Preventing Nausea and Vomiting After Bariatric Surgery: Is the Apfel Risk Prediction Score Enough to Guide Prophylaxis?
- PDF / 203,293 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 80 Downloads / 149 Views
BRIEF COMMUNICATION
Preventing Nausea and Vomiting After Bariatric Surgery: Is the Apfel Risk Prediction Score Enough to Guide Prophylaxis? Patrick Ziemann-Gimmel 1,2
&
Roman Schumann 3,4 & Wayne English 5 & John Morton 6 & Anupama Wadhwa 7,8,9
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Postoperative nausea and vomiting (PONV) is a frequent side effect in patients undergoing bariatric procedures. The simplified Apfel score is an attractive and frequently used tool to assess PONV risk in the general surgical population. Despite applying the recommendations based on the Apfel risk prediction score, several studies show that up to 82% of patients undergoing metabolic and bariatric surgery suffer from PONV in the PACU. A combination of multiple antiemetic drugs of different pharmacologic classes targeting a variety of receptors in addition to an intraoperative opioid-free TIVA technique should be considered in high-risk patients. Keywords PONV . Bariatric surgery . Metabolic surgery . Morbid obesity . Narcotic free anesthesia . Antiemetics
Postoperative nausea and vomiting (PONV) is a frequent side effect in patients undergoing bariatric procedures. It prolongs the time spent in the post-anesthesia recovery room and is one of the most common causes for readmission after metabolic and bariatric surgery [1–3]. While the readmission rate seems more common with gastric bypass than sleeve gastrectomy, the latter is more associated with readmissions due to nausea and vomiting. Long-term complications that may play a role in nausea and vomiting after gastric bypass include anastomotic strictures (5.4–7.3%) and ulcers (2.3–4%). These complications are less than 1% in the short term [4, 5]. Surgery related and delayed nausea and vomiting are beyond the scope of this commentary
due to a different pathophysiological profile and we will focus on the PONV in the recovery room and up to 48 h after surgery. The incidence of PONV in the recovery room ranges from 18 to 98.7% after bariatric procedures [6, 7]. Class 2 or class 3 obesity per se (increased BMI) is not a risk factor for increased PONV. The most common causes for PONV associated with administration of anesthesia are inhalational anesthetic agents, nitrous oxide—rarely used in contemporary bariatric anesthesia—and opioids, in a dose-dependent manner [8]. Causes for PONV that are associated with surgery include laparoscopic technique, surgical performance, and probably most importantly the type of the metabolic and bariatric procedure
* Patrick Ziemann-Gimmel [email protected]
3
Anesthesiology and Surgery, Tufts University School of Medicine, Boston, USA
4
Anesthesia for Research and Development, Department of Anesthesiology and Critical Care, VA Boston Healthcare System, Boston, USA
5
Surgery, Vanderbilt University Medical Center, Nashville, USA
6
Bariatric and Minimally Invasive Surgery, Yale School of Medicine, New Haven, USA
7
Associate Professor of Anesthesiology, University of California, San Diego, CA, USA
8
Outco
Data Loading...
