Comparison of palonosetron and ondansetron in preventing postoperative nausea and vomiting in renal transplantation recipients: a randomized clinical trial

Abstract Background: End-stage renal diseases patients have a high risk of postoperative nausea and vomiting (PONV), which is multifactorial and need acute attention after renal transplantation for a successful outcome in term of an uneventful postoperative period. The study was done to compare the efficacy of palonosetron and ondansetron in preventing early and late-onset PONV in live donor renal transplantation recipients (LDRT). Methods: The prospective randomized double-blinded study was done on 112 consecutive patients planned for live donor renal transplantation. Patients of both sexes in the age group of 18-60 years were randomly divided into two groups: Group O (Ondansetron) and Group P (Palonosetron) with 56 patients in each group by computer-generated randomization. The study drug was administered intravenously (IV) slowly over 30 seconds, one hour before extubation. Postoperatively, the patients were accessed for PONV at 6, 24, and 72 hours using the Visual Analogue Scale (VAS) nausea score and PONV intensity scale. Results: The incidence of PONV in the study was found to be 30.35%. There was significant difference in incidence of PONV between Group P and Group O at 6 hours (12.5% vs. 32.1%, p = 0.013) and 72 hours (1.8% vs. 33.9%, p < 0.001), but insignificant difference at 24 hours (1.8% vs. 10.7%, p = 0.113). VAS-nausea score was significantly lower in Group P as compared to Group O at a time point of 24 hours (45.54 ± 12.64 vs. 51.96 ± 14.70, p = 0.015) and 72 hours (39.11 ± 10.32 vs. 45.7 ± 15.12, p = 0.015). Conclusion: Palonosetron is clinically superior to ondansetron in preventing early and delayed onset postoperative nausea and vomiting in live-related renal transplant recipients.

Postoperative effects of bilateral sphenopalatine ganglion blockade in septorhinoplasty operations; double-blind randomized clinical trial

Abstract Objective We aimed to investigate the effect of bilateral sphenopalatine ganglion blockade (SPGB) on the main postoperative complications in septorhinoplasty operations. Methods In this randomized, controlled, prospective study, 80 cases planned for Septorhinoplasty operations under general anesthesia were included in the study. The cases were divided into two groups; SPGB was performed with 2 mL of 0.25% bupivacaine bilaterally 15 min before the end of the operation in the SPGB group (Group S, n = 40). In the control group (Group C, n = 40), 2 mL of 0.9% NaCl solution was applied into both SPG areas. In the recovery unit after the operation; the pain and analgesic needs of the patients at 0, 2, 6 and 24 h were evaluated. Results There was no statistically significant difference between the groups in terms of hemodynamic parameters (ASA, MBP, HR) (p> 0.05) All VAS values were statistically lower in Group S than in Group C (p< 0.05). In Group S, the need for analgesic medication was found in 5 cases between 0-2 h, whereas in Group C, this rate was found in 17 cases, and it was statistically significant (p< 0.05). Conclusion Bilateral SPGB application was determined to provide better analgesia in the early postoperative period compared to the control group, it was concluded that further studies are needed to say that there are significant effects on laryngospasm and nausea-vomiting. Level of evidence: 2, degree of recommendation B.

Olanzapine as a prophylactic antiemetic for preventing postoperative nausea and vomiting after general anesthesia: A systematic review and metaanalysis

Abstract Background: The antiemetic effectiveness of olanzapine, as a prophylactic off-label antiemetic drug, for Postoperative Nausea and Vomiting (PONV) is unknown. In this systematic review and meta-analysis, the authors evaluate the efficacy and side effects of olanzapine as a prophylactic antiemetic in adult patients who undergo general anesthesia and assess adverse effects. Methods: A systematic search was done on electronic bibliographic databases in July 2023. Randomized controlled trials of olanzapine as a prophylactic antiemetic for PONV in adults who underwent general anesthesia were included. The authors excluded non-RCTs and retracted studies. The authors set no date of publication or language limits. The outcomes were the incidence of PONV within 24 h postoperatively and the safety of olanzapine. The risk of bias was assessed according to the tool suggested by the National Heart, Lung, and Blood Institute. Results: Meta-analysis included 446 adult patients. Olanzapine reduced on average 38 % the incidence of PONV. The estimated risk ratio (95 % CI) of olanzapine versus control was 0.62 (0.42-0.90), p = 0.010, I2 = 67 %. In the subgroup meta-analysis, doses of olanzapine (10 mg) reduced on average 49 % of the incidence of PONV (RR = 0.51 [0.34-0.77], p = 0.001, I2 = 31 %). Conclusion: This systematic review with meta-analysis indicated that olanzapine as a prophylactic antiemetic alone or combined with other antiemetic agents reduced the incidence of postoperative nausea and vomiting. However, this conclusion must be presented with some degree of uncertainty due to the small number of studies included. There was a lack of any evidence to draw conclusions on side effects.

