BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of ...BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.展开更多
In this editorial,we reviewed the article by Li et al.We aimed to explore various perspectives to further mitigate the risk factors for postoperative nausea and vomiting(PONV),which could significantly reduce its inci...In this editorial,we reviewed the article by Li et al.We aimed to explore various perspectives to further mitigate the risk factors for postoperative nausea and vomiting(PONV),which could significantly reduce its incidence and related post-operative complications.PONV is highly prevalent among patients undergoing bariatric surgery,yet there are relatively few related studies.Currently,the main-stream bariatric surgery methods include laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy.Despite the effectiveness of surgery in helping patients lose weight,postoperative PONV may occur,potentially leading to various complications(such as aspiration and wound dehiscence).A retro-spective study by Li et al has compared the impact of different operative positions during laparoscopic sleeve gastroplasty on the incidence of PONV,providing new insights into the clinical practice aimed at reducing PONV incidence and thereby improving patient’s postoperative experience.展开更多
Postoperative nausea and vomiting (PONV) is a common complication in ambulatory surgery patients, which affects their quality of life and recovery process. In recent years, acupuncture stimulation as a non-pharmacolog...Postoperative nausea and vomiting (PONV) is a common complication in ambulatory surgery patients, which affects their quality of life and recovery process. In recent years, acupuncture stimulation as a non-pharmacological therapy has shown significant efficacy in the prevention and treatment of PONV. This review mainly discusses the current research on using PC6 stimulation to prevent PONV in ambulatory surgery patients, elucidates the various effects and mechanisms of PC6 stimulation, analyzes the advantages and disadvantages, safety, and feasibility of different stimulation methods, aiming to improve the postoperative recovery quality of ambulatory surgery patients, reduce medical costs, and promote the application of integrative medicine in the prevention and treatment of PONV.展开更多
Background:Postoperative nausea and vomiting(PONV)refers to a problem commonly occurring after surgery.Acupuncture is considered a critical complementary alternative therapy for PONV.The acupoints selection critically...Background:Postoperative nausea and vomiting(PONV)refers to a problem commonly occurring after surgery.Acupuncture is considered a critical complementary alternative therapy for PONV.The acupoints selection critically determines the efficacy of acupuncture,whereas the selection rules remain unclear.The objective of the present study was to delve into the principles of acupoints selection for PONV using data mining technology.Methods:The clinical trials assessing the acupuncture effect for PONV were searched with the use of computer in PubMed,China National Knowledge Infrastructure,and Chinese Biomedical Database;the time span was confined as 2009–2019.The database of acupuncture prescriptions for PONV was built using Excel 2016;the description and association were analyzed by IBM SPSS modeler 18.Result:Eighty-three relevant literatures were screened out.The number of specific acupoints took up 72.5%of all acupoints;specific acupoints exhibited the frequency taking up 91.30%of the total frequency.As revealed from the result,Neiguan(PC 6),Zusanli(ST 36),Hegu(LI 4),and Zhongwan(CV 12)were most frequently applied,suggesting the tightest associations.Most acupoints were taken from the stomach meridian and pericardium meridian.The common acupoints were concentrated in the lower limbs,chest,as well as abdomen.Conclusion:Data mining acts as a feasible method to identify acupoints selection and compatibility characteristics.As suggested from our study,the acupoints selection for PONV prioritizes specific acupoints and related meridians.The selection and combination of acupoints comply with the theory of traditional Chinese medicine.展开更多
BACKGROUND The incidence of postoperative nausea and vomiting(PONV)in patients undergoing laparoscopic hysterectomy is very high compared with other surgeries,even when many prophylactic measures have been taken.Howev...BACKGROUND The incidence of postoperative nausea and vomiting(PONV)in patients undergoing laparoscopic hysterectomy is very high compared with other surgeries,even when many prophylactic measures have been taken.However,the pathogenesis of PONV is multifactorial.Female sex,a history of motion sickness or PONV,nonsmokers,and perioperative opioid use are the most closely related factors.Among the multiple risk factors,suboptimal gastrointestinal(GI)perfusion may be attributed to some cases of PONV,and increased systemic vascular resistance(SVR)may lead to GI ischemia.The hypothesis of this research was that SVR is related to PONV.AIM To investigate the relationship between SVR and PONV in patients undergoing laparoscopic hysterectomy.METHODS A total of 228 patients who underwent elective laparoscopic hysterectomy were included in this prospective observational study.SVR was monitored using a noninvasive hemodynamic monitoring system.Four indices of SVR,the baseline,mean,area under the curve(AUC),and weighted AUC,were used for analysis.The incidence and severity of nausea and vomiting were evaluated while patients were awake and throughout the intervals from 0 to 2 h,2 to 6 h,and 6 to 24 h starting upon arrival at the