The essential oil of ginger, Zingiber officinale, and anaesthesia

Abstract

It is proposed that a 5% solution of essential oil of ginger, Zingiber offi-cinale, is an effective post-operative nausea and vomiting (PONV) prevention when administered preoperatively, naso-cutaneously concurrently with conventional therapies to general anaesthesia patients at high risk for PONV. This is a summary of six months clinical experience and impressions of a single anaesthesia practi-tioner using best practice multimodal management plus 5% oil of ginger, Zingiber officinale, in the prevention of PONV in high risk group adult patients. The results of the clinical experience show improvement gained in patient response as measured by lower incidence of nausea and vomiting in the post-anaes-thesia recovery unit (PACU). The group treated with the essential oil of ginger expe-rienced approximately less than 20% nausea in the PACU. This low percentage of high risk PONV patients that experienced nausea in the ginger group mostly required only one single intravenous supplemental medication to control nausea. Approxi-mately, 80% of high risk patients had no complaint of PONV and therefore did not require any further intravenous therapy during recovery from anaesthesia through discharge from PACU. The non-ginger oil treated patients in this clinical experience had a roughly 50/50 chance of PONV. A 5% solution of the essential oil of Zingiber officinale in grape seed carrier oil, when applied naso-cutaneously, can be administered safely for the effective pre-vention and therapeutic management of nausea in general anaesthesia patients at high risk for post-operative nausea and vomiting, with increased patient satisfaction and less expense to patients and hospital. Guidelines and regulations established for the safe use of integrative therapy with an essential oil are critical to observe.

Full text

The essential oil of ginger, Zingiber officinale,
and anaesthesia
James L. Geiger
*
Banner Desert Medical Center, Integrative Therapy, Mesa, AZ 85296, USA
Summary It is proposed that a 5% solution of essential oil of ginger, Zingiber offi-
cinale, is an effective post-operative nausea and vomiting (PONV) prevention when
administered preoperatively, naso-cutaneously concurrently with conventional
therapies to general anaesthesia patients at high risk for PONV. This is a summary
of six months clinical experience and impressions of a single anaesthesia practi-
tioner using best practice multimodal management plus 5% oil of ginger, Zingiber
officinale, in the prevention of PONV in high risk group adult patients.
The results of the clinical experience show improvement gained in patient
response as measured by lower incidence of nausea and vomiting in the post-anaes-
thesia recovery unit (PACU). The group treated with the essential oil of ginger expe-
rienced approximately less than 20% nausea in the PACU. This low percentage of
high risk PONV patients that experienced nausea in the ginger group mostly required
only one single intravenous supplemental medication to control nausea. Approxi-
mately, 80% of high risk patients had no complaint of PONV and therefore did not
require any further intravenous therapy during recovery from anaesthesia through
discharge from PACU. The non-ginger oil treated patients in this clinical experience
had a roughly 50/50 chance of PONV.
A 5% solution of the essential oil of Zingiber officinale in grape seed carrier oil,
when applied naso-cutaneously, can be administered safely for the effective pre-
vention and therapeutic management of nausea in general anaesthesia patients at
high risk for post-operative nausea and vomiting, with increased patient satisfaction
and less expense to patients and hospital. Guidelines and regulations established for
the safe use of integrative therapy with an essential oil are critical to observe.

c2004 Elsevier Ltd. All rights reserved.
KEYWORDS
Ginger;
Zingiber officinale;
Integrative;
Anaesthesia;
Nausea;
PONV;
CAM
Introduction
Smell is a learned process shaped by language and
experience (Stevenson and Boakes, 2003) and
genetics (Buck, 1992). The medical science of
0962-4562/$ - see front matter 
c2004 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ijat.2004.12.002
*
Tel.: +1 480 421 1019; fax: +1 480 421 9697.
E-mail address: jlgeiger@OilMD.com.
URL: www.oilmd.com.
The International Journal of Aromatherapy (2005) 15, 7–14
intl.elsevierhealth.com/journals/ijar
The International
Journal of
Aromatherapy

nausea is complexly interwoven with coexisting dis-
ease states. Safe practical choices in essential oil
therapy can be extrapolated from evidenced based
clinical references, which may be integrated into
the medical management of various conditions.
