Articles: nausea.
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Best Pract Res Clin Anaesthesiol · Dec 2020
ReviewRisk-adapted strategy or universal multimodal approach for PONV prophylaxis?
The issue of postoperative nausea and vomiting (PONV) remains important in surgical practice, contributing to patient distress, slower recovery, and increased use of healthcare resources. Many surgical patients report it to be a worse problem than pain. Numerous findings of research indicate that PONV significantly affects patients' well-being and is among the important determinants of patient satisfaction with perioperative care. ⋯ Thus, perhaps the biggest challenge across the field is to achieve a uniformly high standard of PONV management using the currently available resources. Although a risk-adapted approach has been advocated in the past, the current trend incorporated in clinical guidelines support a more liberal approach of multimodal antiemetic prevention. The current article emphasizes pros and cons of the various approaches to PONV prophylaxis and depicts most promising strategies to achieve a "PONV-free hospital."
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Best Pract Res Clin Anaesthesiol · Dec 2020
ReviewThe optimum management of nausea and vomiting during and after cesarean delivery.
Intraoperative and postoperative nausea and vomiting (IONV and PONV) afflict up to 80% of parturients undergoing cesarean delivery with neuraxial anesthesia. Preventing nausea and emesis is a top priority for women undergoing cesarean delivery and is included in the quality of recovery measures and enhanced recovery after cesarean delivery protocols. The majority of known perioperative emetic triggers can be avoided or mitigated by optimizing anesthetic and surgical management. ⋯ Furthermore, uterine exteriorization and peritoneal irrigation increase IONV risk. Conversely, preventing PONV mainly focuses on optimizing analgesia through an opioid-sparing, multimodal strategy. In addition, combination prophylactic antiemetic therapy should be instituted in this high-risk population to further reduce the risk of IONV and PONV.
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Cochrane Db Syst Rev · Oct 2020
ReviewInterventions to reduce body temperature to 35 ⁰C to 37 ⁰C in adults and children with traumatic brain injury.
Traumatic brain injury (TBI) is a major cause of death and disability, with an estimated 5.5 million people experiencing severe TBI worldwide every year. Observational clinical studies of people with TBI suggest an association between raised body temperature and unfavourable outcome, although this relationship is inconsistent. Additionally, preclinical models suggest that reducing temperature to 35 °C to 37.5 °C improves biochemical and histopathological outcomes compared to reducing temperature to a lower threshold of 33 °C to 35 °C. It is unknown whether reducing body temperature to 35 °C to 37.5 °C in people admitted to hospital with TBI is beneficial, has no effect, or causes harm. This is an update of a review last published in 2014. ⋯ One small study contributed very low-certainty evidence for mortality to this review. The uncertainty is largely driven by limited research into reduction of body temperature to 35 °C to 37.5 °C in people with TBI. Further research that evaluates pharmacological or physical interventions, or both, may increase certainty in this field. We propose that future updates of the review, and ongoing and future research in this field, incorporate outcomes that are important to the people receiving the interventions, including side effects of any pharmacological agent (e.g. nausea or vomiting), and discomfort caused by physical therapies.
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Meta Analysis
Auricular acupuncture for migraine: A protocol for systematic review and meta-analysis.
Migraines are caused by neurological and vascular dysfunction, with a side or both sides of the head pain recurrent attack, often accompanied by nausea, vomiting, light, and sound allergy as the characteristics, is the clinical common disease, frequently occurring disease. The incidence of migraine is 8.4% to 28% worldwide (highest in Germany), and the lifetime incidence is about 14.0%. About 18.2% for women and 6.5% for men, About 23 percent of families have at least one migraine sufferer. It can occur at any age, and more than half of patients have headaches that interfere with work or school, while nearly a third may miss work or school because of the headache. Therefore, how to relief headache immediately and reduce the impact on life and work, becomes the basic clinical appeal of many patients. Analgesics are the main treatment for migraine in western medicine, many patients, who worried about the side effects of drugs, often take them only when the pain is unbearable, which can only treat the symptoms rather than the root causes. Auricular acupuncture as a form of acupuncture therapy which is proved to be effective in RCTs and very suitable for patients, has been used in patients who suffer from migraine for a long time, therefore a systematic review is necessary to provide available evidence for further study. ⋯ October 2, 2020 osf.io/q6arf. (https://osf.io/q6arf/.).
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Meta Analysis
Home enteral nutrition after esophagectomy for esophageal cancer: A systematic review and meta-analysis.
Not only has the placement rate of enteral feeding tubes during operations for esophageal cancer increased, but also has number of patients who choose to continue enteral feeding at home instead of removing the feeding tube at discharge. The impacts of home enteral nutrition (HEN) after esophagectomy in esophageal cancer patients are analyzed. ⋯ HEN improved nutrition status, physical and role function, and reduced nausea/vomiting, fatigue, appetite loss, diarrhea, and sleep disturbance compared with an oral diet in esophageal cancer patients postsurgery. HEN did not increase adverse reactions.