Network meta-analysis of triple therapy for the prevention and treatment of acute nausea and vomiting caused by emetogenic chemotherapy drugs with moderate and high risk / 中国药房

OBJECTIVE To evaluate the efficacy of the triple therapy of 5-HT3 receptor antagonists， neurokinin-1 receptor antagonists and dexamethasone （referred to as “triple therapy”） in the prevention and treatment of acute nausea and vomiting caused by moderately and highly emetogenic chemotherapy drugs. METHODS Retrieved from PubMed， Embase， the Cochrane Library， CNKI and Wanfang data， randomized controlled trials （RCTs） about triple therapy or 5-HT3 receptor antagonist combined with dexamethasone （referred to as “dual therapy”） were collected during the inception to May 2023. After literature screening， data extraction and literature evaluation， network meta-analysis was performed by using Stata 16.0 software. RESULTS A total of 59 RCTs were included， involving 23 418 patients and 15 interventions. Results of network meta-analysis showed that fosaprepitant + palonosetron + dexamethasone （FPD） was most effective in terms of acute nausea and vomiting control rate， followed by fosaprepitant + granisetron + dexamethasone （FGD） and aprepitant + ramosetron + dexamethasone （AMD）. In terms of acute nausea control rate， FPD was the most effective， followed by aprepitant + palonosetron + dexamethasone （APD） and FGD. In terms of acute vomiting control rate， FPD was the most effective， followed by FGD and APD. CONCLUSIONS Fosaprepitant + palonosetron + dexamethasone is better than other triple therapy or dual therapy in preventing acute nausea and vomiting caused by moderately and highly emetogenic chemotherapy drugs.

Post-operative nausea and vomiting prophylaxis: A meta-review on systematic reviews and meta-analyses

Introduction: Postoperative nausea and vomiting (PONV) are common complications in surgical patients undergoing general anesthesia, and multiple strategies have been suggested to prevent them. Objective: To describe the available evidence on the effectiveness of pharmacological and non-pharmacological strategies for preventing PONV in adults undergoing surgery under general anesthesia, as reported in previous meta-analyses and systematic reviews. Methodology: An overview of systematic reviews and meta-analyses was conducted. Searches were performed in PubMed, EBSCO, EMBASE, Cochrane Database, Science Direct, and Scopus, without restrictions as to gender, clinical condition, or date of publication, including articles in Spanish, French, and English only. Two reviewers independently and in duplicate did the screening, data extraction, quality evaluation, and risk of bias assessment according to AMSTAR-2. The PRISMA and PRIOR statements were followed for reporting. PROSPERO registration number CRD42021251999. Results: Out of 80 candidate articles, three were viable for meta-analysis. 1.5 mg to 18 mg doses of Dexamethasone showed a significant reduction in the risk of PONV, with a RR of 0.48 (95 % CI 0.41-0.57; p<0.001), I2=63 % (p=0.07), and a NNTc of 5 and 7. Other effective strategies included the use of acoustic stimulation/acupuncture/acupressure, 5HT3 antagonists, NK1 antagonists, gabapentinoids, haloperidol, droperidol, metoclopramide, midazolam, mirtazapine, among others. The risk of publication bias was low. Conclusion: Different strategies are effective for PONV prophylaxis in surgeries under general anesthesia. Dexamethasone shows the best available evidence at the moment. The documented methodological quality suggests the need for better studies to establish the effectiveness of the strategies.

Introducción: Las náuseas y el vómito posoperatorios (NVPO) son comunes en pacientes quirúrgicos bajo anestesia general y se han planteado múltiples estrategias para prevenirlos. Objetivo: Describir la evidencia disponible sobre la efectividad de las estrategias farmacológicas y no farmacológicas para prevenir las NVPO en adultos sometidos a cirugía bajo anestesia general, según lo descrito en metaanálisis y revisiones sistemáticas previas. Metodología: Se realizó una metarrevisión de revisiones sistemáticas y metaanálisis. Se ejecutaron búsquedas en PubMed, EBSCO, Embase, Cochrane Database, ScienceDirect y Scopus, sin restricción por sexo, condición clínica ni fecha de publicación, solo de artículos en español, francés e inglés. Dos revisores llevaron a cabo tamizaje, extracción de datos, evaluación de calidad y riesgo de sesgo según AMSTAR-2, de manera independiente y en duplicado. Se siguieron las declaraciones PRISMA y PRIOR para el reporte, previo registro en Prospero CRD42021251999. Resultados: De 80 artículos candidatos, se seleccionaron tres viables para realización de metaanálisis. La dexametasona entre 1,5 mg y 18 mg mostró un RR=0,48 (IC95 % [0,41-0,57]; p<0,001), I2=63 % (p=0,07) y un NNTc 5 y 7. Otras estrategias efectivas incluyen el uso de acuestimulación/acupuntura/acupresión, antagonistas 5HT3, antagonistas NK1, gabapentinoides, haloperidol, droperidol, metoclopramida, midazolam, mirtazapina, entre otras. El riesgo de sesgo de las publicaciones fue bajo. Conclusión: Diferentes estrategias son efectivas para profilaxis NVPO en cirugías con anestesia general. Dexametasona presenta la mejor evidencia disponible al momento. La calidad metodológica documentada sugiere la necesidad de realizar mejores trabajos para determinar la efectividad de las estrategias.

