Post-Operatively Nausea and Vomiting - Literature review Example

Literature Review--- Post-Operatively Nausea and Vomiting Post-operatively nausea and vomiting (PONV) continues to be a multifactorial issue that can be triggered by different receptor pathways at central, peripheral or both ways. There is consensus among scholars that a number of anaesthesia-related, patient-specific, and surgery related factors are associated with high incidences of PONV (Sawatzky et al. 2014; Gupta & Choudhary 2010). In as much as these studies expanded knowledge regarding PONV, there are a number of issues that should be researched. For instance, Apfel et al. (2012) found that risks factors have merely correlative relationship with a certain outcome but it is not clear how these factors are clinically essential. Recent studies by Dostbil et al. (2014) challenged findings by Apfel et al. (2012) adding that independent predictors were likely to have a causative relationship and to the extent, clinicians can use them to predict an outcome when numerically corrected for other confounders or factors. Different approach was given when Jones et al. (2012) while researching on Dexamethasone for the prevention of PONV in Korean Women Undergoing. The thesis statement of the research was to investigate risks factors for PONV. Using multivariate logistic regression analysis the authors found that women’s reactions to some drugs were major causative factors. While general review of risks factors of PONV, including authors’ opinion, clinical trials and evidences suggests that there is no common risk factor attributable to PONV, there is paucity of information on systematic and evidence-based review that has attempted to quantify the effect of independent predictors for PONV. However, it has to be noted that by the time of this review, research by Hambridge (2013) made a systematic literature search by also synthesizing the data on all risks factors previously discussed but failed to calculate accurate overall point estimate for each factor analysed. If actual estimates are to be found then this review suggests that a research should not just concentrate on gender, age or region but emphasis of any analysis should be based on quantification rather than identification as this will help in establishment of anaesthesia-related, patient-specific, and surgery-related risk factors. Brampton et al. (2013) aimed at identifying evidence supporting risk factors of PONV in Australia. The researcher systematically searched databases of EMBASE, PubMed and Cochrane without restricting the search to language, publication date, gender, status or age. In the process of identifying additional possible relevant data sources on the topic, the authors hand-searched list of reference of the retrieved databases and studies of main related journals including British Journal of Anaesthesia (BJA), Anaesthesia, Anesthesiology, British Medical Journal (BMJ) and the New England Journal of Medicine (NEJM). After assessing risks factors such as history or migraine, non-smoking, history of PONV, and female gender, the conclusion from this research was that there are different risk factors for PONV in Australia but known tend to be common. However, the data indicated that when sample group data from Australia were regressed, PONV could be triggered by perioperative administration of emetogenic stimuli. What the authors argue about is that there is no single factor that can stand alone as a single predictor which is clinically sufficient for making clinical decisions regarding the need for prophylactic antiemetics. Recent studies have now focused on the relationship between age and PONV. A single centre study by Peterson et al. (2012) identified 6 independent predictors of PONV in individuals between 1-5 years, 6-13 years, 14-17 years, 18-35years and those above 35years but not older than 70 years. The duration of surgery according to the study was >40 minutes, history of PONV in the family, sibling, patient and strabismus surgery were also considered. The conclusion made was that there is no distinct relationship between age and PONV. However, different results were noted depending on perioperative administration of emetogenic stimuli. The conclusion he made was that antiemetics that were used in the study had some relationship with PONV which ranged in severity from mild headache, nausea and vomiting to possibly severe cases. Age however, did not show any reliable trend. In Australia, Ledowski et al. (2014) performed independent validation of these findings in a different institution with the same age gap but not undergoing strabismus surgery. Their study noted the same trend of PONV especially when prophylaxis was used. While