NLM 3,6,8,11Indeed, we found that some risk factors were predictive of both nausea and vomiting (female gender, nonsmoking status, general anesthesia) but that history of migraine and type of surgery, with the exception of urology, were solely related to nausea. , female gender, history of motion sickness, or PONV), anesthetic factors (e.g. Br J Anaesth 109(5): 742-753. This process was repeated every 2 h for the first 4 h and was continued every 4 h within 72 h on the surgical ward. Risk factors for postoperative nausea and vomiting Risk factors for postoperative nausea and vomiting KENNY, G. N. C. 1994-01-01 00:00:00 Summary Although the aetiology o postoperative nausea and vomiting is not completely clear, a number o key contributing factors f f increase the risk for an individual patient. Time-related pain VAS measurements were summarized by various parameters as described elsewhere: AUC = area under the VAS–time curve (cm × h); mean VAS (cm); VASmax = peak of VAS (cm); Tmax = time of VASmax (h); and PVAS > 3 = the persistence of pain VAS over 3 cm, i.e. Modern PONV risk research began in the 1990s with publication of studies using logistic regression analysis to simultaneously identify multiple independent PONV predictors and publication of meta-analyses and systematic reviews. Statistical calculations were carried out by means of the SAS package (SAS Institute, Cary, NC; version 8 for Windows), always using all data available. Conversely, negative coefficients correspond to a protective effect against the complication (OR < 1). The predictive effect of risk factors … In addition, the Dale model has an attractive property in the sense that the marginal probabilities, P(nausea) and P(vomiting), can be expressed as logistic functions and the effects of the covariates can be interpreted in terms of odds ratios (OR). 1–13It is assumed that PONV has a multifactorial origin, such as patient-related factors (e.g. Assessing Risk Factors for Postoperative Nausea and Vomiting: A Retrospective Study in Patients Undergoing Retromastoid Craniectomy With Microvascular Decompression of Cranial Nerves. 1,32Postoperative pain did not influence nausea and vomiting. 6,8However, review of the literature on individual factors contributing to PONV is often complicated by the lack of standardization in the definitions of “nausea,”“retching,” and “vomiting.” The interchangeable use of the terms nausea and vomiting has led to much confusion because the symptoms do not always accompany each other in severity. History of migraine and type of surgery were mainly responsible for nausea but not for vomiting. A sample of 671 surgical patients with complete case report forms was included in the study. It has … , mask ventilation, volatile anesthetics, opioids), and surgical factors. The list goes on and on. Patients undergoing gynecologic (32%), abdominal (26%), maxillofacial (27%), plastic (25%), neurosurgical (24%) and urological (19%) surgical procedures had the highest incidences of PONV. Postoperative nausea and/or vomiting (PONV) is an unpleasant experience that afflicts 20–30% of surgical patients after general anaesthesia.1 PONV decreases patient comfort and satisfaction, and, rarely, may cause dehydration and electrolyte imbalances, aspiration of gastric contents, oesophageal rupture, suture dehiscence, and bleeding.2–9 PONV and its resulting complications are costly for the healthcare sector worldwide, with several hundred million dollars spent annually in the USA alone.10 P… Traditionally, investigation focused on a single potential factor at a time, with little to no attempt to control for other variables, i.e., to account for the possible independent effects of additional factors (21,22). PONV risk factors have been described in the literature since the late 1800s (20). By Pete Chapman [CC-BY-SA-3.0], via Wikimedia Commons Figure 1 – Opioid analgesics, such as diamorphine hydrochloride, … However, there continue to be mistaken notions about PONV, such as the association between PONV and post-anaesthesia care unit stays, or assuming that it is a risk factor … In the subsequent study, nausea and vomiting were considered as the two outcomes of interest. They can be divided into patient factors, surgical factors, and anaesthetic factors. Supplemental oxygen reduces the incidence of postoperative nausea and vomiting. Kim JH, Lim MS, Choi JW, Kim H, Kwon YS, Lee JJ. 2006 Jun;22(6):1093-9. doi: 10.1185/030079906X104830. Prior to the start of the study, local Ethics Committee (Charleroi, Belgium) approval was obtained, and written informed consent was given by all patients. In assessing a patient’s risk for postoperative nausea and vomiting (PONV), it is important to know which risk factors are independent predictors, and which factors are not relevant for predicting PONV. The clinical implication is important for prophylaxis and treatment of the two symptoms and could influence how future work in this area is done. Although the aetiology of postoperative nausea and vomiting is not completely clear, a number of key contributing factors increase the risk for an individual patient. History of migraine and a variety of surgeries (gynecological, abdominal, neurologic, ophthalmology, and maxillofacial) do or tend to influence nausea only. The mean dose of sufentanil used was 23.3 ± 53.9 μg. Nausea was more frequently encountered in the postanesthesia care unit, but vomiting episodes appeared later, around