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Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent and unpredictable episodes of intense vomiting, interspersed with periods of apparent wellbeing. This disorder, which primarily affects children and adolescents but can persist into adulthood, has recently been the subject of extensive study and analysis in the medical literature. The aim of the present review is to examine the most important aspects of the epidemiology, pathophysiology, subtypes, diagnostic criteria, and current management of CVS. Even though the exact etiology remains unknown, genetic factors (polymorphisms), nervous system alterations and autonomic dysregulation, and environmental factors (use and abuse of cannabinoids) are postulated as possible triggers. CVS has significant diagnostic challenges, given that there is no specific test for confirming its presence. Thorough evaluation of symptoms and the ruling out of other possible causes of recurrent vomiting are required. Management of CVS typically involves a multidisciplinary approach. Pharmacologic options are explored, such as antiemetics and preventive medications, as well as behavioral and psychologic support therapies. Treatment personalization is essential, adapting it to the individual needs of each patient. Despite advances in the understanding of CVS, it remains a significant clinical challenge. This disorder impacts the quality of life of those affected and their families, underscoring the ongoing need for research and the development of more effective treatment strategies.

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Para avaliar o papel da pregabalina na proteção das náuseas e vômitos induzidos pela quimioterapia, foi realizado um ensaio clínico de fase II, aleatorizado, duplamente cego, controlado por placebo, para investigar se a pregabalina poderia melhorar o controle completo das náuseas e vômitos (desfecho primário). Inscrevemos 82 pacientes virgens de quimioterapia, programados para receber quimioterapia moderadamente e altamente emetogênica. Todos os doentes receberam ondansetron 8mg por via intravenosa, dexametasona 10mg antes da quimioterapia no primeiro dia e, dexametasona 4 mg por via oral, b.d., nos dias dois e três. Os doentes foram distribuídos aleatoriamente para tomar pregabalina 75 mg ou placebo, bd, desde a noite anterior à quimioterapia até ao quinto dia. A resposta completa global não foi estatisticamente significativa entre os grupos (53,7 versus 48,8%, respetivamente, no grupo da pregabalina e no grupo de controlo (P=0,65)). Também não houve diferença estatística significativa durante a fase aguda (primeiras 24 horas) e a fase tardia (24-120h): 80,5% versus 82,9% (P=0,77), 53,7 versus 51,2% (P=0,82), respectivamente. Neste estudo não foi identificada ação da pregabalina na prevenção de náuseas e vômitos induzidos por quimioterapia. Número de registo no Clinicaltrial.gov: NCT04181346.

To evaluate the role of pregabalin in the protection of chemotherapy-induced nausea and vomiting, we performed a phase II randomized, double-blind, placebo-controlled trial to investigate whether pregabalin could improve the complete control of nausea and vomiting (primary end point). We enrolled 82 chemotherapy-naive patients, scheduled to receive moderately and highly emetogenic chemotherapy. All patients received IV ondansetron 8mg, dexamethasone 10mg before chemotherapy on day one and oral dexamethasone 4mg, b.d., on days two and three. Patients were randomly assigned to take pregabalin 75mg or placebo, bd, from the night before chemotherapy to day five. The overall complete response was not statistically significant between the groups (53.7 versus 48.8%, respectively, in the pregabalin group and the control group (P=0.65)). There was also no significant difference during the acute phase (first 24 hours) and delayed phase (24-120h): 80.5% versus 82.9% (P=0.77), 53.7 versus 51.2% (P=0.82), respectively. There is no role for pregabalin preventing chemotherapy-induced nausea and vomiting. Clinicaltrial.gov registration number: NCT04181346.

