Chewing Gum for The Prophylaxis of Postoperative Nausea and Vomiting Following Laparoscopic Cholecystectomy in Female Patients

Dania  Abdulmajeed Hassan; Mohamed  Mosa Abdlhasn Alshaher

doi:10.17605/cajmns.v6i2.2741

Dania Abdulmajeed Hassan Ministry of health, Baghdad teaching hospital, Anesthesia department
Mohamed Mosa Abdlhasn Alshaher Alhussain teaching hospital

DOI: https://doi.org/10.17605/cajmns.v6i2.2741

Keywords: ideology, moral, spiritual experiences, phenomenon, social renewal, national traditions, development, ideological immunity, human dignity

Abstract

PONV remains the most frequent side eﬀect of general anesthesia which contributes significantly to patients’ dissatisfactions, complications and costs. Chewing gum potentially can be novel, drug free alternative for PONV . There is a big issue in modern anesthetic practices due to the consequences like unpredicted hospital admission, late work return to ambulatory people, dehydration, wound dehiscence and pulmonary aspiration. A holistic approach can be tried for the high request for ambulatory surgeries prior to and during surgeries for the prevention of PONV. We conduct trial of the eﬃcacy of mint flavored chewing gum as a prophylactic measure to prevent PONV as a part of post anesthesia care. A prospective randomized controlled trial was conducted. 88 female patients of age (37-62 years old) with volatile anesthetic according to general anesthesia for laparoscopic cholecystectomy will be randomized. All randomized patients have grade 3 risk factor for PONV according to APFL score, 44 patients asked for chewing mint flavored gum after having grade 5 OAA/S score (respond to name in normal tone) and the other 44 patients conducted as a control group. Both groups had monitored for PONV for three hours in the postoperative period. In the chewing gum group, nine patients experienced PONV (20.5%), while nineteen patients of the control group had PONV (43.2%). The symbol * indicates a significant difference between percentages was determined by the Pearson Chi-square (χ²) test at a significance (0.05) and # the Student's t-test at a 0.05 significance level showing significant differences between two independent means. Chewing gum showed a prophylactic eﬃcacy in managing PONV in female patients taking laparoscopic cholecystectomy. Further research with larger sample size and many kinds of surgeries are essential to investigate this therapy.

References

S. Swaika, A. Pal, S. Chatterjee, D. Saha, and N. Dawar, “Ondansetron, ramosetron, or palonosetron: Which is a better choice of antiemetic to prevent postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy?,” Anesth. Essays Res., vol. 5, pp. 182–186, 2011.

J. Fortier, F. Chung, and J. Su, “Unanticipated admission after ambulatory surgery – A prospective study,” Can. J. Anaesth., vol. 45, pp. 612–619, 1998.

B. S. Gold, D. S. Kitz, J. H. Lecky, and J. M. Neuhaus, “Unanticipated admission to the hospital following ambulatory surgery,” JAMA, vol. 262, pp. 3008–3010, 1989.

R. P. Hill, D. A. Lubarsky, B. Phillips-Bute, J. T. Fortney, M. R. Creed, P. S. Glass, et al., “Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo,” Anesthesiology, vol. 92, pp. 958–967, 2000.

M. R. Tramèr, “Strategies for postoperative nausea and vomiting,” Best Pract. Res. Clin. Anaesthesiol., vol. 18, pp. 693–701, 2004.

S. Islam and P. Jain, “Post-operative nausea and vomiting (PONV),” Indian J. Anaesth., vol. 48, p. 253, 2004.

T. J. Gan, P. Diemunsch, A. S. Habib, A. Kovac, P. Kranke, T. A. Meyer, et al., “Consensus guidelines for the management of postoperative nausea and vomiting,” Anesth. Analg., vol. 118, pp. 85–113, 2014.

S. Chatterjee, A. Rudra, and S. Sengupta, “Current concepts in the management of postoperative nausea and vomiting,” Anesthesiol. Res. Pract., vol. 2011, p. 748031, 2011.

M. Tramèr, A. Moore, and H. McQuay, “Meta-analytic comparison of prophylactic antiemetic efficacy for postoperative nausea and vomiting: Propofol anaesthesia vs omitting nitrous oxide vs total i.v. anaesthesia with propofol,” Br. J. Anaesth., vol. 78, pp. 2561–2569, 1997.