Specifically, the naso-cutaneous application of
essential oil of ginger, Zingiber officinale, can be
a safe and effective addition to the medical man-
agement for the prevention and treatment of the
complications of nausea and vomiting associated
with general anaesthesia.
The 2004 Nobel Prize in physiology or medicine
has been awarded to Richard Axel and Linda Buck
for their discoveries of odorant receptors and
the genetic organization of the olfactory system
(Nobelprize.org, 2004). Previously numerous similar
theories for odorant detection systems and mecha-
nisms of actions of anaesthesia have been proposed.
These similar theories are the spectral recognition
of vibrational molecules (Turin, 1996), metallo-
protein ‘‘shuttlecock’’ mechanism (Wang et al.,
2003), mnemonic perception (Stevenson and Boa-
kes, 2003), agonist–antagonist receptor binding
(Firestein, 2004), cell membrane molecular configu-
ration stress (Cantor, 2001), and cyclic nucleotide
ligand-gated ion channels (Yamakura et al., 2001).
Our understanding of the odorant detection system
is evolving. The mechanism of action of the chemi-
cal constituents of ginger oil at the level of cellular
biosynthesis shows that ginger extracts block activa-
tion of proinflammatory mediators and its transcrip-
tional regulator in human synoviocyte cultures
(Frondoza et al., 2004). The mechanism of action
of the chemical constituents of scents at the cellu-
lar level may involve intranuclear protein synthesis
from DNA.
The uptake and distribution mechanism of ana-
esthetics is known (Eger, 1998). A predominantly
accepted theory ascribed to the action of anaes-
thetics, namely ‘‘molecular membrane stress’’ ap-
plied to the bilipid layer of cell membranes (Ueda,
2001), might conceivably be applied to explain
some of the actions of essential oils at the cellular
level. Many essential oils and many anaesthetic
molecules are aliphatic hydrocarbon chains. The
natural plasticity of the bilipid layers of cell walls
and organelles of various body tissues is due in part
to the orientation of the hydrophilic and hydropho-
bic lipid layers. The cell membranes have abundant
embedded protein receptors and ionic channels,
which are thought to be acted upon by the various
volatile chemicals of the anaesthetic gas agents.
Perhaps the chemical constituents of the vapours
from essential oils as well as the absorbed chemical
constituents act directly as chemical messengers
on the cell membranes and other cellular compo-
nents. The second messenger neurotransmitter,
cyclic adenosine monophosphate (c-AMP), working
with olfactory G protein and ionic calcium modu-
late an excitatory synapse at the olfactory bulb
mediating c-aminobutryic acid (GABA) and
N-methyl-
DD
-aspartate (NMDA) receptors (Chen
et al., 2000). GABA is a receptor system for seda-
tion. NMDA is a receptor system for pain.
After an essential oil is applied to the skin a
blood level is achieved. The following example is
given for Lavandula angustifolia. A 2.0% dilution
of L. angustifolia oil applied to the abdomen of a
volunteer showed that approximately 10% of the
Lavender oil was absorbed into the general blood
circulation. Then plasma levels peaked 20 min
after application as circulation via capillaries to
tissue continued. After 90 min, both linalool and li-
nalyl acetate had dropped almost to zero, illustrat-
ing almost complete metabolism (Ja
¨ger, 1992).
Renal and hepatic mechanisms probably metabo-
lize the majority of an average essential oil treat-
ment dose.
Similar kinetics could apply to transnasal inhala-
tional absorption. There is potentially more rapid
absorption across the highly vascular cribiform
plate in the nose, which is a direct transdural
pathway to the brain. This complex cellular vas-
culo-lymphatic plexus, associated with abundant
glomerulo-mitral apparatus in the olfactory bulb,
cross the blood–brain barrier to perfuse brain tis-
sue. The kinetics of an anaesthetic agent is similar
in that the volatilized gas is absorbed across the
basement membranes of the lungs. The anaesthetic
chemicals cross into the bloodstream and rapidly
circulate to vascular rich organs first, such as brain,
liver, lungs, heart, kidney and muscles. Then, by
mass action, as concentration effect increases over
time, less vascular rich organs such as bowels, epi-
dermis, bones and fat gain in tissue anaesthetic
content.
