Among the 126 patients with nausea, 53 (42%) experienced vomiting. Thus, by taking the exponential of the association coefficient (3.55), the odds of vomiting for patients with nausea were about 35 times the odds of vomiting for patients without nausea, and vice versa , emphasizing the strong association between the two outcomes. Approximately half of the patients with nausea suffered also from vomiting. Anesth Analg 118 (1): 85 – 113. "Evidence-based analysis of risk factors for postoperative nausea and vomiting." Clipboard, Search History, and several other advanced features are temporarily unavailable. To identify among preoperative and perioperative risk factors those predictive of postoperative nausea and vomiting, we fitted the bivariate Dale model to the data set by including all covariates, namely, gender, age, BMI, nonsmoking status, history of migraine and of PONV, type of anesthesia, and duration and type of surgery (using ENT as the reference group). Preoperative communication with anesthetists via anesthesia service platform (ASP) helps alleviate patients' preoperative anxiety. Positive coefficients are associated with an increased risk of developing the complication (OR > 1). Acta Anaesthesiol Scand 1998; 42: 495–501, Apfel CC, Greim CA, Haubitz I, Grundt D, Goepfert C, Sefrin P, Roewer N: The discriminating power of a risk score for postoperative vomiting in adults undergoing various types of surgery. Results were considered to be significant at the 5% critical level (P < 0.05). The role of opioids in PONV is unclear. Nausea alone occurred in 73 (11%) patients, vomiting alone occurred in 13 (2%) patients, 53 (8%) patients suffered from both nausea and vomiting, while 532 (79%) were free from the complications. 29Review of the literature on anesthetic factors contributing to PONV is difficult because of a lack of standardization. In assessing a patient’s risk for postoperative nausea and vomiting (PONV), it is important to know which risk factors are independent predictors, and which factors are not relevant for predicting PONV. Peng F, Peng T, Yang Q, Liu M, Chen G, Wang M. Sci Rep. 2020 Oct 30;10(1):18708. doi: 10.1038/s41598-020-74697-3. Anesth Analg 2001; 92: 1203–9, Muir JJ, Warner MA, Offord KP, Buck CF, Harper JV, Kunkel SE: Role of nitrous oxide and other factors in postoperative nausea and vomiting: A randomized and blinded prospective study. New concepts and problems like post-discharge nausea and vomiting, new risk factors and new drugs are appearing. Among the patients, 480 (72%) received general anesthesia, and 191 (28%) received locoregional anesthesia. The majority of them received midazolam (92%) and atropine (74%). However, there continue to be mistaken notions about PONV, such as the association between PONV and post-anaesthesia care unit stays, or assuming that it is a risk factor … , mask ventilation, volatile anesthetics, opioids), and surgical factors. BMC Anesthesiol. There are so many other factors (like anesthesia, pain medication, and patient issues) that can lead to PONV that it is assumed that any surgery is a risk for postoperative nausea and vomiting. 6and Koivuranta et al. Several studies have outlined the factors related to an increased incidence of PONV with the aim to target specific patients who might need effective antiemetic prophylaxis. , droperidol, or more antiemetic efficacy, i.e. 1–13It is assumed that PONV has a multifactorial origin, such as patient-related factors (e.g. Both the incidence of nausea (OR 3.76, 95% CI 2.06–6.88) and vomiting (OR 4.48, 95% CI 2.4–8.37) were increased in patients not receiving steroids. Postoperative nausea scores, expressed as area under the nausea–VAS time curve (AUC) was 2.9 ± 11.4 cm × h, mean VAS 0.32 ± 0.83 cm and VASmax 0.7 ± 1.8 cm. Factors considered to have a possible effect on the risk of experiencing PONV (nausea and/or vomiting) included age, female gender, body mass index (BMI), nonsmoking status, history of migraine, motion sickness and PONV, type of anesthesia (general or locoregional), and type and duration of surgery (> 100 min or not). 8, The importance of female gender is well estab-lished and appears as the most important predictor of PONV. The incidence of PONV after administration of various anesthetic agents reported by different authors cannot be compared since each group of authors used different criteria and different population groups. 