[Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment].
ABSTRACT Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Española de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.
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ABSTRACT: 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.Anesthesia and analgesia 01/2014; 118(1):85-113. DOI:10.1213/ANE.0000000000000002 · 3.42 Impact Factor
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ABSTRACT: The knowledge of the influence of anesthetic techniques in postoperative outcomes has opened a large field of research in recent years.In this second part, we review some of the major controversies arising from the literature on the impact of anesthetic techniques on postoperative outcomes in 6 areas: postoperative cognitive dysfunction, chronic postoperative pain, cancer recurrence, postoperative nausea/vomiting, surgical outcomes, and resources utilization.The development of protective and preventive anesthetic strategies against short and long-term postoperative complications will probably occupy an important role in our daily anesthetic practice.Dynamic postoperative pain control has been confirmed as one of the basic requirements of accelerated postoperative recovery programs («fast-track surgery»), and it is also a preventive factor for development of chronic postoperative pain.The weight of anesthetic technique on postoperative immunosuppression is to be defined. The potential influence of anesthesia on cancer recurrence, is a highly controversial area of research.The classic pattern of perioperative fluid therapy may increase postoperative complications. On the other hand, the maintenance of normoglycemia and normothermia was associated with a decreased postoperative morbidity.The high volume of surgical procedures means that the adequacy of human, organizational and technological resources have a major impact on overall costs.Revista espanola de anestesiologia y reanimacion 02/2013; 60(2):93–102. DOI:10.1016/j.redar.2012.09.002
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ABSTRACT: Background and Objectives Opioid is the gold standard for treating moderate-to-severe pain in pediatric patients. However, its undesirable side effects lead to unsatisfied postoperative pain management outcome (Pediatr Anesth, 17, 2007, 756). The most commonly reported opioid-related side effects are vomiting (40%), pruritus (20–60%) (Anesthesiology, 77, 1992, 162; Drugs, 67, 2007, 2323), and constipation (15–90%) (Int J Clin Pract, 61, 2007, 1181). The potential life-threatening adverse event, respiratory depression, is less common (0.0013%) (Pediatr Anesth, 20, 2010, 119). The aim of this review was to evaluate prevention strategies that have been shown to decrease opioid side effects in pediatric patients during the postoperative period.Methods Literature searches were conducted from 1984 to February 2013. Meta-analysis, systematic review, and randomized, placebo-controlled studies were obtained from PubMed and the Cochrane Library. The medical subject heading (MeSH) terms were opioid analgesics, adverse effects, pediatrics, children, side effects, and postoperative pain.Results and conclusionData from 62 studies were reviewed. The strategies that could effectively prevent and reduce opioid side effects in pediatric patients during the postoperative period included minimizing the amount of opioid consumption by a multimodal approach, opioid titration, using local anesthetic techniques and providing the specific prophylaxis for each side effect.Pediatric Anesthesia 06/2014; 24(6). DOI:10.1111/pan.12420 · 1.74 Impact Factor