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Management of postoperative nausea and vomiting in children
Pasquale De Negri1, Giorgio Ivani
1Department of Anaesthesia, Intensive Care and Pain Management, Centro di Riferimento Oncologico della Basilicata, Cancer Hospital, Rionero in Vulture, Italy.
Insights
Postoperative nausea and vomiting (PONV) remains a challenge despite anesthesia advances. High-risk patients may benefit from antiemetics, but research continues for better, safer options.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Postoperative nausea and vomiting (PONV) is a common complication impacting patient recovery and hospital stays.
- It is a significant cause of readmission, particularly after day surgery.
- Current anesthesia improvements have not fully resolved this 'big little problem'.
Purpose of the Study:
- To review current approaches for managing postoperative nausea and vomiting (PONV).
- To highlight the benefits of antiemetic drugs for high-risk populations.
- To discuss the ongoing search for ideal antiemetic agents.
Main Methods:
- Review of pharmacological and non-pharmacological antiemetic strategies.
- Categorization of available antiemetic drug classes.
- Discussion of limitations and future research directions.
Main Results:
- Prophylactic antiemetics have limited evidence in low-risk patients but are beneficial for high-risk individuals.
- Various drug classes, including 5-HT(3) antagonists, are effective but have side effects.
- Non-pharmacological methods also contribute to PONV management.
Conclusions:
- Effective PONV management requires tailored approaches, especially for high-risk patients.
- Existing antiemetics have limitations, necessitating the development of improved agents.
- The ideal antiemetic should be effective, well-tolerated, and cost-effective.
Abstract:
In spite of improvements in anesthesia techniques, the 'big little problem' of postoperative nausea and vomiting (PONV) still exists. PONV can prolong recovery room stay and hospitalization, and is one of the most common causes of hospital readmission after day surgery. While there is little evidence to support prophylactic administration of antiemetics in patients at low risk of PONV, the higher risk population could benefit from the use of adequate antiemetic drugs. A wide variety of pharmacological approaches have been reported to be effective, as well as some nonpharmacological approaches. Antiemetic drugs available to treat or prevent PONV include phenothiazines, antihistamines, anticholinergics, benzamides, butyrophenones and 5-HT(3) antagonists. Since available drugs still present undesired adverse effects and are not completely able to control PONV, clinical investigations are ongoing for more effective and better tolerated agents; indeed, the ideal antiemetic drug might be cost-effective for routine use.