Julie Golembiewski1, Eric Chernin, Tania Chopra. 1. Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, 60612-7230, USA. jgolemb@uic.edu
Abstract
PURPOSE: The physiology, risk factors, and prevention and treatment of postoperative nausea and vomiting (PONV) are discussed. SUMMARY: Factors to consider when determining a patient's risk for PONV include sex, history of PONV, history of motion sickness, smoking status, duration of anesthesia, use of opioids, and type of surgery. Receptors that, when activated, can cause nausea or vomiting or both include dopamine type 2, serotonin type 3, histamine type 1, and muscarinic cholinergic type 1 receptors. Patients at moderate to high risk for PONV benefit from the administration of a prophylactic antiemetic agent that blocks one or more of these receptors. Effective agents include transdermal scopolamine, prochlorperazine, promethazine, droperidol, ondansetron, dolasetron, granisetron, and dexamethasone. In high-risk patients, combining two or more antiemetics with different mechanisms of action has been shown to be more effective than using a single agent. In addition to administering a prophylactic antiemetic, it is important to reduce the patient's risk by considering regional anesthesia, considering inducing and maintaining general anesthesia with propofol, ensuring good intravenous hydration, avoiding hypotension, and providing effective analgesia. If PONV occurs in the immediate postoperative period, it is best treated with an antiemetic agent from a pharmacologic class different from that of the prophylactic agent. CONCLUSION: Prophylactic antiemetic therapy for PONV is effective, but combinations of agents may be necessary for high-risk patients. Nonpharmacologic strategies are also important.
PURPOSE: The physiology, risk factors, and prevention and treatment of postoperative nausea and vomiting (PONV) are discussed. SUMMARY: Factors to consider when determining a patient's risk for PONV include sex, history of PONV, history of motion sickness, smoking status, duration of anesthesia, use of opioids, and type of surgery. Receptors that, when activated, can cause nausea or vomiting or both include dopamine type 2, serotonin type 3, histamine type 1, and muscarinic cholinergic type 1 receptors. Patients at moderate to high risk for PONV benefit from the administration of a prophylactic antiemetic agent that blocks one or more of these receptors. Effective agents include transdermal scopolamine, prochlorperazine, promethazine, droperidol, ondansetron, dolasetron, granisetron, and dexamethasone. In high-risk patients, combining two or more antiemetics with different mechanisms of action has been shown to be more effective than using a single agent. In addition to administering a prophylactic antiemetic, it is important to reduce the patient's risk by considering regional anesthesia, considering inducing and maintaining general anesthesia with propofol, ensuring good intravenous hydration, avoiding hypotension, and providing effective analgesia. If PONV occurs in the immediate postoperative period, it is best treated with an antiemetic agent from a pharmacologic class different from that of the prophylactic agent. CONCLUSION: Prophylactic antiemetic therapy for PONV is effective, but combinations of agents may be necessary for high-risk patients. Nonpharmacologic strategies are also important.
Authors: T Hasenberg; M Niedergethmann; P Rittler; S Post; K W Jauch; M Senkal; C Spies; W Schwenk; E Shang Journal: Anaesthesist Date: 2007-12 Impact factor: 1.041
Authors: Tae Soo Hahm; Jung Won Hwang; Won Ho Kim; Eun Jung Oh; Duk-Kyung Kim; Won Joon Choi; Yun Hong Kim; Jung Hee Ryu; Byung Hoon Yoo; Jun Heum Yon Journal: J Anesth Date: 2014-07-19 Impact factor: 2.078