Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review.

Autor:	Elvir-Lazo OL; Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA., White PF; Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.; The White Mountain Institute, The Sea Ranch, Sonoma, CA, 95497, USA.; Instituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy., Yumul R; Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.; David Geffen School of Medicine-UCLA, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90095, USA., Cruz Eng H; Department of Anesthesiology, PennState Hershey Medical Center, Hershey, PA, 17033, USA.
Jazyk:	angličtina
Zdroj:	F1000Research [F1000Res] 2020 Aug 13; Vol. 9. Date of Electronic Publication: 2020 Aug 13 (Print Publication: 2020).
DOI:	10.12688/f1000research.21832.1
Abstrakt:	Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient's risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery. Competing Interests: No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed. (Copyright: © 2020 Elvir-Lazo OL et al.)
Databáze:	MEDLINE
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