Perioperative Antiemetic Therapy for Fast-Track Laparoscopic Bariatric Surgery
Postoperative nausea and vomiting (PONV) is problematic in bariatric surgery patients and has negative impacts on perioperative outcome. Antiemetic prophylaxis may reduce PONV. Perioperative antiemetic prophylaxis or therapy is crucial and may enhance fast-track bariatric surgery. This study examined the impact of intraoperative multimodal antiemetic prophylaxis on fast-track bariatric surgery.
This prospective observational clinical study explored the perioperative data of 400 consecutive laparoscopic bariatric surgery patients, over a 6-year period. Perioperative outcomes and variables were analyzed and compared between different intraoperative antiemetic modes.
The mean BMI was 49, mean age was 42, and male:female ratio was 1:4. About 70% of patients received intraoperative multimodal antiemetic, comprising combinations of prochlorperazine, dexamethasone, ondansetron, or cyclizine. PONV occurred in 19.5% of patients. Intraoperative multimodal antiemetic was associated with significantly less PONV, shorter post-anesthesia care unit duration, earlier postoperative drinking, and shorter hospital stay (p = 0.001). Compared to other multimodal antiemetic modes, dexamethasone + cyclizine + prochlorperazine provided the best prophylaxis and outcome: p = 0.002.
PONV is a common and peculiar problem in bariatric surgery patients. However, intraoperative multimodal antiemetic prophylaxis effectively minimizes PONV. Intraoperative multimodal antiemetic enhances fast-track bariatric surgical care, patient satisfaction, and perioperative outcomes.
KeywordsPostoperative vomiting Multimodal antiemetic Laparoscopic bariatric surgery Fast track Enhanced recovery Dexamethasone Cyclizine Prochlorperazine
This study was approved and registered by the research department of Central Manchester University Hospital, Manchester, England. Institutional support is acknowledged, but there was no conflict of interest or financial involvement regarding any of the authors.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants in the study.
Statement of Human Rights
All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 9.Bataille A, Letourneulx JF, Charmeau A, et al. Impact of a prophylactic combination of dexamethasone-ondansetron on postoperative nausea and vomiting in obese adult patients undergoing laparoscopic sleeve gastrectomy during closed-loop propofol-remifentanil anaesthesia. Eur J Anaesthesiol. 2016;33(12):898–905.CrossRefPubMedGoogle Scholar
- 13.Therneau IW, Martin EE, Sprung J, et al. The role of aprepitant in prevention of postoperative nausea and vomiting after bariatric surgery. Obes Surg. 2017; https://doi.org/10.1007/s11695-017-2797-0.