post-anesthesia care unit.The associations between various SVR indices and PONV were investigated by logistic regression.P<0.05 was considered statistically significant.RESULTS The incidence of PONV in the study was 56.14%(128/228),and PONV tended to appear within 6 h after surgery.Five variables were significant in univariate analyses,however,only SVR mean[odds ratio(OR)=1.015,95%CI:1.005-1.109,P=0.047]and duration of surgery(OR=1.316,95%CI:1.003-2.030,P=0.012)were associated with PONV after logistic regression analysis.Furthermore,patients with high SVR mean were more likely to suffer from PONV after laparoscopic hysterectomy.On average,patients who developed PONV needed more time to tolerate diet and demonstrated poorer sleep quality on the first night after surgery.CONCLUSION In this study,PONV was a common complication after laparoscopic hysterectomy.SVR was associated with PONV,and high SVR mean was associated with a significantly increased risk of PONV.展开更多
Objectives: Current prophylactic interventions fail to completely eliminate postoperative nausea and vomiting (PONV) for a substantial number of patients. A new antiemetic (aprepitant) has been effective in preventing...Objectives: Current prophylactic interventions fail to completely eliminate postoperative nausea and vomiting (PONV) for a substantial number of patients. A new antiemetic (aprepitant) has been effective in preventing chemotherapy induced nausea and vomiting (CINV). We hypothesized that adding aprepitant to our current prophylactic regimen of dexamethasone and ondansetron would reduce the incidence of PONV in our elective hysterectomy population. Methods: 256 patients undergoing elective hysterectomy were enrolled in this prospective, randomized, double blinded, placebo controlled trial. Subjects received either oral aprepitant 40 mg or oral placebo 30 minutes prior to induction of standardized anesthesia. The primary outcome was vomiting within the first 24 hours after surgery. Postoperative nausea, vomiting, and use of rescue antiemetics were documented over a 24 h period. Additionally, adverse events, hospitalization days, and readmissions for PONV were compared. Results: There was a trend towards reduction of postoperative nausea and vomiting in the aprepitant group. Nausea and vomiting were noted for 24% and 17% of women in the aprepitant group versus 38% and 29% of women in the Placebo group, respectively. Supplemental antiemetic medication was used by 42% of women in the aprepitant group versus 60% of women in the Placebo group. No adverse events were substantially more common in the aprepitant group than the Placebo group. Conclusions: Preemptive use of aprepitant prior to elective hysterectomy may reduce the incidence of PONV and diminish the need for rescue antiemetics postoperatively. Further studies with larger power are needed to confirm the trends observed in this study.展开更多
However,the best choice of acupuncture therapy for postoperative nausea and vomiting remains controversy.Methods:Several databases were searched from inception to April 2020.Randomized controlled trials met the criter...However,the best choice of acupuncture therapy for postoperative nausea and vomiting remains controversy.Methods:Several databases were searched from inception to April 2020.Randomized controlled trials met the criterion were included.Risk of bias was implemented with Cochrane risk-of-bias tool.Addis,R,OpenBUGS and STATA were used to conduct meta-analysis.The evidence was assessed by GRADE profiler 3.6.Results:Fifty studies involving 5980 patients were included.The risk of bias of most included studies were acceptable.The results of network meta-analyses indicated,compared with placebo,electroacupuncture was the best choice for postoperative nausea(odds ratio=0.09,95%confidence interval:0.02-0.51)and acupoint plaster for postoperative vomiting(odds ratio=0.07,95%confidence interval:0.01-0.42),acupoint catgut embedding+5HTRA for postoperative nausea and vomiting(odds ratio=0.05,95%confidence interval:0.01-0.15),and transcutaneous electrical nerve stimulation+5-hydroxytryptamine receptor antagonists for postoperative rescue antiemetics(odds ratio=0.14,95%confidence interval:0.08-0.46).Conclusion:It was suggested transcutaneous electrical nerve stimulation+5-hydroxytryptamine receptor antagonists was the best choice.The results provided guidance for the prevention of postoperative nausea and vomiting.展开更多
Objective:To compare the safety and efficacy of dexmedetomidine and dexamethasone for the prevention of postoperative nausea and vomiting(PONV)in patients scheduled for laparoscopic surgery.Methods:A total of 86 femal...Objective:To compare the safety and efficacy of dexmedetomidine and dexamethasone for the prevention of postoperative nausea and vomiting(PONV)in patients scheduled for laparoscopic surgery.Methods:A total of 86 female patients were prospectively administered dexmedetomidine 1μg/kg i.v.(the group A,n=43),and dexamethasone 8 mg i.v.(the group B,n=43).The two groups were compared in treatment response,hemodynamic changes,and Numerical Analog Scale(NAS).Besides,the relation of PONV with patient baseline characteristics in the perioperative period was determined as well.Results:Patients in group A had lower PONV scores(t=3.1,P<0.002),less needs for rescue anti-emetics(χ2=0.47,P<0.001),and decreased intraoperative heart rate(t=9.72,P<0.001)and mean arterial pressure(t=7.58,P<0.001)compared to that of group B.Group A reported lower NAS than group B(t=2.66,P<0.001).In addition,we found no relationship between PONV score and rescue anti-emetic requirement,age,or body mass index(P=0.96,P=0.60,P=0.28,respectively).Conclusion:Dexmedetomidine could be used as an effective antiemetic in laparoscopic surgeries,with better efficacy than dexamethasone.Dexmedetomidine not only can reduce PONV but also is effective in postoperative analgesia.展开更多