What are the effects of drugs for nausea and vomiting prevention following general anesthesia? Summary and comments regarding a Cochrane Collaboration network meta-analysis

The aim of this special article is to summarize and discuss, from an anesthesia perspective, the network meta-analysis on drugs used for the prevention of postoperative nausea and vomiting after general anesthesia, in agreement with the Cochrane Colombia collaboration and within the framework of the Cochrane Corners strategy. Through the combination of indirect comparisons and based on the evidence, the use of aprepitant, ramosetron, granisetron, dexamethasone and ondansetron is recommended with a high degree of certainty for the reduction of postoperative nausea and vomiting.

Este artículo especial tiene el objetivo de resumir y discutir desde la perspectiva de la anestesiología, el metaanálisis en red sobre fármacos para prevenir náuseas y vómito posoperatorio luego de anestesia general, en acuerdo con la colaboración Cochrane Colombia y en el marco de la estrategia Cochrane Corners. Mediante la combinación de la evidencia y el uso de comparaciones indirectas, se ha recomendado con alto grado de certeza el uso de aprepitant, ramosetrón, granisetrón, dexametasona y ondansetrón para la reducción de náuseas y vómito posoperatorio.

Prognostic predictive model for PONV in cesarean delivery

Introduction: Apfel simplified risk score for postoperative nausea and vomiting (PONV) has shown to be useful in anesthesia; however, since it has not been calibrated in regional anesthesia or in pregnant patients, its use in cesarean section is limited. Objective: To develop a prognostic predictive model for postoperative nausea and vomiting in pregnant patients undergoing cesarean section under spinal anesthesia. Methods: In a cohort of 703 term pregnant patients scheduled of cesarean section, 15 variables were prospectively assessed, to design a prognostic predictive model for the development of postoperative nausea and vomiting. A logistic regression analysis was used to construct the model and its calibration and discrimination were based on the Hosmer-Lemeshow test, the calibration curves, and C statistic. Additionally, the internal calibration was performed with the Bootstrap resampling method. Results: Postoperative nausea and vomiting were experienced by 27% of the patients during the first six hours after surgery. The model included as prognostic variables the development of intraoperative nausea and vomiting, age under 28 years, a history of PONV, the mother's BMI and the weight of the newborn baby. The model showed an adequate calibration (x2: 4.65 p: 0.5888), though a low discrimination (Statistic C = 0.68). Conclusions: A prognostic predictive model was created for the development of PONV in cesarean section. This model was used to build a prognostic scale for the classification of patients into risk groups.

Introducción: La escala de riesgo simplificada de Apfel para náuseas y vómito posoperatorio (NVPO) ha mostrado utilidad en anestesia; sin embargo, al no haber sido calibrada en anestesia regional o en pacientes embarazadas, su utilidad en cesárea es limitado. Objetivo: Desarrollar un modelo de predicción pronóstica para náuseas y vómito posoperatorios en pacientes embarazadas, llevadas a cesárea bajo anestesia espinal. Métodos: En una cohorte de 703 pacientes con embarazo a término programadas para cesárea, se evaluaron 15 variables de forma prospectiva para construir un modelo de predicción pronóstica para el desarrollo de náuseas y vómito posoperatorio. Se utilizó el análisis de regresión logística para la construcción del modelo y se calculó su calibración y discriminación con la prueba de Hosmer-Lemeshow, las curvas de calibración y el estadístico C. Además, se realizó la calibración interna con el método de remuestreo Bootstrap. Resultados: Las náuseas y vómito posoperatorio se presentaron en el 27% de las pacientes durante las primeras seis horas después de la cirugía. El modelo incluyó como variables pro-nósticas el desarrollo de náuseas y vómito en el intraoperatorio, edad menor de 28 años, antecedentes de NVPO, índice de masa corporal (IMC) de la madre y el peso del recién nacido. El modelo mostró una adecuada calibración (x2: 4,65 p: 0,5888), aunque una baja discriminación (Estadístico C = 0,68). Conclusiones: Se construyó un modelo de predicción pronóstica para el desarrollo de NVPO en cirugía cesárea, y con este se construyó una escala pronóstica que permite clasificar a las pacientes por grupos de riesgo.

