Summary of the Best Evidence for the Evaluation and Management of Chemotherapy-Related Nausea and Vomiting in Cancer Patients

Objective: To summarize the best evidence for the evaluation and management of chemotherapy-related nausea and vomiting in cancer patients, so as to promote the standardized management of chemotherapy-related nausea and vomiting in cancer patients. Methods: A computer search was conducted for all evidence on chemotherapy-associated nausea and vomiting interventions, including guidelines, expert consensus, best clinical practice information booklet, recommended practice, evidence summary, and systematic review. The search period is from April 30, 2022. After the literature quality evaluation, the evidence extraction and summary of the literature meeting the quality standards. Results: A total of 16 literatures were included, including 9 guidelines, 5 systematic reviews and 2 expert consensus papers. 46 pieces of best evidence on the assessment and management of chemotherapy related nausea and vomiting in cancer patients were summarized, including 6 aspects including risk assessment and management, non-drug management, drug management, multidisciplinary cooperation, education and training, and health education. Conclusion: This study summarized the current best evidence on the assessment and management of chemotherapy-related nausea and vomiting in cancer patients. Clinical staff should apply evidence according to specific clinical scenarios, professional skills and patients’ wishes in order to reduce the degree and incidence of chemotherapy-related nausea and vomiting in cancer patients and improve the quality of care.

Propofol with Varied Functions: A Potential Therapeutic Opportunity for Postoperative Nausea, Vomiting and Pruritus—A Narrative Review

Background: Despite the advances in anesthetics and non-pharmacological techniques, the prevalence of postoperative nausea and vomiting in all patients remains high. It is one of the most common distressing symptoms that cause dissatisfaction among patients after anesthesia and surgery. A sub-hypnotic dose of propofol has been shown to reduce morphine-induced postoperative nausea, vomiting, and pruritus. This review article will provide sufficient knowledge on the role of propofol in minimizing opioid-induced postoperative nausea, vomiting, and pruritus by providing detailed information on propofol antiemetic and antipruritic effects, as well as discussions based on empirically available data. Method: We conducted a narrative review of the literature published between 1990 and 2023 from a range of databases;PubMed, BioMed Central, Biosis Previews, Nature, International Pharmaceutical Abstracts, Springer-Link, and Elsevier. Discussion and Conclusion: The literatures reviewed in this study have demonstrated that propofol may have diverse therapeutic effects including antiemetic and antipruritic. The antiemetic effect of propofol may be an effective therapeutic approach for the prevention of postoperative nausea and vomiting. The literature also demonstrated that the use of propofol for sedation during surgery may as well ameliorates opioids induced postoperative pruritus, which may be beneficial to surgical patients. Also, it was demonstrated that prophylactic use of propofol may be an effective way of preventing nausea and vomiting and pruritus during opioid use.

Association between operative position and postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy

BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.

Effect of music therapy on chemotherapy-induced nausea and vomiting in gastrointestinal cancer:A systematic review and metaanalysis

BACKGROUND Chemotherapy is the primary treatment for patients with advanced gastrointestinal cancer,but it has many adverse reactions,particularly nausea and vomiting.Music therapy can reduce anxiety symptoms,avoid the response to the human body under various stress conditions through psychological adjustment,and improve the adverse reactions of chemotherapy.AIM To investigate the impact of music therapy on relieving gastrointestinal adverse reactions in chemotherapy for patients with digestive tract cancer by metaanalysis.METHODS EMBASE,PubMed,OVID,WoS,CNKI,CBM,and VIP database were all used for searching relevant literature,and the efficacy after treatment was combined for analysis and evaluation.RESULTS This study included seven articles.The results of meta-analysis indicated that music therapy could reduce the nausea symptom score of patients after chemotherapy[mean difference(MD)=-3.15,95%confidence interval(CI):-4.62 to-1.68,Z=-4.20,P<0.0001].Music therapy could reduce the vomiting symptom score of patients after chemotherapy(MD=-2.28,95%CI:-2.46 to-2.11,Z=-25.15,P<0.0001).Furthermore,music therapy could minimize the incidence of grade I and above nausea or vomiting in patients after chemotherapy(odds ratio=0.38,95%CI:0.26-0.56,Z=-4.88,P<0.0001).Meta-regression analysis found that publication year was not a specific factor affecting the combined results.There was no significant publication bias(P>0.05).CONCLUSION Music therapy can significantly improve the scores of nausea and vomiting symptoms in patients with digestive system cancer during chemotherapy and reduce the incidence of grade I and above nausea and vomiting after chemotherapy,making it an effective psychological intervention method worthy of clinical promotion.

