Postoperative Nausea and Vomiting in Day-Case Surgery

The influence of perioperative analgesia modes on the prevalence of postoperative nausea and vomiting in day-case surgery patients is investigated in the article. The study involved 100 cases of unilateral phlebectomy under propofol and nitrous oxide anaesthesia, randomized by 4 groups with different perioperative analgesia modes of 25 patients each. In the first group fentanyl IV infusion was provided during surgery, in the second group it was amplified with ketoprofen 100 mg IV. In the third group sodium adenosintriphosphate IV infusion was provided for the whole surgery time, whereas the patients in the fourth group received 100 mg ketoprofen IV before it. Analgesic efficacy of all the four modes was equal, while ketoprofen administration aggravated and prolonged postoperative nausea and vomiting without influence on PONV morbidity.

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Postoperative nausea and vomiting in arthroscopic day‐case surgery: a comparison between desflurane and isoflurane

Anaesthesia ◽

10.1046/j.1365-2044.1998.00516.x ◽

1998 ◽

Vol 53 (9) ◽

pp. 910-914 ◽

Cited By ~ 34

Author(s):

M. B. Hough ◽

B. Sweeney

Keyword(s):

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Day Case ◽

Day Case Surgery ◽

Case Surgery

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Minor Morbidity after Day-Case Surgery

Scottish Medical Journal ◽

10.1177/003693309804300209 ◽

1998 ◽

Vol 43 (2) ◽

pp. 54-56 ◽

Cited By ~ 9

Author(s):

J.D. Hunter ◽

W.A. Chambers ◽

K.I. Penny

Keyword(s):

Postoperative Nausea And Vomiting ◽

Diagnostic Procedures ◽

Postal Questionnaire ◽

Nausea And Vomiting ◽

Day Case ◽

Day Case Surgery ◽

Number Of Patients ◽

Case Surgery ◽

The Uk ◽

The Impact

The number of patients and procedures considered suitable for day-case anaesthesia and surgery continues to grow and it is hoped that 50–60% of all operations in the UK will eventually be performed on a day-patient basis.1 However, minor but troublesome post-operative side effects remain common. We have examined the incidence of the most common causes of minor morbidity, namely headache, nausea /vomiting and pain occurring after a wide variety of day-case surgical and diagnostic procedures. Patient satisfaction with treatment and the impact of day case surgery on the workload of the general practitioner was also assessed. The anaesthetic records of the patients involved were reviewed in an attempt to determine if there was any association between the anaesthetic technique and an adverse outcome. A simple postal questionnaire completed on the morning after surgery was returned by 553 patients (response rate over 87%). More than 50% of respondents complained of some morbidity, with 40% complaining of pain, 19% of headache and 9% of nausea and vomiting. One third self-medicated to modify their symptoms, and in most cases (81%) this was effective. However, 6% of patients called their GP for advice and 2% received a home visit. No patient required readmission. A total of 92 patients (17%) would have preferred treatment as an in-patient. Analysis of the anaesthetic drugs and techniques suggested that the commonly used anti-emetics droperidol and metoclopramide had little effect on the incidence of postoperative nausea and vomiting. Intubation was associated with a significantly higher incidence of minor morbidity although this may be related to surgical factors.

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Morphine-sparing Effect of Acetaminophen in Pediatric Day-case Surgery

Anesthesiology ◽

10.1097/00000542-199908000-00019 ◽

1999 ◽

Vol 91 (2) ◽

pp. 442-447 ◽

Cited By ~ 155

Author(s):

Reijo Korpela ◽

Pekka Korvenoja ◽

Olli A. Meretoja

Keyword(s):

Single Dose ◽

Postoperative Pain ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Postanesthesia Care Unit ◽

Day Case ◽

Rescue Analgesia ◽

Day Case Surgery ◽

Case Surgery ◽

Sparing Effect

Background Postoperative pain is a major problem in day-case surgery in children. Nonsteroidal antiinflammatory drugs have gained popularity in management of pediatric surgical patients to reduce the need for opioids. The aim of this study was to evaluate the efficacy of different doses of rectal acetaminophen in day-case surgery in children. Methods A randomized, double-blinded, placebo-controlled study design was used. Patients (n = 120) were randomized to receive a single dose of 0, 20, 40, or 60 mg/kg of rectal acetaminophen after induction of anesthesia. General anesthesia was induced by mask ventilation with sevoflurane (7%) in nitrous oxide and oxygen and maintained with 2.5-4.0% end-tidal sevoflurane. Opioids or local anesthetics were not used. Postoperative pain was evaluated by behavioral assessment and physiologic measurements every 10 min after arrival at the postanesthesia care unit. The pain intensity was scored using a 0-100 visual analog scale used in the authors' clinic. The need for rescue medication, intravenous morphine 0.1 mg/kg, was decided by the nurse, who was unaware of the rectal acetaminophen dose. The parents were interviewed by phone after 24 h regarding pain and its treatment, nausea, and vomiting. Rescue analgesia at home was rectal ibuprofen, 10 mg/kg. Results In the postanesthesia care unit pain scores were significantly lower in the 40- and 60-mg/kg groups compared with placebo and 20-mg/kg groups. Acetaminophen resulted in a dose-related reduction in the number of children who required postoperative rescue opioid, with significance reached with 40 or 60 mg/kg doses. Calculated dose of acetaminophen at which 50% of the children not requiring a rescue opioid was 35 mg/kg. The need for rescue analgesia at home during the first 24 h after surgery was also significantly less in patients in the 40- or 60-mg/kg groups than in the 0- or 20-mg/kg groups (20-17 vs. 80-63%). Thirty-three percent of patients receiving placebo had postoperative nausea and vomiting, compared with 0-3% in groups receiving 40 or 60 mg/kg acetaminophen. Conclusions A single dose of 40 or 60 mg/kg of rectal acetaminophen has a clear morphine-sparing effect in day-case surgery in children if administered at the induction of anesthesia. Moreover, children with adequate analgesia with acetaminophen have less postoperative nausea and vomiting.

