非胃肠道日间手术患儿术后早期经口进食恶心呕吐的危险因素

目的 分析影响患儿非胃肠道日间手术后早期经口进食恶心呕吐（EOINV）的危险因素。
方法 选择2020年6月至2022年3月全麻下行非胃肠道日间手术、麻醉后进食前未发生恶心呕吐的患儿306例,男206例,女100例,年龄1～12岁,体重5～60 kg,ASA Ⅰ或Ⅱ级。收集患儿性别、年龄、体重、术前禁食禁饮时间、麻醉方式、术中阿片类药、肌松药和肌松拮抗药使用情况、手术类型、手术时间、麻醉时间和术后24 h内EOINV的发生情况。根据EOINV的发生情况将患儿分为两组：EOINV组和无EOINV组,通过单因素与多因素Logistic回归分析患儿EOINV的独立危险因素。
结果 有46例（15.0%）患儿发生EOINV。两组患儿性别、年龄、体重、术前禁食禁饮时间、麻醉方式、肌松药和拮抗药使用情况、手术时间、麻醉时间差异无统计学意义。与无EOINV组比较,EOINV组阿片类药使用率和口内手术比例明显升高（P<0.05）。二元Logistic回归分析结果显示,术中阿片类药使用（OR=3.7,95%CI 1.0～12.5,P=0.048）、口内手术（OR=4.8,95%CI 1.3～16.7,P=0.017）是患儿非胃肠道手术后EOINV的独立危险因素。
结论 术中阿片类药使用、口内手术是患儿非胃肠道日间手术后早期经口进食恶心呕吐的独立危险因素。     

日间手术患儿术前禁食禁饮时间研究

目的 缩短日间手术患儿术前禁食禁饮时间、减少围手术期不良反应。方法 根据收治时间将2019年7月行日间手术的233例患儿作为对照组,采用常规的术前禁食禁饮管理;2019年8月收治的252例患儿作为观察组,采用加速康复外科多学科协作的术前禁食禁饮管理,比较两组术前禁食禁饮时间、术前和术中不良反应发生情况。结果 观察组术前禁食、禁饮时间显著短于对照组（均P<0.01）;患儿术前不良反应发生程度显著轻于对照组（均P<0.01）;两组术中均无不良反应发生。结论 加速康复外科多学科协作的术前禁食禁饮管理,能缩短日间手术患儿术前禁食禁饮时间,降低术前不良反应发生情况。     

妇科腹腔镜手术术后恶心呕吐的临床研究

目的 分析妇科腹腔镜手术术后恶心呕吐(PONV)的发生情况及其影响因素.方法 按前瞻性临床队列研究设计,应用单因素和多因素logistic回归分析围术期变量与术后PONV发生之间的关系.术后6 h及24 h内发生的恶心或呕吐为本研究的结局变量.结果 研究期间共有260例患者行妇科腹腔镜手术,最终有237例有效病例.其中术后6 h内有80例出现PONV,术后24 h内有94例发生PONV.多因素logistic回归分析提示妇科腹腔镜手术术后6 h及24 h PONV的危险因素为既往FONV史及术毕疼痛,而氟哌利多有助于减轻术后6 h内PONV.结论 妇科腹腔镜手术PONV,高发,尤以6 h内明显;既往PONV史及术毕疼痛可增加本次手术PONV发生的风险.     

肾积水患儿术前禁食禁饮多学科链式管理的实践

目的 探讨多学科协作模式下肾积水患儿术前禁食禁饮链式管理临床可行性、安全性和有效性.方法 将146例肾积水患儿按时间段分组,2018年4～12月78例患儿作为对照组,2019年1～9月68例患儿作为观察组.对照组采用传统的术前禁食禁饮管理方式,观察组采用多学科协作模式下术前禁食禁饮链式管理方式,评估记录两组禁食禁饮情况...     

胸科手术病人术后恶心呕吐的危险因素

目的:筛选胸科手术病人术后恶心呕吐(PONV)的危险因素。方法:回顾性收集2018年1月至2020年1月择期行胸科手术病人的病历资料,性别不限,年龄18~80岁,ASA分级Ⅰ~Ⅲ级。记录病人年龄、性别、学历、ASA分级、晕动症、吸烟史、饮酒史、心脏病史、高血压病史、糖尿病病史、术前血常规、肝功能、电解质指标;手术方式、...     

神经外科术后恶心呕吐预测模型的构建与评价

目的 探讨神经外科患者发生术后恶心呕吐的高危因素,构建预测模型,并评价其效果.方法 收集326例神经外科全麻择期手术成人患者的临床病例资料,根据术后24 h是否发生恶心呕吐分为发生组和未发生组,比较两组高危因素,通过Logistic回归分析结果建立预测模型,采用ROC曲线下面积评价该模型的预测效果.结果 神经外科患者术...     

