Clinical Strategies for Preventing Postoperative Nausea and Vomiting After Middle Ear Surgery in Adult Patients

摘要

Middle ear surgery (tympanoplasty and mastoidectomy) performed under general or local anesthesia is associated with a high incidence of postoperative nausea and vomiting (PONV). Between 50% and 80% of patients who undergo these surgical procedures experience PONV. Numerous antiemetics have been studied for the prevention of PONV after middle ear surgery. Traditional antiemetics, including anticholinergics (e.g., scopolamine), phenothiazines (e.g., promethazine), butyrophenones (e.g., droperidol), and benzamide (e.g., metoclopramide), are used for the prevention of PONV during 0-24 h after anesthesia. The available nontraditional antiemetics that have been shown to be effective for the prophylaxis against PONV are propofol, dexamethasone, tandospirone, and midazolam. Antiserotinins (ondansetron, granisetron, and ramosetron) are highly effective in decreasing the incidence of PONV for 24 h postoperatively, compared with traditional antiemetics. Ramosetron is effective for the long-term (up to 48 h) prevention of PONV. None of the available antiemetics is entirely effective, perhaps because most of them act through the blockade on one type of receptor. There is a possibility that combined antiemetics with different sites of activity would be more effective than one drug alone for preventing PONV. Nonpharmacological technique is acustimulation at P6 (Nei-Kuwan) point.nClinicians should consider these clinical strategies as mentioned above for preventing PONV after middle ear surgery in adult patients.