Association between intraoperative hypotension and postoperative nausea and vomiting: a retrospective analysis of 247 thyroidectomy cases

Abstract Background: Postoperative nausea and vomiting (PONV) are major complications after general anesthesia. Although various pathways are involved in triggering PONV, hypotension plays an important role. We hypothesized that intraoperative hypotension during general anesthesia might be responsible for the incidence of PONV. Methods: We retrospectively investigated patients who underwent thyroidectomy. The initial blood pressure measured before induction of anesthesia was used as the baseline value. The systolic blood pressure measured during the operation from the start to the end of anesthesia was extracted from anesthetic records. The time integral value when the measured systolic blood pressure fell below the baseline value was calculated as area under the curve (AUC) of s100%. Results: There were 247 eligible cases. Eighty-eight patients (35.6%) had PONV. There was no difference in patient background between the patients with or without PONV. Univariate analysis showed that the total intravenous anesthesia (TIVA) (p = 0.02), smoking history (p = 0.02), and AUC-s100% (p = 0.006) were significantly associated with PONV. Multiple logistic regression analysis revealed that TIVA (OR: 0.54, 95% CI: 0.29-0.99), smoking history (OR: 0.60, 95% CI: 0.37-0.96), and AUC-s100% (OR: 1.006, 95% CI: 1.0-1.01) were significantly associated with PONV. Conclusion: Intraoperative hypotension evaluated by AUC-s100% was related to PONV in thyroidectomy.

Rachianesthésie en ambulatoire au Centre Hospitalier Universitaire Andrainjato Fianarantsoa, Madagascar: tolérance et efficacité / Ambulatory spinal anaesthesia at the Andrainjato University Hospital of Fianarantsoa, Madagascar: tolerance and effectiveness

La rachianesthésie ambulatoire est une des méthodes d'anesthésies loco- régionales de plus en plus utilisées car permet une réhabilitation précoce. L'objectif de l'étude est d'évaluer la tolérance et l'efficacité de la rachianesthésie réalisée en ambulatoire. Méthodes : Il s'agit d'une étude rétrospective, analytique réalisée au Centre Hospitalier Universitaire Andrainjato Fianarantsoa pendant cinq ans (du mois de janvier 2016 au mois de décembre 2020). La tolérance de la rachianesthésie était évaluée par la fréquence et la gravité des incidents peropératoires et complications postopératoires. Son efficacité était estimée par le taux de sortie le jour de l'intervention et la ré-hospitalisation. Résultats : Soixante-quatre patients âgés de 44 [14-85] ans ont bénéficié d'une chirurgie viscérale, gynécologique, traumatologique ou vasculaire sous rachianesthésie. L'hypotension artérielle (n=04) et les nausées et vomissements peropératoires (n = 01) étaient les incidents retrouvés. Les complications postopératoires étaient la céphalée (n = 13), la douleur postopératoire d'intensité modérée à intense (n = 05) et les nausées et vomissements (n = 02). L'âge supérieur à 50 ans (p = 0,012) et une dose supérieure à 12 mg de bupivacaïne (p = 0,011) étaient corrélés à l'hypotension artérielle peropératoire. Le genre féminin (p = 0,004) et l'utilisation de la bupivacaïne hyperbare (p = 0,027) étaient associés aux complications postopératoires. Tous ces patients étaient sortis le jour même de l'intervention sans ré-hospitalisation. Conclusion : La rachianesthésie ambulatoire connaît actuellement un grand essor dans la pratique anesthésique. La prévention de certaines complications devrait être systématique afin d'optimiser sa tolérance et son efficacité

Aldehyde dehydrogenase 2 rs671 genetic polymorphisms are associated with chemotherapy-induced nausea and vomiting / 南方医科大学学报

OBJECTIVE@#To investigate the correlation between aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphisms and chemotherapy-induced nausea and vomiting (CINV).@*METHODS@#A total of 90 Chinese patients with malignant tumors receiving chemotherapy for the first time were recruited in this study. The occurrence of CINV was observed within 120 h after treatment with docetaxel and cis-platinum chemotherapy (DP regimen). The data of the patients (including age, gender, tumor stage, habitual alcohol consumption, motion sickness, morning sickness, and average sleep time prior to chemotherapy) were collected through a questionnaire. ALDH2 rs671 polymorphisms of the patients were analyzed using a multiple single nucleotide polymorphism genotyping, and the Hardy-Weinberg equation was used for genetic linkage analysis. The correlations between the factors including ALDH2 rs671 polymorphisms and the occurrence of CINV were analyzed.@*RESULTS@#The incidence of CINV was 48.9% among the patients receiving their first chemotherapy with DP regimen. Univariate analysis indicated that the genetic polymorphisms of ALDH2 rs671 were significantly correlated with the occurrence of CINV (P < 0.05). Multivariate logistic analysis indicated that ALDH2 rs671 mutation (OR: 3.019, 95% CI: 1.056-8.628, P < 0.05) and average sleep time prior to chemotherapy no longer than 6 h (OR: 2.807, 95% CI: 1.033-7.628, P < 0.05) were risk factors for CINV in patients with malignant tumors receiving the first chemotherapy with DP regimen.@*CONCLUSION@#ALDH2 gene mutation at rs671 is a risk factor contributing to the occurrence of CINV, and understanding of the underlying mechanism may help to more effectively control the occurrence of CINV.

