Reduction of Postoperative Nausea and Vomiting through Patient Risk Stratification

Objective: To develop a patient risk stratification algorithm that will reduce the incidence of postoperative nausea and vomiting (PONV) in an ambulatory plastic surgery practice by increasing the use of prophylactic medications as the risk of PONV increases. Design: Retrospective review of an ambulatory plastic surgery practice before and after a PONV patient risk stratification algorithm was introduced. A patient risk stratification algorithm was developed based on known causes of PONV. Incidence of patients experiencing PONV before and after the introduction of the patient risk stratification algorithm was compared. Results of the study were analyzed with logistic regression. Results: The rate of PONV was 17.7% before the patient risk stratification algorithm was instituted and 4.47% after. This difference is significant (one-sided P value against no difference in true incidence of PONV = .003). A history of PONV and longer lengths of anesthesia were associated with higher likelihoods of PONV (P = .02 and .0056, respectively), and application of our patient algorithm (ie, membership in the study group as opposed to the control group) was associated with a lower likelihood of PONV (P < .001). Conclusion: Patient risk stratification and a multimodality approach to PONV prophylaxis effectively reduce the rate of PONV in an ambulatory plastic surgery practice.

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Pengaruh Terapi Komplementer Akupresur terhadap Mual Muntah Pasca Operasi di RSUD Dr. H. Abdul Moeloek Provinsi Lampung

Jurnal Kesehatan ◽

10.26630/jk.v8i3.649 ◽

2017 ◽

Vol 8 (3) ◽

pp. 382

Author(s):

El Rahmayati ◽

Anggi Irawan ◽

Tumiur Sormin

Keyword(s):

Postoperative Nausea ◽

Complementary Therapies ◽

Postoperative Nausea And Vomiting ◽

Sampling Technique ◽

Nausea And Vomiting ◽

Bivariate Analysis ◽

Control Group ◽

P Value ◽

The Difference ◽

Post Operative Nausea

<p class="Normal1">Postoperative Nausea and vomiting (PONV) is a common complication after surgery.The incidence of postoperative nausea vomiting is approximately 30% of all patients undergoing inpatient surgery and 70% of cases occur within the first 24 hours. One of nausea and vomiting treatment is non-pharmacological therapies with complementary acupressure therapy. Furthermore, the research was conducted to determine the effect of acupressure complementary therapies against postoperative nausea and vomiting.The research was Quasi-Experimental research design Non-equivalent Control Group, the sampling technique used purposive sampling technique. Based on results of sample calculation used amounted to 22 respondents, consisting of 11 experimental groups and 11 control groups. Collecting data was used questionnaire and analyzed using univariate and bivariate analysis by Wilcoxon and Mann-Whitney with α values (<0.05).The results showed the difference in score of nausea and vomiting the first and second measurements in the control group given a placebo action is 0.91 with a p-value (0.26). Nausea and vomiting difference in scores obtained before and after acupressure complementary therapies in the experimental group was 2:18 with a p-value (0.004). As well as the difference in scores obtained post-operative nausea and vomiting in the control group and the experiment is 1:27 with the p-value (0.009). The above statistical test results can be concluded that there was the effect of complementary acupressure therapy on postoperative nausea vomiting. Based on the conclusion of the research, the authors suggest that complementary acupressure therapy can be applied as a companion therapy and it is expected that nursing staff can learn complementary acupressure therapy.</p>

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Comparison of Anesthesia Depth Monitoring using Conventional and Bispectral Index on Incidence and Severity of Nausea and Vomiting after Urological Surgeries

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.v.6n.2p.25 ◽

2018 ◽

Vol 6 (2) ◽

pp. 25

Author(s):

Reihan Shenasi ◽

Hamzeh Hoseinzadeh ◽

Hasan Mohammadpor-Anvari ◽

Davod Aghamohammadi ◽

Reza Sari-Motlagh

Keyword(s):

General Anesthesia ◽

Bispectral Index ◽

Postoperative Nausea ◽

Operating Time ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Control Group ◽

Anesthetic Drugs ◽

Urological Surgery ◽

Anesthesia Depth

Bispectral index parameter is used to guide the titration of general anesthesia. This monitoring improves recovery times and hospital discharges, as well as minimizes adverse events. The objective of this study is the comparison of anesthesia depth monitoring by conventional and bispectral index on nausea and vomiting after urological surgery. 180 participants who were scheduled for abdominal urological surgery were studied. Patients before induction of anesthesia were randomize into two groups with and without bispectral index monitoring. Incidence and severity of nausea and vomiting were recorded every 30 minutes for 2 hours and every 6 hours to 24 hours after surgery. The incidence of postoperative nausea and vomiting in Bispectral index group is 14.4% and 8.9% and in control group 28.9% and 23.3%, respectively. The risk of nausea and vomiting after surgery was reduced by 14.5% and 14.4%, respectively in patients monitored with bispectral index.INTRODUCTIONNausea is the conscious perception of medulla stimulation that is associated with vomiting center and create vomiting response (1). General anesthesia with the use of inhalants can cause nausea and vomiting after surgery (Postoperative nausea and vomiting, PONV). The incidence of PONV is reported about 20-30 percent (2). It seems that multiple-factor can cause PONV and few items such as anesthetic drugs, kind of surgery and personal risk factors is effective on PONV. These factors make into two categories that includes factors out of control by anesthesiologists and factors can control by anesthesiologists.1. Factors out of control by anesthesiologists: some of these factors are age, gender, past history of PONV and motion sickness, smoking, kind of surgery, operating time and anesthesia time, anxiety of patients and parents. 2. Factors controlled by anesthesiologists: these factors are associated of anesthesia settings, including premedications, kind of anesthesia, anesthesia drugs during surPublishedby Australian

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Use of Aprepitant and Factors Associated With Incidence of Postoperative Nausea and Vomiting in Patients Undergoing Facial Plastic Surgery

JAMA Facial Plastic Surgery ◽

10.1001/jamafacial.2015.0307 ◽

2015 ◽

Vol 17 (4) ◽

pp. 251-255 ◽

Cited By ~ 5

Author(s):

Scott J. Trimas ◽

Morgan D. Trimas

Keyword(s):

Plastic Surgery ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Facial Plastic Surgery ◽

Factors Associated ◽

Facial Plastic

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Ondansetron for the Prevention of Postoperative Nausea and Vomiting: Which is the Best Dosage for Aesthetic Plastic Surgery?

