Acupressure and postoperative nausea and vomiting

Despite great strides during the preceding 3 decades, the ability to consistently eliminate postoperative nausea and vomiting (PONV) continues to elude anesthesia practitioners. The occurrence of PONV related to anesthesia and surgery prolongs hospital stays and increases healthcare costs. Protracted recovery times place constraints on patients, healthcare systems, and healthcare financiers. Many pharmacological antiemetics have been developed and are in use in the attempt to alleviate PONV. Side effects and cost profiles of many of these interventions, however, reinforce the broadly held belief that there remains opportunity for improvement. Because the Western culture almost exclusively favors evidence-based scientific practice and interventions, the search continues for an ideal, cost-effective, safe, and efficacious pharmacological agent to prevent PONV. Eastern culture, on the other hand, relies heavily on naturopathic remedies whose successful use has spanned thousands of years. Increasing attention has been given to the potential benefits of nonpharmacological intervention for the prevention of PONV in association with anesthesia care. Therefore, the purpose of this AANA Journal course will be to focus attention on what is known and what is unknown in the literature regarding use of the nonallopathic remedy of acupressure as a nonpharmacological alternative to commonly utilized antiemetic prophylaxis.     

术后恶心呕吐非药物管理的最佳证据总结

目的评价、总结国内外术后恶心呕吐非药物管理的最佳证据,为临床护理人员预防术后恶心呕吐提供参考。方法系统检索中国生物医学文献数据库、中国知网、中华医学会麻醉分会官网、UpToDate、BMJ Best Practice、乔安娜布里格斯研究所循证卫生保健研究中心、Cochrane Library等数据库中关于术后恶心呕吐管理的证据,包括临床决策、指南、系统评价等。检索时限为建库至2020年12月31日。由2名研究者进行文献质量评价和资料提取。结果该研究共纳入20篇文献,包括1篇临床决策、3篇指南、16篇系统评价。最终从风险评估、常规化管理、非药物干预措施以及成本效益分析4个方面总结了8条最佳证据。结论该研究总结的证据可为临床医护人员开展术后恶心呕吐风险评估和非药物管理实践提供依据。在临床应用时,需要充分考虑临床情景,结合专业人士的判断及患者的意愿,遵循个体化原则,分析证据应用的障碍因素及促进因素,审慎地将证据应用于临床实践中。     

A systematic approach to the management of postoperative nausea and vomiting.

Postoperative nausea and vomiting (PONV), a common complication after anesthesia and surgery, often results in delayed discharge with the patient's unpleasant symptoms continuing at home. To effectively prevent and treat PONV, it is important to understand the factors implicated in PONV, the mechanisms of PONV, the pharmacology of the antiemetic agents, and the nonpharmacologic measures that have been shown to be effective. The cause of PONV is likely to be multifactorial, with important predictors being female gender, history of PONV, and history of motion sickness. The vomiting center can be triggered by activation of dopamine, serotonin (type 3), histamine (type 1), and muscarinic cholingergic receptors in the chemoreceptor trigger zone and the nucleus tractus solitarus, as well as acetylcholine receptors in the vestibular apparatus, vagal afferents from the periphery, and the endocrine environment. Antiemetic agents such as the serotonin antagonists (eg, ondansetron, dolasetron), droperidol, antihistamines (eg, diphenhydramine, dimenhydrinate), and promethazine can prevent and treat PONV effectively. Transdermal scopolamine and dexamethasone have a role in the prevention of PONV, particularly for certain high-risk patients. Nonpharmacologic measures and alternative treatments such as hydration, maintaining blood pressure, acupressure techniques, trancutaneous acupoint stimulation, and isopropyl alcohol must not be overlooked. Finally, an evidence-based algorithm for the prevention and treatment of PONV in adults is presented.     

