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Titolo:
Prevention and treatment of postoperative nausea and vomiting
Autore:
Kovac, AL;
Indirizzi:
Univ Kansas, Med Ctr, Dept Anaesthesiol, Kansas City, KS 66160 USA Univ Kansas Kansas City KS USA 66160 esthesiol, Kansas City, KS 66160 USA
Titolo Testata:
DRUGS
fascicolo: 2, volume: 59, anno: 2000,
pagine: 213 - 243
SICI:
0012-6667(200002)59:2<213:PATOPN>2.0.ZU;2-D
Fonte:
ISI
Lingua:
ENG
Soggetto:
PROPHYLACTIC ANTIEMETIC THERAPY; OUTPATIENT STRABISMUS SURGERY; RECEIVING EPIDURAL MORPHINE; MAJOR GYNECOLOGIC SURGERY; ORAL DOLASETRON MESYLATE; DOUBLE-BLIND; NITROUS-OXIDE; INTRAVENOUS DOLASETRON; CESAREAN-SECTION; LAPAROSCOPIC CHOLECYSTECTOMY;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
206
Recensione:
Indirizzi per estratti:
Indirizzo: Kovac, AL Univ Kansas, Med Ctr, Dept Anaesthesiol, 3901 Rainbow Blvd, Kansas City, KS 66160 USA Univ Kansas 3901 Rainbow Blvd Kansas City KS USA 66160 66160 USA
Citazione:
A.L. Kovac, "Prevention and treatment of postoperative nausea and vomiting", DRUGS, 59(2), 2000, pp. 213-243

Abstract

Pain, nausea and vomiting are frequently listed by patients as their most important perioperative concerns. With the change in emphasis from an inpatient to outpatient hospital and office-based medical/surgical environment, there has been increased interest in the 'big little problem' of postoperative nausea and vomiting (PONV). Currently, the overall incidence of PONV isestimated to be 25 to 30%, with severe, intractable PONV estimated to occur in approximately 0.18% of all patients undergoing surgery, PONV can lead to delayed postanaesthesia care unit (PACU) recovery room discharge and unanticipated hospital admission, thereby increasing medical costs. The aetiology and consequences of PONV are complex and multifactorial, with patient-, medical- and surgery-related factors. A thorough understanding of these factors, as well as the neuropharmacology of multiple emetic receptors [dopaminergic, muscarinic, cholinergic, opioid, histamine, serotonin (5-hydroxy-tryptamine; 5-HT)] and physiology [cranial nerves Vm (acoustic-vestibular), IX (glossopharyngeal) and X (vagus), gastrointestinal reflex] relating to PONV are necessary to most effectively manage PONV. Commonly usedolder, traditional antiemetics for PONV include the anticholinergics (scopolamine), phenothiazines (promethazine), antihistamines (diphenhydramine), butyrophenones (droperidol) and benzamides (metoclopramide). These antiemetics have adverse effects such as dry mouth, sedation, hypotension, extrapyramidal symptoms, dystonic effects and restlessness. The newest class of antiemetics used for the prevention and treatment of PONV are the serotonin receptor antagonists (ondansetron, granisetron, tropisetron, dolasetron). These antiemetics do not have the adverse effects of the older, traditional antiemetics. Headache and dizziness are the main adverse effects of the serotonin receptor antagonists in the dosages used for PONV. The serotonin receptor antagonists have improved antiemetic effectiveness but are not as completely efficacious for PONV as they are for chemotherapy-induced nausea and vomiting. Older, traditional antiemetics (such as droperidol) compare favourably with the serotonin receptor antagonists regarding efficacy for PONV prevention. Combination antiemetic therapy improves efficacy for PONV prevention and treatment. In the difficult-to-treat PONV patient las in the chemotherapy patient), suppression of numerous emetogenic peripheral stimuli and central neuroemetic receptors may be necessary. This multimodal PONV management approach includes use of: (ii multiple different antiemetic medications (double or triple combination antiemetic therapy acting at different neuroreceptor sites); (ii) less emetogenic anaesthesia techniques; (iii) adequate intravenous hydration; and (iv) adequate pain control.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 18/09/20 alle ore 16:58:30