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Resumen ANTECEDENTES: Los tumores intracraneales se diagnostican con una frecuencia muy baja durante el embarazo. Entre los síntomas iniciales destacan: cefalea, náuseas y vómitos frecuentes que, a su vez, son característicos del embarazo, de ahí la necesidad de establecer un diagnóstico diferencial correcto. CASO CLÍNICO: Paciente primigesta, de 25 años, 11+4 semanas de embarazo, con un cuadro de vómitos, cefalea, vértigo e inestabilidad, de inicio subagudo en los últimos dos meses. Antecedentes de interés: cefalea de características tensionales en comparación con migraña crónica no estudiada previamente. Durante la exploración se advirtió enlentecimiento en el lenguaje, nistagmo evocado por la mirada de manera bilateral y dolor periocular izquierdo, junto con vómitos incoercibles que no cedían, pese a la dieta absoluta y administración pautada de metoclopramida y pantoprazol. La resonancia magnética nuclear cerebral con contraste mostró una masa tumoral centrada en el cuarto ventrículo. Con base en lo anterior se procedió a la craniectomía suboccipital con exéresis subtotal del tumor y diagnóstico anatomopatológico de ependimoma de fosa posterior grupo A. Se propuso, y la paciente aceptó, la interrupción del embarazo con el propósito de completar el tratamiento coadyuvante con radioterapia. La intervención quirúrgica le dejó importantes secuelas neurológicas que ameritaron un proceso de rehabilitación. CONCLUSIONES: El momento del diagnóstico es decisivo para indicar el tratamiento de las tumoraciones intracraneales, sobre todo si son de naturaleza maligna, puesto que habrá que establecer un equilibrio entre la salud de la madre y la viabilidad de la gestación. En tanto se trata de pacientes con una afección compleja, su atención médica debe ser multidisciplinaria para disminuir los riesgos para la madre y el feto.

Abstract BACKGROUND: Intracranial tumours are diagnosed very rarely during pregnancy. The initial symptoms include headache, nausea and frequent vomiting, which are characteristic of pregnancy, so a correct differential diagnosis is necessary. CLINICAL CASE: Primigravida patient, 25 years old, 11+4 weeks pregnant, with a history of vomiting, headache, dizziness and instability of subacute onset in the last two months. History of interest: tension-type headache compared with chronic migraine, not previously studied. On examination, slowed speech, bilateral gaze-evoked nystagmus and left periocular pain were noted, together with incoercive vomiting that did not resolve despite a strict diet and prescribed metoclopramide and pantoprazole. A contrast-enhanced MRI of the brain showed a tumour mass centred in the fourth ventricle. Based on the above, a suboccipital craniectomy was performed with subtotal excision of the tumour and anatomopathological diagnosis of group A posterior fossa ependymoma. The interruption of pregnancy was proposed and accepted by the patient to complete the adjuvant treatment with radiotherapy. The surgical intervention left her with significant neurological sequelae that merited rehabilitation. CONCLUSIONS: The time of diagnosis is crucial in the management of intracranial tumours, especially if they are malignant, as a balance must be struck between the health of the mother and the viability of the pregnancy. As these are patients with a complex condition, their medical care must be multidisciplinary in order to reduce the risks to the mother and foetus.

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Anestesia, náuseas y vómitos postoperatorios van unidas prácticamente desde que la anestesia general se introdujo en la práctica clínica quirúrgica, y todavía en la actualidad sigue presentando una incidencia inaceptablemente alta. Con el objetivo de evaluarla efectividad de la medicación preanestésica antiemética con ondansetrón en comparación con dexametasona, en la prevención de la aparición de náuseas y vómitos postoperatorios, se realizó un estudio prospectivo, cuasiexperimental, con grupo control no equivalente en pacientes operados por cirugía de mínimo acceso en el hospital provincial general "Carlos Manuel de Céspedes″ de Bayamo, entre septiembre 2017 hasta diciembre 2020, distribuidos aleatoriamente en dos grupos de 78 pacientes cada uno: el grupo I tratado con ondansetrón, y el grupo II tratado con dexametasona. Fueron utilizados el test del Xi-cuadrado (X2), y la prueba de diferencias de proporciones, con un valor de p = 0,05; los pacientes entre 40 a 49 años de edad, el sexo femenino, ASA II, sin antecedentes de náuseas y vómitos; y con estratificación de riesgo intermedio de nausea y vómitos, fueron más frecuente en el grupo al que se le administró dexametasona. En el grupo I, el mayor número de pacientes tuvo intensidad leve y un número reducido de pacientes requirieron rescate antiemético con dimenhidrinato. En el grupo II, el mayor número de pacientes reportó intensidad moderada seguida de fuerte, requiriendo rescate antiemético. Se concluyó que la administración de ondansetrón en monoterapia es más efectiva en la prevención de la aparición de náuseas y vómitos postoperatorios que la administración de dexametasona.