The Effects of Acupressure on Vomiting, Stress, and Anxiety in Chinese Pregnant Women with Hyperemesis Gravidarum

Objective:To investigate the role of acupressure therapy in helping pregnant women with HG reduce the frequency or severity of vomiting and relieve stress and anxiety.Method:A quantitative study with a quasi-experimental design and non-equivalent group design was used.Sixty-six valid data points were obtained from pregnant mothers diagnosed with HG in a general hospital in Linyi City.These pregnant women received either acupressure(n=33)or general therapeutic care(n=33).They completed standardized questionnaires designed to assess vomiting,anxiety,and stress levels.Results:Data showed no differences between the experimental and control groups before the intervention.After the intervention,there were significant differences in anxiety(P≤0.05)and stress(P≤0.05)scores between the two groups.However,there was no significant difference in vomiting scores(P>0.05)between the two groups after the intervention.The anxiety and stress scores of the experimental group were significantly lower than those of the control group post-intervention,while the vomiting scores of the two groups were similar.Conclusion:The findings suggest that acupressure significantly reduces anxiety and stress in pregnant women with hyperemesis gravidarum(HG)and also helps reduce vomiting.Acupressure presents a viable clinical option for pregnant women seeking relief from HG symptoms.

Non-pharmacological management for chemotherapy-induced nausea and vomiting in patients with cancer:a scoping review

Objective:This review aimed to map and summarize published studies that tested non-pharmacological management for chemotherapyinduced nausea and vomiting(CINV).Methods:We searched for eligible studies in 5 electronic databases and screened the retrieved studies using the inclusion and exclusion criteria.Data were then collated according to the types of interventions,measurement tool,and outcomes.Results:The search yielded 2343 records,of which 11 were included.Four categories of non-pharmacological CINV management were made;manipulative and body-based therapy(n=5 studies);mind–body therapy(n=3 studies);biologically based practice(n=1 study),and energy therapy(n=2 studies).Seven different scales were used to measure CINV.Nine studies repor ted improvement in CINV.Conclusions:This scoping review demonstrates the breadth of non-pharmacological management to address CINV.Various types of CINV scales were used to measure CINV severity.The management and scale can be utilized to improve nursing care,par ticularly in cancer care.

Effect of anesthesia induction with butorphanol on postoperative nausea and vomiting:A randomized controlled trial

BACKGROUND Postoperative nausea and vomiting(PONV)are common complications that affect the recovery and well-being of elderly patients undergoing gastrointestinal laparoscopic surgery.AIM To investigate the effect of butorphanol on PONV in this patient population.METHODS A total of 110 elderly patients(≥65 years old)who underwent gastrointestinal laparoscopic surgery were randomly assigned to receive butorphanol(40μg/kg)or sufentanil(0.3μg/kg)during anesthesia induction in a 1:1 ratio.The measured outcomes included the incidence of PONV at 48 h after surgery,intraoperative dose of propofol and remifentanil,Bruggrmann Comfort Scale score in the postanesthesia care unit(PACU),number of compressions for postoperative patientcontrolled intravenous analgesia(PCIA),and time to first flatulence after surgery.RESULTS The results revealed a noteworthy reduction in the occurrence of PONV at 24 h after surgery in the butorphanol group,when compared to the sufentanil group(T1:23.64%vs 5.45%,T2:43.64%vs 20.00%,P<0.05).However,no significant variations were observed between the two groups,in terms of the clinical characteristics,such as the PONV or motion sickness history,intraoperative and postoperative 48-h total infusion volume and hemodynamic parameters,intraoperative dose of propofol and remifentanil,number of postoperative PCIA compressions,time until the first occurrence of postoperative flatulence,and incidence of PONV at 48 h post-surgery(all,P>0.05).Furthermore,patients in the butorphanol group were more comfortable,when compared to patients in the sufentanil group in the PACU.CONCLUSION The present study revealed that butorphanol can be an efficacious substitute for sufentanil during anesthesia induction to diminish PONV within 24 h following gastrointestinal laparoscopic surgery in the elderly,simultaneously improving patient comfort in the PACU.

