Reversal of Neuromuscular Blockade with Neostigmine Does not Increase the Incidence of Postoperative Nausea and Vomiting

Background Electrical stimulation of the P6 acupuncture point reduces the incidence of postoperative nausea and vomiting (PONV). Neuromuscular blockade during general anesthesia can be monitored with electrical peripheral nerve stimulation at the wrist. The authors tested the effect of neuromuscular monitoring over the P6 acupuncture point on the reduction of PONV. Methods In this prospective, double-blinded, randomized control trial, the authors investigated, with institutional review board approval and informed consent, 220 women undergoing elective laparoscopic surgery anesthetized with fentanyl, sevoflurane, and rocuronium. During anesthesia, neuromuscular blockade was monitored by a conventional nerve stimulator at a frequency of 1 Hz over the ulnar nerve (n = 110, control group) or over the median nerve (n = 110, P6 group) stimulating at the P6 acupuncture point at the same time. The authors evaluated the incidence of nausea and vomiting during the first 24 h. Results No differences in demographic and morphometric data were found between both groups. The 24-h incidence of PONV was 45% in the P6 acupuncture group versus 61% in the control group (P = 0.022). Nausea decreased from 56% in the control group to 40% in the P6 group (P = 0.022), but emesis decreased only from 28% to 23% (P = 0.439). Nausea decreased substantially during the first 6 h of the observation period (P = 0.009). Fewer subjects in the acupuncture group required ondansetron as rescue therapy (27% vs. 39%; P = 0.086). Conclusion Intraoperative P6 acupuncture point stimulation with a conventional nerve stimulator during surgery significantly reduced the incidence of PONV over 24 h. The efficacy of P6 stimulation is similar to that of commonly used antiemetic drugs in the prevention of PONV.

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Monitoring of Neuromuscular Blockade at the P6 Acupuncture Point Reduces the Incidence of Postoperative Nausea and Vomiting

Deutsche Zeitschrift für Akupunktur ◽

10.1016/j.dza.2008.04.004 ◽

2008 ◽

Vol 51 (2) ◽

pp. 44-45

Keyword(s):

Neuromuscular Blockade ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Acupuncture Point ◽

Nausea And Vomiting

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Monitoring of Neuromuscular Blockade at the P6 Acupuncture Point Reduces the Incidence of Postoperative Nausea and Vomiting

Survey of Anesthesiology ◽

10.1097/.sa.0000344056.83855.6e ◽

2009 ◽

Vol 53 (1) ◽

pp. 40-41

Author(s):

&NA;

Keyword(s):

Neuromuscular Blockade ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Acupuncture Point ◽

Nausea And Vomiting

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Faculty Opinions recommendation of Monitoring of neuromuscular blockade at the P6 acupuncture point reduces the incidence of postoperative nausea and vomiting.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1098195.560060 ◽

2008 ◽

Author(s):

Paul Barash

Keyword(s):

Neuromuscular Blockade ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Acupuncture Point ◽

Nausea And Vomiting

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The Post-Anesthesia Care Unit

10.2310/anes.18368 ◽

2018 ◽

Author(s):

Evan R Bohnenblust

Keyword(s):

Neuromuscular Blockade ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Scoring Systems ◽

Nausea And Vomiting ◽

Postanesthesia Care Unit ◽

Emergence Delirium ◽

Residual Neuromuscular Blockade ◽

Hemodynamic Compromise ◽

Standards And Guidelines

physiologic changes caused by both recent administration of anesthesia as well as the preceding surgical intervention. This general overview of the postanesthesia care unit (PACU) summarizes the most current standards and guidelines for patient care and monitoring. It also details the causes and treatment of the most common complications observed in PACU, such as postoperative nausea and vomiting, hemodynamic compromise, and respiratory insufficiency. Other relevant topics such as residual neuromuscular blockade and emergence delirium are also addressed. Finally, this chapter concludes with a discussion of the development of commonly used discharge scoring systems, including a discussion of the differences between the ambulatory and inpatient surgery populations. Each of these sections discusses current trends in management as supported by the latest literature and guidelines. This review contains 1 figure, 6 tables, and 50 references Key Words: Aldrete scoring, delayed awakening, emergence delirium, postanesthesia care unit, postanesthesia care unit discharge criteria, postoperative nausea and vomiting, postoperative respiratory failure, residual neuromuscular blockade, sugammadex

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