Analysis of influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization based on two models / 中国实用护理杂志

Objective:To analyze the influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization based on Logistic regression model and decision tree model.Methods:This was a cross-sectional study. A total of 236 patients with primary liver cancer after transarterial chemoembolization in The Second Affiliated Hospital of Air Force Military Medical University from March 2021 to June 2022 were conveniently selected as the research subjects. The factors related to delayed nausea and vomiting were collected, and Logistic regression and decision tree models were established, respectively, and the differences between the two models were compared.Results:The incidence of delayed nausea and vomiting of patients with primary liver cancer after transarterial chemoembolization was 45.34% (107/236). Logistic regression model showed that age, anxiety, sleep disorder, emetic risk level of chemotherapeutic drugs, embolic agent type, and pain 24 hours after surgery were the influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization(all P<0.05). Decision tree model showed that age, sleep disorder, emetic risk level of chemotherapeutic drugs, embolic agent type, and pain 24 hours after surgery were the influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization (all P<0.05). The classification accuracy rates of Logistic regression, decision tree model and combined diagnosis of two models were 72.9%, 71.2% and 72.0% respectively; the areas under the ROC curve were 0.778, 0.781 and 0.806 respectively, with no significant difference (all P>0.05). Conclusions:The analysis results of Logistic regression and decision tree model on the influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization are highly consistent, which can be combined to provide a more comprehensive reference for the evaluation and intervention of medical staff.

Study on the Development and Implementation of Electronic Patient Reported Outcome - Pharmaceutical Management System for Enhanced CINV Control - / 医薬品情報学

Objective: Chemotherapy-induced nausea and vomiting (CINV) can affect a patient’s quality of life and make them resistant to the treatment. We created an electronic patient reported outcome ePRO-linked pharmaceutical management system (PMS) for CINV (CINVePRO) for storing information, such as nausea and vomiting status, food intake, etc., and suggesting the type of anti-nausea medication and dosage changes to the physicians for controlling CINV.Design: At the Gifu University Hospital, the collaborative research institute, inpatients and pharmacists in charge used CINVePRO-PMS, and a questionnaire survey was done to assess the system’s reliability.Methods: The daily entry of data into CINVePRO shows the number and duration of vomiting, degree of nausea, and amount of food consumed and displays a list and graph of these data over time. The PMS enables pharmacists to list the presence or absence of nausea and the number of vomiting for all patients in their charge and record the intervention and display its list.Results: The questionnaire was distributed to 17 inpatients. All patients and pharmacists answered the questionnaire. According to the results of the questionnaire survey of patients, each screen of CINVePRO received a good evaluation that mentioned it was “easy to understand,” “easy to use,” and “especially useful for communicating one’s symptoms.” In addition, the results of a questionnaire survey of the pharmacists revealed that the system was rated as easy to check the patients’ symptoms and practical to use.Conclusion: CINVePRO-PMS was evaluated as a convenient and applicative system. However, linking CINVePRO to the electronic medical record of each hospital is necessary for sharing it among multiple professions.

Fluid preloading before beach chair positioning for arthroscopic shoulder procedures: a randomized controlled trial

Abstract Background and objectives The Beach Chair Position (BCP) has many advantages such as less neurovascular injury and better intra-articular visualization, but it has also negative consequences, including hemodynamic instability. Although maintaining normal Mean Arterial Pressure (MAP) is important, fluid management is also a crucial concept for hemodynamic stability. The main objective of this study is whether preloading before positioning would be effective for less hemodynamic instability. Methods This randomized, controlled study was conducted in a single center in the Istanbul University, Istanbul Faculty of Medicine. Forty-nine patients undergoing elective arthroscopic surgery in the BCP were recruited. In the study group, crystalloid fluid at 10 mL.kg-1 of ideal body weight was administered intravenously 30 min before the BCP for preloading. The primary outcome measures were differences of hemodynamic variables as MAP, Stroke Volume (SV), Heart Rate (HR), and Cardiac Output (CO). The secondary outcome measures were Postoperative Nausea and Vomiting (PONV) rates in postoperative first day, surgical satisfaction scale, total ephedrine dose used during surgery, and total amount of fluid. Results The MAP, CO, and SV measurements of the study group were higher than those of the control group in the 5th minute after the BCP (respectively, p= 0.001, p= 0.016, p= 0.01). The total amount of crystalloid and surgical satisfaction scales were higher in the study group (respectively, p= 0.016, p= 0.001). Total amount of colloid and ephedrine dose used in the intraoperative period, and PONV rates were lower in the study group (p= 0.003, p= 0.018, p= 0.019, respectively). Conclusion Consequently, preloading can be favorable approach to preserve hemodynamic stability.