Patterns of antiemetic prophylaxis for chemotherapy-induced nausea and vomiting in China

Background： Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting （CINV） at a national level in China or to assess how treatment regimens adhere to current guidelines. Methods： We searched the China Health Insurance Research Association （CHIRA） Database to identify patients with cancer who were 〉 18 years old and received either moderately or highly emetogenie chemotherapy （MEC and HEC, respectively） between 2008 and 2012. Patients＇ characteristics as well as usage of specific antiemetic regimens were analyzed using descriptive statistics. Results： Of the 14,548 patients included in the study, 6,477 received HEC while 8,071 were treated with MEC. Approximately 89.9% used antiemetics prophylactically to prevent acute CINV and 71.5% for delayed CINV while 9.0% were prescribed antiemetics as rescue therapy. A significantly lower proportion of patients treated with HEC received prophylactic antiemetic therapy for delayed CINV as compared to those treated with MEC （59.4% vs. 81.3 %; P〈0.001）. The HEC group had a slightly lower proportion of patients using a mixed regimen containing a 5-HT3 antagonist to prevent both acute and delayed CINV than the MEC group （P〈0.012）; however, a higher proportion received a mixed regimen containing eorticosteroids （P≤0.007）. Although more than half of the patients in the HEC group took three antiemeties to prevent acute and delayed CINV, these rates were significantly lower than those of the MEC group （both P〈0.001）. Finally, analysis of the regimens used revealed that there is over-utilization of drugs within the same class of antiemetic. Conclusions： These findings indicate that more attention is needed for treatment of delayed CINV, in terms of both overall use and the components of a typical treatment regimen.

Effect of transcutaneous electrical acupoint stimulation combined with palonosetron on chemotherapy-induced nausea and vomiting: a single.blind,randomized, controlled trial

Background: Chemotherapy?induced nausea and vomiting adversely affects the quality of life of patients who receive chemotherapy via intravenous infusion or transcatheter arterial chemoembolization(TACE). This study aimed to investigate the clinical effects of transcutaneous electrical acupoint stimulation(TEAS) on nausea and vomiting after TACE.Methods: A total of 142 patients who received TACE with cisplatin for primary or metastatic liver cancer were assigned to the active?acupuncture(n = 72) or placebo?acupuncture(n Hegu(LI4), Neiguan(P6), an= 70) groups using a covariate?adaptive randomization at a ratio of 1:1. The acupointsd Zusanli(ST36) were stimulated twice daily for 6 days. The effects of TEAS on nausea and vomiting were assessed by using occurrence rate and severity of these symptoms. Anorexia scale and M. D. Anderson Symptom Inventory(MDASI) scores were secondary endpoints and were used to assess the effect of TEAS on patient appetite and quality of life. The safety of the treatments was also monitored.Results: Between the two groups, the differences in occurrence rates and severities of nausea and vomiting after TACE were not significant(all P > 0.05). From the second day after TACE, anorexia scores were significantly lower in the active?acupuncture group than in the placebo?acupuncture group and continued to decrease over time with treat?ment(all P values less than 0.01). On days 0, 1, and 2, the mean MDASI scores for the active?acupuncture group were slightly lower than those for the placebo?acupuncture group, but the differences were not statistically significant(all P > 0.05). No significant differences were found between the two groups in the occurrence rate of any adverse event(P > 0.05).Conclusion: TEAS appears to be a safe and effective therapy to relieve patients' gastrointestinal discomfort after chemotherapy.

