Antiemetic Prophylaxis and Anesthetic Approaches to Reduce Postoperative Nausea and Vomiting in Bariatric Surgery Patien
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REVIEW
Antiemetic Prophylaxis and Anesthetic Approaches to Reduce Postoperative Nausea and Vomiting in Bariatric Surgery Patients: a Systematic Review Zaina Naeem 1 & Ingrid L. Chen 1 & Aurora D. Pryor 1 & Salvatore Docimo 1 & Tong J. Gan 2 & Konstantinos Spaniolas 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract While guidelines exist for the management of postoperative nausea and vomiting (PONV) in the general surgical setting, there are no established guidelines for the prevention or treatment of PONV in bariatric patients, in whom PONV contributes significantly to perioperative morbidity and hospital resource utilization. This systematic review found that the multimodal pharmacological approach to PONV prevention recommended in current guidelines for high-risk surgical patients is appropriate for the bariatric subset. This includes multi-agent antiemetic prophylaxis with dexamethasone and one or more agents from other classes, and opioid-free total intravenous anesthesia, though the advantages of the latter need further evaluation. There remains a need for a standardized validated instrument to assess PONV in the bariatric setting. Keywords Postoperative nausea and vomiting . PONV . Antiemetic . Prophylaxis . Anesthesia . Bariatric surgery . Morbid obesity . Gastric bypass . RYGB . Sleeve gastrectomy . Morbidity
Introduction Postoperative nausea and vomiting (PONV) is an important source of patient morbidity following bariatric surgical procedures, contributing to delays in oral intake and mobilization with subsequent prolonged hospital length of stay, unexpected hospital readmissions, and patient dissatisfaction with the perioperative experience [1–3]. Current strategies for the prevention and treatment of PONV include proactive risk assessment, avoidance of PONV triggers, administration of prophylactic antiemetics in the preoperative setting or rescue antiemetics postoperatively, and optimization of anesthetic protocols [4]. The risk of PONV is often estimated preoperatively using the Apfel score, which comprises female gender, history of motion sickness or PONV, non-smoking status, and postoperative use of opioids * Konstantinos Spaniolas [email protected] 1
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[5]. Conditions affecting the gastroesophageal junction, including hiatal hernia and obesity, blood and secretions in the stomach, choice of anesthetic technique (opioids, nitric oxide, halogenated anesthetics), and duration of surgery, may also place bariatric surgery patients at higher risk compared with other surgical subpopulations [1]. While guidelines exist for the management of PONV in the general adult and pediatric surgical setting, there are no established guidelines for the prevention or treatment of PONV in the bariatric subset in particular, in whom PONV contributes significantly to perioperative morbidity and hospital resource utilization [1, 6, 7]. To this end, the aims of this systematic review were to (1) describe instruments for PONV assessment; (2) identify effective ph
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