Antiemetic Prophylaxis and Anesthetic Approaches to Reduce Postoperative Nausea and Vomiting in Bariatric Surgery Patients: a Systematic Review

Abstract

While guidelines exist for the management of postoperative nausea and vomiting (PONV) in the general surgical setting, there are no established guidelines for the prevention or treatment of PONV in bariatric patients, in whom PONV contributes significantly to perioperative morbidity and hospital resource utilization. This systematic review found that the multimodal pharmacological approach to PONV prevention recommended in current guidelines for high-risk surgical patients is appropriate for the bariatric subset. This includes multi-agent antiemetic prophylaxis with dexamethasone and one or more agents from other classes, and opioid-free total intravenous anesthesia, though the advantages of the latter need further evaluation. There remains a need for a standardized validated instrument to assess PONV in the bariatric setting.

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Acknowledgments

The authors thank Ms. Jessica Koos, MLS, MSEd, AHIP, Health Sciences Librarian at Stony Brook University, for insights on the search strategy.

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Correspondence to Konstantinos Spaniolas.

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Dr. Naeem and Dr. Chen report no conflicts of interest. Dr. Pryor reports personal fees from Ethicon, personal fees from Medtronic, personal fees from Stryker, personal fees from Gore, personal fees from Merck, grants from Baranova, grants from Obalon, outside the submitted work. Dr. Docimo reports personal fees from Boston Scientific, outside the submitted work. Dr. Gan reports personal fees from Acacia, personal fees from Merck, personal fees from Masimo, personal fees from Medtronic, outside the submitted work. Dr. Spaniolas reports grants from Merck, personal fees from Biom-Up, outside the submitted work.

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Naeem, Z., Chen, I.L., Pryor, A.D. et al. Antiemetic Prophylaxis and Anesthetic Approaches to Reduce Postoperative Nausea and Vomiting in Bariatric Surgery Patients: a Systematic Review. OBES SURG 30, 3188–3200 (2020). https://doi.org/10.1007/s11695-020-04683-1

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Keywords

  • Postoperative nausea and vomiting
  • PONV
  • Antiemetic
  • Prophylaxis
  • Anesthesia
  • Bariatric surgery
  • Morbid obesity
  • Gastric bypass
  • RYGB
  • Sleeve gastrectomy
  • Morbidity