甲状腺术后恶心呕吐症状的原因分析及护理

目的探讨甲状腺术后出现恶心呕吐的原因，找到护理恶心呕吐的适当方法，提高护理质量。方法对183例甲状腺术后恶心呕吐患者。根据不同原因所致呕吐采取适当的预防与治疗措施。结果适当的生理、心理、体位、药物治疗等护理有效地防止了病人恶心呕吐的发生，及时缓解了患者的呕吐症状，防止严重并发症的进一步发生。     

术前口服不同浓度含糖液对围手术期患者应激反应的影响

目的探讨术前口服不同浓度含糖液对围手术期患者不同时段血糖、血清C反应蛋白、白蛋白及术后消化道症状的影响。方法将全麻下行择期手术的190例脊柱外科住院患者分为三组,于术日晨分别口服温开水(温开水组,58例)、5%葡萄糖溶液(5%葡萄糖组,67例)、12.5%葡萄糖溶液(12.5%葡萄糖组,65例)各350mL,0.5h内饮完。比较三组围手术期不同时间段血糖、血清C反应蛋白、白蛋白的变化趋势以及对术后患者消化道症状的影响。结果三组术前1h、术中、术后6h血糖值比较,差异有统计学意义(均P0.01)。三组术后C反应蛋白、白蛋白值比较,差异无统计学意义(均P0.05);三组不同时段C反应蛋白、白蛋白值组内比较,差异有统计学意义(均P0.01)。三组术后腹胀发生率比较,差异有统计学意义(P0.05)。结论术前口服含糖液可适度缓解患者围手术期应激性反应,5%葡萄糖溶液可减轻患者术后腹胀,临床术前可选择饮用。     

术前应用曲马多对其术后镇痛效果和恶心呕吐的影响

应用曲马多进行术后镇痛,效果确切,不抑制呼吸,对心血管系统功能影响小,成瘾性及耐受性低,但由于其术后恶心呕吐(PONV)不良反应较为突出,往往影响患者的镇痛满意度.本研究选择手术不同阶段给予曲马多,观察其对术后镇痛效果和PONV的影响.     

Impact of an antiemetic protocol on postoperative nausea and vomiting in children

The objective of the study was to demonstrate a decreased incidence of postoperative nausea and vomiting (PONV) in children through the use of an antiemetic protocol. PONV was recorded in children (1.5-15 years) after inpatient surgery under general anaesthesia in a prospective, interview based survey. Group 1 consisted of children having surgery 1 month before the introduction of a formalized antiemetic protocol and group 2, 2 months after its introduction. Data were collected over a 1-month period in each group. Outcome measures of nausea, emesis, antiemetic requirement and patient satisfaction were monitored for the first 24-h postoperative period. There were 272 children enrolled: 138 in group 1 and 134 in group 2. There was a difference between the two groups for gender (P=0.03), type of surgery (P=0.017), perioperative opioid (P=0.003) and perioperative antiemetic use (P=0.024). However, multivariate analysis did not demonstrate an impact on outcome from these factors. The incidence of postoperative nausea (PON) and postoperative vomiting (POV) following the introduction of the protocol was 36% and 34%, respectively. Moderate to severe nausea was decreased after introduction of the protocol (18% versus 9%, P=0.028) but moderate to severe vomiting failed to reach significance (19% versus 11%, P=0.078). The proportion of children who had repeated nausea decreased after the introduction of the protocol (17% versus 8%, P=0.02) but repeated episodes of vomiting remained unchanged (19% versus 14%). This was attributed to a significant increase in antiemetic prescribing by protocol in group 2 (10% versus 59%, P < 0.001). Patient satisfaction was high in both groups (85% versus 90%). The introduction of a postoperative antiemetic protocol improved prescribing frequency. This resulted in a decreased incidence of moderate to severe PON and a reduction in the number of patients with repeated nausea.     

Management of postoperative nausea and vomiting in ambulatory surgery

The management of PONV has improved significantly over the years but remains a frequent occurrence in postoperative patients. Evaluation of individual patient risk and the consideration for prophylactic antiemetic in high-risk populations should reduce these unpleasant symptoms and help direct appropriate clinical strategies. Treatment following failure of prophylactic antiemetic therapy requires knowledge of previously used antiemetics and the time of their administration.     

