Low incidence of postoperative nausea, vomiting, regurgitation, and aspiration pneumonia in geriatric dogs receiving maropitant, famotidine, and fentanyl as part of an anesthesia protocol

2021 ◽  
Vol 260 (S1) ◽  
pp. S46-S51
Author(s):  
Ashley L. Moyer ◽  
Talon S. McKee ◽  
Philip J. Bergman ◽  
Arathi Vinayak
Keyword(s):  
Risk Factors ◽  
Aspiration Pneumonia ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Asa Score ◽  
Surgery Patient ◽  
Potential Risk Factors ◽  
Low Incidence ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract OBJECTIVE To determine the incidence of and potential risk factors for postoperative regurgitation and vomiting (PORV), postoperative nausea and vomiting (PONV), and aspiration pneumonia in geriatric dogs using premedication with maropitant and famotidine, intraoperative fentanyl, and postoperative fentanyl as part of an anesthetic protocol. ANIMALS 105 client-owned geriatric dogs that underwent general anesthesia for a major surgical procedure between January 2019 and March 2020. PROCEDURES Medical records were reviewed to collect data on signalment, historical gastrointestinal signs, American Society of Anesthesiologists (ASA) score, indication for surgery, duration of anesthesia and surgery, patient position during surgery, mode of ventilation, and perioperative administration of maropitant, famotidine, anticholinergics, opioids, colloidal support, NSAID, corticosteroids, and appetite stimulants. The incidence of postoperative regurgitation, vomiting, nausea, and aspiration pneumonia was calculated, and variables were each analyzed for their association with these outcomes. RESULTS 2 of 105 (1.9%) dogs regurgitated, 1 of 105 (1.0%) dogs developed aspiration pneumonia, 4 of 105 (3.8%) dogs exhibited nausea, and no dogs vomited. Identified possible risk factors included older age (≥ 13 years old) for postoperative regurgitation, regurgitation for postoperative aspiration pneumonia, and high ASA score (≥ 4) for both regurgitation and aspiration pneumonia. CONCLUSIONS AND CLINICAL RELEVANCE The use of an antiemetic protocol including maropitant, famotidine, and fentanyl in geriatric dogs resulted in very low incidences of PORV, PONV, and aspiration pneumonia. Future prospective studies are warranted to further evaluate and mitigate postoperative risks.

scholarly journals Dexmedetomidine use during epiduroscopy reduces fentanyl use and postoperative nausea and vomiting: A single-center retrospective study

2018 ◽  
Vol 6 ◽  
pp. 205031211875680 ◽  
Author(s):  
Takashi Suzuki ◽  
Ryota Inokuchi ◽  
Kazuo Hanaoka ◽  
Machi Suka ◽  
Hiroyuki Yanagisawa
Keyword(s):  
Retrospective Study ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Anesthesia Care ◽  
Low Back ◽  
Monitored Anesthesia Care ◽  
History Of ◽  
American Society ◽  
American Society Of Anesthesiologists

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.

scholarly journals Gambaran Kejadian Postoperative Nausea and Vomiting (PONV) pada Pasien Pasca Tindakan Dilatasi Kuretase dengan Anestesi Umum di RSIA B pada Tahun 2019

2021 ◽  
Vol 2 (1) ◽  
pp. 10
Author(s):  
Resiana Karnina ◽  
Mayinda Nabilla Ismah
Keyword(s):  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
American Society ◽  
American Society Of Anesthesiologists

Latar Belakang: Anestesi umum merupakan salah satu jenis anestesi yang banyak digunakan untuk tindakan dilatasi dan kuretase. Meskipun demikian, anestesi umum memiliki komplikasi salah satunya yaitu kejadian Postoperative Nausea and Vomiting (PONV). Tujuan: Mengetahui gambaran kejadian Postoperative Nausea and Vomiting (PONV) pada pasien pasca tindakan dilatasi dan kuretase menggunakan anestesi umum di RSIA B pada tahun 2019. Metode: Desain penelitian ini adalah penelitian deskriptif observasional, data diambil dari catatan rekam medis pasien pasca tindakan dilatasi dan kuretase dengan anestesi umum di RSIA B. Sampel diambil dengan metode total sampling sebanyak 139 sampel. Analisa data menggunakan SPSS 26.0 for Windows. Hasil: Dari 139 pasien, angka kejadian Postoperative Nausea and Vomiting (PONV) adalah 16 kasus (11.5%). PONV dengan anestesi umum paling banyak terjadi pada rentang usia 29 – 34 tahun (14%) dan pasien dengan status American Society of Anesthesiologists (ASA) I (13%). Proporsi pasien PONV berdasarkan jenis obat anestesi yaitu pada jenis obat anestesi intravena sebanyak 16 kasus (11.5%). Simpulan: Kejadian Postoperative Nausea and Vomiting (PONV) cukup tinggi, terutama pada rentang usia 29 – 34, status ASA I dan jenis obat anestesi intravena.

