Der Anaesthesist
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Numerous factors have been claimed to influence postoperative nausea and vomiting (PONV). A critical review of the literature reveals, that strong evidence based on original double-blind, randomized, controlled trials or their meta-analyses is only available for very few risk factors. For most other factors, although mentioned in narrative reviews, there is insufficient evidence. ⋯ No evidence due to lack of data applies to postoperative movement, hemodynamic stability, hypercarbia and acid-base-shifts. For adipositas++ there is not only a lack of evidence for an effect but evidence for a lack of effect based on several multivariate analyses. In conclusion, we have developed the following simplified view: PONV is mainly caused by opioids and volatile anaesthetics when applied to susceptible patients (females, non-smoker, positive history of previous sickness).
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Procedures in clinical nutrition have gained both invasiveness as well as the complexity. Thus improved education of professionals and their alliance in hospital based nutritional support teams (NST) is demanding. Two forms of collaboration, the "interdisciplinary nutritional committee" and the "department for nutritional therapy", are discussed. ⋯ Costs/benefit balances have to be assessable and must be documented. Although the effectiveness of selected nutritional support teams was clearly shown, it is the challenge of each individual team to produce proof of effectiveness for itself. Acceptable working conditions, however, should be provided as they have to be considered indispensable to achieve high quality performance.