Postoperative anaesthesia, nausea and vomiting have been linked practically since general anaesthesia was introduced into clinical surgical practice, and still today it continues to have an unacceptably high incidence. With the objective of evaluating the effectiveness of preanesthetic antiemetic medication with ondansetron compared to dexamethasone, in the prevention of the appearance of postoperative nausea and vomiting, a prospective, quasi-experimental study was carried out with a control group not equivalent in patients operated by minimally accessible surgery in the general provincial hospital "Carlos Manuel de Céspedes" of Bayamo. between September 2017 to December 2020, randomly distributed into two groups of 78 patients each: group I treated with ondansetron, and group II treated with dexamethasone. The Xi-square test (X2) and the proportions differences test were used, with a value of p = 0.05; patients between 40 and 49 years of age, female, ASA II, with no history of nausea and vomiting; and with intermediate risk stratification of nausea and vomiting, were more frequent in the group administered dexamethasone. In group I, the largest number of patients had mild intensity and a small number of patients required antiemetic rescue with dimenhydrinate. In group II, the largest number of patients reported moderate intensity followed by strong intensity, requiring antiemetic rescue. It was concluded that ondansetron monotherapy is more effective in preventing postoperative nausea and vomiting than dexamethasone administration.

Anestesia pós-operatória, náuseas e vômitos têm sido associados praticamente desde que a anestesia geral foi introduzida na prática clínica cirúrgica, e ainda hoje continua a ter uma incidência inaceitavelmente alta. Como objetivo de avaliar a eficácia da medicação antiemética pré-anestésica com ondansetrona comparada à dexametasona na prevenção do aparecimento de náuseas e vômitos pós-operatórios, foi realizado um estudo prospectivo, quase experimental, com um grupo controle não equivalente em pacientes operados por cirurgia minimamente acessível no hospital geral provincial "Carlos Manuel de Céspedes" de Bayamo entre setembro de 2017 a dezembro de 2020, distribuídos aleatoriamente em dois grupos de 78 pacientes cada: grupo I tratado com ondansetron e grupo II tratado com dexametasona. Foram utilizados o teste do xi-quadrado (X2) e o teste de diferenças de proporções, com valor de p = 0,05; pacientes entre 40 e 49 anos, sexo feminino, ASA II, sem história de náuseas e vômitos; e com estratificação de risco intermediário para náuseas e vômitos, foram mais frequentes no grupo que recebeu dexametasona. No grupo I, o maior número de pacientes apresentou intensidade leve e um pequeno número de pacientes necessitou de resgate antiemético com dimenidrinato. No grupo II, o maior número de pacientes relatou intensidade moderada seguida de intensidade forte, necessitando de resgate antiemético. Concluiu-se que a monoterapia com ondansetrona é mais efetiva na prevenção de náuseas e vômitos pós-operatórios do que a administração de dexametasona.

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RESUMEN Objetivo: Determinar las características clínicas y epidemiológicas de la estenosis hipertrófica de píloro en un hospital de Lima, Perú. Materiales y métodos: Se realizó un estudio descriptivo, retrospectivo correspondiente a los años 2013 al 2019, en el servicio de Cirugía Pediátrica del Hospital Docente Madre Niño "San Bartolomé". Se recolectaron datos de las historias clínicas con diagnóstico de estenosis hipertrófica de píloro. Resultados: Participaron un total de 59 pacientes, de los cuales 79,7 % fueron varones, 68,4 % primogénitos, con una media de edad de 31.3 +/- 13.6 días de nacido. 100 % presentó vómitos, 44,1 % reptación abdominal y solo 35,6 % presentó oliva pilórica palpable. Tiempo quirúrgico promedio 51.39 minutos, estancia hospitalaria promedio de 6.35, se presentó complicaciones mayores en un 13,6 %, con una mortalidad de 3,4 %. Conclusiones: Es importante el inicio precoz de la vía oral, así como el manejo postquirúrgico en estos pacientes para disminuir su estancia hospitalaria y el desarrollo de complicaciones ventilatorias posquirúrgicas.