Evaluation of Adherence to Chemotherapy-Induced Nausea and Vomiting Guidelines. An Observational Study

Objective: To describe the prescribing trends of antiemetics in chemotherapy-induced nausea and vomiting (CINV), assess adherence to American Society of Clinical Oncology (ASCO) guidelines, and evaluate the effectiveness of prescribed antiemetics. Additionally, we also sought to explore barriers that hinder clinical practice guideline (CPG) implementation. Methods: One hundred fifty-five patients between the ages of 18 and 60 who were admitted to the haematology/oncology department/clinic to receive intravenous chemotherapy, either as in-patients or outpatients, were enrolled in a prospective observational study. Relevant patient demographic data, chemotherapy protocols and antiemetics were collected. Chemotherapies were classified according to their emetogenic potential. This information was used to assess whether the antiemetic prescribed matched the emetogenic risk of treatment. The analysis of outcomes was performed using the MASCC antiemetic assessment tool. Key Findings: The results showed that 95% of antiemetic prescription pre-chemotherapy regimens did not adhere to the guidelines. The findings were use of twice the recommended dose of granisetron (87.7%), overuse granisetron (16%) and metoclopramide (62.6%), and underuse dexamethasone (27%) and corticosteroid duplication (7.7%). With respect to post-chemotherapy antiemetic prescriptions, 91% of prescriptions were not adherent to guidelines, with overuse of granisetron (81.9%) and metoclpramide (34.2%) and underuse of dexamethasone (66.5%) being the most frequently reported trends. Conclusion: This study shows a lack of conformity to antiemetic guidelines, resulting mainly in overtreatment. Although vomiting was well-managed, nausea remains under controlled and requires additional medical attention. The lack of knowledge and motivation are considered barriers to CPG implementation.

Prevention of Postoperative Nausea and Vomiting in Elective Hysterectomy: A Prospective, Randomized, Placebo Controlled Outcomes Trial of Aprepitant NK-1-Receptor Antagonist

Objectives: Current prophylactic interventions fail to completely eliminate postoperative nausea and vomiting (PONV) for a substantial number of patients. A new antiemetic (aprepitant) has been effective in preventing chemotherapy induced nausea and vomiting (CINV). We hypothesized that adding aprepitant to our current prophylactic regimen of dexamethasone and ondansetron would reduce the incidence of PONV in our elective hysterectomy population. Methods: 256 patients undergoing elective hysterectomy were enrolled in this prospective, randomized, double blinded, placebo controlled trial. Subjects received either oral aprepitant 40 mg or oral placebo 30 minutes prior to induction of standardized anesthesia. The primary outcome was vomiting within the first 24 hours after surgery. Postoperative nausea, vomiting, and use of rescue antiemetics were documented over a 24 h period. Additionally, adverse events, hospitalization days, and readmissions for PONV were compared. Results: There was a trend towards reduction of postoperative nausea and vomiting in the aprepitant group. Nausea and vomiting were noted for 24% and 17% of women in the aprepitant group versus 38% and 29% of women in the Placebo group, respectively. Supplemental antiemetic medication was used by 42% of women in the aprepitant group versus 60% of women in the Placebo group. No adverse events were substantially more common in the aprepitant group than the Placebo group. Conclusions: Preemptive use of aprepitant prior to elective hysterectomy may reduce the incidence of PONV and diminish the need for rescue antiemetics postoperatively. Further studies with larger power are needed to confirm the trends observed in this study.

Stimulation of the P6 Acupuncture Point for Prophylaxis of Nausea and Vomiting in Pregnant Women Submitted to Cesarean Section: A Blinded Clinical Trial

