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      Postoperative nausea and vomiting in bariatric surgery in comparison to non-bariatric gastric surgery

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          Abstract

          Introduction

          Postoperative nausea and vomiting (PONV) are complications of general anesthesia. Patient-specific factors, type of surgery and a variety of drugs determine the frequency. Clinical experience shows nausea and vomiting to be very frequent in morbidly obese patients undergoing bariatric surgery.

          Aim

          To detect the onset and extent of nausea and vomiting in the group of morbidly obese patients undergoing laparoscopic bariatric surgery.

          Material and methods

          We conducted a retrospective data bank analysis (since 2004) of all patients with body mass index > 35 kg/m 2 undergoing laparoscopic bariatric surgery in comparison to patients with a body mass index < 35 kg/m 2 undergoing gastric surgery. Propensity score matching was applied to minimize bias effects. The frequency of postoperative nausea was defined as the primary outcome parameter.

          Results

          One hundred and thirty-eight patients were included. There was a significant difference between the morbidly obese group and the control group concerning the frequency of postoperative nausea (15.9% vs. 55.1%; p < 0.001). In patients receiving volatile anesthetics a significant difference between groups concerning frequency of PONV was not observed. Intravenous anesthetics were suitable to reduce PONV in the control group but not in the morbidly obese group (12.5% vs. 56.8%, p < 0.001). With given prophylaxis PONV events still occurred in 15.6% vs. 48.8% (p = 0.003).

          Conclusions

          Morbidly obese patients undergoing laparoscopic bariatric surgery are at higher risk of suffering from PONV than non-morbidly obese patients. To reduce the PONV incidence in morbidly obese patients, further research, especially focusing on more efficient use of antiemetic drugs, seems to be necessary.

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          A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers.

          C. C. Apfel, E Läärä, M Koivuranta … (1999)
          Recently, two centers have independently developed a risk score for predicting postoperative nausea and vomiting (PONV). This study investigated (1) whether risk scores are valid across centers and (2) whether risk scores based on logistic regression coefficients can be simplified without loss of discriminating power. Adult patients from two centers (Oulu, Finland: n = 520, and Wuerzburg, Germany: n = 2202) received inhalational anesthesia (without antiemetic prophylaxis) for various types of surgery. PONV was defined as nausea or vomiting within 24 h of surgery. Risk scores to estimate the probability of PONV were obtained by fitting logistic regression models. Simplified risk scores were constructed based on the number of risk factors that were found significant in the logistic regression analyses. Original and simplified scores were cross-validated. A combined data set was created to estimate a potential center effect and to construct a final risk score. The discriminating power of each score was assessed using the area under the receiver operating characteristic curves. Risk scores derived from one center were able to predict PONV from the other center (area under the curve = 0.65-0.75). Simplification did not essentially weaken the discriminating power (area under the curve = 0.63-0.73). No center effect could be detected in a combined data set (odds ratio = 1.06, 95% confidence interval = 0.71-1.59). The final score consisted of four predictors: female gender, history of motion sickness (MS) or PONV, nonsmoking, and the use of postoperative opioids. If none, one, two, three, or four of these risk factors were present, the incidences of PONV were 10%, 21%, 39%, 61% and 79%. The risk scores derived from one center proved valid in the other and could be simplified without significant loss of discriminating power. Therefore, it appears that this risk score has broad applicability in predicting PONV in adult patients undergoing inhalational anesthesia for various types of surgery. For patients with at least two out of these four identified predictors a prophylactic antiemetic strategy should be considered.
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            Design, synthesis, and pharmacological evaluation of ultrashort- to long-acting opioid analgetics.