Therapy with essential oils is somewhat like
general anaesthesia in that volatile anaesthetic
vapour is delivered diluted in the carrier gases
oxygen and or nitrous oxide via a breathing cir-
cuit. In the field of essential oil therapy, 100%
pure volatile essential oils from select plant parts
are diluted with various carrier oils for delivery
by numerous methods in concentrations, usually
ranging from 1% to 5%. The concentration chosen
depends on the clinical circumstances, which is
similar to administration of anaesthesia vapour.
The uptake and distribution of the chemical con-
stituents of essential oils are transmitted via
chemical messengers directly into the brain and
brain stem via complex neuronal and circulatory
pathways when inhaled.
8 J.L. Geiger

The science of nausea
The first cranial nerves, CNI (the olfactory nerves),
are embedded into the base of the frontal lobes of
the brain. Early human clinical treatment series
using surgically implanted glial support cell cul-
tures of olfactory ensheathing cells, OEC, of the
olfactory nerves are shown to aid regeneration
spinal nerve function (Huang et al., 2003). There
appears to be right nasal to right hemisphere dom-
inance of unfamiliar odour recognition. Familiar
odours are recognized symmetrically, when lan-
guage is involved (Savic and Berglund, 2000). The
sensory cells for odours have receptor binding sites
which have unique properties for odorant chemical
recognition and information mediation. In the
olfactory bulb, olfactory receptor cells recognize,
convert and transmit chemical odorant generated
information into chemical messengers across glom-
erulo-mitral pathways by G-protein activation.
These chemical messages are transmitted as chem-
ical data along aroma mediated pathways to vari-
ous areas of the brain, such as the amygdala,
hippocampus and thalamus. The stress of surgery
activates the amygdala and learning occurs during
general anaesthesia (Gidron et al., 2002; Andrade,
1995).
The cranial nerves of the oropharynx, Facial,
CNVII, Glossopharyngeal, CNIX and Vagus, CNX, lo-
cated at the base of the tongue and back of the
throat have taste receptors that transmit chemi-
cally translated data to the medulla in the brain-
stem. Located next to the medulla is the
chemotactic trigger zone, CTZ, which mediate nau-
sea and vomiting. These receptors are located
bilaterally and lateral to the fourth ventricle in
the area postrema. These receptors for nausea
and vomiting respond to vagal and sympathetic
afferents, as well as blood-borne toxins. The most
commonly used volatile anaesthetic, Sevoflurane,
is ether-based. Ether is known as a highly emetic
anaesthetic vapour agent.
Intravenous medications work on specific path-
ways and receptors for nausea prevention and
treatment. These various classes of medications
administered in combination therapy are estab-
lished as the foundation of effective multimodal
therapy for prevention and treatment of nausea
and vomiting of various origins (Scuderi et al.,
2000). Some causes of nausea and vomiting respond
better to different drug choices to manage specific
nausea receptors (Bone et al., 1990). The routine
prophylactic use of antiemetics decreases the inci-
dence of PONV (Gupta et al., 2003). Escalating
multimodal therapy for PONV is generally accepted
as effective, evidence based, best practice with
known PONV failure rates (Habib and Gan, 2004;
Apfel et al., 2004).
The powdered root of ginger is as effective as
metaclopamide in the prevention of PONV in cer-
tain settings (Ernst and Pittler, 2000). Ginger juice
produces anti-motion sickness action possibly by
central and peripheral anticholinergic and has
antihistaminic effects (Qian and Liu, 1992). Ginger
syrup decreased duration and severity of nausea in
pregnancy (Keating and Chez, 2002). Powered gin-
ger root was shown to be as effective as Vitamin B6
in reducing the symptoms of nausea vomiting and
dry retching of pregnancy. No untoward tetaro-
genic effects were shown (Portnoi et al., 2003;
Smith et al., 2004). Powered ginger root has shown
negative results for effective prevention of PONV
post-laparoscopy (Eberhart et al., 2003). There ap-
pears to be a difference between the potency of
ginger preparations and the degree of the effects
they mediate when comparing the various prepara-
tions administered orally, such as ginger juice, gin-
ger powdered root and syrup of ginger. To date no
studies have examined the efficacy of ginger
essential oil, Zingiber officinale, administered
naso-cutaneously for prevention of nausea and
vomiting in conjunction with surgery and general
anaesthesia.
