scholarly journals Aggressive Prophylactic Treatments for Postoperative Nausea and Vomiting Improve Outcomes in Pediatric Adenotonsillectomy Procedure

2020 ◽  
Vol 25 (4) ◽  
pp. 303-308
Author(s):  
Tatyana Demidovich ◽  
Orlando Perez-Franco ◽  
Marco Silvestrini-Suarez ◽  
Pin Yue
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
General Anesthesia ◽  
Postoperative Nausea ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Antiemetic Drugs ◽  
Pacu Stay

OBJECTIVE Postoperative nausea and vomiting (PONV) is an extremely common side effect of general anesthesia that is difficult to manage. We tested a hypothesis that an aggressive prophylactic intervention with additional antiemetic drugs will reduce the incidence of PONV in a high-risk pediatric population undergoing adenotonsillectomy. METHODS In this retrospective study, pediatric patients undergoing adenotonsillectomy were screened for their risk factors for PONV. Patients who had 3 or more risk factors were identified as high risk and received either scopolamine patch preoperatively (for patients over 40 kg body weight) or diphenhydramine immediately postextubation in addition to ondansetron and dexamethasone, which are given routinely. Incidences of PONV within the first 60 minutes of a postanesthesia care unit (PACU) stay were collected and analyzed. RESULTS Overall postoperative vomiting rates during the first hour of a PACU stay were 4.3% for the group that was treated with dexamethasone and ondansetron only and 3.9% for the group that was treated with additional antiemetic drugs. Aggressive prophylactic management of PONV did reduce the rate of nausea and vomiting in a group of high-risk patients (p < 0.0001). The postoperative antiemetic drug usage was also decreased during the first 60 minutes of a PACU stay. However, the approach did not reduce the overall rate of PONV for the entire study population (p = 0.1612 for nausea and p = 0.0678 for vomiting). CONCLUSION Aggressive intraoperative management of PONV with additional antiemetic drugs are beneficial in high-risk pediatric population. Intraoperative diphenhydramine usage decreased the rate of PONV. However, preoperative scopolamine patch prevention did not improve PONV, which may be related to the drug's longer onset of action. Our result suggests that current clinical practice is undertreating PONV in pediatric patients receiving general anesthesia.

scholarly journals A Comparative Study of Single Dose Dexamethasone versus Ondansetron for control of Post Operative Nausea and Vomiting after High-Risk Surgeries

2020 ◽  
Vol 8 (1) ◽  
pp. 64-70
Author(s):  
Ashwin Joginipally ◽  
Nikhil Mudgalkar
Keyword(s):  
High Risk ◽  
General Anesthesia ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Age Group ◽  
Dexamethasone Group ◽  
Group I ◽  
Group Ii ◽  
Post Operative Nausea

The occurrence of postoperative nausea and vomiting is generally associated with anesthesia and surgery. The problem is compounded in cases of high-risk surgeries where the incidence is quite high. The present study was designed to compare the efficacy of Dexamethasone and Ondansetron. Methods: This study was undertaken at the Prathima Institute of Medical Sciences, Naganoor, Karimnagar. In this randomized, open clinical trial, we studied 80 ASA grades I to 1V patients of age group 20-60 years undergoing Laparoscopic Laparotomy, Major Gynecological surgeries, Renal, Shoulder and ENT surgeries under general anesthesia. The patients were randomly divided into two groups, Group I and Group II, each consisting of 80 patients. Group I received 4mg dexamethasone intravenous (IV) just after intubation and group II received 4mg Ondansetron intravenous (IV), just before extubation. Results: The most common age group was 50 – 59 years which had n=45(28.1%) patients out of which group I was n=24(15%) patients and n=21(13.1%) patients. The next common age group was 20 – 29 years out of which n=23 (14.4%) and n=18(11.2%). ondansetron group, early nausea is mild in 6.9%, moderate in 3.8%, and severe in 1.2% of patients. Whereas in the dexamethasone group early nausea is mild in 6.2%, moderate in 4.4%, severe in 1.9% of patients. In the ondansetron group, late nausea is mild in 9.4%, moderate in 3.8%, and severe in 0.6% of patients. Whereas in the dexamethasone group late nausea is mild in 7.5%, moderate in 4.4%, severe in 0.6% of patients. In the ondansetron group, early vomiting is mild in 5.0%, moderate in 0.6%, and severe in 0.6% of patients. Whereas in the dexamethasone group early vomiting is mild in 4.4%, moderate in 1.2%, severe in 0.6% of patients. Conclusion: dexamethasone given intravenously just after intubation and ondansetron given intravenously just before extubation are safe and have similar efficacy in postoperative nausea and vomiting after elective surgeries under general anesthesia having a high risk of PONV

