Urits Ivan, Orhurhu Vwaire, Jones Mark R, Adamian Leena, Borchart Matthew, Galasso Annemarie, Viswanath Omar
Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, AZ, USA.
Turk J Anaesthesiol Reanim. 2020 Apr;48(2):88-95. doi: 10.5152/TJAR.2019.67503. Epub 2019 Nov 11.
Postoperative nausea and vomiting (PONV) is a common complication in paediatric anaesthesia and is a source of significant morbidity. Various independent risk factors have been implicated in the development of paediatric PONV, including higher pain scores postoperatively, the use of opioids for pain management and the use of volatile anaesthetics for the maintenance of anaesthesia. This review of the current literature regarding the prevention and treatment of paediatric PONV is based on a search of the PubMed database, which identified published clinical trials, systematic reviews and meta-analyses. While the occurrence of PONV in many cases is difficult to avoid entirely, the risk can be mitigated by the use of multimodal nonopioid analgesic regimens, total intravenous drugs in favour of volatile anaesthetics and an appropriate regimen of prophylactic pharmacotherapy. Frequently administered drug classes for the prevention of PONV include corticosteroids, 5HT3 antagonists and anticholinergics. The clinical use of the findings in the literature may help to reduce the occurrence of PONV in children. In this review, we provide comprehensive and updated information on the risk factors contributing the occurrence of PONV in children, outline the current opinion on the drugs that are commonly used for management and provide an overview of the guidelines that are used to help establish the prophylaxis and treatment of paediatric PONV.
术后恶心呕吐（PONV）是小儿麻醉中常见的并发症，是导致显著发病的原因。小儿PONV的发生涉及多种独立危险因素，包括术后疼痛评分较高、使用阿片类药物进行疼痛管理以及使用挥发性麻醉剂维持麻醉。本关于小儿PONV预防和治疗的当前文献综述基于对PubMed数据库的检索，该检索确定了已发表的临床试验、系统评价和荟萃分析。虽然在许多情况下PONV的发生难以完全避免，但通过使用多模式非阿片类镇痛方案、使用全静脉药物而非挥发性麻醉剂以及适当的预防性药物治疗方案，可以降低风险。预防PONV常用的药物类别包括皮质类固醇、5HT3拮抗剂和抗胆碱能药物。文献中这些研究结果的临床应用可能有助于减少儿童PONV的发生。在本综述中，我们提供了关于导致儿童PONV发生的危险因素的全面和最新信息，概述了目前对常用治疗药物的观点，并提供了用于帮助制定小儿PONV预防和治疗的指南概述。