ABSTRACT Objective: To determine clinical and epidemiological characteristics of hypertrophic pyloric stenosis in a hospital in Lima, Peru. Materials and Methods: A descriptive and retrospective study encompassing years 2013 to 2019 was performed in the Pediatric Surgery Service of San Bartolome Teaching Mother and Child Hospital. Data from clinical records of patients diagnosed with hypertrophic pyloric stenosis was collected. Results: Records from fifty-nine patients were obtained, 79% were male, 68.4% were first born, and their mean age was 31.3 ± 13.6 days. All patients (100 %) had vomit, 44.1% had abnormal abdominal movement, and only 35.6% had palpable pyloric olive. The average surgical correction time was 51.39 minutes, and the average hospital stay was 6.35 days, major complications occurred in 13.6% of all children, and the mortality rate was 3.4%. Conclusions: Early initiation of oral intake is important, as well as post-surgical management in these patients, in order to reduce their in-hospital stay and the development of post-surgical ventilatory complications.

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ABSTRACT Objectives: to identify the effectiveness of auriculotherapy in the treatment of nausea and vomiting through a systematic review of the scientific literature. Methods: it was performed a systematic review of the literature making use of the following data basis: The Scopus, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, LILACS and Cochrane databases were used. Articles from complete research from randomized controlled clinical trials that describe using auriculotherapy in nausea and vomiting treatment were selected, without restriction of date or language. Results: eleven articles were selected for analysis. The majority approached the population in surgical situations, followed by patients undergoing chemotherapy and pregnant women. As for results, 81% (n=8) of the articles reported that nausea and vomiting were lower in incidence and/or intensity in the intervention group. Conclusions: the review provided relevant data on the effects of auriculotherapy in nausea and vomiting treatment, with a decrease in the intensity and frequency of these symptoms in different populations.

RESUMEN Objetivos: identificar la efectividad de la auriculoterapia en el tratamiento de náuseas y vómitos mediante una revisión sistemática de la literatura científica. Métodos: se realizó una revisión sistemática de la literatura en las bases de datos Scopus, PubMed, CINAHL, Web of Science, LILACS y Cochrane. Se seleccionaron artículos de investigación completa de ensayos clínicos controlados aleatorios que describen el uso de la auriculoterapia en el tratamiento de náuseas y vómitos, sin restricción de fecha o idioma. Resultados: se seleccionaron 11 artículos para su análisis. La mayoría se acercó a la población en situaciones quirúrgicas, seguida de pacientes en quimioterapia y embarazadas. En cuanto a los resultados, el 81% (n=8) de los artículos informaron que las náuseas y los vómitos fueron de menor incidencia y/o intensidad en el grupo de intervención. Conclusiones: la revisión aportó datos relevantes sobre los efectos de la auriculoterapia en el tratamiento de las náuseas y los vómitos, con disminución de la intensidad y frecuencia de estos síntomas en diferentes poblaciones.

RESUMO Objetivos: identificar a eficácia da auriculoterapia no tratamento de náuseas e vômitos através de uma revisão sistemática da literatura científica. Métodos: foi realizada uma revisão sistemática da literatura nas bases de dados Scopus, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, LILACS e Cochrane. Foram selecionados artigos de pesquisas completas de ensaios clínicos randomizados controlados e que descrevem o uso da auriculoterapia no tratamento de náuseas e vômitos, sem restrição de data ou idioma. Resultados: foram selecionados 11 artigos para análise. A maioria abordou população em situações cirúrgicas, seguidos de pacientes em quimioterapia e gestantes. Quanto aos resultados, 81% (n=8) dos artigos reportaram que náuseas e vômitos foram menores em incidência e/ou intensidade no grupo intervenção. Conclusão: a revisão forneceu dados relevantes sobre os efeitos da auriculoterapia no tratamento de náuseas e vômitos, apresentando diminuição de intensidade e frequência desses sintomas em diferentes populações.