In pregnant women subjected to spinal anesthesia for a Cesarean section, episodes of nausea and vomiting are common both during and following surgery. Acupuncture for the prophylaxis and treatment of these complications has been gaining in popularity due to its low cost, simplicity, absence of side effects and confirmed efficacy. This study investigated the efficacy of stimulating the P6 acupoint in conjunction with the use of dexamethasone as prophylaxis for nausea and vomiting in pregnant women submitted to spinal anesthesia for a Cesarean section. The patients (n = 100) were randomly distributed into two groups. In the first group (n = 50), a site located one centimeter laterally from P6 was stimulated. This is not a true acupuncture point (sham acupuncture). In the second group (n = 50), P6 was stimulated. In both groups, 4 mg of dexamethasone were administered intravenously. A questionnaire was used to obtain information on the occurrence of nausea and vomiting during surgery and in the first 12 hours postpartum. The chi-square test and Fisher’s exact test were used to assess differences between the groups. Age and physical status were similar in both groups. The incidence of nausea during surgery was 32% (n = 16) in the control group and 22% (n = 11) in the P6 group (p > 0.05). In the first 12 hours following surgery, nausea occurred in 16% of the women in the control group (n = 6) and in 4% in the P6 group (n = 4) (p = 0.045). The incidence of vomiting in the control group was 12% (n = 6) during surgery and 10% (n = 5) in the postoperative period compared to 8% (n = 4) and 4% (n = 2), respectively, in the P6 group (p > 0.05). Although these differences were not statistically significant with the exception of the incidence of nausea in the first 12 hours postpartum, a reduction occurred in the incidence of all the outcomes evaluated in the P6 group.

The selection rules of acupoints and meridians of traditional acupuncture for postoperative nausea and vomiting:a data mining-based literature study

Background:Postoperative nausea and vomiting(PONV)refers to a problem commonly occurring after surgery.Acupuncture is considered a critical complementary alternative therapy for PONV.The acupoints selection critically determines the efficacy of acupuncture,whereas the selection rules remain unclear.The objective of the present study was to delve into the principles of acupoints selection for PONV using data mining technology.Methods:The clinical trials assessing the acupuncture effect for PONV were searched with the use of computer in PubMed,China National Knowledge Infrastructure,and Chinese Biomedical Database;the time span was confined as 2009–2019.The database of acupuncture prescriptions for PONV was built using Excel 2016;the description and association were analyzed by IBM SPSS modeler 18.Result:Eighty-three relevant literatures were screened out.The number of specific acupoints took up 72.5%of all acupoints;specific acupoints exhibited the frequency taking up 91.30%of the total frequency.As revealed from the result,Neiguan(PC 6),Zusanli(ST 36),Hegu(LI 4),and Zhongwan(CV 12)were most frequently applied,suggesting the tightest associations.Most acupoints were taken from the stomach meridian and pericardium meridian.The common acupoints were concentrated in the lower limbs,chest,as well as abdomen.Conclusion:Data mining acts as a feasible method to identify acupoints selection and compatibility characteristics.As suggested from our study,the acupoints selection for PONV prioritizes specific acupoints and related meridians.The selection and combination of acupoints comply with the theory of traditional Chinese medicine.

Intraoperative systemic vascular resistance is associated with postoperative nausea and vomiting after laparoscopic hysterectomy

BACKGROUND The incidence of postoperative nausea and vomiting(PONV)in patients undergoing laparoscopic hysterectomy is very high compared with other surgeries,even when many prophylactic measures have been taken.However,the pathogenesis of PONV is multifactorial.Female sex,a history of motion sickness or PONV,nonsmokers,and perioperative opioid use are the most closely related factors.Among the multiple risk factors,suboptimal gastrointestinal(GI)perfusion may be attributed to some cases of PONV,and increased systemic vascular resistance(SVR)may lead to GI ischemia.The hypothesis of this research was that SVR is related to PONV.AIM To investigate the relationship between SVR and PONV in patients undergoing laparoscopic hysterectomy.METHODS A total of 228 patients who underwent elective laparoscopic hysterectomy were included in this prospective observational study.SVR was monitored using a noninvasive hemodynamic monitoring system.Four indices of SVR,the baseline,mean,area under the curve(AUC),and weighted AUC,were used for analysis.The incidence and severity of nausea and vomiting were evaluated while patients were awake and throughout the intervals from 0 to 2 h,2 to 6 h,and 6 to 24 h starting upon arrival at the post-anesthesia care unit.The associations between various SVR indices and PONV were investigated by logistic regression.P<0.05 was considered statistically significant.RESULTS The incidence of PONV in the study was 56.14%(128/228),and PONV tended to appear within 6 h after surgery.Five variables were significant in univariate analyses,however,only SVR mean[odds ratio(OR)=1.015,95%CI:1.005-1.109,P=0.047]and duration of surgery(OR=1.316,95%CI:1.003-2.030,P=0.012)were associated with PONV after logistic regression analysis.Furthermore,patients with high SVR mean were more likely to suffer from PONV after laparoscopic hysterectomy.On average,patients who developed PONV needed more time to tolerate diet and demonstrated poorer sleep quality on the first night after surgery.CONCLUSION In this study,PONV was a common complication after laparoscopic hysterectomy.SVR was associated with PONV,and high SVR mean was associated with a significantly increased risk of PONV.