Background: Postoperative nausea and vomiting (PONV) can lead to complications and increased healthcare costs. We investigated whether patient preoperative concern about PONV is associated with postoperative antiemeti...Background: Postoperative nausea and vomiting (PONV) can lead to complications and increased healthcare costs. We investigated whether patient preoperative concern about PONV is associated with postoperative antiemetic use, independently of Apfel score. Methods: Patients eligible for study were English- or Spanish-speaking women with breast cancer undergoing mastectomy, lumpectomy or reconstructive surgery as outpatients during July 2014-July 2017, when the pre-anesthesia clinic routinely screened for preoperative concern via tablet computer-based survey. Excluded were patients who did not rate their concern or lacked Apfel score. Risk factors for concern were evaluated in a multinomial model adjusted for multiple hypotheses. Using generalized linear regression, preoperative concern was tested for association with number of antiemetics administered in the postanesthesia care unit. Results:?Of preoperative surveys, 7.1% (58/812) were excluded for missing data, leaving n = 754 surveys contributed by n = 706 subjects (age 26 - 80 years). Patient preoperative concern ranged from none (32.8%), mild (30.2%), moderate (22.9%), severe (7.8%), to very severe (6.2%). Adjusted for age, concern was increased by history of motion sickness (Odds Ratio 1.51, 95% Confidence Interval 1.11 - 2.06) and history of PONV (9.02, 6.30 - 12.90) and decreased by prior surgery without PONV (0.35, 0.23 - 0.53) and Spanish as primary language (0.42, 0.25 - 0.68). Number of postoperative antiemetics, usually 1 (41.2%) or 2 (33.4%) drugs, was unassociated with preoperative concern before or after adjustment for Apfel score. Conclusions: Among women undergoing breast cancer-related surgery, preoperative concern about PONV varies by prior history of PONV and motion sickness and by ethnicity. However, preoperative concern is not associated with postoperative antiemetic medications.展开更多
Background: If untreated, one third of patients who undergo surgery develop postoperative nausea and/or vomiting (PONV). The prevention of postoperative nausea and vomiting can improve satisfaction among vulnerable pa...Background: If untreated, one third of patients who undergo surgery develop postoperative nausea and/or vomiting (PONV). The prevention of postoperative nausea and vomiting can improve satisfaction among vulnerable patients. We hypothesized that preoperative anxiety may increase the incidence of PONV. The objective was to assess whether administration of a benzodiazepine prior to surgery would reduce the incidence of PONV. Methods: 130 women (ASA I and II) scheduled to undergo dilatation and curettage comprised the study group. The women were allocated randomly to two study groups according to the type of anesthesia administered (with and without midazolam). Results: Sixty-eight women received midazolam and 62 did not. Patients treated with midazolam were feeling more comfortable (“friendliness”, p = 0.005 and “elation”, p = 0.01) and had less postoperative fatigue (p = 0.04) than non-midazolam-treated group. Patients treated with midazolam had significantly fewer emetic episodes during the first 4 hours after surgery than those without midazolam (0.1 ± 0.2 vs 0.3 ± 0.6, respectively, p = 0.003). Conclusions: Midazolam reduces the incidence of PONV and improves patient’s comfort. We suggest that midazolam has to be routinely included in the anesthesia protocol for short-term gynecological procedures (dilatation and curettage).展开更多
<b><span style="font-family:Verdana;">Introduction:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family...<b><span style="font-family:Verdana;">Introduction:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Postoperative nausea and vomiting (PONV) are prevalent symptoms after laparoscopic surgeries with an incidence rate of (54</span><span style="font-family:Verdana;">% </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">79%) in bariatric procedures. Despite its popularity, limited studies assessed the effect of antiemetics for PONV prophylaxis after laparoscopic sleeve gastrectomy (LSG). The aim of this trail is to compare the effectiveness of a single pre-induction intravenous dose of Palonosetron versus Ondansetron for prophylaxis of PONV, 24 hours after LSG</span><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Subjects and Methods:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">This prospective randomized controlled double-blind parallel-group study was</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">conducted from May till December 2019. Recruited patients were consented and randomized using a closed envelop method into two groups with fifty patients each.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The total number of nausea and vomiting attacks in the 24 hours postoperatively was considered as a primary end point. The secondary end points were the frequency of nausea, retching and vomiting attacks in the 24 hours post-surgery.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The severity of nausea was evaluated using a 10 cm visual analogue scale (VAS).