide use and emesis. There are logical reasons for expecting PONV with nitrous oxide use. Both nitrous oxide and halogenated anaesthetics decrease lower oesophageal sphincter tone. Any of these agents may facilitate gas entering the stomach during assisted mask ventilation. Belching, flatus, and gastric distention could then promote postoperative vomiting.

Postoperative nausea and vomiting (PONV) is defined as nausea or vomiting within 24 hours of surgery. It is the most frequent side effect after anesthesia, occurring in approximately 30% of unselected patients, and can be in- creased up to 70% in certain populations and procedures [1]. Intraabdominal surgery, gynecologic surgery, and prolonged duration of anesthesia are risk factors for experiencing PONV. Moreover, the incidence in females is estimated to be three times greater than males [2]. Despite screening and routine prophylaxis of patients at high risk for PONV, current prophylactic interventions fail to completely eliminate PONV for a substantial number of patients, leading to dehydration, electrolyte imbalance, prolonged hospitalizations, multiple doses of rescue medications, and readmissions to the hospital [3].

Background : Pain and Postoperative Nausea and Vomiting (PONV) are surgical side effects. Pain management can use opioids and non-opioids. Opioids have side effects such as nausea, vomiting, pruritus, somnolence, and respiratory depression, so other alternatives are needed to reduce pain. Paracetamol is an analgesic while dexamethasone is anti- inflammatory and anti-emetic. This study was to determine whether the combination of paracetamol and dexamethasone was more effective in dealing with pain and PONV after cesarean section than paracetamol. Materials and Methods : This was an experimental study employing post-test only control group design, using two study groups. Group PD (combined paracetamol and dexamethasone) was treated using dexamethasone 8 mg and paracetamol 1 gram intravenously, while the group P (paracetamol) was treated using paracetamol 1 gram intravenously. Data of Pain and PONV were collected using the Wong Baker Faces Scale, Numeric Rating Scale, and a frequency table for PONV at the 4 th , 6 th ,

Purpose: We investigated the effect of total intravenous anesthesia (TIVA) with propofol on postoperative nausea and vomiting (PONV) after robot-assisted lapa- roscopic radical prostatectomy (RLRP) in patients at low risk of developing PONV, in comparison to balanced anesthesia with desflurane. Materials and Methods: Sixty two patients were randomly assigned to the Des or TIVA group. Propofol and remifentanil were used for induction of anesthesia in both groups and for maintenance of the anesthesia in the TIVA group. In the Des group, anes- thesia was maintained with desflurane and remifentanil. In both groups, postopera- tive pain was controlled using fentanyl-based intravenous patient controlled anal- gesia, and ramosetron 0.3 mg was administered at the end of surgery. The incidence of PONV, severity of nausea and pain, and requirements of rescue anti- emetics and analgesics were recorded. Results: The incidence of nausea in the post-anesthetic care unit was 22.6% in the Des group and 6.5% in the TIVA (p=0.001) group. The incidence of nausea at postoperative 1-6 hours was 54.8% in the Des group and 16.1% in the TIVA group (p=0.001). At postoperative 6-48 hours, there were no significant differences in the incidence of nausea between groups. Conclusion: In order to prevent PONV after RLRP in the early postopera- tive period, anesthesia using TIVA with propofol is required regardless of patient- related risk factors.

Postoperative nausea and vomiting (PONV) is one of the most common adverse effects of anesthesia and is experi- enced by 25–30% of patients [1]. This affects the recovery process and patient satisfaction following surgery [2, 3]. Several factors, including the patient characteristics (sex, smoking status, history of motion sickness or PONV), anesthetic technique employed, and the type of surgery performed, are known to increase the risk of PONV. Total intravenous anesthesia (TIVA) is one method that can be

Postoperative nausea and vomiting (PONV) are distressing and frequent adverse events of anesthesia and surgery, with a relatively high incidence following laparoscopic cholecyatectomy (LC). When no prophylactic antiemetic is given, the reported incidence of PONV is 46–72% in patients undergoing LC. These symptoms predispose to aspiration of gastric contents, wound dehiscence, psychological distress, and delayed recovery and discharge times. Patients who experience PONV consume more resources and require additional health care professional time than do those in whom these complications are avoided. [4] Pharmacological approaches, including anticholinergics, antihistamines, phenothiazines, butyrophenones, benzamides, corticosteroides, and serotonin receptor antagonists, have been investigated in the prevention and treatment of PONV, with various results. [5] Among them, serotonin receptor antagonists (e.g., ondansetron) are the most effective antiemetics in patients undergoing various types of surgery. Previously, Hemly demonstrated that ondansetron was more effective than traditional antiemetics, droperidol, and metoclopramide, for the prophylaxis against PONV following LC. [6] However, several investigations have criticized the use of prophylactic antiemetic therapy with serotonin receptor antagonists, because of their high cost. [7]

