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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Postoperative nausea and vomiting: Physiopathology, risk factors, prophylaxis an...
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Vol. 64. Issue 4.
Pages 223-232 (April 2017)
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Vol. 64. Issue 4.
Pages 223-232 (April 2017)
Review
Postoperative nausea and vomiting: Physiopathology, risk factors, prophylaxis and treatment
Náuseas y vómitos postoperatorios: fisiopatología, factores de riesgo, profilaxis y tratamiento
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L. Veiga-Gila,
Corresponding author
noraveigagil@gmail.com

Corresponding author.
, J. Pueyob, L. López-Olaondob
a Servicio de Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
b Departamento de Anestesiología y Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Table 1. Risk factors for postoperative and post-discharge nausea and vomiting from 48h until the seventh postoperative day.
Table 2. Comparison of the traditional Apfel postoperative nausea and vomiting risk scale for adult and the new Apfel post-discharge nausea and vomiting risk scale for patients undergoing outpatient surgery.
Table 3. Summary of recommended prophylaxis according to patient risk and type of surgery.
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Abstract

Recognising the importance of the prevention and early treatment of postoperative nausea and vomiting (PONV) is essential to avoid postoperative complications, improve patient satisfaction and enable the development of major outpatient surgery and fast-track surgery. The topic of PONV might seem to have become stagnant, but we are moving forward. New concepts and problems like post-discharge nausea and vomiting, new risk factors and new drugs are appearing. However, there continue to be mistaken notions about PONV, such as the association between PONV and post-anaesthesia care unit stays, or assuming that it is a risk factor characteristic of the patient, anaesthesia or surgery when it is not. Perhaps, now is the moment to tackle PONV in a different manner, implementing guidelines and going for more aggressive prophylaxis in some groups of patients. We present an extensive review of this topic.

Keywords:
Postoperative nausea and vomiting
Risk factors
Antiemetics
Risk score
Emesis
Resumen

Reconocer la importancia de prevenir y tratar precozmente las náuseas y los vómitos postoperatorios (NVPO) es fundamental para evitar complicaciones postoperatorias, mejorar la satisfacción del paciente y permitir el desarrollo de la cirugía mayor ambulatoria y de la cirugía fast-track. El tema de las NVPO podría parecer estancado, pero seguimos avanzando. Aparecen nuevos conceptos y problemas como las náuseas y vómitos postalta, nuevos factores de riesgo y nuevos fármacos. Por otro lado, siguen existiendo ideas erróneas, como asociar las NVPO con la estancia en la unidad de recuperación postanestésica o asumir como factores de riesgo características del paciente, de la anestesia o de la cirugía que realmente no lo son. Debemos enfrentarnos a las NVPO de otro modo, implementando el uso de las guías clínicas en nuestros centros y apostando por una profilaxis más agresiva en determinados grupos de pacientes. Presentamos a continuación una amplia revisión del tema.

Palabras clave:
Náuseas y vómitos postoperatorios
Factores de riesgo
Antieméticos
Escala de riesgo
Emesis

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