Chemistry receptor applications
Receptor chemistry is a challenging field of study
because every system has system specific receptor
sites serving as information conversion stations.
There are two commonly known receptors of the
vomiting centre in the brainstem located in the
reticular formation of the medulla. The well-known
muscarinic receptors are mediated by acetylcho-
line. Histamine receptors are blocked by H1 antag-
onists and H2 antagonists. The chemoreceptor
trigger zone (CTZ) has receptor sites for benzodi-
azepines, histamine and dopamine. D3 dopaminer-
gic receptors are blocked by dopamine antagonists.
The therapeutic successes of the expensive intra-
venous medications, the 5-HT3 serotonin receptor
antagonists, work slowly but degrade quickly, hav-
ing half-lives on the order of 2–3 h. This peripher-
ally acting class works indirectly via the vagus
nerve to block receptor sites to circulating seroto-
nin at end-organs.
Ginger exhibits 5HT3 receptor antagonistism
which effectively antagonizes serotonin at 5-HT3
receptors. This effect is mediated by galanolactone,
The essential oil of ginger, Zingiber officinale, and anaesthesia 9

a diterpenoid isolated from ginger (Huang et al.,
1991). Ginger essential oil appears to mediate its
warming effects by decreasing body serotonin
(Huang et al., 1990). The shogaols and 6-, 8-, and
10-gingerols, isolated from the methanolic extract
of Zingiber officinale rhizome, exhibit anti-emetic
principles (Kawai et al., 1994). The capsaicin-like ef-
fect of 6-shogaol is possibly the analgesic substance
found in ginger that inhibits the release of the neuro-
peptide, substance P (Onogi et al., 1992). Ginger
essential oil is thought to be analgesic as well as anx-
iolytic (Vishwakarma et al., 2002), whilst ginger
powder taken orally decreased osteoarthritis symp-
tomatology (Altman and Marcussen, 2001).
Side effect profiles of antiemetics
There are numerous potentially serious adverse drug
reactions attributed the various classes of antie-
metic medications. These adverse drug reactions
range from mild confusion, dysphoria, headache,
phlebitis, tics, torticolis, serotonin syndrome, neu-
roleptic malignant syndrome, and a-blockade alter-
ations in blood pressure to potential life threatening
cardiac rhythm disturbances. Droperidol has re-
cently been subjected to a ‘‘Black Box’’ warning
by the FDA (Habib and Gan, 2003). This controversial
warning describes the rational for patients to have a
normal QT interval documented by ECG prior to
intravenous administration of droperidol. The risk
of the malignant ventricular dysrhythmia called Tor-
sades de Pointes associated with droperidol is also
known to occur with several of the new selective
blocking agents of the serotonin 5-HT3 receptor
antagonists. The chemical restraint, haloperidol is
a useful antiemetic, without significant side effects
when given intravenously at very low dose (Buttner
et al., 2004). Perhaps ginger essential oil could be
considered an alternative for droperidol, even
though one investigation failed to show benefit when
compared with powdered ginger root (Visalyaputra
et al., 1998).
Ginger is a food product which is both safe and
non-toxic, although sensitization could pose a po-
tential problem. IgE allergy and food spice allergy
had negative prick-test results for sensitization to
ginger (Moneret-Vautrin et al., 2002). Mild gastro-
intestinal burning and sedation appears to be the
only side effect of several grams orally ingested
per day (Sripramote and Lekhyananda, 2003). The
essential oil of ginger can be safely and directly
administered to the emetic centres of the brain
in the chemoreceptor trigger zone via the olfactory
pathways and skin absorption, naso-cutaneously.
