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Canadian Journal of Anesthesia

, Volume 51, Issue 4, pp 326–341 | Cite as

Evidence-based management of postoperative nausea and vomiting: a review

  • Ashraf S. Habib
  • Tong J. GanEmail author
General anesthesia

Abstract

Purpose

To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV).

Source

Literature from randomized controlled trials, systematic reviews, logistic regression analyses and expert opinion in the management of PONV.

Principal findings

The etiology of PONV is multifactorial. Patient, anesthesia, and surgery related risk factors have been identified. Universal PONV prophylaxis is not cost-effective. Identification of patients at high-risk of PONV allows targeting prophylaxis to those who will benefit most from it. No prophylaxis is needed for patients at low risk for PONV. For patients at moderate risk for PONV, prophylaxis using a single antiemetic or a combination of two agents should be considered. Double and triple antiemetic combinations should be considered for patients at high risk for PONV. Furthermore, a multimodal approach should be adopted incorporating steps to keep the baseline risk of PONV low. The optimum cost-effective approach to the management of PONV will differ between an ambulatory centre and an inpatient hospital setting. For the treatment of established PONV in patients who failed prophylaxis, patients should not receive a repeat dose of the prophylactic antiemetic. Rather, a drug acting at a different receptor should be used. Beyond six hours after surgery, patients can be treated with any of the agents used for prophylaxis, except dexamethasone and transdermal scopolamine.

Conclusion

PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature.

Keywords

Ondansetron Granisetron Droperidol Postoperative Nausea Tropisetron 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Le traitement des nausées et des vomissements postopératoires fondé sur des données probantes: une revue

Résumé

Objectif

Énoncer des lignes de conduite fondées sur des données probantes pour la prévention et le traitement des nausées et des vomissements postopératoires (NVPO).

Source

Les publications d’essais contrôlés et randomisés, les études méthodiques, les analyses de régression logistique et l’opinion d’experts sur le traitement des NVPO.

Constatations principales

L’origine des NVPO est multifactorielle. Les facteurs de risque reliés au patient, à l’anesthésie et au type de chirurgie sont connus. La prévention universelle des NVPO n’est pas rentable. L’identification des patients à haut risque de NVPO permet une prévention mieux ciblée. Aucune prophylaxie n’est nécessaire en cas de risque faible. En cas de risque modéré, l’usage d’un seul antiémétique ou d’une combinaison de deux médicaments est une mesure préventive à envisager. On peut combiner deux ou trois antiémétiques en cas de risque élevé. De plus, une approche multimodale doit être adoptée et utilisée par étapes afin de conserver le risque de base faible. La méthode de traitement des NVPO la plus rentable sera différente selon qu’il s’agit d’un patient ambulatoire ou hospitalisé. Le traitement des NVPO établis chez des patients qui n’ont pas répondu au traitement préventif ne doit pas comporter une seconde dose de l’antiémétique prophylactique. Un médicament actif au niveau d’un autre récepteur sera privilégié. Au delà de six heures après l’opération, on peut traiter avec n’importe quel médicament utilisé comme prévention, sauf la dexaméthasone et la scopolamine transdermique.

Conclusion

Les NVPO sont fréquents après l’anesthésie et la chirurgie. Nous avons présenté des lignes de conduite à adopter fondées sur les données probantes de la documentation disponible.

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Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  1. 1.Department of AnesthesiologyDuke University Medical CenterDurhamUSA

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