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">This RCT included 100 patients divided into 2 groups of 50 patients each. Patients received either 75</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">mcg Palonosetron (Group I) or Ondansetron 4 mg (group II).</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Group I had statistically significant fewer episodes of nausea, retching and vomiting in the first 4 hours (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.022)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">and from 4 to 12</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">hours</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.024)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">but not after 12 hours post</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">LSG. Total episodes of nausea, retching and vomiting in 24 hours postoperative were significantly less in group I</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.021).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">A single dose of intravenous 75</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">mcg Palonosetron is superior to Ondansetron 4 mg in preventing PONV for patients after LSG.</span>展开更多
BACKGROUND Postoperative nausea and vomiting(PONV)are common complications that affect the recovery and well-being of elderly patients undergoing gastrointestinal laparoscopic surgery.AIM To investigate the effect of ...BACKGROUND Postoperative nausea and vomiting(PONV)are common complications that affect the recovery and well-being of elderly patients undergoing gastrointestinal laparoscopic surgery.AIM To investigate the effect of butorphanol on PONV in this patient population.METHODS A total of 110 elderly patients(≥65 years old)who underwent gastrointestinal laparoscopic surgery were randomly assigned to receive butorphanol(40μg/kg)or sufentanil(0.3μg/kg)during anesthesia induction in a 1:1 ratio.The measured outcomes included the incidence of PONV at 48 h after surgery,intraoperative dose of propofol and remifentanil,Bruggrmann Comfort Scale score in the postanesthesia care unit(PACU),number of compressions for postoperative patientcontrolled intravenous analgesia(PCIA),and time to first flatulence after surgery.RESULTS The results revealed a noteworthy reduction in the occurrence of PONV at 24 h after surgery in the butorphanol group,when compared to the sufentanil group(T1:23.64%vs 5.45%,T2:43.64%vs 20.00%,P<0.05).However,no significant variations were observed between the two groups,in terms of the clinical characteristics,such as the PONV or motion sickness history,intraoperative and postoperative 48-h total infusion volume and hemodynamic parameters,intraoperative dose of propofol and remifentanil,number of postoperative PCIA compressions,time until the first occurrence of postoperative flatulence,and incidence of PONV at 48 h post-surgery(all,P>0.05).Furthermore,patients in the butorphanol group were more comfortable,when compared to patients in the sufentanil group in the PACU.CONCLUSION The present study revealed that butorphanol can be an efficacious substitute for sufentanil during anesthesia induction to diminish PONV within 24 h following gastrointestinal laparoscopic surgery in the elderly,simultaneously improving patient comfort in the PACU.展开更多
Background: Postoperative nausea and vomiting are common complications of anaesthesia and surgery. Known risk factors include motion sickness, migraine, gender and types of surgery. Other possible risk factors for pos...Background: Postoperative nausea and vomiting are common complications of anaesthesia and surgery. Known risk factors include motion sickness, migraine, gender and types of surgery. Other possible risk factors for postoperative nausea and vomiting are ethnicity and genetics surgery. Objective: The main objective of the study was to describe factors associated with postoperative nausea and vomiting among adult Malawians. Methods: This was a prospective observational study. 138 adult patients were recruited into the study. Data were collected using a predesigned questionnaire. Patients were followed up to 18 hours postoperatively and any episodes of postoperative nausea and vomiting were noted. Results: A total of 138 patients were enrolled in the study. 78 were female (56.5%) and 60 were males (43.5%). The ages ranged from 18 to 87 years. The mean age was 36.9 years. The overall incidence of postoperative nausea and vomiting was 29.6%. It was higher among women than men. Patients with motion sickness had the highest incidence of postoperative nausea and vomiting (78.6%) followed by those with migraine (73.3%). Patients whose intraoperative systolic blood pressure fell <80 mmHg had an incidence of 71.4% and those who received postoperative opioids had an incidence of 37.7%. Conclusions: Patients with a history of migraine, motion sickness, whose intraoperative blood pressures fall below a systolic of 80 mmHg and who receive postoperative opioids are at an increased risk for postoperative nausea and vomiting.展开更多
complications in neurosurgical patients consequent to elevated intracranial and arterial pressure.1 Dexamethasone （Dex） was applauded to reduce the incidence of PONV,2 but some literatures showed dexamethasone did n...complications in neurosurgical patients consequent to elevated intracranial and arterial pressure.1 Dexamethasone （Dex） was applauded to reduce the incidence of PONV,2 but some literatures showed dexamethasone did not reduce the incidence of PONV.1＇3 The aim of this study was to determine whether a single-dose of dexamethasone before induction of general anesthesia would affect PONV after MVD for facial spasm.展开更多
文摘BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.