the two studies succinctly showed that PONV may not be having significant relationship with age, the gap in knowledge that Ledowski et al. (2014) failed to bridge was indeed their failure to explain whether the use of a simplified score could estimate risks of PONV. Secondly, Ledowski et al. (2014) failed to factor aspects such as ‘high-risk patients’ in understanding the relationship between age and PONV risk factors. Different studies have been conducted with an aim of reducing PONV in high-risk patients (Needham et al. 2012; Faria et al. 2014; Peyton & Wu, 2014). Faria et al. (2014) for instance noted that a combination of air/oxygen and propofol had additive effects thus reducing PONV risks by 30%. According to Peyton & Wu (2014) randomized, placebo-controlled volatile anesthetics were the primary cause of early PONV for patients between the ages of 3-35 years (0–2 hours after surgery). When Peterson et al. (2012) conclude that ‘no distinct relationship between age and PONV,’ then such conclusion negate essential issues and factors that Peyton & Wu (2014) found. Studies that have been conducted in Australia indicate that female have higher chances of experiencing PONV (Rozentsveig et al. 2015; Griffiths et al. 2013). As a matter of fact, these conclusions have been informed by interests scholars have been developing in nausea and vomiting when it comes to postoperative observations. Griffiths et al. (2013) took a case study on 219 gynecological surgical procedures and related them with incidences of PONV. He concluded that incidences of PONV in gynecological procedures or surgeries were higher than other procedures. In as much as the reason the study offers is that women often experience incidences of PONV due to their hormonal state, relationship between gender and incidences of PONV has stretched beyond this findings. Rozentsveig et al. (2015) on the other hand, recorded demographics and incidences of PONV when 55 women and 55 men underwent laparoscopic procedures. Informed by earlier findings (that gynecological procedures had higher incidences of PONV), the research aimed at understanding whether women could still experience higher incidences of PONV if they undergo the same procedure as men. The statistical analysis of the research showed that incidences of nausea among men were lowest 9(11%) 0-2 hours after operation. On the other hand, incidence of nausea among women was 29 (62%) 0-2 hours after operation. Statistical analysis of the two groups further indicated that women had higher chances of vomiting or vomited 23 (48%) while men had 8(11%). Other effects such as drowsiness, pain, shivering, fever, headache, dizziness or extra pyramidal side effects were higher among women compared with men. The statistical results suggest that PONV were frequent among women compared to men. In as much the study was succinct and comprehensive; Rozentsveig et al. (2015) failed to give reasons for the higher incidences of PONV related effects among women compared to men. Earlier, Watts et al. (2012) carried a randomized, controlled research conducted at the Kyungpook National University Hospital assessing 71 men and 71 women undergoing the same operation. While their findings supports what Rozentsveig et al. (2015) found 3 years later, Watts et al. (2012) concluded that women had higher chances of experiencing PONV due to hormones in their bodies and they already known hypersensitivity. Again, what Watts et al. (2012) finds is insightful and was based on modern regression and statistical analyses. However, their research methodology failed to consider primary end point which should be the total PONV rate within 24 hours postanaesthesia. The study also lacked secondary end points such as incidences of vomiting, nausea, headache among others. Researchers have agreed that common causes of PONV could be nitrous oxide, volatile anaesthetics, and postoperative opioids (Dostbil et al. 2014; Gupta & Choudhary 2010). However, the impact of volatile anaesthetics on PONV depends on the dosages. Specifically, researchers are also concerned with inappropriate dose use of anesthesia and the effect of this on incidences of PONV. While Gupta & Choudhary (2010) noted that certain type of surgery can be linked with frequent incidences of PONV (for instance abdominal surgeries), the amount of dosage used can be a factor. While providing same emetogenic pathway, a research conducted on 14 male and 14 female patients revealed that when higher dosages of opioids were induced, incidences of PONV reported were higher (Apfel et al. 2012). Recent studies suggest that in as much as cholecystectomy, gynecological and laparoscopic independently increase risks associated with PONV, wrong or inaccurate