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

Objectives: Minimally invasive epiduroscopy has recently been reported as an effective treatment procedure for chronic and intractable low back pain. However, no study has determined safe anesthetics for monitored anesthesia care during epiduroscopy. We aimed to compare and evaluate conventional monitored anesthesia care drugs with dexmedetomidine. Methods: A retrospective study including all patients who underwent epiduroscopy at the JR Tokyo General Hospital from April 2011 to March 2016 was designed. The epiduroscopy procedures were performed under anesthesia with dexmedetomidine plus fentanyl (dexmedetomidine group) or droperidol plus fentanyl (neuroleptanalgesia group). Patients who received analgesics other than fentanyl, another analgesic combined with fentanyl, any sedative other than dexmedetomidine or droperidol, or who had incomplete data were excluded. We compared (1) the type and dose of medication during the epiduroscopy and (2) the incidence of postoperative nausea and vomiting. Results: We identified 45 patients (31 and 14 in the dexmedetomidine and neuroleptanalgesia groups, respectively) with a mean age of 69.0 years. The two groups had comparable characteristics, such as age, sex, body mass index, the American Society of Anesthesiologists Physical Status, analgesics used in the clinic, comorbidities, history of smoking, and the duration of anesthesia. The dexmedetomidine group received a significantly lower fentanyl dose during surgery (126 ± 14 vs 193 ± 21 µg, mean ± standard deviation, p = 0.014) and exhibited a significantly lower incidence of postoperative nausea and vomiting (1 vs 3, p = 0.047) than the neuroleptanalgesia group. Conclusion: This study involved elderly patients, and the use of dexmedetomidine in monitored anesthesia care during epiduroscopy procedures in these patients may reduce the required fentanyl dose during surgery and the incidence of postoperative nausea and vomiting. This strategy may help prevent respiratory depression and aspiration.

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Opioid administration via epidural catheter is a risk factor for postoperative nausea and vomiting in total hip arthroplasty: A retrospective study

Journal of Orthopaedic Science ◽

10.1016/j.jos.2018.06.011 ◽

2018 ◽

Vol 23 (6) ◽

pp. 973-976 ◽

Cited By ~ 2

Author(s):

Taku Ukai ◽

Goro Ebihara ◽

Masahiko Watanabe

Keyword(s):

Risk Factor ◽

Retrospective Study ◽

Total Hip Arthroplasty ◽

Epidural Catheter ◽

Hip Arthroplasty ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Total Hip ◽

Opioid Administration

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The Effect of a Multifaceted Postoperative Nausea and Vomiting Reduction Strategy on Prophylaxis Administration Amongst Higher-Risk Adult Surgical Patients

Anaesthesia and Intensive Care ◽

10.1177/0310057x1804600207 ◽

2018 ◽

Vol 46 (2) ◽

pp. 185-189 ◽

Cited By ~ 4

Author(s):

A. Pym ◽

E. Ben-Menachem

Keyword(s):

High Risk ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Outcome Data ◽

Nausea And Vomiting ◽

Surgical Patients ◽

Evidence Based ◽

Post Intervention ◽

Reduction Strategy ◽

Risk Patients

Postoperative nausea and vomiting (PONV) is a common and distressing problem for patients and increases the burden of care in post-anaesthesia care units (PACU). As such it has been a recent focus for quality improvement. Evidence-based guidelines have demonstrated the benefit of PONV risk stratification and prophylaxis, but may be underutilised in clinical practice. This prospective pre-/post-intervention study was conducted at an adult tertiary hospital in non-cardiac adult surgical patients at higher risk of PONV. The intervention included promotion of an evidence-based PONV guideline, and provision of individualised prescribing and patient outcome data to anaesthetists. Six hundred and twenty-eight patients with ≥2 risk factors for PONV following general anaesthesia for non-cardiac surgery were included (333 pre-intervention and 295 post-intervention). Prior to the intervention, 9.0% (30/333) of moderate- and high-risk patients received antiemetic prophylaxis consistent with our guideline. Post-intervention, the rate of guideline adherence was 19.3% (57/295). In the high-risk PONV group, the time in PACU was significantly reduced post-intervention, 66 minutes versus 83 minutes (P=0.032). This institution-specific PONV reduction strategy had a modest but significant effect on improving prophylaxis administration. However, our findings indicate that further efforts would be required to ensure fuller compliance with the current extensive evidence base for PONV management in higher-risk patients.

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Nitrous Oxide Makes Me Sick: Or Does It? (Nitrous Oxide and Postoperative Nausea and Vomiting)

Journal of Perioperative Practice ◽

10.1177/175045891002000605 ◽

2010 ◽

Vol 20 (6) ◽

pp. 215-218

Author(s):

Luke Ewart

Keyword(s):

Nitrous Oxide ◽

Postoperative Nausea ◽

Clinical Management ◽

Management Strategy ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Surgical Patients ◽

Baseline Risk ◽

Multimodal Approach ◽

Strength Of Evidence

This article evaluates whether avoidance of nitrous oxide in general anaesthesia can improve clinical outcomes in surgical patients by reducing postoperative nausea and vomiting, and whether avoidance should become part of a routine clinical management strategy. Despite some controversy, the greatest strength of evidence suggests that avoidance of nitrous oxide may be justified as a pre-emptive perioperative strategy as part of a multimodal approach to postoperative nausea and vomiting, especially in those patients known to have a higher baseline risk.

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