Acupuncture in preventing postoperative nausea and vomiting:a systematic review and Bayesian network meta-analysis

However,the best choice of acupuncture therapy for postoperative nausea and vomiting remains controversy.Methods:Several databases were searched from inception to April 2020.Randomized controlled trials met the criterion were included.Risk of bias was implemented with Cochrane risk-of-bias tool.Addis,R,OpenBUGS and STATA were used to conduct meta-analysis.The evidence was assessed by GRADE profiler 3.6.Results:Fifty studies involving 5980 patients were included.The risk of bias of most included studies were acceptable.The results of network meta-analyses indicated,compared with placebo,electroacupuncture was the best choice for postoperative nausea(odds ratio=0.09,95%confidence interval:0.02-0.51)and acupoint plaster for postoperative vomiting(odds ratio=0.07,95%confidence interval:0.01-0.42),acupoint catgut embedding+5HTRA for postoperative nausea and vomiting(odds ratio=0.05,95%confidence interval:0.01-0.15),and transcutaneous electrical nerve stimulation+5-hydroxytryptamine receptor antagonists for postoperative rescue antiemetics(odds ratio=0.14,95%confidence interval:0.08-0.46).Conclusion:It was suggested transcutaneous electrical nerve stimulation+5-hydroxytryptamine receptor antagonists was the best choice.The results provided guidance for the prevention of postoperative nausea and vomiting.

NEIGUAN(PC 6) BLOCKING FOR PREVENTING NAUSEA AND VOMITING CAUSED BY SUBARACHOID MORPHINE ANALGESIA

To find a simple and an inexpensive by method to reduce postoperative nausea and vom iting abbreviated to (PONV) caused subarachoid morphine analgesia. Methods: ninty-eight gyneeco logic patients who took 0. 5 mg morphine by subarahaid space to control postoperative pain, randomly divided into group Ⅰ (n = 50) whose bilateral Neiguan were blocked by 0. 25% bupivacaine 2 ml, group Ⅱ (n= 48), who were intravenously injected ondansetron 4 mg, preoperatively and postopera tively to prevent nausea and vomiting. The numbers of the patients experienced PONV were observed for 48 hrs after operation. Result: group i had 15 patients, group Ⅱ had 14 ones, who experienced ~ (P >0. 05 ), Conclusion: Neiguan blocking can effectively prevnt PONV caused by subara choid morphine anslgesia without side effects.

MAGNETIC DISK APPLIED ON NEIGUAN POINT FOR PREVENTION AND TREATMENT OF CISPLATIN-INDUCED NAUSEA AND VOMITING

Cisplatin is commonly used in the treat-ment of cancers,but at the same time oftencauses side-effects like severe nausea andvomiting,which cannot be prevented ortreated satisfactorily with ordinary westernor traditional Chinese drugs,thus hinderingthe chemotherapy from being carried outsmoothly.We tried several methods to tack-le the situation,and found that placing a flatpiece of magnetic disk on Neiguan pointhad a remarkable effect.The following is areport of our work.