Background: Postoperative nausea and vomiting (PONV) are the most common symptoms affecting patients after surgery under general anesthesia and that is one of the most common causes of patient dissatisfaction after anesthesia. Objective: the purpose of this study was to evaluate the effect of oral lorazepam in reducing PONV after laparoscopic cholecystectomy. Methods: This doubles blind clinical prospective study was conducted on 76 patients aged 20-60 years, with American Society of Anesthesiologist physical status I or II who were scheduled for laparoscopic cholecystectomy, at Razi Hospital, Ahwaz, Iran from Desamber21, 2015 to January 20, 2016. Patients were divided in to lorazepam (Group 1) or control group (Group 2). Patients were assigned using a computer-generated random number table. The incidence of nausea and vomiting, use of antiemetic drugs and severity of nausea vomiting according to NVS score during the first 24 hours post anesthesia in 3 time periods (0, 6 and 24 hours post anesthesia). were recorded. Result: The comparisons of the groups for the number of patients with nausea showed a significant difference at 6(3.437times in group 2 more than group 1, p-value=0.003) and at 24 hours (4.391 times in group 2 more than group 1, p-value=0.007), also The comparisons of the groups for the number of patients

Introduction: Postoperative nausea and vomiting (PONV) is the most common and unpleasant postoperative complication. There is much controversy on preoperative fluid therapy. The aim of this study was to examine the effect of crystalloid fluid (Ringer solution) versus colloid (Haemaccel solution) on the incidence of postoperative nausea and vomiting in patients receiving spinal anesthesia.

Abstract: Postoperative nausea and vomiting (PONV) remains a signifi cant problem in modern anesthetic practice, with an incidence in high-risk groups of up to 80%. In addition to being unpleasant and distressing for the patient, PONV has the potential to adversely affect patient and surgical outcomes. Advances in PONV prophylaxis over recent years include using non-pharmacological means to reduce baseline risk, a change to less emetogenic anesthetic techniques and the combination of multiple antiemetic drugs. The 5-hydroxytryptamine-3 (5-HT 3 ) antagonists have proven a particularly valuable addition to the armamentarium against PONV. Palonosetron is a second-generation 5-HT 3 antagonist that has recently been approved for prophylaxis against PONV. It has unique structural, pharmacological and clinical properties that distinguish it from other agents in its class. This review summarizes current evidence on PONV prophylaxis, reviews the 5-HT 3 antagonists in particular and focuses on the established and future roles of palonosetron.

Purpose: We compared the prophylactic effects of intravenously administered azasetron (10 mg) and ondansetron (8 mg) on postoperative nausea and vomiting (PONV) in patients undergoing gynecological laparoscopic surgery under general anesthesia. Materials and Methods: We studied 98 ASA physical status I or II 20-65 years old, female patients, in this prospective, randomized, double blind study. Patients were randomly divided into two groups and received ondansetron 8 mg (group O) or azasetron 10 mg (group A) 5 min before the end of surgery. The incidence of PONV, Visual Analogue Scale (VAS) for pain, need for rescue antiemetic and analgesics, and adverse effects were checked at 1, 6, 12, 24, and 48 h postoperatively. Results: The overall incidence of PONV was 65% in group O and 49% in group A. The incidence of PONV was significantly higher in group O than in group A at 12-24 h postoperatively (nausea; 24% vs. 45%, p = 0.035, vomiting; 2% vs. 18%, p = 0.008), but there were no significant differences at 0-1, 1-6, 6-12 or 24-48 h. Conclusion: In conclusion, azasetron (10 mg) produced same incidence of PONV as ondansetron (8 mg) in patients undergoing general anesthesia for gynecological laparoscopic surgery. Azasetron was more effective, in the intermediate post-operative period, between 12 and 24 h.

