NDLI: The impact of current antiemetic practices on patient outcomes: a prospective study on high-risk patients.

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The impact of current antiemetic practices on patient outcomes: a prospective study on high-risk patients.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	White, Paul F. O'Hara, Jerome F. Roberson, Charles R. Wender, Ronald H. Candiotti, Keith A.
Description	Country affiliation: United States Author Affiliation: White PF ( Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX 75390-9068, USA. paul.white@utsouthwestern.edu)
Abstract	BACKGROUND: In this prospective, multicenter, observational study, we evaluated the incidence and time course of postoperative nausea and vomiting (PONV), assessed prophylactic and rescue antiemetic use in high-risk patients, and determined population-based effectiveness of antiemetics, including the impact of American Society of Anesthesiologists (ASA) and American Society of Perianesthesia Nurses (ASPAN) guideline compliance. METHODS: Eligible patients undergoing elective laparoscopic or major plastic surgery possessed two or more of the following Apfel PONV risk factors: female gender, history of PONV or motion sickness, and nonsmoking status. Antiemetic use, emetic episodes, severity of nausea, and functional interference due to PONV were documented during the first 72 h after surgery. Complete response (CR) was defined as no emesis or rescue medication use, and complete control was defined as CR and no moderate-severe nausea. The effect of compliance (versus noncompliance) with ASA and ASPAN guidelines on PONV outcomes was also analyzed. RESULTS: The proportion of patients experiencing postoperative emesis ranged from 18% to 40% depending on the number of antiemetics administered. The rate of rescue medication (45%) was similar to the reported incidences of moderate-to-severe nausea (47%) and functional interference due to emetic symptoms (44%). The administration of three or more antiemetics produced better patient outcomes overall compared to <1 prophylactic antiemetic. CR rates were <70% despite adherence to current organizational PONV management guidelines (ASA: 69%; ASPAN: 63%). The complete control rates were 10% lower than CR rates over the 3 day study period. CONCLUSIONS: Administration of three or more prophylactic antiemetics had the most positive impact on emetic outcomes over 72 hrs in patients at risk of developing PONV. Although compliance with organizational PONV management guidelines improved patient outcomes, postoperative emetic symptoms and interference with patient functioning still occurred in more than 30% of these high-risk patients.
File Format	HTM / HTML
ISSN	00032999
Issue Number	2
Volume Number	107
e-ISSN	15267598
Journal	Anesthesia & Analgesia
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2008-08-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Anesthesiology Antiemetics Therapeutic Use Postoperative Nausea And Vomiting Prevention & Control Abdomen Surgery Adult Aged Aged, 80 And Over Female Guideline Adherence Humans Laparoscopy Male Middle Aged Drug Therapy Practice Guidelines As Topic Risk Factors Surgery, Plastic Treatment Outcome Journal Article Multicenter Study Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine

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