Revisiones_bibliográficas TyO_Web

Nausea y vomito después de cirugía bajo anestesia general- una evidencia basada en revisión concerniente a la evaluación de riesgo, prevención y tratamiento. Nausea and vomiting after surgery under general anesthesia-an evidence-based review concerning risk assessment, prevention, and treatment. Rüsch D, Eberhart LHJ, Wallenborn J, Kranke P. Dtsch Arztebl Int 2010;107(42): 733-41. DOI: 10.3238/arztebl.2010.0733 SUMMARY Background: The German-language recommendations for the management of postoperative nausea and vomiting (PONV) have been revised by an expert committee. Major aspects of this revision are presented here in the form of an evidence-based review article. Methods: The literature was systematically reviewed with the goal of revising the existing recommendations. New evidence-based recommendations for the management of PONV were developed, approved by consensus, and graded according to the scheme of the Scottish Intercollegiate Guidelines Network (SIGN). Results: The relevant risk factors for PONV include female sex, nonsmoker status, prior history of PONV, motion sickness, use of opioids during and after surgery, use of inhalational anesthetics and nitrous oxide, and the duration of anesthesia. PONV scoring systems provide a rough assessment of risk that can serve as the basis for a riskadapted approach. Risk adapted prophylaxis, however, has not been shown to provide any greater benefit than fixed (combination) prophylaxis, and PONV risk scores have inherent limitations; thus, fixed prophylaxis may be advantageous. Whichever of these two approaches to manage PONV is chosen, high-risk patients must be given multimodal prophylaxis, involving both the avoidance of known risk factors and the application of multiple validated and effective antiemetic interventions. PONV should be treated as soon as it arises, to minimize patient discomfort, the risk of medical complications, and the costs involved. Conclusion: PONV lowers patient satisfaction but is treatable. The effective, evidence-based measures of preventing and treating it should be implemented in routine practice. http://www.aerzteblatt.de/v4/archiv/pdf.asp?id=78885  Incidencia de nausea y vomito postoperatorio en pacientes en un hospital universitario. ¿Donde estamos hoy? Incidence of postoperative nausea and vomiting in patients at a university hospital. Where are we today? Doubravska L, Dostalova K, Fritscherova S, Zapletalova J, Adamus M. Department of Anesthesiology and Resuscitation, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010 Mar;154(1):69-76. Abstract AIM: To determine the incidence of postoperative nausea and vomiting (PONV), identify risk factors, assess treatment and its effectiveness. DESIGN: A prospective, observational, questionnaire- and interview-based study. SETTING: Standard and intensive care units of the following university hospital departments: abdominal, thoracic and vascular surgery; gynecology; plastic and esthetic surgery; urology; and traumatology. MATERIAL AND METHODS: Adult patients scheduled for elective surgery who gave informed consent were enrolled. A questionnaire-based study was performed on the first postoperative day. The collected data relevant to PONV were statistically analyzed. CONCLUSION: The incidence of PONV was significantly lower than generally presumed and was related to the patient gender, type of surgery and overall health status. PONV was more frequent in obese patients and when drugs antagonizing opioids or muscle relaxants were used. Early administration of antiemetic agents led to considerably less discomfort. http://publib.upol.cz/~obd/fulltext/Biomed/2010/1/69.pdf

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