Difference in Risk Factors for Postoperative Nausea and Vomiting

2003 ◽  
Vol 98 (1) ◽  
pp. 46-52 ◽  
Author(s):  
Michaela Stadler ◽  
Françoise Bardiau ◽  
Laurence Seidel ◽  
Adelin Albert ◽  
Jean G. Boogaerts
Keyword(s):  
Risk Factors ◽  
Postoperative Nausea ◽  
Clinical Audit ◽  
Postoperative Nausea And Vomiting ◽  
Female Gender ◽  
Nausea And Vomiting ◽  
Scale Scores ◽  
Potential Risk Factors ◽  
History Of ◽  
A Prospective Study

Background It is commonly stated that risk factors for postoperative nausea are the same as for vomiting. The authors designed a prospective study to identify and differentiate the risk factors for postoperative nausea and vomiting in various surgical populations in a clinical audit setting. Methods The study included 671 consecutive surgical inpatients, aged 15 yr or more, undergoing various procedures. The study focused on postoperative nausea visual analog scale scores every 4 h and vomiting episodes within 72 h. Both vomiting and retching were considered as emetic events. Patient-, anesthesia-, and surgery-related variables that were considered to have a possible effect on the proportion of patients experiencing postoperative nausea and/or vomiting were examined. The bivariate Dale model for binary correlated outcomes was used to identify selectively the potential risk factors of postoperative nausea and vomiting. Results Among the 671 patients in the study, 126 (19%) reported one or more episodes of nausea, and 66 patients (10%) suffered one or more emetic episodes during the studied period. There was a highly significant association between the two outcomes. Some risk factors were predictive of both nausea and vomiting (female gender, nonsmoking status, and general anesthesia). History of migraine and type of surgery were mainly responsible for nausea but not for vomiting. The predictive effect of risk factors was controlled for postoperative pain and analgesic drugs. Conclusion This study shows that differences exist in risk factors of postoperative nausea and vomiting. These could be explained by differences in the physiopathology of the two symptoms.

scholarly journals Comparative Study of Ondansetron Versus Dexamethasone in the Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy Under General Anesthesia

2021 ◽  
Vol 4 (1) ◽  
pp. 81-84
Author(s):  
Sundar Prasad Hyoju
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anesthesia ◽  
Postoperative Nausea ◽  
Vital Signs ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Double Blind ◽  
American Society ◽  
American Society Of Anesthesiologists

Introduction: Postoperative nausea and vomiting (PONV) have been termed as the “big little problem” for anesthesiology during laparoscopic surgery. Pain and postoperative nausea and vomiting are the most common causes of morbidity after anesthesia and surgery. We aimed to evaluate the effects of Ondansetron and Dexamethasone in preventing postoperative nausea and vomiting following laparoscopic cholecystectomy, as well as to note any pharmacological side effects that occurred after their usage. Methods: In this prospective, randomized, double blind controlled study, trial was done after approval from the IRB and trail registry, 60 female patients of American Society of Anesthesiologists physical status I and II, aged 18 to 65 years, weighing 50-60 kg, and standing 150 to 160 cm, were given institutional ethical committee clearance and written informed consent before undergoing laparoscopic cholecystectomy (duration 90 minutes) under general anesthesia. Patients arriving in the operating room were sorted into two groups of 30 patients each. All patients were monitored after surgery, documenting vital signs and any difficulties that arose. For the first 12 hours after surgery, all bouts of PONV (nausea, vomiting, and retching) were documented. Each patient's data was gathered and tallied. Results: The patients in the study group were similar in age, weight, height, ASA status, and operation duration (p 0.05), and there was no significant statistical difference between the data gathered throughout the study Conclusions: Ondansetron is just as effective as Dexamethasone at lowering nausea and vomiting after laparoscopic cholecystectomy, and it comes with less adverse effects.

