Macario Alex, Claybon Louis, Pergolizzi Joseph V
Department of Anesthesia, and Health Research & Policy, Stanford University School of Medicine, Stanford, CA, USA.
BMC Anesthesiol. 2006 Jun 1;6:6. doi: 10.1186/1471-2253-6-6.
When patients are asked what they find most anxiety provoking about having surgery, the top concerns almost always include postoperative nausea and vomiting (PONV). Only until recently have there been any published recommendations, mostly derived from expert opinion, as to which regimens to use once a patient develops PONV. The goal of this study was to assess the responses to a written survey to address the following questions: 1) If no prophylaxis is administered to an ambulatory patient, what agent do anesthesiologists use for treatment of PONV in the ambulatory Post-Anesthesia Care Unit (PACU)?; 2) Do anesthesiologists use non-pharmacologic interventions for PONV treatment?; and 3) If a PONV prophylaxis agent is administered during the anesthetic, do anesthesiologists choose an antiemetic in a different class for treatment?
A questionnaire with five short hypothetical clinical vignettes was mailed to 300 randomly selected USA anesthesiologists. The types of pharmacological and nonpharmacological interventions for PONV treatment were analyzed.
The questionnaire was completed by 106 anesthesiologists (38% response rate), who reported that on average 52% of their practice was ambulatory. If a patient develops PONV and received no prophylaxis, 67% (95% CI, 62%-79%) of anesthesiologists reported they would administer a 5-HT3-antagonist as first choice for treatment, with metoclopramide and dexamethasone being the next two most common choices. 65% (95% CI, 55%-74%) of anesthesiologists reported they would also use non-pharmacologic interventions to treat PONV in the PACU, with an i.v. fluid bolus or nasal cannula oxygen being the most common. When PONV prophylaxis was given during the anesthetic, the preferred PONV treatment choice changed. Whereas 3%-7% of anesthesiologists would repeat dose metoclopramide, dexamethasone, or droperidol, 26% (95% confidence intervals, 18%-36%) of practitioners would re-dose the 5-HT3-antagonist for PONV treatment.
5-HT3-antagonists are the most common choice for treatment of established PONV for outpatients when no prophylaxis is used, and also following prophylactic regimens that include a 5HT3 antagonist, regardless of the number of prophylactic antiemetics given. Whereas 3%-7% of anesthesiologists would repeat dose metoclopramide, dexamethasone, or droperidol, 26% of practitioners would re-dose the 5-HT3-antagonist for PONV treatment.
当询问患者手术中最令他们焦虑的事情时，首要担忧几乎总是包括术后恶心和呕吐（PONV）。直到最近才有一些已发表的建议，大多源自专家意见，涉及患者发生PONV后应采用何种治疗方案。本研究的目的是评估对一份书面调查问卷的回复，以解决以下问题：1）如果未对门诊患者进行预防处理，麻醉医生在门诊麻醉后护理单元（PACU）中会使用何种药物治疗PONV？；2）麻醉医生是否会使用非药物干预措施治疗PONV？；3）如果在麻醉期间给予了PONV预防药物，麻醉医生在治疗时会选择不同类别的止吐药吗？
向300名随机挑选的美国麻醉医生邮寄了一份包含五个简短假设临床病例的问卷。分析了用于治疗PONV的药物和非药物干预措施的类型。
106名麻醉医生完成了问卷（回复率38%），他们报告其门诊手术患者平均占其业务量的52%。如果患者发生PONV且未接受预防处理，67%（95%可信区间，62%-79%）的麻醉医生报告他们会将5-HT3拮抗剂作为首选治疗药物，其次最常用的是甲氧氯普胺和地塞米松。65%（95%可信区间，55%-74%）的麻醉医生报告他们也会在PACU中使用非药物干预措施治疗PONV，但最常用的是静脉推注液体或鼻导管吸氧。当在麻醉期间给予PONV预防药物时，首选的PONV治疗选择发生了变化。虽然3%-7%的麻醉医生会重复给予甲氧氯普胺、地塞米松或氟哌利多，但26%（95%可信区间，18%-36%）的从业者会重新给予5-HT^3拮抗剂用于治疗PONV。
当未使用预防措施时，以及在采用包括5-HT3拮抗剂的预防方案后，5-HT3拮抗剂是门诊患者已发生PONV治疗的最常用选择，无论给予的预防性止吐药数量如何。虽然3%-7%的麻醉医生会重复给予甲氧氯普胺、地塞米松或氟哌利多，但26%的从业者会重新给予5-HT3拮抗剂用于治疗PONV。