Effects of steroids on postoperative nausea and vomiting

The purpose of this study was to determine if the use of intraoperative steroids was effective in decreasing the incidence of postanesthetic nausea and vomiting and whether or not those complications were gender related. This retrospective study involved a chart review of 208 patients undergoing lumbar laminectomy at a large metropolitan hospital during a 10-month period in 1989-1990. Sixty-one patients met inclusion criteria and were accepted into the study. Of these, 34 patients had received an intraoperative steroid; 21 were male and 13 female. Twenty-seven patients did not receive intraoperative steroids; 17 were male and 13 female. Data collected included the number of pain medications and antiemetics used in the postoperative period, as well as the number of episodes of nausea and vomiting in the 24 hours following surgery. Results demonstrated that those patients who received intraoperative steroids were less likely to experience problems of nausea and vomiting than those who did not receive the drug. Requirements for postoperative pain medication were also reduced in the steroid group. Female patients in both groups were shown to have a greater incidence of nausea and vomiting than male patients.     

Low-dose granisetron for postoperative nausea and vomiting prophylaxis

OBJECTIVE: To evaluate the use of low-dose granisetron in postoperative nausea and vomiting prophylaxis. DATA SOURCES: Clinical trials available through PubMed and OVID (1966-July 2003), as well as information supplied by the drug manufacturer, were accessed. DATA SYNTHESIS: Safety concerns associated with droperidol and limited availability of other agents have created a need to restructure prophylaxis guidelines for postoperative nausea and vomiting. It has recently been proposed that granisetron may be effective at a dose that is one-tenth of the Food and Drug Administration-approved dose. Conflicting evidence for this regimen is evaluated. CONCLUSIONS: Based on the scarcity of supporting data, this regimen is not recommended for prophylaxis in patients at risk for postoperative nausea and vomiting.     

The development of postoperative nausea and vomiting care

Nausea and vomiting is a common post-operative complication that exacerbates patient discomfort and puts tension on suture lines, which may cause hematomas beneath surgical flaps and place patient at risk of aspiration pneumonia. Nausea and vomiting decreases patient comfort and satisfaction and increases hospital stay length and costs. Postoperative nausea and vomiting are common occurrences. Nurses typically give medicine in accordance with doctors' orders without understanding patient symptoms. Such results in less than optimal holistic care management. This situation encouraged the author to collect references on current international trends related to postoperative nausea and vomiting treatment in the clinical setting. The author further worked to recommend a care management protocol based on findings. This paper describes risk factors of postoperative nausea and vomiting and the related drugs, prevention procedures, and treatment recommendations. Finally, the author developed a simple care flow chart suited for use in internal clinical situations that may provide a valuable reference for medical professionals.     

Alternative therapy applications for postoperative nausea and vomiting

The potential for postoperative nausea and vomiting is present in any patient who undergoes surgery and both are unpleasant and potentially dangerous consequences of surgery. Three types of complementary and alternative therapies that may help patients with postoperative nausea and vomiting include acupressure, acupuncture, and aromatherapy.     

The management of chemotherapy-induced nausea and vomiting

This paper reviews one of the major side-effects of chemotherapy, emesis. Included are patient and treatment factors that can affect the control of nausea and vomiting as well as a summary of the management of chemotherapy-induced emesis.     

The management of post-operative nausea and vomiting

Despite the advent of new technology and pharmacological agents, post-operative nausea and vomiting (PONV) continues to have an incidence of 20-30% today. Development of PONV can lead to serious complications such as aspiration, dehydration, electrolyte disturbances and disruption of the surgical site. PONV leads to increased cost of treatment, and may be associated with increased anxiety, dissatisfaction with the surgical experience and anticipatory nausea in the future. The mechanisms of PONV are examined with associated risk factors. A review of the literature of PONV management is included covering pharmacological, dietary and behavioural interventions; culminating in the development of assessment and management guidelines and identification of areas for further study.     