scholarly journals Discordant American Society of Anesthesiologists Physical Status Scoring between Anesthesiologists and Surgeons Is Correlated With Adverse Patient Outcomes: A Retrospective Cohort Study of 46284 Elective Surgical Patients

2021 ◽  
Author(s):  
Charlene Xian Wen Kwa ◽  
Jiaqian Cui ◽  
Daniel Yan Zheng Lim ◽  
Yilin Eileen Sim ◽  
Yuhe Ke ◽  
...  
Keyword(s):  
Cohort Study ◽  
Patient Outcomes ◽  
Real World ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Clinical Factors ◽  
Physical Status ◽  
Asa Score ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract BackgroundThe American Society of Anesthesiologists Physical Status Classification (ASA) score is used for communication of patient health status, risk scoring, benchmarking and financial claims. Prior studies using hypothetical scenarios have shown poor concordance of ASA scoring among healthcare providers. However, there is a paucity of concordance studies using real-world data, as well as studies of clinical factors or patient outcomes associated with discordant scoring. The study aims to assess real-world ASA score concordance between surgeons and anesthesiologists, factors surrounding discordance and its impact on patient outcomes. MethodsThis retrospective cohort study was conducted in a tertiary academic medical center on 46284 consecutive patients undergoing elective surgery between January 2017 and December 2019. ASA scores entered by surgeons and anesthesiologists, patient demographics, and post-operative outcomes were collected. We assessed the concordance of preoperative ASA scoring between surgeons and anesthesiologists, clinical factors associated with score discordance, the impact of score discordance on clinically important outcomes, and the discriminative ability of the two scores for 30-day mortality, 1-year mortality, and intensive care unit (ICU) admission. Statistical tests used included Cohen’s weighted 𝜅 score, chi-square test, t-test, unadjusted odds ratios and logistic regression models. ResultsThe ASA score showed moderate concordance (weighted Cohen’s 𝜅 0.53) between surgeons and anesthesiologists. 15098 patients (32.6%) had discordant scores, of which 11985 (79.4%) were scored lower by surgeons. We found significant associations between discordant scores and anesthesiologist-assessed comorbidities, patient age and race. Patients with discordant scores had a higher risk of 30-day mortality (odds ratio 2.00, 95% confidence interval [CI] = 1.52-2.62, p<0.0001), 1-year mortality (odds ratio 1.53, 95% CI = 1.38-1.69, p < 0.0001), and ICU admission >24 hours (odds ratio 1.69, 95% CI = 1.47-1.94, p< 0.0001), and stratified analyses showed a trend towards higher risk when the surgeons’ ASA score was lower. ConclusionsThere is moderate concordance between surgeons and anesthesiologists in assigning the ASA classification. Discordant ASA scores are associated with adverse patient outcomes. Hence, there is a need for improved standardization of ASA scoring and cross-specialty review in ASA-discordant cases.

Prevention of Postoperative Nausea and Vomiting

2018 ◽  
pp. 147-152
Keyword(s):  
Risk Factors ◽  
Nitrous Oxide ◽  
Relative Risk ◽  
Adverse Events ◽  
Postoperative Nausea ◽  
Volatile Anesthetic ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Baseline Risk ◽  
Maximum Reduction

This case focuses on the prevention of postoperative nausea and vomiting (PONV) by asking the question: What is the efficacy of six well-established prophylactic antiemetic strategies individually and in combination for the prevention of postoperative nausea and vomiting? Each of the three antiemetics in this study (ondansetron, dexamethasone, and droperidol) reduced the risk for PONV by approximately 26%; substituting propofol for volatile anesthetic reduced the risk by 19%; and substituting nitrogen (air) for nitrous oxide reduced the risk by 12%. A maximum reduction of 70% in the relative risk for PONV can be expected when total intravenous anesthesia is used with three antiemetics. The appropriate approach to the management of PONV depends on the patient’s baseline risk factors as well as the likelihood of adverse events and costs from the antiemetic medications.

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