The nasal route of administration is utilized suc-
cessfully for many FDA approved medications,
especially those related to the treatment of aller-
gic and vasomotor rhinitis.
Ginger had been thought to adversely affect
platelet aggregation. Ginger had been thought to ad-
versely affect platelet aggregation. Ginger’s plate-
let inhibition is like that of aspirin and the anti-
coagulation effect of warfarin is potentiated by
acetaminophen (Lesho et al., 2004). It is notable
that only two reported cases of bleeding in humans
have been associated with the combined anticoagu-
lation effect of warfarin with acetaminophen while
dieting on ginger herbal powder tea and eating
pieces of ginger root (Lesho et al., 2004;Kruth
et al., 2004). Previous studies show that eating large
oral doses of ginger powder or raw ginger root do
change thromboxane concentration, which is
reversible (Guh et al., 1995) but do not adversely af-
fect the clotting ability of platelets as measured
with clinical laboratory data (Lamb, 1994; Janssen
et al., 1996). Preanaesthesia check lists name ‘‘gin-
ger’’ for possibly associated bleeding problems
(Hodges and Kam, 2002). This consideration possibly
should be modified to include safe applications for
the use of ginger.
Materials
The essential oil of ginger, Zingiber officinale, was
obtained from lot number 4702 dated August 3,
2002 by The Fragrant Earth. A 5% solution of the
essential oil was mixed in grape seed oil and placed
in a rollerball applicator. The essential oil used in
this clinical application costs a few cents per
patient.
Medical management of PONV:
procedure and method
Informed consent was obtained prior to surgery for
general anaesthesia. As specific consent for the use
of ginger essential oil was also obtained, it was pos-
itively suggested that smelling ginger essential oil
could possibly assist in the prevention of PONV
(Laurion and Fetzer, 2003). Patients resulted from
daily case work of one clinical practitioner at one
facility, adding ginger essential oil to the MD anaes-
thesia management of PONV. The essential oil of
ginger solution was applied to both wrists during
preoperative anaesthesia evaluation immediately
prior to surgery.
10 J.L. Geiger

The rollerball applicator method was utilized for
application of 5% ginger essential oil to the volar as-
pects of both wrists at the P6 NEI-KUAN accupres-
sure points (Wang and Kain, 2002). The volume of
oil applied covered approximately a 4 ·4cm
2
area,
using slight pressure at the P6 sites bilaterally, with
the suggestion for the patient to smell those sites ad
lib prior to induction of general anaesthesia.
The clinical experience presented here is with
patients at high risk for PONV, during a six month
period using similar combinations of intravenous
multimodal therapy to prevent PONV. The initial
three month period consisted of similar combina-
tions of intravenous multimodal therapy alone.
During the following three months, similar combi-
nations of intravenous multimodal therapy plus
5% essential oil of ginger were given in combina-
tion. All cases were high risk for PONV; defined as
either having significant history of prior PONV
and/or they were subject to a surgical intervention
that predisposed them to PONV. The surgeries cho-
sen were open gynaecological surgeries, upper and
lower abdominal laparoscopic procedures and
operations requiring high dose intravenous narcotic
management of major post-surgical pain, as seen in
spine fusion or total joint replacement. Patients
were excluded if there was lack of time, interest,
known ginger sensitivity, surgical or personnel con-
siderations. Possible congenital, acquired, or iatro-
genic coagulation disorders, including preoperative
thrombo-embolic prophylaxis were also excluded.
Patients were prescribed multimodal antiemetic
intravenous medication regimens including similar
intravenous drug combinations of the selective
blocking agent of the serotonin 5-HT3 receptor
class, H1 and H2 blockers, metaclopamide and dex-
amethazone. Oxygen was provided for all patients
in PACU continuously for SpO
2
less than 94%. Upon
awakening in PACU, the patient responded to ques-
tioning by a PACU nurse pertaining to nausea and
pain and medicated as needed. Response to ques-
tioning determined any patient that received an
antiemetic in the PACU, as a ‘ginger failure’.