文摘In this editorial,we reviewed the article by Li et al.We aimed to explore various perspectives to further mitigate the risk factors for postoperative nausea and vomiting(PONV),which could significantly reduce its incidence and related post-operative complications.PONV is highly prevalent among patients undergoing bariatric surgery,yet there are relatively few related studies.Currently,the main-stream bariatric surgery methods include laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy.Despite the effectiveness of surgery in helping patients lose weight,postoperative PONV may occur,potentially leading to various complications(such as aspiration and wound dehiscence).A retro-spective study by Li et al has compared the impact of different operative positions during laparoscopic sleeve gastroplasty on the incidence of PONV,providing new insights into the clinical practice aimed at reducing PONV incidence and thereby improving patient’s postoperative experience.
文摘Postoperative nausea and vomiting (PONV) is a common complication in ambulatory surgery patients, which affects their quality of life and recovery process. In recent years, acupuncture stimulation as a non-pharmacological therapy has shown significant efficacy in the prevention and treatment of PONV. This review mainly discusses the current research on using PC6 stimulation to prevent PONV in ambulatory surgery patients, elucidates the various effects and mechanisms of PC6 stimulation, analyzes the advantages and disadvantages, safety, and feasibility of different stimulation methods, aiming to improve the postoperative recovery quality of ambulatory surgery patients, reduce medical costs, and promote the application of integrative medicine in the prevention and treatment of PONV.
基金This study was supported by the Major projects of Sichuan Science and Technology Department of China (No.18ZDYF0347)Mianyang Science and Technology Bureau of China (No. 17YFHM008).
文摘Background:Postoperative nausea and vomiting(PONV)refers to a problem commonly occurring after surgery.Acupuncture is considered a critical complementary alternative therapy for PONV.The acupoints selection critically determines the efficacy of acupuncture,whereas the selection rules remain unclear.The objective of the present study was to delve into the principles of acupoints selection for PONV using data mining technology.Methods:The clinical trials assessing the acupuncture effect for PONV were searched with the use of computer in PubMed,China National Knowledge Infrastructure,and Chinese Biomedical Database;the time span was confined as 2009–2019.The database of acupuncture prescriptions for PONV was built using Excel 2016;the description and association were analyzed by IBM SPSS modeler 18.Result:Eighty-three relevant literatures were screened out.The number of specific acupoints took up 72.5%of all acupoints;specific acupoints exhibited the frequency taking up 91.30%of the total frequency.As revealed from the result,Neiguan(PC 6),Zusanli(ST 36),Hegu(LI 4),and Zhongwan(CV 12)were most frequently applied,suggesting the tightest associations.Most acupoints were taken from the stomach meridian and pericardium meridian.The common acupoints were concentrated in the lower limbs,chest,as well as abdomen.Conclusion:Data mining acts as a feasible method to identify acupoints selection and compatibility characteristics.As suggested from our study,the acupoints selection for PONV prioritizes specific acupoints and related meridians.The selection and combination of acupoints comply with the theory of traditional Chinese medicine.