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El objetivo del estudio es determinar la eficacia de la Dexametasona frente a la Metoclopramida en la prevención de náuseas y vómitos posoperatorios en pacientes sometidos a procedimiento quirúrgico bajo anestesia general. Se realizó un estudio descriptivo, comparativo, observacional. Se estudiaron pacientes adultos entre 18 y 60 años de edad, los cuales se dividieron en dos grupos. Grupo A se les administro Dexametasona 8 mg IV y a otro grupo B Metoclopramida 10 mg IV, posterior a la inducción anestésica. Ambos grupos fueron comparables en cuanto a sus características según los resultados se evidencia que en el grupo A de la Dexametasona se presentó menos náuseas y vómitos postoperatorios. Después de realizar el estudio se concluye que con la dexametasona existe menos incidencia de náuseas y vómitos con la dosis administrada, por lo tanto, este medicamento es eficaz para el manejo de este tipo de pacientes a comparación de la metoclopramida.

The objective of this study is to determine the efficacy of Dexamethasone versus Metoclopramide in the prevention of postoperative nausea and vomiting in patients undergoing a surgical procedure under general anesthesia. A descriptive, comparative, observational study was carried out. Adult patients between 18 and 60 years of age were studied, who were divided into two groups. Group A received Dexamethasone 8 mg IV and another group B Metoclopramide 10 mg IV, after anesthetic induction. Both groups were comparable in terms of their characteristics. It is evidenced that in group A dexamethasone there was less postoperative nausea and vomiting. Conducting the study, it is concluded that with dexamethasone there is less incidence of nausea and vomiting with the administered dose, so it is concluded that it is effective for the management of this type of patients compared to metoclopramide.

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Introducción: las náuseas y vómitos postoperatorios (PONV) son una complicación postoperatoria común de la anestesia, por lo que la búsqueda de nuevas profilaxis efectivas ha aumentado durante los últimos años, en este contexto se perfila como una opción efectiva el amisulprida, antipsicótico que actúa bloqueando los receptores dopaminérgicos D2 y D3, en dosis bajas. Métodos: se realizó una búsqueda en bases de datos establecidas como: Pubmed, Embase, Google Scholar, Medline y la Cochrane central registed of controlled trials. Con las siguientes definiciones clave: "NV" or "postoperative nausea and vomiting" or "postoperative nausea" or "postoperative vomiting" and "Amisulpride" or "APD421", con el fin de cumplir el objetivo general de verificar la efectividad de amisulprida como medicamento profiláctico en manejo de PONV. Resultados: se evaluaron 3 estudios multicéntricos randomizados controlados, con alto grado de confiabilidad y buena calidad metodológica. Se evidencia que el amisulprida es un medicamento profiláctico efectivo contra PONV y con buen perfil de seguridad. Discusión/Conclusión: el amisulprida es un medicamento profiláctico eficaz para prevención de PONV, en dosis óptima de 5 mg, administrado durante el intraoperatorio de cirugías electivas en que se utilice anestesia general en pacientes de moderado a alto riesgo de PONV según escala de Apfel.

Introduction: postoperative nausea and vomiting (PONV) are common postoperative complications of anaesthesia, that is why the search for new effective prophylaxis has increased in recent years. Between the drugs that have been tested for this purpose, Amisulpride, an antipsychotic that blocks D2 and D3 dopaminergic receptors, seems to be an effective option when used in low doses. Methods: This search was done by using databases such as Pubmed, Embase, Google Scholar, Medline and the Cochrane central register of controlled. With the following keywords: "NV" or "postoperative nausea and vomiting" or "postoperative nausea" or "postoperative vomiting" and"Amisulpride" or "APD421", with the purpose of verifying the effectiveness of Amisulpride as prophylactic medication in PONV man-agement, which is our main objective. Results: 3 randomised, controlled, multicenter, with high reliability and good methodological quality studies were evaluated. Evidence suggests that Amisulpride is effective as a prophylactic medication against PONV, and it also has a good safety profile. Discussion/Conclusion: Amisulpride administered in an optimal dose of 5 mg during intraoperative elective surgeries that required general anaesthesia, showed to be effective in preventing PONV as a prophylactic drug in patients with moderate to high risk of PONV according to the Apfel scale.