Clinical impressions
Prevention of post-op nausea using prophylactic
multimodal intravenous medication therapy plus
essential oil of ginger was effective over 80% of
the time, as measured by no complaint of nausea
during the PACU recovery period. The nausea fail-
ure rate in the ginger treated group was less than
20%. In a similar group of patients prophylactically
treated with multimodal intravenous therapy with-
out ginger essential oil there was almost no differ-
ence in the nausea/no nausea in PACU out come,
which was approximately 50/50.
There have been no ill-effects such as gastric
burning or sensitization reported in any patients
utilizing these methods when administered prior
to the induction of general anaesthesia. In this sit-
uation, in which sometimes as many as 5–15 differ-
ent medicines are given intravenously during the
course of the anaesthetic and surgery, no known
adverse reactions or bleeding due to essential oil
of ginger occurred.
Limitations and considerations for
future investigations
The following enumerates the problems with the
realization of this clinical treatment series. Risk
factors mentioned in studies that influence a mean-
ingful clinical investigation included control for
multiple variables such as age, gender and non-
smoking history (Apfel and Roewer, 2003). More
challenging control group considerations possibly
could include; nasal dominance, blood pressure,
dependent or non-dependent learned states, alter-
nations in sense of smell due to medications and
coexisting diseases states, as well as prior ginger
experience.
The specific NSAID cyclooxygenase (Cox-2)
receptor of anti-inflammatory pain management
strategy has been called in question as shown by
the FDA issued public health advisory recommend-
ing limited use of Cox-2 inhibitors and the volun-
tary recall of rofecoxib, Vioxx (www.FDA.GOV).
These problems arise from the unbalanced critical
relationship of the dual actions of Cox and 5-lipo-
oxygenase (5-Lox) receptor inhibition on the ara-
chidonic acid and leukotriene enzymatic pathways
combined with the altered induction of receptors
for certain broad spectrum protective mechanisms
(Fiorucci et al., 2001). Initially known Cox/5-Lox
benefits were cardiovascular (stroke/heart attack)
gastrointestinal (bleeding/PONV), pulmonary
(bronchoconstrictive), and prevention of neurode-
generation (Bertolini et al., 2002). Specifically,
the chemical constituent, [8]-paradol, in ginger
oil is fibrinolytically active, increasing the Cox-1
inhibitory anti-platelet aggregation activity as
strongly as aspirin (Tjendraputra, 2003). The
anti-inflammatory action of [8]-shogaol of ginger
oil at Cox-2 blocks pro-inflammatory enzymatic
biosynthetic pathways of the undesirable
prostaglandin-2 (Tjendraputra et al., 2001). The
curcuminoid oils of the Zingaberaceae family
The essential oil of ginger, Zingiber officinale, and anaesthesia 11

chemically mediate the dual action of Cox/5-Lox
inhibitors (Chainani-Wu, 2003) while providing
anticarcinogenic actions as well as anti-inflamma-
tory mediated pain control (Hong et al., 2004).
These more challenging variables are potentially
significant and relatively difficult and are perhaps
unquantifiable control variables for most investiga-
tional purposes. This review of clinical practice is
presented with respect for the investigational re-
view board protocols and thus patient privacy and
safety. These considerations should be a primary
concern in the care provided by aromatherapy
practitioners (Myles and Tan, 2003). Standardized
extracts of phytopharmaceutical preparations are
available and have been utilized for specific inves-
tigations of the various effects of the chemical
constituents of ginger (Bonati, 1991).
Increasing numbers of adults are using comple-
mentary and alternative medicine (CAM) to im-
prove their health. Some patients and surgeries
may not be suited to receive essential oils. Ginger
is considered a CAM therapy for migraine head-
aches (Mustafa and Srivastava, 1990). Perhaps the
serotonin mediated vasodilating properties of gin-
ger are propagated via nasal inhalation. Cutaneous
application of ginger oil, perioperatively, might
contribute in the maintenance of critical body tem-
perature during surgery. Other properties of the
various chemical constituents of ginger are recog-
nized such as the anti-tumour promoting effects
of 6-gingerol and 6-paradol and the antimicrobial
effects of the monoterpenes 1,8-cineole, b-pinene
and a-terpineol found in ginger essential oil (Surh
et al., 1999; Martins et al., 2001).