文摘BACKGROUND The incidence of postoperative nausea and vomiting(PONV)in patients undergoing laparoscopic hysterectomy is very high compared with other surgeries,even when many prophylactic measures have been taken.However,the pathogenesis of PONV is multifactorial.Female sex,a history of motion sickness or PONV,nonsmokers,and perioperative opioid use are the most closely related factors.Among the multiple risk factors,suboptimal gastrointestinal(GI)perfusion may be attributed to some cases of PONV,and increased systemic vascular resistance(SVR)may lead to GI ischemia.The hypothesis of this research was that SVR is related to PONV.AIM To investigate the relationship between SVR and PONV in patients undergoing laparoscopic hysterectomy.METHODS A total of 228 patients who underwent elective laparoscopic hysterectomy were included in this prospective observational study.SVR was monitored using a noninvasive hemodynamic monitoring system.Four indices of SVR,the baseline,mean,area under the curve(AUC),and weighted AUC,were used for analysis.The incidence and severity of nausea and vomiting were evaluated while patients were awake and throughout the intervals from 0 to 2 h,2 to 6 h,and 6 to 24 h starting upon arrival at the post-anesthesia care unit.The associations between various SVR indices and PONV were investigated by logistic regression.P<0.05 was considered statistically significant.RESULTS The incidence of PONV in the study was 56.14%(128/228),and PONV tended to appear within 6 h after surgery.Five variables were significant in univariate analyses,however,only SVR mean[odds ratio(OR)=1.015,95%CI:1.005-1.109,P=0.047]and duration of surgery(OR=1.316,95%CI:1.003-2.030,P=0.012)were associated with PONV after logistic regression analysis.Furthermore,patients with high SVR mean were more likely to suffer from PONV after laparoscopic hysterectomy.On average,patients who developed PONV needed more time to tolerate diet and demonstrated poorer sleep quality on the first night after surgery.CONCLUSION In this study,PONV was a common complication after laparoscopic hysterectomy.SVR was associated with PONV,and high SVR mean was associated with a significantly increased risk of PONV.
文摘Objectives: Current prophylactic interventions fail to completely eliminate postoperative nausea and vomiting (PONV) for a substantial number of patients. A new antiemetic (aprepitant) has been effective in preventing chemotherapy induced nausea and vomiting (CINV). We hypothesized that adding aprepitant to our current prophylactic regimen of dexamethasone and ondansetron would reduce the incidence of PONV in our elective hysterectomy population. Methods: 256 patients undergoing elective hysterectomy were enrolled in this prospective, randomized, double blinded, placebo controlled trial. Subjects received either oral aprepitant 40 mg or oral placebo 30 minutes prior to induction of standardized anesthesia. The primary outcome was vomiting within the first 24 hours after surgery. Postoperative nausea, vomiting, and use of rescue antiemetics were documented over a 24 h period. Additionally, adverse events, hospitalization days, and readmissions for PONV were compared. Results: There was a trend towards reduction of postoperative nausea and vomiting in the aprepitant group. Nausea and vomiting were noted for 24% and 17% of women in the aprepitant group versus 38% and 29% of women in the Placebo group, respectively. Supplemental antiemetic medication was used by 42% of women in the aprepitant group versus 60% of women in the Placebo group. No adverse events were substantially more common in the aprepitant group than the Placebo group. Conclusions: Preemptive use of aprepitant prior to elective hysterectomy may reduce the incidence of PONV and diminish the need for rescue antiemetics postoperatively. Further studies with larger power are needed to confirm the trends observed in this study.
基金This work was supported by the National Natural Science Foundation of China(No.81804180).
文摘However,the best choice of acupuncture therapy for postoperative nausea and vomiting remains controversy.Methods:Several databases were searched from inception to April 2020.Randomized controlled trials met the criterion were included.Risk of bias was implemented with Cochrane risk-of-bias tool.Addis,R,OpenBUGS and STATA were used to conduct meta-analysis.The evidence was assessed by GRADE profiler 3.6.Results:Fifty studies involving 5980 patients were included.The risk of bias of most included studies were acceptable.The results of network meta-analyses indicated,compared with placebo,electroacupuncture was the best choice for postoperative nausea(odds ratio=0.09,95%confidence interval:0.02-0.51)and acupoint plaster for postoperative vomiting(odds ratio=0.07,95%confidence interval:0.01-0.42),acupoint catgut embedding+5HTRA for postoperative nausea and vomiting(odds ratio=0.05,95%confidence interval:0.01-0.15),and transcutaneous electrical nerve stimulation+5-hydroxytryptamine receptor antagonists for postoperative rescue antiemetics(odds ratio=0.14,95%confidence interval:0.08-0.46).Conclusion:It was suggested transcutaneous electrical nerve stimulation+5-hydroxytryptamine receptor antagonists was the best choice.The results provided guidance for the prevention of postoperative nausea and vomiting.