6,8However, review of the literature on individual factors contributing to PONV is often complicated by the lack of standardization in the definitions of “nausea,”“retching,” and “vomiting.” The interchangeable use of the terms nausea and vomiting has led to much confusion because the symptoms do not always accompany each other in severity. Nausea was more frequently encountered in the postanesthesia care unit, but vomiting episodes appeared later, around the 12th postoperative hour. 8. Scopolamine is used to prevent nausea and vomiting … Early-phase menstruation, obesity and lack of supplemental oxygen are disproved risk factors. Conversely, negative coefficients correspond to a protective effect against the complication (OR < 1). AUC = area under the curve; BMI = body mass index; NSAID = nonsteroidal antiinflammatory drug; PONV = postoperative nausea and vomiting; PVAS = persistence of VAS pain scores; VAS = visual analog scale; T max = time of the maximal pain score. To control for postoperative factors, VAS pain parameters (AUC, mean VAS, VASmax, Tmax, and PVAS > 3) and analgesic drugs (morphine, paracetamol, and nonsteroidal antiinflammatory drugs) were also included in the Dale model. At the time of the preoperative visit, a case report form was filled out for each patient by the attending anesthesiologist. Premedication was administered to 653 (97%) of the patients. Nausea was not assessed while the patient was asleep. 14, As recently stated by Tramèr, 14,35“more precise quantification of PONV incidence will come from studies where nausea and vomiting are separate endpoints, and the cumulative incidence of nausea and vomiting is reported at different time points.” The methodological issue used in this survey considered these recommendations. Br J Anaesth 1992; 69(suppl 1): 20S–23S, Bellville JW, Bross IDJ, Howland S: Postoperative nausea and vomiting: IV. By fitting the tetrachoric model (Dale model with no covariates), the parameters were highly significant (estimates ± SE): 1.43 ± 0.12 for nausea, 2.09 ± 0.15 for vomiting, and 3.55 ± 0.40 for the association, respectively (P < 0.0001). Overall, however, the type of surgery was significantly associated with nausea but not with vomiting, except for urological procedures (P = 0.037). All drugs given for pain relief were documented. Patient-, anesthesia-, and surgery-related variables that were considered to have a possible effect on the proportion of patients experiencing postoperative nausea and/or vomiting were examined. Postoperative nausea and vomiting (PONV), postoperative vomiting (POV), post-discharge nausea and vomiting (PDNV), and opioid-induced nausea and vomiting (OINV) continue to be causes of pediatric morbidity, delay in discharge, and unplanned hospital admission. A sample of 671 surgical patients with complete case report forms was included in the study.  |  2006 Sep;64(9):1385-97. doi: 10.1016/j.joms.2006.05.024. Thus, a representative sample of everyday surgery was achieved. The study focused on postoperative nausea visual analog scale scores every 4 h and vomiting episodes within 72 h. Both vomiting and retching were considered as emetic events. 19This method models the joint probability of the two binary outcomes, P(nausea, vomiting), where nausea and vomiting are coded 0 for absent and 1 for present, and accounts for the association between them, in contrast to classic approaches, which simply consist of considering the two outcomes as independent and applying logistic regression to each of them separately. Br J Anaesth 2002; 88: 234–40, Bardiau FM, Braeckman MM, Seidel L, Albert A, Boogaerts JG: Effectiveness of an acute pain service inception in a general hospital. ASA = American Society of Anesthesiologists; BMI = body mass index; PONV = postoperative nausea and vomiting. … Our study pointed out that BMI and history of PONV or motion sickness had no predictive value for the occurrence of nausea and vomiting when accounting for the other factors. Comparison of the Effects of Sugammadex, Neostigmine, and Pyridostigmine on Postoperative Nausea and Vomiting: A Propensity Matched Study of Five Hospitals. NSAID = nonsteroidal antiinflammatory drug. Anaesthesia 1997; 52: 300–6, Chimbira W, Sweeney BP: The effect of smoking on postoperative nausea and vomiting. Postoperative nausea and vomiting … The intensity of pain was also evaluated at the same time as nausea using a VAS. Postoperative nausea and vomiting results from patient factors, surgical & anesthetic factors. Knowledge of postoperative nausea and vomiting (PONV) risk factors allows anesthesiologists to optimize the use of prophylactic regimens. Eighty patients (12%) had an American Society of Anesthesiologists physical status of III or IV, whereas 102 patients (15%) experienced their first surgery. 11,12only dealt with vomiting and did not try to predict nausea. As seen in table 5, patients undergoing gynecological (P = 0.0082), urological (P = 0.022), abdominal (P = 0.028), and, to a lesser extent, neurologic (P = 0.074), ophthalmologic (P = 0.074), or maxillofacial (P = 0.066) surgery had an increased risk of developing nausea but not vomiting when compared to ENT patients. 