In this prospective, randomized, and double-blind trial, administration of Granisetron provided an overall superior antiemetic efficacy than dexamethasone in terms of PONV scores at different intervals of time and the incidence of use rescue medications after laparoscopic abdominal surgery. Postoperative nausea and vomiting shows a variable incidence depending on the duration of surgery, the type of anaesthetic agents used (dose, inhalational drugs, opioids), smoking habit etc (Lerman, 1992). Primary event in the initiation of vomiting reflex is the 5-HT receptor stimulation which are situated on the nerve terminal of the vagus nerve in the periphery and centrally on the chemoreceptor trigger zone (CTZ) of the area postrema (Bunce and Tyers, 1992; Watcha and White, 1992).

Background: If untreated, one third of patients who undergo surgery develop postoperative nau- sea and/or vomiting (PONV). The prevention of postoperative nausea and vomiting can improve satisfaction among vulnerable patients. We hypothesized that preoperative anxiety may increase the incidence of PONV. The objective was to assess whether administration of a benzodiazepine prior to surgery would reduce the incidence of PONV. Methods: 130 women (ASA I and II) sche- duled to undergo dilatation and curettage comprised the study group. The women were allocated randomly to two study groups according to the type of anesthesia administered (with and without midazolam). Results: Sixty-eight women received midazolam and 62 did not. Patients treated with midazolam were feeling more comfortable (“friendliness”, p = 0.005 and “elation”, p = 0.01) and had less postoperative fatigue (p = 0.04) than non-midazolam-treated group. Patients treated with midazolam had significantly fewer emetic episodes during the first 4 hours after surgery than those without midazolam (0.1 ± 0.2 vs 0.3 ± 0.6, respectively, p = 0.003). Conclusions: Midazolam reduces the incidence of PONV and improves patient’s comfort. We suggest that midazolam has to be routinely included in the anesthesia protocol for short-term gynecological procedures (dilata- tion and curettage).

We searched the PubMed and EMBASE databases up to November 2014 for relevant clinical studies. Search terms used for PubMed were: (“ramosetron” [Supplementary Concept] OR “ramosetron” [All Fields]) AND (“ondanse- tron” [MeSH Terms] OR “ondansetron” [All Fields]) AND (“postoperative nausea and vomiting” [MeSH Terms] OR (“postoperative” [All Fields] AND “nausea” [All Fields] AND “vomiting” [All Fields]) OR “postoperative nausea and vomiting” [All Fields] OR “ponv” [All Fields]). Search terms used for EMBASE were: postoperative vomiting/or postoperative complication/or ondansetron/or ramosetron/ or nausea/or vomiting/AND randomized clinical trial ramosetron.ti,ab./AND *ondansetron/and *ramosetron/. Clinical studies in the reference lists of recent published trials with retrievable full text were also searched. Ran- domized controlled clinical trials comparing the efficacy and safety profiles of ramosetron and ondansetron were selected by title and abstract screening followed by full text retrieval. Reviews, conference abstracts, and non-English language articles were excluded. Only studies using stan- dard doses of ramosetron (4 mg) and ondansetron (0.3 mg) without dexamethasone as an adjunct were selected for meta-analysis. Two authors (CG, BL) independently

Abstract: Postoperative nausea and vomiting (PONV) is a persistent problem in perianesthesia practice. Approximately 30% of patients receiving anesthesia will experience this complication, which can increase patient dissatisfaction, increase costs, and in some patients precipitate other postoperative complications. During the last three decades, there has been increasing interest and research on best practices to diminish the incidence of this clinical problem, as patient satisfaction is linked to PONV guideline use. Some institutions have low incident rates because of consistent protocol use, and new medication classifications and multiple complementary therapies have been incorporated into daily use. There are several clinically useful guidelines and algorithms used to guide primary prevention strategies, as discussed in this review. However, severe PONV continues to be refractory to available interventions, and the best hope for elimination of this complication may arise from pharmacogenomics.

The first one was approached first, and then so on so forth until the required sample size of 138 was achieved. Patients were first seen on the ward 12 to 18 hours preoperatively. The purpose of the study was explained and written consent was obtained. They were then interviewed on the ward according to a predesigned data sheet. Each interview took 5 to 7 minutes. Data obtained included biographic data, and presence or absence of certain preoperative risk factors for postoperative nausea and vomiting.

