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Background and Aims: Postoperative nausea and vomiting (PONV) is a common complication after surgery. Preventing PONV in high-risk patients often requires a multimodal approach combining antiemetic drugs with diverse mechanisms. While aprepitant, a neurokinin-1 receptor antagonist, is recognised as highly effective for PONV prevention, uncertainties remain regarding its effectiveness. Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The analysis assessed the effectiveness of aprepitant (A), aprepitant plus ondansetron (AO) and aprepitant plus dexamethasone and ondansetron (ADO) in preventing PONV compared to ondansetron alone (O) or in combination with dexamethasone (DO). Results: In the analysis of 12 studies involving 2729 patients, aprepitant demonstrated significant efficacy in preventing PONV compared to ondansetron alone (A versus [vs.] O: PONV incidence 12.5% vs. 28.5%, relative risk [RR] = 0.45, P < 0.001; complete response rate 55.97% vs. 50.35%, RR = 1.13, P = 0.010). The combination of aprepitant with ondansetron (AO) also showed a significantly lower incidence of PONV compared to ondansetron alone (11.3% vs. 26.8%, RR = 0.43, P < 0.001) and a higher complete response rate (38.1% vs. 26.84%, RR = 1.41, P = 0.020). In addition, ADO significantly reduced PONV incidence compared to DO (ADO vs. DO: 13.63% vs. 35.38%, RR = 0.38, P = 0.006). Conclusion: Aprepitant, whether used alone or in combination with ondansetron or both ondansetron and dexamethasone, consistently outperforms ondansetron in achieving a complete response as it lowers vomiting rates and reduces the need for rescue therapy during the crucial 24-48-h postoperative period. Keywords: Antiemetics, aprepitant, dexamethasone, neurokinin-1 receptor antagonist, ondansetron, postoperative nausea and vomiting, substance P, Author(s): Madhusudan P. Singh [1]; Meenalotchini P. Gurunthalingam (corresponding author) [1]; Ayushee Gupta [2]; Juhi Singh [3] INTRODUCTION Postoperative nausea and vomiting (PONV) is a prevalent complication occurring within 24 [...]

Background and Aims: Post-discharge nausea and vomiting (PDNV) is a pertinent problem in patients undergoing ambulatory surgery. The objective of this study was to assess the efficacy of the novel drug olanzapine, which has proved its efficiency in patients undergoing highly emetogenic chemotherapy for PDNV prevention. Methods: This randomised controlled trial recruited 106 adult patients (18-65 years) undergoing highly emetogenic daycare surgeries with propofol-based general anaesthesia (GA). Group O received preoperative oral olanzapine 10 mg, and Group C, acting as a control, received 8 mg of intravenous dexamethasone and 4 mg of ondansetron intraoperatively. The primary outcome was nausea (numeric rating scale >3) and/or vomiting 24 h after discharge. Secondary outcomes included nausea and vomiting in the post-anaesthesia care unit (PACU), severe nausea, vomiting and side effects. Normality was assessed using the Shapiro-Wilk test, and the independent samples t-test or the Mann-Whitney U test was used to compare continuous variables. Fisher's exact test was used to assess any non-random associations between the categorical variables. Results: The incidence and severity of postoperative nausea and vomiting were similar in both groups within PACU (four patients experienced nausea and vomiting, three had severe symptoms in Group O, P = 0.057) and in the post-discharge period (three patients in Group O had nausea and vomiting compared to five patients in Group C, of which four were severe, P = 0.484). The side effects (sedation, dizziness, and light-headedness) were comparable between the two groups. Conclusion: A single preoperative oral olanzapine can be an effective alternative to standard antiemetic prophylaxis involving dexamethasone and ondansetron for preventing PDNV in highly emetogenic daycare surgeries with propofol-based GA. Keywords: Ambulatory surgery, dexamethasone, emetogenic, general anaesthesia, olanzapine, ondansetron, postoperative nausea and vomiting, propofol, Author(s): Binayak Deb [1]; Kulbhushan Saini (corresponding author) [1]; Suman Arora [1]; Sanjay Kumar [1]; Shiv L. Soni [1]; Manu Saini [2] INTRODUCTION Post-discharge nausea and vomiting (PDNV) refers to [...]

It is proposed that a 5% solution of essential oil of ginger, Zingiber officinale, is an effective post-operative nausea and vomiting (PONV) prevention when administered preoperatively, naso-cutaneously concurrently with conventional therapies to general anaesthesia patients at high risk for PONV. This is a summary of six months clinical experience and impressions of a single anaesthesia practitioner using best practice multimodal management plus 5% oil of ginger, Zingiber officinale, in the prevention of PONV in high risk group adult patients. The results of the clinical experience show improvement gained in patient response as measured by tower incidence of nausea and vomiting in the post-anaesthesia recovery unit (PACU). The group treated with the essential oil of ginger experienced approximately less than 20% nausea in the PACU. This low percentage of high risk PONV patients that experienced nausea in the ginger group mostly required only one single intravenous supplemental medication to control nausea. Approximately, 80% of high risk patients had no complaint of PONV and therefore did not require any further intravenous therapy during recovery from anaesthesia through discharge from PACU. The non-ginger oil treated patients in this clinical experience had a roughly 50/50 chance of PONV. A 5% solution of the essential oil of Zingiber officinale in grape seed carrier oil, when applied naso-cutaneously, can be administered safely for the effective prevention and therapeutic management of nausea in general anaesthesia patients at high risk for post-operative nausea and vomiting, with increased patient satisfaction and less expense to patients and hospital. Guidelines and regulations established for the safe use of integrative therapy with an essential oil are critical to observe. KEYWORDS Ginger; Zingiber officinale; Integrative; Anaesthesia; Nausea; PONV; CAM

A randomized, controlled factorial trial of six interventions is conducted for the prevention of postoperative nausea and vomiting. The findings indicate that ondansetron, dexamethasone and droperidol each reduced the risk of postoperative nausea and vomiting by about 26 percent.