the 12th postoperative hour. The same argument applies for nonsmokers who are more likely to develop the complications than smokers: nausea (OR = 2.41; 1.26–4.60) and vomiting (OR = 3.0; 1.35–6.71). Michaela Stadler, Françoise Bardiau, Laurence Seidel, Adelin Albert, Jean G. Boogaerts; Difference in Risk Factors for Postoperative Nausea and Vomiting. Nevertheless, our patients benefited from formal acute pain management in the form of an acute pain service. Can J Anaesth 2002; 49: 237–42, Andrews PLR: Physiology of nausea and vomiting. During the 72 postoperative hours (table 2), paracetamol was given to all patients with a mean dose of 9.7 ± 6.2 g. Nonsteroidal antiinflammatory drugs were used in 429 patients (64%), and morphine was administered in 324 patients (48%) at a mean dose of 11.4 ± 23.1 mg. Patient-controlled analgesia was prescribed in 20 patients (1.5%) during the study period. Patient-, anesthesia-, and surgery-related variables that were considered to have a possible effect on the proportion of patients experiencing postoperative nausea and/or vomiting were examined. Patients who had nausea or vomiting received a similar amount of sufentanil throughout the perioperative period as patients without these symptoms (P = 0.74). In the Dale model, one has to estimate (1) the regression coefficients of the covariates for nausea, (2) the regression coefficients of the covariates for vomiting, and (3) the association parameter between nausea and vomiting. In turn, the most complicated model incorporates all covariates for both outcomes. Nausea was not assessed while the patient was asleep. Nausea alone occurred in 73 (11%) patients, vomiting alone occurred in 13 (2%) patients, 53 (8%) patients suffered from both nausea and vomiting, while 532 (79%) were free from the complications. Postoperative nausea and vomiting: physiopathology, risk factors, prophylaxis and treatment. Apfel, C. C., et al. Eur J Anaesth 1992; 9(suppl 6): 25–31, Andrews PLR: Towards an understanding of the mechanism of PONV, The Effective Management of Postoperative Nausea and Vomiting. The physiology of PONV is complex and not perfectly understood. The proportion of nonsmokers was amounted to 63%. The inhalational agents are variably associated with postoperative nausea … White PF, Sacan O, Nuangchamnong N, Sun T, Eng MR. Anesth Analg. This is in accordance with the results of a meta-analysis performed by Tramèr et al. NSAID = nonsteroidal antiinflammatory drug. Studies published to date have used a variety of methodologies that do not permit meaningful conclusions to be drawn. The survey was performed in a clinical audit setting. Nausea and vomiting were recorded as two different end points, using a quantitative analysis. Acta Anaesthesiol Scand 2001; 45: 14–9, Boogaerts JG, Vanacker E, Seidel L, Albert A, Bardiau FM: Assessment of postoperative nausea using a visual analogue scale. Both the incidence of nausea (OR 3.76, 95% CI 2.06–6.88) and vomiting (OR 4.48, 95% CI 2.4–8.37) were increased in patients not receiving steroids. It is therefore possible to assess the significance of each covariate's effect and of the association by a classic normal test (parameter estimate divided by SE). The score constructed by Apfel et al. To control for postoperative factors, VAS pain parameters (AUC, mean VAS, VASmax, Tmax, and PVAS > 3) and analgesic drugs (morphine, paracetamol, and nonsteroidal antiinflammatory drugs) were also included in the Dale model. There are a number of risk factors for PONV. A standardized follow-up survey of PONV incidence was performed over a 3-month period, including all surgical inpatients older than 15 yr who were able to read and understand French and were undergoing various elective surgical procedures: orthopedics, neurosurgery, vascular–thoracic, ophthalmology, maxillofacial, gynecology, urology, plastic, abdominal, stomatology, and ear, nose, and throat (ENT). Grabowska-Gaweł A, Porzych K, Piskunowicz G. J Oral Maxillofac Surg. Habib AS, Chen YT, Taguchi A, Hu XH, Gan TJ. Results were expressed as mean ± SD for quantitative variables and as proportions for categorical factors. The VAS score measured nausea intensity at the time of assessment. It is commonly stated that risk factors for postoperative nausea are the same as for vomiting. Patient records, nurses’ notes, and medication sheets were reviewed in detail by the study investigators to ensure completeness of the information. In assessing a patient’s risk for postoperative nausea and vomiting (PONV), it is important to know which risk factors are independent predictors, and which factors are … The intensity of pain was also evaluated at the same time as nausea using a VAS. The simplest Dale model is the so-called tetrachoric model (no covariate included), which is fitted to the 2 × 2 table obtained by cross-classifying patients according to nausea and vomiting. Inclusion was prospective and consecutive. A nesthesiology 1955; 16: 564–72, Burtles R, Peckett BW: Postoperative vomiting: Some factors affecting its incidence. Many studies have sought to determine risk factors … % of the two outcomes sheets were reviewed in detail by the attending anesthesiologist regarding anesthesia and analgesia...: ( 1 ): 85 – 113 the data epidemiologic study was designed to discern risk factors of nausea., droperidol, or more antiemetic efficacy, i.e after specific surgical procedures i.e! 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