16,24and other authors 8,22,31who found that the type of surgery did not seem to play a major role in the incidence of PONV. It should be noted that postoperative morphine doses were slightly more significantly associated with vomiting (OR = 1.02;P = 0.029) than with nausea (OR = 1.01;P = 0.05), while pain parameters were not significant. More than 25% of the patients had a history of PONV, motion sickness, or migraine. Patients undergoing gynecologic (32%), abdominal (26%), maxillofacial (27%), plastic (25%), neurosurgical (24%) and urological (19%) surgical procedures had the highest incidences of PONV. Possible risk factors include history of migraine, history of PONV or motion sickness in a child's parent or sibling, better ASA physical status, intense preoperative anxiety, certain ethnicities or surgery types, … 28Results of our study are unable to support this statement. Background: Postoperative nausea and vomiting (PONV) is a common complication after total hip/knee arthroplasty (THA/TKA) that affects patient satisfaction and postoperative recovery. Table 3. Acta Anaesthesiol Scand 2001; 45: 160–6, Tramèr M, Moore A, McQuay H: Propofol anesthesia and post-operative nausea and vomiting: Quantitative systematic review of randomized controlled studies. Br J Anaesth 1992; 69(suppl 1): 24S–32S, Kortilla K: The study of postoperative nausea and vomiting. The study included 671 consecutive surgical inpatients, aged 15 yr or more, undergoing various procedures. Minerva Anestesiol. Br J Anaesth 2002; 88: 659–68, Pierre S, Benais H, Pouymayou J: Apfel's simplified score may favorably predict the risk of postoperative nausea and vomiting. Anaesthesia 1997; 52: 443–9, Dent SJ, Ramachandra V, Stephen CR: Postoperative vomiting: Incidence, analysis and therapeutic measures in 3,000 patients. eCollection 2020. The authors thank Professor Geert Molenberghs, Ph.D. (Department of Biostatistics, Limburgs Universitair Centrum, Diepenbeek, Belgium), for helpful discussions and advice on the Dale model. Results were expressed as mean ± SD for quantitative variables and as proportions for categorical factors. It is commonly stated that the type of surgery influences the risk of PONV. 17,18The bivariate Dale model was used to identify risk factors specifically associated with nausea, vomiting, or both complications. Hysterectomies trigger part of the nervous system that can predispose to nausea and vomiting after surgery. There was a highly significant association between the two outcomes. Association parameter between the two outcomes, nausea and vomiting: 3.74 ± 0.54 (P < 0.0001). The list goes on and on. Neuromuscular blocking agents, including atracurium or rocuronium, were administered in 385 (80%) of the patients. The simplest Dale model is the so-called tetrachoric model (no covariate included), which is fitted to the 2 × 2 table obtained by cross-classifying patients according to nausea and vomiting. , 23Apfel et al. Habib AS, Chen YT, Taguchi A, Hu XH, Gan TJ. To our knowledge, this is the first that accounts for the high association between the two outcomes. Opioids were antagonized in six patients (1.2%) using naloxone. The estimation of the unknown parameters of the Dale model and of their SEs is carried out by the maximum likelihood method. Curr Opin Anaesthesiol 1997; 10: 438–44, Sneyd JR, Carr A, Byrom WD, Bilski AJT: A meta-analysis of nausea and vomiting following maintenance of anaesthesia with propofol or inhalational agents. BMC Anesthesiol. During the 72 postoperative hours (table 2), paracetamol was given to all patients with a mean dose of 9.7 ± 6.2 g. Nonsteroidal antiinflammatory drugs were used in 429 patients (64%), and morphine was administered in 324 patients (48%) at a mean dose of 11.4 ± 23.1 mg. Patient-controlled analgesia was prescribed in 20 patients (1.5%) during the study period. It is therefore possible to assess the significance of each covariate's effect and of the association by a classic normal test (parameter estimate divided by SE). Risk factors of postoperative nausea and vomiting after total hip arthroplasty or total knee arthroplasty: a retrospective study.  |  1,32Postoperative pain did not influence nausea and vomiting. * Number of patients shown with percent in parentheses. [Article in English, Spanish] Veiga-Gil L(1), Pueyo J(2), López-Olaondo L(2). It is also possible to test whether the association is dependent on the covariates. Grabowska-Gaweł A, Porzych K, Piskunowicz G. J Oral Maxillofac Surg. In that respect, the bivariate Dale model is an interesting alternative to classic approaches, which apply logistic regression to each outcome separately and hence ignore the dependence structure of nausea and vomiting. 1,2,6Muir et al. Nevertheless, this study included 46% of children and focused only on patients after specific surgical procedures, i.e. Br J Anaesth 109(5): 742-753. J Clin Anesth 1999; 11: 583–9, Boogaerts JG, Bardiau FM, Seidel L, Albert A, Ickx BE: Tropisetron in the prevention of postoperative nausea and vomiting. 27and Ericksson and Kortilla. Factors related to postoperative nausea and vomiting. The distribution of patients according to postoperative nausea and vomiting is given in table 3. Risk Factors for Postoperative Nausea, Vomiting and Pruritus The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Can J Anaesth 2002; 49: 237–42, Andrews PLR: Physiology of nausea and vomiting. The VAS score measured nausea intensity at the time of assessment.

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