Impact of extending prevention of postoperative nausea and vomiting for cancer surgical patients in the PACU: a before and after retrospective study

Abstract Backgrounds Procedures for Postoperative Nausea and Vomiting (PONV) prevention are mostly based on identification of the risk factors before administering antiemetic drugs. The purpose of this study was to evaluate the impact of the extended use of antiemetic on the PONV in the Postanesthetic Care Unit (PACU). Methods Two separate 4-year periods (2007-2010, P1, and (2015-2018, P2) were evaluated. During P1, the protocol consisted of dexamethasone and droperidol for patients with a locally adapted high PONV score, followed by ondansetron for rescue in the PACU. For Period 2, dexamethasone (8 mg) and ondansetron (4 mg) were administered in patients under general or regional anesthesia, or sedation longer than 30 minutes, while droperidol (1.25 mg) in rescue was injected in cases of PONV in the PACU. An Anesthesia Information Management System was used to evaluate the intensity score of PONV (1 to 5), putative compliance, sedation, and perioperative opioid consumption upon arrival in the PACU. Results A total of 27,602 patients were assessed in P1 and 36,100 in P2. The administration of dexamethasone and ondansetron increased several fold (p < 0.0001). The high PONV scores were more improved in P2 than in P1, with scores (3+4+5) for P1 vs. P2, p < 0.0001. Overall, 99.7% of the patients in P2 were asymptomatic at discharge. Morphine consumption decreased from 6.9±1.5 mg in P1 to 3.5 ± 1.5 mg in P2 (p < 0.0001). Discussion The extension of pharmacological prevention of PONV was associated with a decrease in the intensity of severe PONV. However, uncertainty regarding confounding factors should not be ignored. IRB nº 92012/33465

A clinical risk analysis of postoperative nausea and vomiting after colorectal cancer surgery

Objective: Postoperative nausea and vomiting (PONV) is a frequent complication following colorectal surgery. The present study investigated the risk factors for PONV after colorectal cancer surgery. Methods: A retrospective study of 204 patients who underwent surgery for colorectal cancer was conducted. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with PONV. Results: The overall incidence of postoperative nausea (PON) and postoperative vomit (POV) was 26.5% (54/204), and 12.3% (25/204), respectively. The univariate analysis showed that female gender (p < 0.001), no current alcohol drinking habit (p = 0.003), and no stoma creation (p = 0.023) were associated with PON. Postoperative vomit was significantly correlated with female gender (p = 0.009), high body mass index (p = 0.017), and right-sided colon cancer (p = 0.001). The multivariate logistic regression analysis revealed that female gender (odds ratio [OR]: 4.225; 95% confidence interval [CI]: 2.170-8.226; p < 0.001) was an independent risk factor for PON. A high body mass index (OR: 1.148; 95%CI: 1.018-1.295; p = 0.025), and right-sided colon cancer (OR: 3.337; 95%CI: 1.287-8.652; p = 0.013) were independent risk factors for POV. Conclusion: Our findings suggest that female gender for PON and a high body mass index and right-sided colon cancer for POV are risk factors after colorectal cancer surgery. An assessment using these factors might be helpful for predicting PONV. (AU)

Antiemetic Efficacy of Prophylactic Ondansetron Versus Ondansetron with Dexamethasone Combination Therapies in Women Undergoing Breast Surgeries: A Randomized Controlled Trial

Objective: To compare the prophylactic antiemetic efficacy of ondansetron monotherapy with that of the combination of ondansetron and dexamethasone in the prevention on postoperative nausea and vomiting (PONV) in breast surgeries by observing the incidence of PONV, assess the percentage of participants requiring rescue antiemetics, know the side effects of drugs, and analyze the effect of the surgical duration of breast surgeries. Methods: The group ondansetron (O) received 0.1 mg/kg IV ondansetron and the other group (ondansetron and dexamethasone combination, OD) received 0.1 mg/kg IV ondansetron and 0.1 mg/kg of dexamethasone. The incidence of PONV in the first 24 h, percentage of population receiving rescue antiemetics, surgical duration, and hemodynamic parameters were noted. Results: In the 0 h to 6 h postoperative period, 38.9% of participants of group O had PONV, whereas only 13.9% in group OD had PONV, which was statistically significant (P < .016). About 30.6% of study population in group O and 8.3% in group OD required rescue antiemetics which was statistically significant (P = .017). Surgical duration of more than 120 min had a statistically significant higher incidence of PONV in the O group with a P-value of .048. Conclusion: The combination of prophylactic ondansetron with dexamethasone is more efficacious than ondansetron alone for the prevention of PONV in women undergoing breast surgeries.