dosages were likely to increase incidences of PONV especially among women or children (Brampton et al. 2013). Brampton et al. (2013) finding was supported by Peyton & Wu (2014) who noted that subhypnotic doses of propofol infusion in combination with an antiemetic significantly reduce incidence of PONV among children and women. In conclusion, the literature review provided above are the most recent data regarding postoperative nausea and vomiting. The literature has compiled a multidisciplinary researches and findings of individuals and expertise in PONV. The review further outlines patients at risk for PONV, recommended strategies for reducing baseline risks for PONV and identification of effective antiemetic therapy or combination therapy regimens needed for PONV. Secondly, the literatures reviewed may not be used to assess the relationship existing among clinical interventions as well as clinical outcomes. Additionally, the literatures may not permit a clear interpretation of findings as a result of methodological issues noted while reviewing them (these concerns include but not limited to study designs, data analysis and implementation of study design). References Apfel, C. C ; Heidrich, F. M ; Jukar - Rao, S ; Jalota, L ; Hornuss, C ; Whelan, R. P ;…Cakmakkaya, O. S.(2012). Evidence-based analysis of risk factors for postoperative nausea and vomiting. British Journal of Anaesthesia, 109(5), 742-753. Brampton, W., Dryburgh, I. R., Wynn-Hebden, A., & Kumar, A. (2013). Simplified measures of postoperative nausea and vomiting do not transfer to other populations. British journal of anaesthesia, 111(4), 677-678. Dostbil, A., Celik, M. G., Aksoy, M., Ahiskalioglu, A., Celik, E. C., Alici, H. A., & Ozbey, I. (2014). The effects of different doses of caudal morphine with levobupivacaine on postoperative vomiting and quality of analgesia after circumcision. Anaesthesia and intensive care, 42(2), 234. Faria, J., Marinho, A., Gomes, D., & Lima, F. (2014). Prevalence and risk analysis for depression after open‐heart valve replacement surgery: 1AP4‐7. European Journal of Anaesthesiology (EJA), 31, 15. Griffiths, J. D., Nguyen, M., Lau, H., Grant, S., & Williams, D. L. (2013). A prospective randomised comparison of the LMA ProSeal (TM) versus endotracheal tube on the severity of postoperative pain following gynaecological laparoscopy. Anaesthesia and intensive care, 41(1), 46. Gupta, S & Choudhary, R. K. (2010). A comparative clinical study of prevention of post-operative nausea and vomiting using granisetron and ondansetron in laparoscopic surgeries.(Report). The Internet Journal of Anesthesiology, 26(1), The Internet Journal of Anesthesiology, Sept 20, 2010, Vol.26(1). Hambridge, K. (2013). Assessing the risk of post-operative nausea and vomiting. Nursing Standard, 27(18), 35-43. Jones, A., Monagle, J. P., Peel, S., Coghlan, M. W., Malkoutzis, V., & Groom, A. (2012). Validity of anaesthetic complication coding data as a clinical indicator. Australian Health Review, 36(2), 229-232. Ledowski, T., Falke, L., Johnston, F., Gillies, E., Greenaway, M., De Mel, A., ... & Phillips, M. (2014). Retrospective investigation of postoperative outcome after reversal of residual neuromuscular blockade: Sugammadex, neostigmine or no reversal. European Journal of Anaesthesiology (EJA), 31(8), 423-429. Needham, E., Guiver, L., Hodgkinson, B., Dennis, C., Campbell, D., & McCrea, K. (2012). Impact of assistive technology on quality of life for elderly in the community. International Journal of Evidence-Based Healthcare, 10(3), 281-282. Peterson, C. R., Stephens, L., Hooper, V. D., Murphy, M., & Apfel, C. C. (2012). Implementation of the Aspan Evidence–Based Clinical Practice Guidelines for the Prevention and/or Management of PONV/PDNV in an Ambulatory Surgical Population. Journal of PeriAnesthesia Nursing, 27(3), e44. Peyton, P. J., & Wu, C. Y. (2014). Nitrous oxide–related postoperative nausea and vomiting depends on duration of exposure. Survey of Anesthesiology, 58(5), 246-247. Rozentsveig, V., Brotfain, E., Klein, M., Koyfman, L., Boyko, M., & Zlotnik, A. (2015). The Addition of Midazolam Reduces the Incidence of Early Postoperative Nausea and Vomiting in Short Time Gynecological Procedures. Open Journal of Anesthesiology, 5(01), 13. Sawatzky, J. V., Rivet, M., Ariano, R. E., Hiebert, B., & Arora, R. C. (2014). Post-operative nausea and vomiting in the cardiac surgery population: Who is at risk?. Heart & Lung, 43(6), 550-554. doi:10.1016/j.hrtlng.2014.07.002 Watts, R. W., London, J. A., van Wijk, R. M. A. W., & Lui, Y. L. (2012). The influence of unrestricted use of sugammadex on clinical anaesthetic practice in a tertiary teaching hospital. Anaesthesia and intensive care, 40(2), 333. Read More