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Postoperative nausea and vomiting in paediatric patients
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, PA, USA.
British Journal of Anaesthesia
|January 5, 2000
Summary
Preventing postoperative vomiting (POV) involves a multi-faceted approach combining regional anesthesia, specific anesthetic agents like propofol, and prophylactic antiemetics. Non-pharmacological methods and careful nursing also play a crucial role in managing this common surgical complication.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Postoperative vomiting (POV) remains a significant challenge, impacting patient recovery and causing distress.
- Recent innovations include serotonin antagonists and combination drug therapies for analgesia and POV control.
Purpose of the Study:
- To outline an optimal anesthetic plan for patients at high risk of severe postoperative nausea and vomiting (PONV).
- To review current and emerging strategies for the prevention and management of POV.
Main Methods:
- Recommends premedication with benzodiazepines and/or clonidine.
- Suggests preferential use of regional anesthetic techniques.
- If general anesthesia is necessary, advocates for propofol, avoidance of nitrous oxide, opioids, and neuromuscular antagonists.
- Emphasizes multimodal prophylaxis including dexamethasone, 5-HT3 antagonists, and other antiemetics.
- Includes non-pharmacological interventions like acupressure, suggestion, and careful nursing care.
Main Results:
- A comprehensive anesthetic plan can significantly reduce the incidence of POV.
- Combination therapy with various antiemetics is more effective than single agents.
- Non-pharmacological and nursing interventions contribute to decreased emesis.
Conclusions:
- An individualized anesthetic strategy incorporating regional techniques, appropriate drug choices, and multimodal prophylaxis is key to eliminating POV.
- New antiemetic classes, such as NKI antagonists, show promise for future management.
- POV should be treated as a serious complication, not a minor issue, especially in pediatric surgery.