Uso de la dexametasona para la prevención de náuseas y vómitos posoperatorios en pacientes tratados con colecistectomía laparoscópica / Use of dexamethasone for the prevention of postoperative nausea and vomiting in patients treated with laparoscopic cholecystectomy

Introducción: Las náuseas y los vómitos posoperatorios muestran una alta incidencia con los procedimientos laparoscópicos y, además, se han posicionado como un marcador de calidad en anestesiología. Objetivo: Determinar la efectividad de la dexametasona en la prevención de náuseas y vómitos posoperatorios en pacientes operados de la vesícula biliar. Métodos: Se realizó una intervención terapéutica en 100 pacientes operados de la vesícula biliar mediante laparoscopia con anestesia general balanceada, en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de enero a diciembre de 2018. Para ello, se conformaron dos grupos: uno de estudio, tratado con dexametasona, y otro de control, que recibió un placebo; cuyos integrantes fueron seleccionados en igual número (50 para cada grupo) por el método aleatorio simple. Resultados: En ambos grupos se obtuvo una mayor frecuencia de las edades de 33 a 46 años y del sexo femenino. Las náuseas posoperatorias se identificaron en 24,0 % del grupo de estudio, mientras que, en el de control, figuraron en un porcentaje superior (52,0). También disminuyó el número de pacientes con vómitos al aplicar la dexametasona, pues 90,0 % de aquellos que la recibieron no presentaron esta reacción adversa en el período posoperatorio, en comparación con 72,0 % de controles. Conclusiones: La dexametasona redujo la aparición de náuseas y vómitos posoperatorios, de modo que puede resultar efectiva en la prevención de estos efectos secundarios en pacientes intervenidos por colecistectomía laparoscópica.

Introduction: The postoperative nausea and vomiting show a high incidence with the laparoscopic procedures and, also, they have been positioned as a marker of quality in anesthesiology. Objective: To determine the effectiveness of dexamethasone in the prevention of postoperative nausea and vomiting in patients operated on for gall bladder. Methods: A therapeutic intervention was carried out in patients operated on for gall bladder by means of laparoscopy with balanced general anesthesia, at Dr. Juan Bruno Zayas Alfonso Teachig General Hospital in Santiago de Cuba, from January to December, 2018. Two groups were conformed: a study group, treated with dexamethasone, and a control group that received a placebo; whose members were selected in same number (50 for each group) by the simple random method. Results: In both groups a higher frequency of the 33 to 46 ages and the female sex was obtained. The postoperative nausea were identified in 24.0 % of the study group, while, in the control group, it was higher percentage (52.0). Also the number of patients vomiting diminished when applying dexamethasone, because 90.0 % of those that received it didn't present this adverse reaction in the postoperative period, in comparison with 72.0 % of controls. Conclusions: Dexamethasone reduced the appearance of postoperative nausea and vomiting, so that can be effective in the prevention of these secondary effects in patients intervened by laparoscopic cholecystectomy.

Effects of preoperative administration of parecoxib sodium on stress reaction and postoperative nausea and vomiting score in patients undergoing laparoscopic cholecystectomy / 中国基层医药

Objective:To investigate the effects of preoperative administration of parecoxib sodium on stress reaction and postoperative nausea and vomiting score in patients undergoing laparoscopic cholecystectomy.Methods:A total of 112 patients undergoing laparoscopic cholecystectomy in Lishui City People's Hospital from January 2020 to January 2021 were included in this study. They were randomly divided into observation group and control group, with 56 patients per group. The observation group was intravenously administered 40 mg parecoxib sodium 30 minutes before surgery, and the control group was identically administered equal amount of 0.9% sodium chloride injection. At 1, 6, 12 and 24 hours after surgery, Visual Analogue Scale (VAS) score, cortisol and adrenocorticotropic hormone levels and postoperative nausea and vomiting score were compared between the two groups.Results:At 1, 6 and 12 hours after surgery, VAS score in the observation group was (3.23 ± 0.85) points, (2.44 ± 0.76) points, (2.37 ± 0.69) points, respectively, which were significantly lower than (4.06 ± 1.12) points, (3.24 ± 0.95) points, (3.10 ± 1.07) points in the control group ( t = 4.41, 4.92, 4.29, all P < 0.001). At 1, 6, 12 and 24 hours after surgery, cortisol level in the observation group was (287.79 ± 35.46) ng/L, (303.55 ± 34.77) ng/L, (368.58 ± 31.22) ng/L, (397.16 ± 32.60) ng/L, respectively, which were significantly lower than (337.64 ± 39.52) ng/L, (364.18 ± 36.90) ng/L, (405.56 ± 37.29) ng/L, (455.51 ± 37.81) ng/L in the control group ( t = 7.02, 8.94, 5.69, 8.74, all P < 0.05). At 1, 6, 12 and 24 hours after surgery, adrenocorticotropic hormone level in the observation group was (59.25 ± 7.63) ng/L, (65.27 ± 8.23) ng/L, (72.29 ± 7.49) ng/L, (83.63 ± 8.57) ng/L, which were significantly lower than (64.48 ± 8.06) ng/L, (71.44 ± 8.59) ng/L, (79.79 ± 8.15) ng/L, (90.08 ± 8.26) ng/L in the control group ( t = 3.52, 3.88, 5.07, 4.05, all P < 0.05). Within 24 hours after surgery, the incidence of postoperative nausea and vomiting in the observation group was significantly lower than that in the control group [12.50% (7/56) vs. 28.57% (16/56), χ2 = 4.43, P < 0.05). Within 2 hours, 2-6 hours, and > 6-24 hours, postoperative nausea and vomiting score in the observation group was (1.31 ± 0.26) points, (1.43 ± 0.32) points, and (1.46 ± 0.41) points, respectively, which was significantly lower than (1.67 ± 0.41) points, (1.83 ± 0.39) points, (1.88 ± 0.44) points in the control group ( t = 2.12, 2.37, 2.14, all P < 0.05). Conclusion:Preoperative administration of parecoxib sodium exhibits a good postoperative analgesic effect in patients undergoing laparoscopic cholecystectomy. It can effectively reduce postoperative stress reactions, decrease the incidence of postoperative nausea and vomiting, and lower the severity of postoperative nausea and vomiting, and thereby can be widely used in clinical practice.