Reduction of postoperative nausea and vomiting by dimenhydrinate suppositories after strabismus surgery in children

Although dimenhydrinate has been used for treatment and prevention of postoperative nausea and vomiting (PONV) since the fifties, there have been few controlled studies about its efficacy. We performed a double-blinded study of 301 children aged 4 to 10 yr who underwent strabismus surgery. Preanesthetic medication with midazolam (0.5 mg/kg) as well as application of either dimenhydrinate suppositories or a placebo preparation was performed 30 min before the induction of anesthesia. Anesthesia was induced with thiopentone (5-10 mg/kg) and vecuronium (0.1 mg/kg) and maintained with halothane (1%-2%) in N(2)O/O(2) (65%/35%). The incidence of PONV, requirements for rescue dimenhydrinate, and time to recovery were recorded. The overall incidence of PONV was 60.1% in the placebo group and 30.7% in the dimenhydrinate group. In the dimenhydrinate group, children had to be observed in the recovery room significantly longer than those in the placebo group. Children having received dimenhydrinate were discharged from the recovery room with lower arousal scores. We conclude that the rectal administration of dimenhydrinate is effective for the prevention of PONV, although the sedative effect may require longer postoperative monitoring. IMPLICATIONS: We performed a double-blinded, randomized study to investigate the effects of prophylactic rectal dimenhydrinate application on postoperative nausea and vomiting in children undergoing strabismus surgery. In comparison with placebo, dimenhydrinate reduced the incidence of postoperative vomiting from 60.1% to 30.7%.     

Prophylaxis of postoperative nausea and vomiting in elective breast surgery

Study Objective

To evaluate strategies to treat postoperative nausea and vomiting (PONV) in patients undergoing elective breast surgery.

Design

Prospective, randomized, double-blinded, placebo-controlled trial.

Setting

University-affiliated hospital.

Patients

480 patients with risk factors for PONV.

Interventions

Patients were randomized to three groups to receive an antiemetic prophylactic combination of haloperidol and tropisetron (Group HT), dimenhydrinate and dexamethasone (Group DD), or no prophylaxis (Group P). Anesthesia was maintained with volatile anesthesia (desflurane or sevoflurane) and fentanyl or total intravenous anesthesia (TIVA).

Measurements

Incidence of nausea, emesis, or both in the early (0 - 2 hrs) and late (2 - 24 hrs) postoperative periods were recorded, as were the number of episodes and the time of each occurrence; and patient assessment of the PONV experience on a scale comparable to a numeric rating scale (NRS).

Main Results

Both antiemetic combinations significantly reduced PONV incidence. In patients who received no prophylaxis, PONV incidence was 48.2% in patients given volatile anesthetics and 43.8% in those who received TIVA. PONV incidence was 17.5% in the Group HT patients who received volatile anesthetics, and 25% in the Group HT patients who received TIVA. PONV incidence was 11.4% in Group DD patients given volatile anesthetics, and 15% in Group DD patients receiving TIVA. TIVA reduced the incidence of PONV in the early postoperative period (0-2 hrs), but increased PONV incidence in the late period (2-24 hrs). Patients given TIVA with propofol and remifentanil intraoperatively required more opioids postoperatively than patients given volatile anesthetics.

Conclusion

The frequency of PONV was reduced significantly with both antiemetic combinations.     

Comparison of oral dolasetron and ondansetron in the prophylaxis of postoperative nausea and vomiting in children

BACKGROUND AND OBJECTIVE: In a randomized, placebo-controlled, double-blind trial, we compared the efficacy of oral dolasetron and ondansetron in preventing postoperative nausea and vomiting in children after various surgical operations. METHODS: Children were assigned randomly to one of three groups (each contained 50 children) to receive dolasetron 1.8 mg kg(-1) or ondansetron 0.15 mg kg(-1) orally, or a placebo. All children received methylene blue capsules (10 mg) orally as an indicator before the induction of anaesthesia. Postoperatively, contamination of the mouth and the endotracheal tube by methylene blue was recorded, and postoperative nausea and vomiting was recorded for 0-1, 1-24 and 0-24 h. Metoclopramide (0.1 mg kg(-1)) intravenously was used as the rescue antiemetic. RESULTS: In the 0-1 h period after operation, there were no differences between the groups. In the 1-24 h period, dolasetron was significantly better than placebo (nausea 8 versus 24%; vomiting 4 versus 20%; total nausea and vomiting scores 16 versus 48%). Over the 0-24 h period, both dolasetron and ondansetron were significantly better than placebo (nausea 16 versus 26 versus 40%), vomiting (8 versus 16 versus 30%), and total nausea and vomiting scores (32 versus 48 versus 78%). There were no significant differences between dolasetron and ondansetron. There was no important methylene blue contamination, and little use of rescue metoclopramide. There were no important adverse events. CONCLUSIONS: Prophylactic oral dolasetron and ondansetron were effective in reducing postoperative nausea and vomiting in children.