            Paul Feldman, Michael K. James, Marcus Brackeen … (1991)
            In an effort to discover a potent ultrashort-acting mu opioid analgetic that is capable of metabolizing to an inactive species independent of hepatic function, several classes of 4-anilidopiperidine analgetics were synthesized and evaluated. One series of compounds displayed potent mu opioid agonist activity with a high degree of analgesic efficacy and an ultrashort to long duration of action. These analgetics, 4-(methoxycarbonyl)-4-[(1-oxopropyl)phenylamino]-1-piperidinepropanoi c acid alkyl esters, were evaluated in vitro in the guinea pig ileum for mu opioid activity, in vivo in the rat tail withdrawal assay for analgesic efficacy and duration of action, and in vitro in human whole blood for their ability to be metabolized in blood. Compounds in this series were all shown to be potent mu agonists in vitro, but depending upon the alkyl ester substitution the potency and duration of action in vivo varied substantially. The discrepancies between the in vitro and in vivo activities and variations in duration of action are probably due to different rates of ester hydrolysis by blood esterase(s). The SAR with respect to analgesic activity and duration of action as a function of the various esters synthesized is discussed. It was also demonstrated that the duration of action for the ultrashort-acting analgetic, 8, does not change upon prolonged infusion or administration of multiple bolus injections.
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              Ondansetron, metoclopramid, dexamethason, and their combinations compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a prospective randomized study.

              P Peryga, K Leksowski, R Szyca (2006)
              A prospective randomized study was performed to assess the value of some individual risk factors for postoperative nausea and vomiting (PONV), and to compare the efficacy of ondansetron, metoclopramide, dexamethason, and combinations of these antiemetics in preventing PONV in patients after laparoscopic cholecystectomy. The study enrolled 210 patients (157 women and 53 men) scheduled for laparoscopic cholecystectomy. The patients were randomly divided into seven groups. In groups 1 to 6, antiemetic drugs were administered. Group 7, the control group, received no antiemetic. For all the patients, individual risk factors for the incidence of nausea also were analyzed. Both nausea and vomiting were assessed separately 1, 4, 8, and 12 h after the procedure. Postoperative nausea and vomiting were significantly less frequent in menopausal women and more frequent in patients with a history of motion sickness. A comparison of mean values for the incidence of nausea and vomiting in groups 1 to 6 with the same values in group 7 showed that the mean PONV incidences were highest in groups 3 and 7, and the difference was significant. Administration of antiemetic drugs significantly decreases the incidence of PONV in patients after laparoscopic cholecystectomy. The best decreases were achieved when ondansetron and dexamethason were applied together.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Wideochir Inne Tech Maloinwazyjne
                Journal ID (iso-abbrev): Wideochir Inne Tech Maloinwazyjne
                Journal ID (publisher-id): WIITM
                Title: Videosurgery and other Miniinvasive Techniques
                Publisher: Termedia Publishing House
                ISSN (Print): 1895-4588
                ISSN (Electronic): 2299-0054
                Publication date (Electronic): 03 October 2018
                Publication date (Print): January 2019
                Volume: 14
                Issue: 1
                Pages: 90-95
                Affiliations
                [1 ]Department of Anaesthesiology, University Hospital, Ludwig Maximilian University, Munich, Germany
                [2 ]Department of General, Visceral and Transplantation Surgery, University Hospital, Ludwig Maximilian University, Munich, Germany
                Author notes
                Address for correspondence Dr. Philipp Groene, Department of Anesthesiology, University Hospital of Munich, Ludwig-Maximilians-University, Marchioninistreet 15, 81377 Munich, Germany. phone: +49 17632972066. e-mail: Philipp.groene@ 123456med.uni-muenchen.de
                Article
                Publisher ID: 33487
                DOI: 10.5114/wiitm.2018.77629
                PMC ID: 6372858
                PubMed ID: 30766634
                SO-VID: addcfde5-c5c9-411f-8870-a4ce226218c3
                Copyright © Copyright: © 2018 Fundacja Videochirurgii
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

                History
                Date received : 21 April 2018
                Date accepted : 13 July 2018
                Categories
                Subject: Original Paper

                Keywords: bariatric surgery,general anesthesia,postoperative nausea and vomiting,nausea,obese
                Data availability:
                Keywords: bariatric surgery, general anesthesia, postoperative nausea and vomiting, nausea, obese

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