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Introducción: Las náuseas y vómitos posoperatorios son una secuela no deseada durante la etapa de recuperación anestésica. Objetivo: Evaluar la utilidad de la dexametasona en comparación con el ondansetrón para la prevención de las náuseas y vómitos posoperatorios después de procedimientos quirúrgicos ginecológicos mayores, bajo anestesia general orotraqueal. Método: Se realizó un estudio observacional analítico, prospectivo, en 84 pacientes mayores de 19 años, en el Hospital Clínico Quirúrgico Miguel Enríquez desde octubre de 2018 hasta septiembre de 2019, divididas de forma secuencial, en orden de llegada a la unidad quirúrgica, en dos grupos. Al grupo 1 se le administró dexametasona (4 mg endovenosa); al grupo 2 (4 mg de ondansetrón), 30 min antes de finalizar la cirugía. Resultados: Predominó de forma significativa el riesgo medio de náuseas y vómitos posoperatorios en los pacientes con edades comprendidas entre 41 y 50 años. Predominó la condición de excelente y buena (pgt;0,05) en cuanto a la efectividad del tratamiento profiláctico. La cefalea prevaleció de forma significativa en el grupo 2. La mayor parte de las pacientes no presentó eventos adversos. Conclusiones: El ondansetrón y la dexametasona son útiles para la profilaxis de las náuseas y vómitos posoperatorios en pacientes intervenidas de cirugía mayor ginecológica, bajo anestesia general orotraqueal por lo que se considera un tratamiento seguro, con eventos adversos leves y de fácil control(AU)

Introduction: Postoperative nausea and vomiting are an unwanted sequel during the anesthetic recovery stage. Objective: To evaluate the usefulness of dexamethasone compared with ondansetron for the prevention of postoperative nausea and vomiting after major gynecological surgical procedures, under general orotracheal anesthesia. Method: A prospective, analytical and observational study was carried out with 84 patients older than 19 years of age, at Miguel Enríquez Hospital Clinical-Surgical Hospital, from October 2018 to September 2019, divided sequentially, in order of arrival at the surgical unit, into two groups. The group 1 was administered dexamethasone (4 mg intravenously), and the group 2 was administered ondansetron (4 mg), 30 min before the end of the surgery. Results: The average risk of postoperative nausea and vomiting prevailed significantly among patients aged 41-50 years. Excellent and good conditions predominated (pgt;0.05) in terms of effectiveness of prophylactic treatment. Headache prevailed significantly in the group 2. Most of the patients did not present adverse events. Conclusions: Ondansetron and dexamethasone are useful for postoperative nausea and vomiting prophylaxis among patients who received major gynecological surgery, under general orotracheal anesthesia, a reason why it is considered a safe treatment, with mild adverse events and easy control(AU)

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Abstract Background and objectives: Postoperative nausea and vomiting (PONV) is a common and undesirable complication observed after laparoscopic cholecystectomy (LC). We investigated the effects of auriculoacupuncture (AA) on the prevention of postoperative nausea and vomiting in the immediate postoperative period of uncomplicated laparoscopic cholecystectomy. Methods: Sixty-eight patients were randomly divided into two groups, auriculoacupuncture (n = 35) and control (n = 33), and then they were evaluated prospectively. The needle was placed before anaesthesia induction and remained for 20 minutes. Nausea intensity was evaluated using an analogic visual scale and PONV events were registered immediately after anaesthesia care unit admission and in the second, fourth and sixth hours after the surgery. Results: The auriculoacupuncture group had a significantly smaller incidence of nausea and vomiting than the control group throughout the whole postoperative period (16/35 vs. 27/33, p= 0.03 and 4/35 vs. 15/33, p= 0.005, respectively); the AA group had fewer nausea events 2 h (p= 0.03) and 6 h (p= 0.001) after surgery and fewer vomiting events 2 h (p= 0.01) and 6 h (p= 0.02) after surgery. Conclusions: Auriculoacupuncture can partially prevent postoperative nausea and vomiting when compared to metoclopramide alone after uncomplicated laparoscopic cholecystectomy. Auriculoacupuncture can be recommended as an adjuvant therapy for postoperative nausea and vomiting prevention in selected patients.

