Nausea and vomiting after office-based anesthesia.
OBJECTIVE
Safety, quality, and patient satisfaction are not only defined by the incidences of serious adverse events but also include postoperative outcomes such as postdischarge nausea and vomiting (PDNV). PDNV has a high impact on patient recovery and may influence the cost-effectiveness of office-based surgical procedures. This article reviews the incidences and risk factors for PDNV as well as medications and concepts for prophylaxis and treatment.


RESULTS
Patients with PDNV require a longer recovery time to resume normal activities. PDNV can delay discharge from postanesthesia care units and is one of the leading causes of unexpected hospital admission after planned outpatient surgery. New data indicate that the incidence of PDNV is higher than expected and therefore we need a model that allows us to identify patients at risk for PDNV. A PDNV prediction model will help clinicians to better identify patients at risk who might benefit from long-acting antiemetics such as transdermal scopolamine, aprepitant, and/or palonosetron.


CONCLUSIONS
PDNV is an under-recognized problem after outpatient anesthesia. Valid data for the incidence and the best treatment of PDNV after office-based anesthesia are rare. For safety, quality, and patient satisfaction, further research is needed to develop a prediction model to better identify patients at risk for PDNV in order to direct antiemetic prophylaxis for ambulatory patients undergoing office-based anesthesia.
Kolodzie
Kerstin
K
Perioperative Clinical Research Core, Department of Anesthesia & Perioperative Care, University of California San Francisco, San Francisco, California 94115, USA.
Apfel
Christian C
CC
D000758:Anesthesia / Q000009:adverse effects*; D000932:Antiemetics / Q000627:therapeutic use*; D004329:Droperidol / Q000627:therapeutic use; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008787:Metoclopramide / Q000627:therapeutic use; D064729:Neurokinin-1 Receptor Antagonists; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D012601:Scopolamine / Q000008:administration & dosage; D058831:Serotonin 5-HT3 Receptor Antagonists; D012702:Serotonin Antagonists / Q000627:therapeutic use
D000932:Antiemetics; D064729:Neurokinin-1 Receptor Antagonists; D058831:Serotonin 5-HT3 Receptor Antagonists; D012702:Serotonin Antagonists; D012601:Scopolamine; D006220:Haloperidol; D008787:Metoclopramide; D004329:Droperidol