In the subsequent study, nausea and vomiting were considered as the two outcomes of interest. All drugs given for pain relief were documented. Postoperative incidence rates of nausea and vomiting were estimated from the data. The authors designed a prospective study to identify and differentiate the risk factors for postoperative nausea and vomiting in various surgical populations in a clinical audit setting. 17,18The bivariate Dale model was used to identify risk factors specifically associated with nausea, vomiting, or both complications. Patients undergoing general anesthesia have an increased risk of nausea (OR = 2.51; 1.10–5.72) and of vomiting (OR = 3.67; 1.25–10.8) when compared to patients undergoing locoregional anesthesia. The inhalational agents are variably associated with postoperative nausea and vomiting, and nitrous oxide ⦠Risk factors of postoperative nausea and vomiting after total hip arthroplasty or total knee arthroplasty: a retrospective study. Br J Anaesth 109(5): 742-753. Anesth Analg 118 (1): 85 â 113. By Pete Chapman [CC-BY-SA-3.0], via Wikimedia Commons Figure 1 â Opioid analgesics, such as diamorphine hydrochloride, ⦠Although the aetiology of postoperative nausea and vomiting is not completely clear, a number of key contributing factors increase the risk for an individual patient. 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. In turn, the most complicated model incorporates all covariates for both outcomes. It is commonly stated that the type of surgery influences the risk of PONV. A nesthesiology 1999; 91: 109–18, Tramèr MR: A rational approach to the control of postoperative nausea and vomiting: Evidence from systematic reviews: Part II. Anaesthesia 1997; 52: 300–6, Chimbira W, Sweeney BP: The effect of smoking on postoperative nausea and vomiting. 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. Results were expressed as mean ± SD for quantitative variables and as proportions for categorical factors. Anti-dopaminergic drug could help ease postoperative nausea and vomiting in high-risk patents. It is also possible to test whether the association is dependent on the covariates. To our knowledge, this is the first that accounts for the high association between the two outcomes. Gan, T. J., et al. 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. Among perioperative related factors, general anesthesia influenced the probability of nausea and vomiting, but there was no direct association between the duration of anesthesia and the incidence of PONV, as demonstrated by Sinclair et al. 2006 Jun;22(6):1093-9. doi: 10.1185/030079906X104830. | , 11,12,24and more recently Kranke et al. 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. Only when propofol was used for induction and maintenance of anesthesia did the risk for early PONV seem to be smaller, as demonstrated by Tramèr et al. There was a strong association between the two outcomes. Acta Anaesthesiol Scand 2000; 44: 470–4, Apfel CC, Kranke P, Eberhart LHJ, Roos A, Roewer N: Comparison of predictive models for postoperative nausea and vomiting. This process was repeated every 2 h for the first 4 h and was continued every 4 h within 72 h on the surgical ward. Apfel, C. C., et al. The estimation of the unknown parameters of the Dale model and of their SEs is carried out by the maximum likelihood method. The present epidemiologic study was designed to discern risk factors of PONV with a clear distinction between the two events. 28Results of our study are unable to support this statement. The distribution of patients according to type of surgery was as follows: orthopedics (141), neurosurgery (54), vascular (32), ophthalmology (8), maxillofacial (41), gynecology (69), urology (58), plastic (32), abdominal (184), stomatology (23), and ENT (29). History of migraine was almost significantly related to nausea (P = 0.052) but not to vomiting (P = 0.63). 2020 Nov 18;20(1):288. doi: 10.1186/s12871-020-01205-5. Eighty patients (12%) had an American Society of Anesthesiologists physical status of III or IV, whereas 102 patients (15%) experienced their first surgery. Among the 126 patients with nausea, 53 (42%) experienced vomiting. Some risk factors were predictive of both nausea and vomiting (female gender, nonsmoking status, and general anesthesia). 32–34Nausea is a subjective sensation requiring activation of neural pathways, which eventually project to areas of the cerebral hemispheres dealing with conscious sensations. Anesthesiol Res Pract. A sample of 671 surgical patients with complete case report forms was included in the study. Acta Anaesthesiol Scand 2001; 45: 4–13, Kamath B, Curran J, Hawkey C, Beattie A, Gorbutt N, Guiblin H, Kong A: Anaesthesia, movement and emesis. This is in accordance with the results of a meta-analysis performed by Tramèr et al. , mask ventilation, volatile anesthetics, opioids), and surgical factors. 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. 2020 Dec 3;20(1):297. doi: 10.1186/s12871-020-01214-4. Prior to the start of the study, local Ethics Committee (Charleroi, Belgium) approval was obtained, and written informed consent was given by all patients. , droperidol, or more antiemetic efficacy, i.e. Patient records, nurses’ notes, and medication sheets were reviewed in detail by the study investigators to ensure completeness of the information. Studies published to date have used a variety of methodologies that do not permit meaningful conclusions to be drawn. A nesthesiology 1955; 16: 564–72, Burtles R, Peckett BW: Postoperative vomiting: Some factors affecting its incidence. Patients were familiarized with a 10-cm VAS device for pain (0 = no pain; 10 = worst imaginable pain) and nausea (0 = no nausea at all, 10 = worst imaginable nausea) assessment. Opioids were antagonized in six patients (1.2%) using naloxone. Neuromuscular blocking agents, including atracurium or rocuronium, were administered in 385 (80%) of the patients. No relationships could be established with our results. Br J Anaesth 1992; 69(suppl 1): 24S–32S, Kortilla K: The study of postoperative nausea and vomiting. 1–3,6Our data reflected a casual impact of surgical procedures on nausea alone, notably gynecology, and abdominal surgery with the exception of urology that increased both nausea and vomiting. Thus, even when accounting for covariates, the two outcomes remained strongly dependent on each other (i.e. Acta Anaesthesiol Scand 1998; 42: 502–9, Sinclair DR, Chung F, Mezei G: Can postoperative nausea and vomiting be predicted. Habib AS, Chen YT, Taguchi A, Hu XH, Gan TJ. "Evidence-based analysis of risk factors for postoperative nausea and vomiting." 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. Statistical calculations were carried out by means of the SAS package (SAS Institute, Cary, NC; version 8 for Windows), always using all data available. 16Postoperative pain and analgesic consumption (morphine, paracetamol, and nonsteroidal antiinflammatory drugs) were also used to control for postoperative status and treatment of the patients. 27and Ericksson and Kortilla. 1,2,6Muir et al. 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