文摘Objective:To compare the safety and efficacy of dexmedetomidine and dexamethasone for the prevention of postoperative nausea and vomiting(PONV)in patients scheduled for laparoscopic surgery.Methods:A total of 86 female patients were prospectively administered dexmedetomidine 1μg/kg i.v.(the group A,n=43),and dexamethasone 8 mg i.v.(the group B,n=43).The two groups were compared in treatment response,hemodynamic changes,and Numerical Analog Scale(NAS).Besides,the relation of PONV with patient baseline characteristics in the perioperative period was determined as well.Results:Patients in group A had lower PONV scores(t=3.1,P<0.002),less needs for rescue anti-emetics(χ2=0.47,P<0.001),and decreased intraoperative heart rate(t=9.72,P<0.001)and mean arterial pressure(t=7.58,P<0.001)compared to that of group B.Group A reported lower NAS than group B(t=2.66,P<0.001).In addition,we found no relationship between PONV score and rescue anti-emetic requirement,age,or body mass index(P=0.96,P=0.60,P=0.28,respectively).Conclusion:Dexmedetomidine could be used as an effective antiemetic in laparoscopic surgeries,with better efficacy than dexamethasone.Dexmedetomidine not only can reduce PONV but also is effective in postoperative analgesia.
文摘Background: Postoperative nausea and vomiting (PONV) can lead to complications and increased healthcare costs. We investigated whether patient preoperative concern about PONV is associated with postoperative antiemetic use, independently of Apfel score. Methods: Patients eligible for study were English- or Spanish-speaking women with breast cancer undergoing mastectomy, lumpectomy or reconstructive surgery as outpatients during July 2014-July 2017, when the pre-anesthesia clinic routinely screened for preoperative concern via tablet computer-based survey. Excluded were patients who did not rate their concern or lacked Apfel score. Risk factors for concern were evaluated in a multinomial model adjusted for multiple hypotheses. Using generalized linear regression, preoperative concern was tested for association with number of antiemetics administered in the postanesthesia care unit. Results:?Of preoperative surveys, 7.1% (58/812) were excluded for missing data, leaving n = 754 surveys contributed by n = 706 subjects (age 26 - 80 years). Patient preoperative concern ranged from none (32.8%), mild (30.2%), moderate (22.9%), severe (7.8%), to very severe (6.2%). Adjusted for age, concern was increased by history of motion sickness (Odds Ratio 1.51, 95% Confidence Interval 1.11 - 2.06) and history of PONV (9.02, 6.30 - 12.90) and decreased by prior surgery without PONV (0.35, 0.23 - 0.53) and Spanish as primary language (0.42, 0.25 - 0.68). Number of postoperative antiemetics, usually 1 (41.2%) or 2 (33.4%) drugs, was unassociated with preoperative concern before or after adjustment for Apfel score. Conclusions: Among women undergoing breast cancer-related surgery, preoperative concern about PONV varies by prior history of PONV and motion sickness and by ethnicity. However, preoperative concern is not associated with postoperative antiemetic medications.
文摘Background: If untreated, one third of patients who undergo surgery develop postoperative nausea and/or vomiting (PONV). The prevention of postoperative nausea and vomiting can improve satisfaction among vulnerable patients. We hypothesized that preoperative anxiety may increase the incidence of PONV. The objective was to assess whether administration of a benzodiazepine prior to surgery would reduce the incidence of PONV. Methods: 130 women (ASA I and II) scheduled to undergo dilatation and curettage comprised the study group. The women were allocated randomly to two study groups according to the type of anesthesia administered (with and without midazolam). Results: Sixty-eight women received midazolam and 62 did not. Patients treated with midazolam were feeling more comfortable (“friendliness”, p = 0.005 and “elation”, p = 0.01) and had less postoperative fatigue (p = 0.04) than non-midazolam-treated group. Patients treated with midazolam had significantly fewer emetic episodes during the first 4 hours after surgery than those without midazolam (0.1 ± 0.2 vs 0.3 ± 0.6, respectively, p = 0.003). Conclusions: Midazolam reduces the incidence of PONV and improves patient’s comfort. We suggest that midazolam has to be routinely included in the anesthesia protocol for short-term gynecological procedures (dilatation and curettage).
