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Anesthesiology 2013: A Different Approach to Managing PONV in Bariatric Surgery

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The Particulars: Postoperative nausea and vomiting (PONV) is common among surgical patients. Studies indicate that morbidly obese patients undergoing general anesthesia for bariatric surgery can experience PONV for up to 48 hours. This complication can put fresh incisions at risk for rupture and decrease patient satisfaction. The addition of oral aprepitant to the standard ondansetron for antiemetic prophylaxis may help reduce PONV in these patients.

Data Breakdown: Drexel University investigators randomized bariatric surgery patients to receive either 40 mg aprepitant in addition to 4 mg ondansetron or placebo plus 4 mg ondansetron preoperatively. Only 3% of patients receiving 40 mg aprepitant plus 4 mg ondansetron experienced vomiting, compared with a 15% rate that was observed in the placebo arm. The authors noted, however, that rates of nausea were similar for both groups.

Take Home Pearls: When compared with using ondansetron as monotherapy, the addition of aprepitant to ondansetron appears to significantly reduce rates of postoperative vomiting. Rates of postoperative nausea, however, appear to be similar between treatment groups.

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