Resumo Justificativa e objetivos: Náuseas e vômitos são complicações comuns e indesejáveis no pós-operatório de colecistectomia laparoscópica (CL). Nós investigamos os efeitos da auriculoacupuntura (AA) para a prevenção de náuseas e vômitos no período pós-operatório (NVPO) imediato da CL não complicada. Métodos: 68 pacientes foram aleatoriamente divididos em dois grupos, auriculoacupuntura (n = 35) e controle (n = 33), e foram avaliados prospectivamente. A agulha foi aplicada antes da indução anestésica e permaneceu no lugar por 20 minutos. A intensidade da náusea foi avaliada mediante escala visual analógica e episódios de NVPO foram registrados imediatamente após a admissão na unidade de recuperação anestésica e duas, quatro e seis horas após a cirurgia. Resultados: O grupo AA apresentou significativamente menos episódios de NVPO do que o grupo controle durante todo o período pós-operatório (16/35 vs. 27/33, p = 0,03 e 4/35 vs. 15/33, p = 0,005, respectivamente). O grupo auriculoacupuntura apresentou episódios de náuseas menos intensos às 2 horas (p = 0,03) e 6 horas (p = 0,001) após a cirurgia e menos episódios de vômitos 2 horas (p = 0,01) e 6 horas (p = 0,02) após a cirurgia. Conclusão: A auriculoacupuntura aliviou náuseas e vômitos no pós-operatório em número significante de pacientes, mas não foi capaz de prevenir náuseas e vômitos no pós-operatório em todos os pacientes. Ela pode ser recomendada como terapia adjuvante para prevenção de náuseas e vômitos no pós-operatório no pós-operatório de colecistectomia laparoscópica em pacientes selecionados.

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Abstract Background: Postoperative Nausea and Vomiting (PONV) risk factors have not been defined for obstetric patients. In this study, our objective was to identify potential risk factors for PONV after cesarean sections performed under spinal anesthesia. Methods: One cohort of patients submitted to cesarean under spinal anesthesia was used to investigate potential risk factors for PONV. The best numerical risk factors were dichotomized using chi-squared method. A conditional independence (incremental association method) casual network was used to select the best predictors for PONV. Results: Two hundred and fifty of 260 patients remained in the study. Odds ratio for PONV of younger maternal age (< 25 years: 2.9 [1.49−5.96]), lower spinal bupivacaine dose (< 13 mg, inf [2.4-inf]), lower spinal morphine dose (< 80 mg, 0.03 [0−0.97]), history of motion sickness (2.5 [1.27−5.25]), significant nausea during the first trimester (0.3 [0.16−0.64]), intraoperative nausea and vomiting (8.2 [3.67−20.47]), and lower gestational age (< 38 weeks, 2.0 [1.01−4.08]) were statistically significant. The causal network selected absence of significant nausea during the first gestational trimester, intraoperative nausea, and gestational age < 38 weeks as the main direct risk factors for PONV. Conclusions: Intraoperative nausea and maternal age < 25 years were the main risk factors for PONV after cesareans under spinal anesthesia. Absence of self-reported nausea during the first trimester was a protective factor for post-cesarean nausea and vomiting.

Resumo Introdução: Os fatores de risco para náusea e vômitos pós-operatórios (NVPO) ainda não foram definidos para pacientes de obstetrícia. Neste estudo, nosso objetivo foi identificar potenciais fatores de risco para NVPO após parto cesariano realizado sob raquianestesia. Método: Uma coorte de pacientes submetidas a cesariana sob raquianestesia foi usada para investigar potenciais fatores de risco para NVPO. Os melhores fatores de risco numéricos foram dicotomizados por meio do método qui-quadrado. Uma rede casual de independência condicional (método de associação adicional) foi usada para selecionar os melhores preditores de NVPO. Resultados: Das 260 pacientes iniciais, 250 completaram o estudo. A razão de chances para NVPO foi estatisticamente significante para menor idade materna (< 25 anos: 2,9 [1,49−5,96]), dose mais baixa de bupivacaina raquidiana (< 13 mg, inf [2,4-inf]), dose mais baixa de morfina raquidiana (< 80 mg, 0,03 [0−0,97]), histórico de enjoo de movimento (2,5 [1,27−5,25]), náuseas importantes durante o primeiro trimestre (0,3 [0,16−0,64]), náusea e vômitos intraoperatórios (8,2 [3,67−20,47]) e menor idade gestacional (< 38 semanas, 2,0 [1,01−4,08]). A rede causal selecionou ausência de náuseas significativas durante o primeiro trimestre gestacional, náusea intraoperatória e idade gestacional < 38 semanas como os principais fatores de risco diretos para NVPO. Conclusões: Náusea intraoperatória e idade materna < 25 anos foram os principais fatores de risco para NVPO após cesariana sob raquianestesia. A ausência de náusea autorreferida durante o primeiro trimestre foi um fator protetor para náusea e vômitos após cesariana.