M. Tramèr, A. Moore, and H. McQuay, “Omitting nitrous oxide in general anaesthesia: Meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials,” Br. J. Anaesth., vol. 76, pp. 186–193, 1996.

M. F. Watcha and P. F. White, “Postoperative nausea and vomiting: Its etiology, treatment, and prevention,” Anesthesiology, vol. 77, pp. 162–184, 1992.

L. C. Jenkins and D. Lahay, “Central mechanisms of vomiting related to catecholamine response: Anaesthetic implication,” Can. Anaesth. Soc. J., vol. 18, pp. 434–441, 1971.

L. Perreault, N. Normandin, L. Plamondon, R. Blain, P. Rousseau, M. Girard, et al., “Middle ear pressure variations during nitrous oxide and oxygen anaesthesia,” Can. Anaesth. Soc. J., vol. 29, pp. 428–434, 1982.

E. I. Eger II and L. J. Saidman, “Hazards of nitrous oxide anesthesia in bowel obstruction and pneumothorax,” Anesthesiology, vol. 26, pp. 61–66, 1965.

C. C. Apfel, P. Kranke, M. H. Katz, C. Goepfert, T. Papenfuss, S. Rauch, et al., “Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: A randomized controlled trial of factorial design,” Br. J. Anaesth., vol. 88, pp. 659–668, 2002.

G. Kestin and P. Dorje, “Anaesthesia for evacuation of retained products of conception: Comparison between alfentanil plus etomidate and fentanyl plus thiopentone,” Br. J. Anaesth., vol. 59, pp. 364–368, 1987.

G. E. Thompson, M. J. Remington, B. S. Millman, and L. D. Bridenbaugh, “Experiences with outpatient anesthesia,” Anesth. Analg., vol. 52, pp. 881–887, 1973.

D. R. Sinclair, F. Chung, and G. Mezei, “Can postoperative nausea and vomiting be predicted?,” Anesthesiology, vol. 91, pp. 109–118, 1999.

J. K. Rickford, H. M. Speedy, J. A. Tytler, and M. Lim, “Comparative evaluation of general, epidural and spinal anaesthesia for extracorporeal shockwave lithotripsy,” Ann. R. Coll. Surg. Engl., vol. 70, pp. 69–73, 1988.

S. J. Dent, V. Ramachandra, and C. R. Stephen, “Postoperative vomiting: Incidence, analysis, and therapeutic measures in 3,000 patients,” Anesthesiology, vol. 16, pp. 564–572, 1955.

J. J. Bonica, W. Crepps, B. Monk, and B. Bennett, “Postanesthetic nausea, retching and vomiting; evaluation of cyclizine (marezine) suppositories for treatment,” Anesthesiology, vol. 19, pp. 532–540, 1958.

J. S. Crocker and L. D. Vandam, “Concerning nausea and vomiting during spinal anesthesia,” Anesthesiology, vol. 20, pp. 587–592, 1959.

C. K. Ratra, R. P. Badola, and K. P. Bhargava, “A study of factors concerned in emesis during spinal anaesthesia,” Br. J. Anaesth., vol. 44, pp. 1208–1211, 1972.

P. F. White and A. Shafer, Seminars in Anesthesia, vol. 6. Philadelphia, PA: Saunders, 1987.

J. Parkhouse, “The cure for postoperative vomiting,” Br. J. Anaesth., vol. 35, pp. 189–193, 1963.

M. G. Palazzo and L. Strunin, “Anaesthesia and emesis. I: Etiology,” Can. Anaesth. Soc. J., vol. 31, pp. 178–187, 1984.

J. Adriani, F. W. Summers, and S. O. Antony, “Is the prophylactic use of antiemetics in surgical patients justified?,” JAMA, vol. 175, pp. 666–671, 1961.

G. W. Roberts, T. B. Bekker, H. H. Carlsen, C. H. Moffatt, P. J. Slattery, and A. F. McClure, “Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner,” Anesth. Analg., vol. 101, pp. 1343–1348, 2005.

C. C. Apfel, B. K. Philip, O. S. Cakmakkaya, et al., “Who is at risk for postdischarge nausea and vomiting after ambulatory surgery?,” Anesthesiology, vol. 117, pp. 475–486, 2012.

Y. E. Moon, “Postoperative nausea and vomiting,” Korean J. Anesthesiol., vol. 67, pp. 164–170, 2014.