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June 2008
Anesthesia & Analgesia
Re: "Avoiding Emetogenic
Triggers in the First Place
Is More Effective than
Using Antiemetics"
Congratulations to Gan et al. on their recent publication describing guidelines for the management and treatment of adults and children at risk for postoperative nausea and vomiting (PONV). Although regional anesthesia is mentioned as part of decreasing baseline PONV risk, the emphasis is heavily biased in favor of antiemetic therapy. The administration of adequate local
analgesia may be the critical key
to avoidance of emetogenic triggers
and the subsequent PONV.
Following this paradigm, a PONV
rate of 0.5% in a high risk group of
elective cosmetic surgery patients
without the use of any antiemetics
was published. Although this experience
was lacking a control
group, the results are consistent
with other studies that included
proper controls.
Barry L. Friedberg, M.D.
Corona del Mar, CA
References:
1. Gan TJ, Meyer TA, Apfel CC, Chung F,
Davis PJ, Habib AS, Hooper VD, Kovac
AL, Kranke P, Myles P, Philip BK, Samsa
G, Sessler DI, Temo J, Trame`r MR, Vander
Kolk C, Watcha M; Society for Ambulatory
Anesthesia. Society for Ambulatory
Anesthesia guidelines for the management
of postoperative nausea and vomiting.
Anesth Analg 2007;105:1615
2. Friedberg BL. Propofol-ketamine technique:
dissociative anesthesia for office
surgery: a five year review of 1264 cases.
Aesthetic Plast Surg 1999;23:70
3. Song D, Greilich NB, White PF, Watcha
MF, Tongier WK. Recovery profiles of
outpatients undergoing unilateral inguinal
herniorraphy: a comparison of
three anesthetic techniques. Anesth Analg
1999; 88:S30
4. Liu SS, Strodtbeck WM, Richman JM, Wu
CL. A comparison of regional versus general
anesthesia for ambulatory anesthesia:
a meta-analysis of randomized controlled
trials. Anesth Analg 2005;101:1634