Closed circuit anaesthesia utilizes injection of
the unit dose of the liquid volatile anaesthetic
agent, according to patient weight and square root
of time interval, directly into the anaesthesia circuit
to induce and maintain general anaesthesia (da Silva
et al., 1997). Pulmonary vascular vasodilatation can
be accomplished for the management of pulmonary
hypertension with inhaled nebulized nitroglycerin,
directly into the anaesthesia circuit via the endotra-
cheal tube (Yurtseven et al., 2003). One referenced
letter portrays a general anaesthesia study ap-
proved by the Ethics Research Committee utilizing
sweet orange essential oil. Children assessed them-
selves as more relaxed and cooperative at induction
of anaesthesia for dental surgery. Four drops of
sweet orange essential oil were applied into a filter
of the anaesthesia circuit. This application was uti-
lized to promote acceptance of the Sevoflurane
vapour gas mask induction of anaesthesia and then
removed for surgery to proceed in 60 children
(Mehta, 1998). Several advantages were noted and
it was concluded that it was safe and recommended
to use it more. There is a lack of study data examin-
ing the differences between oropharnygeal uptake
and distribution of vapour agents versus direct pul-
monary uptake and distribution. Exogenous lipoid
pneumonia should be prevented by safe inhalational
applications of essential oil therapies that have yet
to be established (Spickard and Hirschmann, 1994).
Other methods of application of oil products could
be considered, such as continuous naso-inhalation
from a medicated nasal adhesive strip.
Different essential oils might have been used to
evaluate the prevention and treatment of PONV,
such as essential oil of peppermint (Anderson and
Gross, 2004). There is evidence of medical litera-
ture pertaining to the effective use of essential oil
of peppermint therapy in this field of PONV (Tate,
1997). Peppermint has possible toxicity issues
regarding G6PD deficiency (Olowe and Ransome-
Kuti, 1980). No other phytopharmaceuticals prepa-
rations have data as pertains to safety and efficacy
in association with general anaesthesia in the med-
ical literature to the same extent to compare to as
the studies with the various preparations of ginger.
Conclusions
Integrating prophylactic intravenous multimodal
therapy with the essential oil of Zingiber officinale
therapy in acute care and ambulatory settings to
prevent the general anaesthesia complication of
post-operative nausea and vomiting significantly in-
creases successful outcomes, resulting in increased
patient satisfaction. This clinical experience with
various limitations is presented as having gener-
ated meaningful information, indicating that a 5%
solution oil of ginger essential oil to be a safe and
effective choice for the prevention of PONV. A pre-
vious multimodal antiemetic study indicated that
choice of intravenous medication prophylaxis of-
fered little impact on clinical outcome or in patient
satisfaction (Darkow et al., 2001). The resulting
clinical impression in this setting implies increased
patient satisfaction and outcomes warrants further
evaluation as well as consideration for change in
the anaesthetic perioperative assessment and man-
agement of PONV. These findings are similar to a
previous study demonstrating the need for less
intravenous anti-nausea medications during the
recovery period in those patients that received gin-
ger powder (Phillips et al., 1993). Reducing the
incidence of PONV by approximately 30%, if repro-
ducible, is noteworthy. Perhaps other patients hav-
ing less risk factors for PONV would benefit from
application of ginger essential oil alone. Ginger
12 J.L. Geiger

essential oil might effectively treat the three ma-
jor components of PONV surrounding surgical inter-
ventions related to general anaesthetic agents,
narcotics and motion sickness.
These improved results over previous clinical
investigations using powered ginger root taken as
an oral premedication (Eberhart et al., 2003; Morin
et al., 2004) are possibly due to the following com-
bined effects. This therapeutic success may be
attributed to the learned smell associated with gin-
ger aromatherapy utilizing suggestion imagery peri-
operatively, the increased potency of the essential
oil of ginger as compared to other preparations, as
well as the method of application, the combined
naso-cutaneous administration of the essential oil
of ginger.
Acknowledgement
Acknowledgement to Kathy Bilko.
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14 J.L. Geiger