Preoperative Concern about Nausea and Vomiting and Postoperative Use of Antiemetics among Patients Undergoing Breast Cancer-Related Surgery

Background: Postoperative nausea and vomiting (PONV) can lead to complications and increased healthcare costs. We investigated whether patient preoperative concern about PONV is associated with postoperative antiemetic use, independently of Apfel score. Methods: Patients eligible for study were English- or Spanish-speaking women with breast cancer undergoing mastectomy, lumpectomy or reconstructive surgery as outpatients during July 2014-July 2017, when the pre-anesthesia clinic routinely screened for preoperative concern via tablet computer-based survey. Excluded were patients who did not rate their concern or lacked Apfel score. Risk factors for concern were evaluated in a multinomial model adjusted for multiple hypotheses. Using generalized linear regression, preoperative concern was tested for association with number of antiemetics administered in the postanesthesia care unit. Results:?Of preoperative surveys, 7.1% (58/812) were excluded for missing data, leaving n = 754 surveys contributed by n = 706 subjects (age 26 - 80 years). Patient preoperative concern ranged from none (32.8%), mild (30.2%), moderate (22.9%), severe (7.8%), to very severe (6.2%). Adjusted for age, concern was increased by history of motion sickness (Odds Ratio 1.51, 95% Confidence Interval 1.11 - 2.06) and history of PONV (9.02, 6.30 - 12.90) and decreased by prior surgery without PONV (0.35, 0.23 - 0.53) and Spanish as primary language (0.42, 0.25 - 0.68). Number of postoperative antiemetics, usually 1 (41.2%) or 2 (33.4%) drugs, was unassociated with preoperative concern before or after adjustment for Apfel score. Conclusions: Among women undergoing breast cancer-related surgery, preoperative concern about PONV varies by prior history of PONV and motion sickness and by ethnicity. However, preoperative concern is not associated with postoperative antiemetic medications.

Postoperative Nausea &Vomiting in Malawi

Background: Postoperative nausea and vomiting are common complications of anaesthesia and surgery. Known risk factors include motion sickness, migraine, gender and types of surgery. Other possible risk factors for postoperative nausea and vomiting are ethnicity and genetics surgery. Objective: The main objective of the study was to describe factors associated with postoperative nausea and vomiting among adult Malawians. Methods: This was a prospective observational study. 138 adult patients were recruited into the study. Data were collected using a predesigned questionnaire. Patients were followed up to 18 hours postoperatively and any episodes of postoperative nausea and vomiting were noted. Results: A total of 138 patients were enrolled in the study. 78 were female (56.5%) and 60 were males (43.5%). The ages ranged from 18 to 87 years. The mean age was 36.9 years. The overall incidence of postoperative nausea and vomiting was 29.6%. It was higher among women than men. Patients with motion sickness had the highest incidence of postoperative nausea and vomiting (78.6%) followed by those with migraine (73.3%). Patients whose intraoperative systolic blood pressure fell <80 mmHg had an incidence of 71.4% and those who received postoperative opioids had an incidence of 37.7%. Conclusions: Patients with a history of migraine, motion sickness, whose intraoperative blood pressures fall below a systolic of 80 mmHg and who receive postoperative opioids are at an increased risk for postoperative nausea and vomiting.

The Addition of Midazolam Reduces the Incidence of Early Postoperative Nausea and Vomiting in Short Time Gynecological Procedures

Background: If untreated, one third of patients who undergo surgery develop postoperative nausea and/or vomiting (PONV). The prevention of postoperative nausea and vomiting can improve satisfaction among vulnerable patients. We hypothesized that preoperative anxiety may increase the incidence of PONV. The objective was to assess whether administration of a benzodiazepine prior to surgery would reduce the incidence of PONV. Methods: 130 women (ASA I and II) scheduled to undergo dilatation and curettage comprised the study group. The women were allocated randomly to two study groups according to the type of anesthesia administered (with and without midazolam). Results: Sixty-eight women received midazolam and 62 did not. Patients treated with midazolam were feeling more comfortable (“friendliness”, p = 0.005 and “elation”, p = 0.01) and had less postoperative fatigue (p = 0.04) than non-midazolam-treated group. Patients treated with midazolam had significantly fewer emetic episodes during the first 4 hours after surgery than those without midazolam (0.1 ± 0.2 vs 0.3 ± 0.6, respectively, p = 0.003). Conclusions: Midazolam reduces the incidence of PONV and improves patient’s comfort. We suggest that midazolam has to be routinely included in the anesthesia protocol for short-term gynecological procedures (dilatation and curettage).