one of the methods of treating kidney and upper ureteral stones with less invasions. This method is often used when the stone is large, numerous and Staghorn calculi, or resistant to Extracorporeal Shock Wave Lithotripsy (ESWL)[4, 5]. Non- treatment of Staghorn calculi leads to the destruction of suffering kidney and in 30% of cases leads to the death of the patient [7]. Today, the use of PNL, especially for the treatment of Staghorn calculi’s, is increasing [8]. Postoperative nausea and vomiting is one of the most common surgical problems and usually occurs after any type of anesthesia [9]. Occurrence of postoperative nausea and vomiting causes dehydration, electrolyte disturbances, and hypertension. This complication can increase the risk of pulmonary aspiration if airway reflexes is reduced due to the remaining effects of anesthetic drugs [9]. Also, nausea and vomiting increase the cost of treatment and delay the discharge of the patient from the hospital [10]. Postoperative nausea and vomiting is a complicated and multifactorial condition that a number of effective factors on it are known. These factors include intravenous and inhaled anesthetics, muscle relaxants, age, sex, history of nausea and vomiting, and motion sickness, obesity, decreased movement and delay in gastric emptying, postoperative pain, especially visceral and pelvic pain, Pain management with opioids and inadequate control of pain [11]. Symptoms and signs of gastrointestinal tract often associated with urologic disorders, due to autonomic and common sense nerves and renal- intestinal reflexes. The proximity of the right kidney to the colon, duodenum, pancreas, biliary duct, liver and bile duct may cause digestive disturbances. Also, the proximity of the left kidney to the colon (flattening), the stomach and spleen may lead to intestinal symptoms. The most common symptoms are nausea, vomiting, diarrhea, discomfort, and abdominal distension. One of the symptoms and symptoms

NSAIDS are commonly used postoperatively in our orthognathic surgery patients. Nausea is frequently accompanied by pain in the early postoperative period and the relief of pain resulted in relief of nausea as well. The basic mechanism of pain-induced emesis is still not well understood; however, it has been suggested that pain is associated with emesis via activation of the sympathetic nervous system. Jenkins and Lahay 29 first proposed a relationship between emesis and increased circulating catecholamines. Researchers have emphasized the role of pain as a primary factor in emesis initiation. Our results also showed a trend of increased PONV with increasing pain level. Our standard protocol for postoperative pain management involves administration of intramuscular administration of voveran 3 ml . Our results indicate that pain may be an influencing factor in the occurrence of PONV, but this was evaluated only in the PACU.

Our previous studies have shown the effectiveness and safety of acupuncture in the treatment of nausea and vomiting following craniotomy. In the clinic, however, we have found that, as the time of PONV is not fixed, patients are eager to receive treatment when they experi- ence nausea and vomiting. Often, however, acupuncture cannot be administered as there is no qualified practi- tioner available. To improve the availability of treatment, acupuncturists need to formulate new protocols. Seaband and TENS are effective treatments for PONV. They are easy to administer and non- invasive, though our previous studies have found that their efficacy is inferior to needle therapy. The intradermal thumbtack needle has a piercing effect and can be in place for 24 hours. When the patient is nauseous, pressing the acupuncture point can achieve de qi sensation. We, therefore, designed this randomised controlled study to demonstrate that intradermal thumb- tack needle buried Neiguan point therapy can reduce nausea and vomiting after craniotomy. It is conducive to clinical use and improved patient satisfaction.

Table 2 illustrates the frequency and intensity of PONV at the times of recov- ery and hospital stay. The Results shows that comparing to preemptive method, the preventive ondansetron reduced PONV only by 5% and indeed the PONV rate was similar in two groups [(37.5% and 32.5% in preemptive and preventive groups, respectively (P = 0.815)]. However PONV generally was more intense in the preemptive group at the PACU and 24 hours after surgery (P-value < 0.05) and rate of vomiting was high in preemptive group (11 vs. 3 episodes, P-value = 0.037). The total consumed antiemetic dose as metoclopramide was 100 and 75 mg in preemptive and preventive groups, respectively. The first request for an- tiemetic drug was earlier in preemptive group (6.42 ± 2.69 vs. 8.01 ± 3.14 hrs, P-value < 0.05) and the antiemetic consumption dose as mg/person was high in preemptive group (2.5 ± 0.32 vs. 1.75 ± 2.6 mg, P-value < 0.05). Both recovery and hospital stay times were high in preemptive group (P-value = 0.01). No ad- verse effect was seen in the any patient (Table 2).

Methods: In this retrospective study, incidence and risk factors for PONV were evaluated with fentanyl IV-PCA during postoperative 48 hours after various sur- geries. 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 desflu- rane 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 sur- gery and higher dose of fentanyl were not risk factors for PONV. Conclusion: De- spite antiemetic prophylaxis with 5 HT 3 -receptor antagonist, 23% of patients with