External validation and comparison of different prediction models of postoperative nausea and vomiting in elderly patients with thoracoscopic partial pneumonectomy / 中国实用护理杂志

Objective:To investigate and compare the predictive effects of two postoperative nausea and vomiting (PONV) prediction models in elderly patients with thoracoscopic partial pneumonectomy.Methods:The total of 227 elderly patients who underwent thoracoscopic partial pneumonectomy in Brain Hospital Affiliated to Nanjing Medical University from October 2021 to January 2022 were collected. Apfel risk score and Koivuranta risk score were used to predict the risk of PONV in each patient. The area under the ROC curve was used to evaluate the discrimination ability of the two prediction models; Hosmer-Lemeshow goodness of fit test was used to evaluate the calibration of the two prediction models.Results:Among 227 patients, 74 had PONV, and the incidence of PONV was 32.6%. The area under the ROC curve of Apfel and Koivuranta risk scores in the risk prediction of PONV in elderly patients with thoracoscopic partial pneumonectomy were 0.640 and 0.683 respectively. There was no significant difference between the two ( Z=1.54, P>0.05). The Hosmer-Lemeshow goodness of fit test showed that the accuracy of the two models in predicting PONV risk in elderly patients with thoracoscopic partial pneumonectomy was better ( P>0.05). Conclusions:The difference between the two models in PONV risk prediction in elderly patients with thoracoscopic partial pneumonectomy is general, Koivuranta model is more suitable for predicting PONV in elderly patients with thoracoscopic partial pneumonectomy, but its applicability is still insufficient.

Risk factors for postoperative nausea and vomiting in patients undergoing thoracic surgery / 中华麻醉学杂志

Objective:To identify the risk factors for postoperative nausea and vomiting (PONV) in the patients undergoing thoracic surgery.Methods:The medical records of patients of either sex, aged 18-80 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, underwent elective thoracic surgery from January 2018 to January 2020, were collected retrospectively.The age, gender, educational background, American Society of Anesthesiologists physical status, motion sickness, history of smoking, history of drinking, history of heart disease, history of hypertension, history of diabetes, preoperative blood routine, liver function, parameters of electrolytes; operation method, type of operation, operation time, intraoperative nerve block, consumption of dexamethasone before anesthesia induction and intraoperative sufentanil and dexmedetomidine, use of postoperative patient-controlled intravenous analgesia (PCIA), and postoperative rescue opioid analgesics and antiemetics were recorded.The patients were divided into PONV group and non-PONV group depending on the occurrence of nausea and vomiting within 24 h after operation.PONV group was further divided into nausea group (PON group) and vomiting group (POV group) according to whether vomiting occurred.Logistic regression analysis was used to identify the risk factors for PONV.Results:A total of 3 791 patients were enrolled in this study, with 144 cases in PONV group and 3 647 cases in non-PONV group.The incidence of PONV was 3.80%.There were 38 patients in POV group, and the incidence was 26.4%.The results of logistic regression analysis showed that motion sickness, female, pulmonary wedge resection, postoperative PCIA and increased use of postoperative rescue opioid analgesics were risk factors for PONV in the patients undergoing thoracic surgery, intraoperative use of dexmedetomidine was a protective factor for PONV; motion sickness, female and history of hypertension were risk factors for postoperative vomiting in the patients at risk for PONV ( P<0.05). Conclusions:Motion sickness, female, pulmonary wedge resection, postoperative PCIA, and increased use of postoperative rescue opioid analgesics are risk factors and intraoperative use of dexmedetomidine is a protective factor for PONV in the patients undergoing thoracic surgery; motion sickness, female and history of hypertension are risk factors for postoperative vomiting in the patients at risk for PONV.