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Introduction
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Postoperative nausea and vomiting (PONV) may be worsened by the use of opiates and can make for a very unhappy experience for both parent and child. Again, protocols vary but many units use prophylactic agents such as ondansetron (a serotonin antagonist) to reduce this troublesome complication. There is now good evidence that one single intraoperative dose of a corticosteroid (dexamethasone) improves PONV.
Women’s cancers and complementary and integrative medicine
Published in Jon Adams, Amie Steel, Alex Broom, Jane Frawley, Women’s Health and Complementary and Integrative Medicine, 2018
Janet Schloss, Lise Alschuler, Ellen McDonell
Acupuncture, a component of traditional Chinese medicine, has been studied and used clinically for management of cancer symptoms and its side effects. Currently, the best evidence for acupuncture and acupressure is for cancer-related fatigue (Zhang et al., 2017), aromatase-inhibitor-induced arthralgia (Chen et al., 2017), and chemotherapy-induced nausea and vomiting (CINV) (Dibble et al., 2007; Molassiotis et al., 2007). In women with gynaecological cancer being treated with chemotherapy, acupuncture to PC6 prior to chemotherapy compared to ondansetron 8 mg, resulted in significantly reduced delayed-onset nausea, fewer additional doses of ondansetron, and fewer adverse effects including constipation and insomnia (Rithirangsriroj et al., 2015). Acupuncture and acupressure may also be beneficial in reducing post-operative nausea and vomiting (PONV), although more research is warranted (Lee, 2015).
Drugs that stop you vomiting
Published in Daniel Cottle, Shondipon Laha, Peter Nightingale, Anaesthetics for Junior Doctors and Allied Professionals, 2018
Nicola Smith, Kenneth McGrattan
Post-operative nausea and vomiting (PONV) is a common side effect following anaesthesia. It can be very upsetting for patients and in severe cases may cause more distress than post-operative pain. As well as being unpleasant for the patient, PONV can cause significant morbidity. Vomiting is associated with increased intracranial and intraocular pressure, and it can contribute to wound dehiscence, incisional hernias and aspiration of gastric contents into the lungs. If prolonged, PONV can cause electrolyte imbalances and dehydration. It can also lead to prolonged hospital stays – an increasingly important consideration given the financial implications and pressures on hospital beds. For these reasons, you must take great care to assess your patient’s risk of PONV and minimise its occurrence.
Ondansetron versus ondansetron with dexamethasone to prevent intrathecal-morphine pruritus for caesarean patients: randomised double-blind trial
Published in Journal of Obstetrics and Gynaecology, 2021
Thaer Ankouni, Saleh Kanawati, Rania El Khatib, Janah El Hassan, Saad Eddine Itani, Omar Rajab, Zoher Naja
Although the antiemetic effect of dexamethasone and ondansetron have been demonstrated by some studies (Apfel et al. 2005; Abdel-Aleem et al. 2012; Allen et al. 2012; Imeh et al. 2014; Kalani et al. 2017); nevertheless, their combination in our study did not show significant difference in PONV compared to dexamethasone monotherapy. On the contrary, a study that examined the combination of dexamethasone and ondansetron versus dexamethasone alone showed that the combination significantly reduced the incidence of PONV when used as a prophylactic treatment for intrathecal morphine side effects in patients undergoing caesarean section (Imeh et al. 2014). Another trial compared the effect of intravenous dexamethasone, intravenous ondansetron, and their combination on nausea and vomiting in caesarean section with spinal anaesthesia. The study showed an increase in the antiemetic efficacy in the combination group; however, the patients did not receive intrathecal morphine (Sane et al. 2015). Dominguez et al reviewed the different prophylaxis and treatment strategies of PONV associated with neuraxial morphine in women undergoing caesarean section. They noted that the combination of antiemetic regimens is more effective but further investigation is required (2013). A recent review by Tan and Habib reported that preventing PONV in women undergoing caesarean delivery focuses on optimising analgesia through an opioid-sparing multimodal strategy as well as using combination prophylactic antiemetic therapy to further decrease the risk of intra- and post- operative nausea and vomiting (2020).
Analgesic efficacy of dexmedetomidine versus fentanyl as an adjunct to thoracic epidural in patients undergoing upper abdominal surgery: a randomized controlled trial
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
Neerja Bharti, Shweta N Pokale, Indu Bala, Vikas Gupta
All complications such as bradycardia, hypotension, hypoxia (SpO2 < 92) and respiratory depression (respiratory rate < 8) were noted and promptly corrected. Other postoperative adverse events like nausea, vomiting, pruritus and urinary retention were also recorded and treated accordingly. Post-operative nausea and vomiting (PONV) was rated on a three-point scale (0 = no PONV, 1 = mild nausea, 2 = severe nausea or vomiting ≤ 2 occasions, 3 = vomiting on 3 or more occasions) and treated by injecting with ondansetron 0.15 mg/kg if the scale was ≥ 2. Pruritus was treated with iv diphenhydramine 0.2 mg/kg. Patients’ satisfaction with the technique was assessed at 24 hours postoperatively on a 0–10 point scale (0 = unsatisfied, 10 = fully satisfied).
Comparative study between dexmedetomidine and fentanyl as adjuvants to bupivacaine for postoperative epidural analgesia in abdominal surgeries: A randomized controlled trial
Published in Egyptian Journal of Anaesthesia, 2023
Mohammed Waheed Mahmoud Emam, Bahaa El-Din Ewees Hassan, Hadeel Magdy Abd El-Hamid, Ibrahim Alshaht Ibrahim, Mohamed Abd Elmawla Saleh
Opioids and alpha 2 agonists as adjuvants in regional anesthesia produce potent analgesic effects [12]. Fentanyl either directly affects the spinal nerve or traverses the dura to act at the dorsal roots containing opioid-binding sites [13]. Dexmedetomidine reduces sympathetic outflow and norepinephrine release by acting on the central nervous system’s pre and postsynaptic nerve terminals. It may produce hypotension and bradycardia. However, it is not associated with the negative consequences of opioids, such as respiratory depression, itching, postoperative nausea, and vomiting (PONV). The motor block may occur due to alpha 2 agonists binding to the motor neurons in the dorsal horn [6].