Influence of postoperative pain therapy on nausea and vomiting

PROBLEM: Postoperative nausea and vomiting remains an important problem. Many risk factors have been identified; however, the importance of postoperative analgesic technique and patient expectation remain poorly defined. METHODS: We prospectively collected data on postoperative nausea and vomiting (PONV) in four groups of randomly selected patients (n=50 per group) who received either simple analgesics, nurse-administered intravenous morphine (NAA), patient-controlled analgesia (PCA) with morphine or epidural analgesia with bupivacaine and fentanyl. Patients were questioned regarding any past history of PONV or motion sickness, their preoperative expectation of suffering PONV and satisfaction with their antiemetic therapy. RESULTS: The incidence of nausea was higher in both morphine groups P<0.05), women (P<0.05), those less than the median age of their group (P<0.05) and those with a past history of PONV (P<0.05) or motion sickness (P<0.05). Most patients did not expect to experience PONV (19.3%). The incidence of nausea was higher in those expecting to experience PONV than in those not expecting to suffer PONV (P<0.01). Of those who received postoperative antiemetic treatment, 23.6% were dissatisfied or very dissatisfied with their therapy. Few patients received a prophylactic antiemetic drug (15%). CONCLUSIONS: Study results show that patient expectation is a potent predictor of postoperative nausea, a risk factor hitherto ignored in the anaesthetic literature, and that, in the provision of analgesia following major surgery, epidural analgesia is associated with less PONV than intravenous morphine.     

托烷司琼不同时间给药预防术后恶心呕吐的效果

目的:观察托烷司琼不同时间给药对预防病人术后恶心呕吐的效果.方法:将90例在静吸复合全身麻醉下行腹腔镜胆囊切除术的病人随机分为3组,每组30例.托烷司琼术前组(Ⅰ组),于麻醉诱导前给予托烷司琼5mg;托烷司琼术后组(Ⅱ组),于手术结束时给予托烷司琼5 mg;对照组(Ⅲ组),不给予托烷司琼.观察记录病人术后24 h恶心呕吐发生情况.结果:Ⅰ组恶心、呕吐发生率为27%和20%,Ⅱ组病人恶心、呕吐的发生率为30%和23%,Ⅰ组与Ⅱ组比较差异无显著性(P＞0.05),Ⅲ组恶心、呕吐发生率为50%和37%,Ⅲ组与Ⅰ组、Ⅱ组比较差异有显著性(P＜0.05).结论:托烷司琼术前和术后不同时间给药,在剂量相同的条件下,均能有效地减少术后病人恶心、呕吐的发生,术前预防性给药效果更优.     

Effect of intramuscular clebopride on postoperative nausea and vomiting

The antiemetic effect of clebopride, a new derivative of the orthopramide group, was compared with that of placebo in 298 women undergoing elective surgery. A group of 150 patients received premedication of 1 mg/kg of meperidine, administered intramuscularly (IM), and a group of 148 patients received premedication of 10 mg of diazepam IM. All patients received 0.5 mg of atropine IM. Anesthesia was induced with thiopental and maintained with halogenated N2O/O2. In a double-blind procedure, clebopride (2 mg) or placebo was injected IM at the end of anesthesia and whenever a patient had a second episode of vomiting. Clebopride appeared to be better than placebo in the prevention of nausea (P less than or equal to 0.05) and vomiting (P less than or equal to 0.001) during the 12-hour observation period. The frequency of side effects was virtually the same in patients given clebopride and patients given placebo.     

The management of nausea and vomiting in pregnancy

The focus of this article is on the current research, theories and management strategies related to simple nausea and vomiting in pregnancy (NVP). Research related to the physiological, psychological and cultural factors associated with the expression of NVP are reviewed. The studies which have examined the effectiveness of non-pharmacological therapies in the treatment of NVP are presented. The results of these studies indicate that more rigorous experimental studies are necessary. However, preliminary findings can serve as a basis for the development of nursing approaches to the treatment of simple nausea and vomiting. The findings of these studies suggest research questions for future study.