scholarly journals Effects of lidocaine, dexmedetomidine, and their combination infusion on postoperative nausea and vomiting following laparoscopic hysterectomy: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Siqi Xu ◽  
Shengbin Wang ◽  
Shenghong Hu ◽  
Xia Ju ◽  
Qing Li ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Continuous Infusion ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Laparoscopic Hysterectomy ◽  
Nausea And Vomiting ◽  
Bolus Infusion ◽  
Significant Difference ◽  
Vas Scores ◽  
Pacu Stay

Abstract Background A few studies have reported that administration of lidocaine and dexmedetomidine relieves the incidence of postoperative nausea and vomiting (PONV). We explored whether combined infusion of lidocaine plus dexmedetomidine had lower occurrence of PONV undergoing laparoscopic hysterectomy with general anesthesia. Methods A total of 248 women undergoing elective laparoscopic hysterectomy were allocated into the following four groups: the control group (group C, n = 62) received an equal volume of saline, the lidocaine group (group L, n = 62) received intravenous lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion), the dexmedetomidine group (group D, n = 62) received dexmedetomidine administration (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion), and the lidocaine plus dexmedetomidine group (group LD, n = 62) received combination of lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion) and dexmedetomidine administration (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion). The primary outcome was the incidence of nausea, vomiting, and PONV during the first 48 h after surgery. The secondary outcomes included the incidence of total 24 h PONV after surgery, intraoperative remifentanil requirement, postoperative pain visual analogue scale (VAS) scores and fentanyl consumption, the incidence of bradycardia, agitation, shivering, and mouth dry during post-anesthesia care unit (PACU) stay period. Results The occurrence of nausea and PONV in group LD (5.0 and 8.3%) at 0–2 h after operation was lower than group C (21.7 and 28.3%) (P < 0.05). There was no statistically significant difference with respect to occurrence of nausea and PONV in groups L (13.3 and 20.0%) and D (8.3 and 13.3%) at 0–2 h after operation compared to group C (21.7 and 28.3%). The incidence of nausea, vomiting, and PONV at 2–24 and 24–48 h after surgery in all four groups was not statistically significant. The incidence of total 24 h PONV in group LD (33.3%) was significantly decreased compared to group C (60.0%) (P < 0.05). The cumulative consumption of fentanyl at 6 and 12 h after surgery was significantly reduced in group LD compared to other three groups (P < 0.05). The pain VAS scores were significantly decreased at 2, 6, and 12 h after operation in group LD compared to other three groups (P < 0.05). Remifentanil dose in the intraoperative period was significantly lower in groups LD and D compared with groups C and L (P < 0.05). The number of mouth dry, bradycardia, and over sedation during the PACU stay period was markedly increased in group LD (28.3, 30.0, and 35.0%, respectively) compared with groups C (1.7, 1.7, and 3.3%, respectively) and L (3.3, 5.0, and 6.7%, respectively) (P < 0.05). Conclusions Lidocaine combined with dexmedetomidine infusion markedly decreased the occurrence of nausea and PONV at 0–2 h as well as the total 24 h PONV. However, it significantly increased the incidence of mouth dry, bradycardia, and over sedation during the PACU stay period after laparoscopic hysterectomy with general anesthesia. Trial registration ClinicalTrials.gov (NCT03809923), registered on January 18, 2019.

Effect of intravenous lidocaine combined with dexmedetomidine on postoperative nausea and vomiting after laparoscopic total hysterectomy

2019 ◽  
Author(s):  
Si-Qi Xu ◽  
Xia Ju ◽  
Sheng-Bin Wang ◽  
Sheng-Hong Hu ◽  
Qing Li ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Control Group ◽  
Total Hysterectomy ◽  
Pacu Stay ◽  
Dexmedetomidine Infusion ◽  
Laparoscopic Total Hysterectomy