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Supplemental oxygen and the incidence of nausea and vomiting after day case surgery

Irish Journal of Medical Science (1971 -) ◽

10.1007/bf03169871 ◽

2001 ◽

Vol 170 (S2) ◽

pp. 84-84

Keyword(s):

Supplemental Oxygen ◽

Nausea And Vomiting ◽

Day Case ◽

Day Case Surgery ◽

Case Surgery

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The Effect of Anaesthetic Technique on Postoperative Nausea and Vomiting after Day-case Gynaecological Laparoscopy

Anaesthesia and Intensive Care ◽

10.1177/0310057x0203000205 ◽

2002 ◽

Vol 30 (2) ◽

pp. 153-159 ◽

Cited By ~ 19

Author(s):

M. J. Paech ◽

B. H. S. Lee ◽

S. F. Evans

Keyword(s):

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Complete Response ◽

Nausea And Vomiting ◽

Day Case ◽

Post Discharge ◽

Gynaecological Laparoscopy ◽

Group I ◽

Inhalational Anaesthesia ◽

Admission Group

Gynaecological surgery is of high emetogenic potential and both total intravenous anaesthesia (TIVA) and prophylactic antiemetic therapy may reduce the incidence of postoperative nausea and vomiting (PONV). We studied 144 patients scheduled for day-case gynaecological laparoscopy in a randomized trial comparing balanced inhalational anaesthesia and prophylactic dolasetron (group I+D) with propofol TIVA and dolasetron (group T+D) or TIVA alone (group T). The primary outcome of “complete response” (no vomiting, no treatment for PONV) was not significantly different among groups (34%, 51%, 32%; groups I+D vs T+D vs T, P=0.12). During the first hour after surgery, group I+D had nausea of greater severity (P<0.03). During hospital admission, group T had more vomiting (P<0.03). From discharge until 24 hours postoperatively, 55% of group I+D experience nausea and 38% vomited. The incidence and severity of nausea were significantly lower in the TIVA groups (P<0.04 and < 0.05 respectively). There were no significant differences between groups T+D and T, although comparing all groups the complete response rate was highest and the post-discharge incidence and severity of nausea lowest in group T+D. In conclusion, propofol TIVA, with or without dolasetron, reduced postoperative nausea, but not perioperative vomiting or antiemetic requirement, when compared with inhalational anaesthesia plus dolasetron.

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A Randomized Double-Blinded Comparison of Metoclopramide, Ondansetron and Cyclizine in Day-Case Laparoscopy

Anaesthesia and Intensive Care ◽

10.1177/0310057x9602400506 ◽

1996 ◽

Vol 24 (5) ◽

pp. 546-551 ◽

Cited By ~ 17

Author(s):

S. A. Watts

Keyword(s):

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Relative Efficacy ◽

Day Case ◽

Detectable Difference ◽

Double Blinded ◽

To Receive ◽

Significant Nausea ◽

Antiemetic Agents

This study determined the overall incidence of postoperative nausea and vomiting (PONV) in 38 patients undergoing laparoscopic gynaecological procedures who received a standardized propofol/isoflurane anaesthetic but no pre-operative antiemetic. A further 166 patients similarly anaesthetized were then randomly allocated to receive either metoclopramide 10 mg, ondansetron 4 mg, or cyclizine 50 mg as an intravenous antiemetic immediately pre-induction. Overall incidence of PONV was determined for all groups and the relative efficacy of the three antiemetic agents assessed. Fifty per cent of patients in the initial group (no antiemetic) reported significant nausea and/or vomiting up to 24 hours postoperatively. The incidence of PONV in the metoclopramide group was 24%, in the ondansetron group 20%, and in the cyclizine group 51%. There was no detectable difference in relative efficacy between ondansetron 4 mg and metoclopramide 10 mg. The incidence of PONV in the group who received cyclizine was similar to that found in the pilot group who received no PONV prophylaxis. Both metoclopramide and ondansetron may potentially decrease the incidence of PONV following gynaecologic laparoscopy by up to 50% when administered intravenously prior to a propofol/isoflurane anaesthetic.

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