Aesthetic Plastic Surgery ◽

10.1007/s00266-004-3087-5 ◽

2004 ◽

Vol 28 (1) ◽

Cited By ~ 2

Author(s):

MarcusVin�ciusJardini Barbosa ◽

FabioXerfan Nahas ◽

LydiaMasako Ferreira ◽

Andr�iaBufoni Farah ◽

RobertaLopes Bariani ◽

...

Keyword(s):

Plastic Surgery ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Aesthetic Plastic Surgery

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Simplified algorithm for the prevention of postoperative nausea and vomiting: a before-and-after study

British Journal of Anaesthesia ◽

10.1016/j.bja.2017.08.003 ◽

2018 ◽

Vol 120 (1) ◽

pp. 156-163 ◽

Cited By ~ 26

Author(s):

G. Dewinter ◽

W. Staelens ◽

E. Veef ◽

A. Teunkens ◽

M. Van de Velde ◽

...

Keyword(s):

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Before And After ◽

Simplified Algorithm ◽

Before And After Study

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Multimodal Low-opioid Anesthesia as an Effective Way to Prevent Postoperative Nausea and Vomiting. Pathophysiological Aspects of this Complication

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs06.01.101 ◽

2021 ◽

Vol 6 (1) ◽

pp. 101-106

Author(s):

Т. Ovsiienko ◽

◽

M. Bondar ◽

O. Loskutov ◽

◽

...

Keyword(s):

General Anesthesia ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Control Group ◽

Average Dose ◽

Kidney Surgery ◽

Group 2 ◽

Total Average ◽

Group 1

Postoperative nausea and vomiting are common adverse effects of anaesthesia and surgery. Up to 80% of patients may be affected. These outcomes are a major cause of patient dissatisfaction. In addition, postoperative nausea and vomiting can independently cause the occurrence of rather serious complications of the postoperative period, such as aspiration of gastric contents into the airways, hemodynamic disorders in patients with a compromised cardiovascular system, failure of surgical sutures, bleeding, dehydration and electrolyte imbalance which ultimately can lead to disability of patients, prolongation of their hospitalization and higher treatment costs. Material and methods. The paper presents the results of our own research on the use of multimodal low-opioid general anesthesia as one of the methods for the prevention of postoperative nausea and vomiting during anesthetic provision of laparoscopic kidney surgery. The study involved 38 patients who underwent laparoscopic kidney surgery. Results and discussion. To compare the incidence of postoperative nausea and vomiting, patients were randomly divided into two groups. Group 1 used multimodal general anesthesia with standard opioid doses, while group 2 used multimodal low-opioid general anesthesia. The total average dose of fentanyl that was used during the entire time of anesthesia in the control group was 373.3 ± 50.8 μg (4.34 μg / kg / h). The total average dose of fentanyl that was used during the entire time of anesthesia in the study group was 217.39 ± 49.1 μg (1.76 μg / kg / h). In group 1, vomiting occurred in 4 patients out of 15 in the postoperative period, in group 2 there were 4 patients with vomitting, but out of 23 operated patients. The standardized rate of postoperative nausea and vomiting in the control group was 26.6%, in the main group it was 17.3%. Conclusion. As a result of comparing the incidence of postoperative nausea and vomiting in patients of both study groups, we found that a decrease in the dose of perioperative use of opioids helps to reduce the incidence of this complication, which increased the safety of anesthetic management, greatly facilitated and accelerated the rehabilitation of patients after laparoscopic kidney surgery. The work also highlighted and systematized information on the morphology of structures involved in the formation of postoperative nausea and vomiting, on the physiology of this process

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Pterygopalatine Fossa Block as a Component of Multimodal Anesthesia in an Ophthalmic Surgery

International scientific-practical journal Ophthalmology ◽

10.30702/ophthalmology30092020-11.1.1506-13 ◽

2020 ◽

pp. 6-14

Author(s):

V Serdiuk ◽

N Mynka ◽

Yu Kobelyatsky

Keyword(s):

Postoperative Nausea ◽

Carbon Dioxide Concentration ◽

Postoperative Nausea And Vomiting ◽

Pterygopalatine Fossa ◽

Nausea And Vomiting ◽

Control Group ◽

Ophthalmic Surgery ◽

Non Invasive ◽

Exhaled Air

Materials and methods. The study included 20 patients aged 25 to 84, 11 men and 9 women with various front eye pathologies. 10 patients were anesthetized according to the classic scheme taken in our clinic. In the other 10 patients, the pain relief scheme was supplemented by the implementation of pterygopalatine fossa block. Monitoring during the operation included non-invasive monitoring of hemodynamics, pulsoxymetry, determination of oxygen and carbon dioxide concentration in exhaled air. In postoperative period level of pain was fixed using visual-analogue scale and frequency of postoperative nausea and vomiting. Results. The study found that patients in the groups had no statistically significant differences in sex, age and severity of surgery. At all stages of the study, the severity of pain in patients with the pterygopalatine fossa block was reliably lower than in patients in the control group. The incidence of postoperative nausea and vomiting was also lower in the blockade group.

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