文摘<b><span style="font-family:Verdana;">Introduction:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Postoperative nausea and vomiting (PONV) are prevalent symptoms after laparoscopic surgeries with an incidence rate of (54</span><span style="font-family:Verdana;">% </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">79%) in bariatric procedures. Despite its popularity, limited studies assessed the effect of antiemetics for PONV prophylaxis after laparoscopic sleeve gastrectomy (LSG). The aim of this trail is to compare the effectiveness of a single pre-induction intravenous dose of Palonosetron versus Ondansetron for prophylaxis of PONV, 24 hours after LSG</span><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Subjects and Methods:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">This prospective randomized controlled double-blind parallel-group study was</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">conducted from May till December 2019. Recruited patients were consented and randomized using a closed envelop method into two groups with fifty patients each.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The total number of nausea and vomiting attacks in the 24 hours postoperatively was considered as a primary end point. The secondary end points were the frequency of nausea, retching and vomiting attacks in the 24 hours post-surgery.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The severity of nausea was evaluated using a 10 cm visual analogue scale (VAS).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">This RCT included 100 patients divided into 2 groups of 50 patients each. Patients received either 75</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">mcg Palonosetron (Group I) or Ondansetron 4 mg (group II).</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Group I had statistically significant fewer episodes of nausea, retching and vomiting in the first 4 hours (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.022)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">and from 4 to 12</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">hours</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.024)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">but not after 12 hours post</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">LSG. Total episodes of nausea, retching and vomiting in 24 hours postoperative were significantly less in group I</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.021).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">A single dose of intravenous 75</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">mcg Palonosetron is superior to Ondansetron 4 mg in preventing PONV for patients after LSG.</span>
基金The study was approved by the Ethics Committee of the First Affiliated Hospital of Dalian Medical University(PJ-KS-KY-2020-161[X]).
文摘BACKGROUND Postoperative nausea and vomiting(PONV)are common complications that affect the recovery and well-being of elderly patients undergoing gastrointestinal laparoscopic surgery.AIM To investigate the effect of butorphanol on PONV in this patient population.METHODS A total of 110 elderly patients(≥65 years old)who underwent gastrointestinal laparoscopic surgery were randomly assigned to receive butorphanol(40μg/kg)or sufentanil(0.3μg/kg)during anesthesia induction in a 1:1 ratio.The measured outcomes included the incidence of PONV at 48 h after surgery,intraoperative dose of propofol and remifentanil,Bruggrmann Comfort Scale score in the postanesthesia care unit(PACU),number of compressions for postoperative patientcontrolled intravenous analgesia(PCIA),and time to first flatulence after surgery.RESULTS The results revealed a noteworthy reduction in the occurrence of PONV at 24 h after surgery in the butorphanol group,when compared to the sufentanil group(T1:23.64%vs 5.45%,T2:43.64%vs 20.00%,P<0.05).However,no significant variations were observed between the two groups,in terms of the clinical characteristics,such as the PONV or motion sickness history,intraoperative and postoperative 48-h total infusion volume and hemodynamic parameters,intraoperative dose of propofol and remifentanil,number of postoperative PCIA compressions,time until the first occurrence of postoperative flatulence,and incidence of PONV at 48 h post-surgery(all,P>0.05).Furthermore,patients in the butorphanol group were more comfortable,when compared to patients in the sufentanil group in the PACU.CONCLUSION The present study revealed that butorphanol can be an efficacious substitute for sufentanil during anesthesia induction to diminish PONV within 24 h following gastrointestinal laparoscopic surgery in the elderly,simultaneously improving patient comfort in the PACU.
文摘Background: Postoperative nausea and vomiting are common complications of anaesthesia and surgery. Known risk factors include motion sickness, migraine, gender and types of surgery. Other possible risk factors for postoperative nausea and vomiting are ethnicity and genetics surgery. Objective: The main objective of the study was to describe factors associated with postoperative nausea and vomiting among adult Malawians. Methods: This was a prospective observational study. 138 adult patients were recruited into the study. Data were collected using a predesigned questionnaire. Patients were followed up to 18 hours postoperatively and any episodes of postoperative nausea and vomiting were noted. Results: A total of 138 patients were enrolled in the study. 78 were female (56.5%) and 60 were males (43.5%). The ages ranged from 18 to 87 years. The mean age was 36.9 years. The overall incidence of postoperative nausea and vomiting was 29.6%. It was higher among women than men. Patients with motion sickness had the highest incidence of postoperative nausea and vomiting (78.6%) followed by those with migraine (73.3%). Patients whose intraoperative systolic blood pressure fell <80 mmHg had an incidence of 71.4% and those who received postoperative opioids had an incidence of 37.7%. Conclusions: Patients with a history of migraine, motion sickness, whose intraoperative blood pressures fall below a systolic of 80 mmHg and who receive postoperative opioids are at an increased risk for postoperative nausea and vomiting.
文摘complications in neurosurgical patients consequent to elevated intracranial and arterial pressure.1 Dexamethasone （Dex） was applauded to reduce the incidence of PONV,2 but some literatures showed dexamethasone did not reduce the incidence of PONV.1＇3 The aim of this study was to determine whether a single-dose of dexamethasone before induction of general anesthesia would affect PONV after MVD for facial spasm.