Abstract Background A few studies have manifested that intravenous (IV) lidocaine or dexmedetomidine decreased the incidence of postoperative nausea and vomiting (PONV). We investigated whether lidocaine plus dexmedetomidine infusion could better reduce the incidence of PONV than placebo after laparoscopic total hysterectomy. Methods This prospective, randomized controlled study enrolled 126 women undergoing elective laparoscopic total hysterectomy with general anesthesia. They divided into the following two groups: patients in the lidocaine combined with dexmedetomidine group (group LD) received lidocaine (1.5 mg/kg loading, 1.5 mg/kg/h infusion) and dexmedetomidine (0.5 μg/kg loading, 0.4 μg/kg/h infusion), respectively. Patients in the control group (group CON) received the equal volume of saline. The primary outcome was the incidence of nausea, vomiting and PONV for the first 48 hours after surgery. The secondary outcomes included intraoperative propofol and remifentanil consumption, postoperative fentanyl requirement, Ramsay sedation score, and the incidence of bradycardia during post-anesthesia care unit (PACU) stay period. Results Data of 59 in CON and 60 in LD groups were analyzed. The incidence of nausea, vomiting, and PONV in group LD during the 0 to 2 hours and 24 to 48 hours after the operation was slightly lower than group CON, but the difference was not statistically significant between the two groups. The incidence of nausea, vomiting, and PONV was much lower in group LD than group CON at 2 to 24 hours after surgery (P<0.05, P<0.01, P<0.01, respectively). The cumulative requirement of fentanyl during the first 48 hours after surgery was significantly reduced in group LD compared to group CON (P<0.01, P<0.01, P<0.05, respectively). Propofol and remifentanil total dose in the intraoperative period was significantly lower in group LD compared with group CON (P<0.01 and P<0.01). However, the level of sedation and incidence of bradycardia during the PACU stay period were markedly increased in group LD compared with group CON (P<0.01 and P<0.01). Conclusion Lidocaine plus dexmedetomidine infusion markedly decreased the occurrence of nausea, vomiting and PONV within the 2 to 24 hours after laparoscopic total hysterectomy with general anesthesia. However, it increased the incidence of bradycardia and the level of sedation during the PACU stay period.

Amisulpride Prevents Postoperative Nausea and Vomiting in Patients at High Risk

2018 ◽  
Vol 128 (6) ◽  
pp. 1099-1106 ◽  
Author(s):  
Peter Kranke ◽  
Sergio D. Bergese ◽  
Harold S. Minkowitz ◽  
Timothy I. Melson ◽  
David G. Leiman ◽  
...  
Keyword(s):  
High Risk ◽  
General Anesthesia ◽  
Postoperative Nausea ◽  
Rescue Medication ◽  
Elective Surgery ◽  
Medication Use ◽  
Postoperative Nausea And Vomiting ◽  
Complete Response ◽  
Nausea And Vomiting ◽  
Control Group

Abstract Background Postoperative nausea and vomiting causes distress for patients and can prolong care requirements. Consensus guidelines recommend use of multiple antiemetics from different mechanistic classes as prophylaxis in patients at high risk of postoperative nausea and vomiting. The prophylactic efficacy of the dopamine D2/D3 antagonist amisulpride in combination with other antiemetics was investigated. Methods This double-blind, randomized, placebo-controlled, international, multicenter trial was conducted in 1,147 adult surgical patients having three or four postoperative nausea and vomiting risk factors. Patients were randomized to receive either intravenous amisulpride (5 mg) or matching placebo at induction of general anesthesia, in addition to one standard, nondopaminergic antiemetic, most commonly ondansetron or dexamethasone. Vomiting/retching, nausea, and use of rescue medication were recorded for 24 h after wound closure. The primary endpoint was complete response, defined as no emesis or rescue medication use in the 24-h postoperative period. Results Complete response occurred in 330 of 572 (57.7%) of the amisulpride group and 268 of 575 (46.6%) of the control group (difference 11.1 percentage points; 95% CI, 5.3 to 16.8; P &lt; 0.001). The incidences of emesis (13.8% vs. 20.0%, P = 0.003), any nausea (50.0% vs. 58.3%, P = 0.002), significant nausea (37.1% vs. 47.7%, P &lt; 0.001), and rescue medication use (40.9% vs. 49.4%, P = 0.002) were significantly lower in the amisulpride group. Adverse events and laboratory and electrocardiogram abnormalities occurred no more frequently with amisulpride than with placebo. Conclusions Intravenous amisulpride was safe and effective as prophylaxis of postoperative nausea and vomiting when given in combination with an antiemetic from another class to adult patients at high risk for suffering postoperative nausea and vomiting undergoing elective surgery under inhalational general anesthesia.

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