Postoperative nausea and vomiting can be minimized by avoiding risk factors and using appropriate drugs that prevent nausea and vomiting. Post-operative nausea and vomiting occurs in about 30% of surgery patients overall, but in up to 70% of high-risk patients.

Dexamethasone alone or combined with ondansetron can prevent nausea and vomiting in chemotherapy patients provided they begin taking the drugs within 24 hours after starting chemotherapy. This was the conclusion of researchers who randomly assigned 705 chemotherapy patients to take dexamethasone, dexamethasone plus ondansetron, or a placebo. The patients were assigned to a low-risk or a high-risk group depending on whether they had developed nausea and vomiting within 24 hours of chemotherapy. Dexamethasone alone or combined with ondansetron completely prevented nausea and vomiting in 90% of the low-risk patients but less than half of the high-risk patients.

Byline: A. Karpe, VM. Patil, A. Joshi, V. Noronha, S. Gupta, A. Ramaswamy, A. Sahu, V. Doshi, T. Gupta, S. Rath, S. Banavali, K. Prabhash PURPOSE: The American Society of [...]

A drug that blocks the neurokinin-1 receptor appears to be effective in preventing nausea and vomiting in cancer patients who take cisplatin. The neurokinin-1 receptor is a receptor for substance P, which can cause vomiting. Researchers randomly assigned 159 patients who were starting treatment with cisplatin to take a drug called L-754,030 or a placebo after taking a single dose of cisplatin. The drug suppressed immediate vomiting in 93% of the patients who took it, and delayed vomiting in 82%. The figures for the placebo group were 67% and 33%, respectively.

Dexamethasone and metoclopramide appear to be as effective or slightly more effective than ondansetron in reducing vomiting and nausea associated with moderately emetogenic (causing vomiting) chemotherapy. Previous studies found ondansetron to be highly effective in reducing the nausea and vomiting in patients who took strongly emetogenic chemotherapy. Of 164 women with breast cancer who were about to receive moderately emetogenic chemotherapy, 84 took odansetron and 80 took dexamethasone and metoclopramide. Overall, about 66% of the women did not vomit in the seven days after chemotherapy. There were no significant differences between groups in the number of women who did not vomit. In the first day after chemotherapy, however, the women who took dexamethasone and metoclopramide experienced significantly less nausea than women who took ondansetron.

Treatment combining ondansetron and metopimazine appears to be more effective than ondansetron alone in reducing nausea and vomiting associated with chemotherapy. Ondansetron effectively reduces acute chemotherapy-induced vomiting and nausea but is less effective in reducing delayed vomiting and nausea. Of 30 chemotherapy patients, 15 took ondansetron and placebo, and 15 took ondansetron and metopimazine. After three weeks, they switched treatments. Combination therapy significantly reduced the number of acute, delayed and overall incidences of vomiting and retching, especially the delayed incidences. Seven of the patients had severe nausea after receiving only ondansetron, but none of the patients experienced it after receiving combination therapy. Two-thirds preferred the combination therapy and 1/3 preferred treatment with ondansetron alone.

Chemotherapy, used for treating cancer, can cause severe side effects such as nausea and vomiting and is found by many patients to greatly disrupt their lives. In younger cancer patients, the side effects associated with chemotherapy are a major cause of noncompliance with treatment. Many of these younger patients develop anticipatory side effects before treatment, meaning that they develop the nausea and vomiting in anticipation of the effects treatment will have. A number of strategies have been tried with these patients to lessen the side effects of chemotherapy and their perceived disruptiveness so as to increase compliance with treatment. Hypnosis has been used, as have active mind-distracting techniques such as playing video games. This study examined which type of treatment to relieve the distress of chemotherapy was most effective in young patients. A total of 54 cancer patients aged 5 to 17 were randomly placed in one of three treatment groups: 21 received hypnotic therapy while undergoing chemotherapy, 16 received support before chemotherapy on distractive and relaxation techniques, and 17 received no specific treatment beyond conversation with a therapist (the control group). Results showed that nausea from chemotherapy lasted a significantly shorter time in both the hypnosis group and the distraction/relaxation group compared with the control group. The duration of vomiting was significantly shorter for the hypnosis group than for the control group. Overall symptom scores improved 31 percent in the hypnosis group and 13 percent in the support group over time, but worsened in the control group by 50 percent. These results indicate that hypnosis may be highly effective in treating the distress associated with chemotherapy and its side effects in young people. (Consumer Summary produced by Reliance Medical Information, Inc.)