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Kwon YS, Choi JW, Lee HS, Kim JH, Kim Y, Lee JJ. Effect of a Preoperative Proton Pump Inhibitor and Gastroesophageal Reflux Disease on Postoperative Nausea and Vomiting. J Clin Med 2020; 9:E825. [PMID: 32197451 PMCID: PMC7141242 DOI: 10.3390/jcm9030825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 01/09/2023] Open
Abstract
Postoperative nausea and vomiting (PONV) are common complications after anesthesia, but no study has considered the effects of a proton pump inhibitor (PPI) and gastroesophageal reflux disease (GERD) on PONV at the same time. Thus, we investigated the effects of a PPI and GERD on PONV. Patients aged ≥18 years who underwent general anesthesia between 2010 and 2019 were enrolled. In total, 202,439 patients were included and 21,361 In a multivariate analysis, the OR for PONV was higher in subjects with GERD (OR, 1.157; 95% CI, 1.032-1.298; p = 0.012). The OR was lower for subjects with taking a PPI (OR, 0.890; 95% CI, 0.832-0.953; p < 0.0001). In patients without GERD, the incidence of PONV was lower when lansoprazole (OR, 0.801; 95% CI, 0.718-0.894; p < 0.0001), pantoprazole (OR, 0.856; 95% CI, 0.748-0.980; p = 0.025) and ilaprazole (OR, 0.391; 95% CI, 0.158-0.966; p = 0.042) were taken. However, in GERD patients, all PPIs did not show reducing the incidence of PONV. Taken together, the results show that a lansoprazole, pantoprazole, and ilaprazole reduced PONV in patients without GERD, and PPI could not reduce PONV in patients with GERD.
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Affiliation(s)
- Young Suk Kwon
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Korea; (Y.S.K.); (H.S.L.); (J.H.K.)
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24253, Korea;
| | - Jun Woo Choi
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Korea; (Y.S.K.); (H.S.L.); (J.H.K.)
| | - Ho Seok Lee
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Korea; (Y.S.K.); (H.S.L.); (J.H.K.)
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24253, Korea;
| | - Jong Ho Kim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Korea; (Y.S.K.); (H.S.L.); (J.H.K.)
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24253, Korea;
| | - Youngmi Kim
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24253, Korea;
| | - Jae Jun Lee
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Korea; (Y.S.K.); (H.S.L.); (J.H.K.)
- Institute of New Frontier Research Team, Hallym University, Chuncheon 24253, Korea;
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Abstract
The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) and an update on the 2 previous sets of guidelines published in 2003 and 2007. These guidelines were compiled by a multidisciplinary international panel of individuals with interest and expertise in PONV under the auspices of the Society for Ambulatory Anesthesia. The panel members critically and systematically evaluated the current medical literature on PONV to provide an evidence-based reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. These guidelines identify patients at risk for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic single therapy and combination therapy regimens for PONV prophylaxis, including nonpharmacologic approaches; recommend strategies for treatment of PONV when it occurs; provide an algorithm for the management of individuals at increased risk for PONV as well as steps to ensure PONV prevention and treatment are implemented in the clinical setting.
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Raeder J, Dahl V, Bjoernestad E, Edlund G, Modin S, Naucler E, Bergheim R, Kilhamn J. Does esomeprazole prevent post-operative nausea and vomiting? Acta Anaesthesiol Scand 2007; 51:217-25. [PMID: 17096672 DOI: 10.1111/j.1399-6576.2006.01179.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Esomeprazole is a potent proton pump inhibitor (PPI), reducing acid production as well as gastric juice volume. This study evaluated the possible beneficial effect of esomeprazole on reducing post-operative nausea and vomiting (PONV). METHODS Patients undergoing laparoscopic or open gynaecological surgery, or laparoscopic cholecystectomy were randomized to receive three peri-operative doses double blindly of either esomeprazole 40 mg or placebo, given intravenously or orally. All patients were given a standardized anaesthesia regimen including fentanyl and sevoflurane/nitrous oxide. RESULTS The study population consisted of 284 patients. Demographic data and known PONV risk factors were similar for the two treatment groups. PONV was observed in 77% of patients on esomeprazole vs. 81% on placebo (NS) and rescue antiemetic medication was needed in 56% vs. 53%, respectively (NS). The proportion of patients that vomited during 0-24 h was lower on esomeprazole than placebo (38% vs. 49%; NS), and the mean amount of vomit was significantly lower (52 vs. 86 g; P < 0.05). The use of neostigmine, use of opioids and type of surgery were significant risk factors for PONV (P < 0.05). The 24-h incidence of PONV was 63% after laparoscopic gynaecology, 80% after laparoscopic cholecystectomy and 88% after open gynaecological laparotomy, whereas laparoscopic cholecystectomy had the lowest risk when corrected for other risk factors of PONV. CONCLUSION Esomeprazole had no clinically relevant effect on the overall 24-h incidence of PONV. However, esomeprazole significantly reduced the total amount of vomit during 24-h post-operatively. This may be of value in patients with an increased risk of pulmonary aspiration.
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Affiliation(s)
- J Raeder
- Department of Anaesthesia, Aleris Hospital AS/University of Oslo, Oslo, Norway.
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