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BACKGROUND: Postoperative Nausea and Vomiting (PONV) risk factors have not been defined for obstetric patients. In this study, our objective was to identify potential risk factors for PONV after cesarean sections performed under spinal anesthesia. METHODS: One cohort of patients submitted to cesarean under spinal anesthesia was used to investigate potential risk factors for PONV. The best numerical risk factors were dichotomized using chi-squared method. A conditional independence (incremental association method) casual network was used to select the best predictors for PONV. RESULTS: Two hundred and fifty of 260 patients remained in the study. Odds ratio for PONV of younger maternal age (< 25 years: 2.9 [1.49-5.96]), lower spinal bupivacaine dose (< 13 mg, inf [2.4-inf]), lower spinal morphine dose (< 80 mg, 0.03 [0-0.97]), history of motion sickness (2.5 [1.27-5.25]), significant nausea during the first trimester (0.3 [0.16-0.64]), intraoperative nausea and vomiting (8.2 [3.67-20.47]), and lower gestational age (< 38 weeks, 2.0 [1.01-4.08]) were statistically significant. The causal network selected absence of significant nausea during the first gestational trimester, intraoperative nausea, and gestational age < 38 weeks as the main direct risk factors for PONV. CONCLUSIONS: Intraoperative nausea and maternal age < 25 years were the main risk factors for PONV after cesareans under spinal anesthesia. Absence of self-reported nausea during the first trimester was a protective factor for post-cesarean nausea and vomiting.

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BACKGROUND AND OBJECTIVES: Postoperative nausea and vomiting (PONV) is a common and undesirable complication observed after laparoscopic cholecystectomy (LC). We investigated the effects of auriculoacupuncture (AA) on the prevention of postoperative nausea and vomiting in the immediate postoperative period of uncomplicated laparoscopic cholecystectomy. METHODS: Sixty-eight patients were randomly divided into two groups, auriculoacupuncture (n = 35) and control (n = 33) and then they were evaluated prospectively. The needle was placed before anaesthesia induction and remained for 20 minutes. Nausea intensity was evaluated using an analogic visual scale and PONV events were registered immediately after anaesthesia care unit admission and in the second, fourth and sixth hours after the surgery. RESULTS: The auriculoacupuncture group had a significantly smaller incidence of nausea and vomiting than the control group throughout the whole postoperative period (16/35 vs. 27/33, p = 0.03 and 4/35 vs. 15/33, p = 0.005, respectively); the AA group had fewer nausea events 2hours (p = 0.03) and 6hours (p = 0.001) after surgery and fewer vomiting events 2hours (p = 0.01) and 6hours (p = 0.02) after surgery. CONCLUSIONS: Auriculoacupuncture can partially prevent postoperative nausea and vomiting when compared to metoclopramide alone after uncomplicated laparoscopic cholecystectomy. Auriculoacupuncture can be recommended as an adjuvant therapy for postoperative nausea and vomiting prevention in selected patients.

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INTRODUCTION: Postoperative nausea and vomiting (PONV) is a common problem in patients undergoing surgical procedures, generating patient dissatisfaction and increasing hospital costs. The Postoperative Nausea and Vomiting Intensity Scale identifies clinically significant cases; however, it has not been validated in Spanish. OBJECTIVE: To carry out a cross-cultural adaptation of the PONV Intensity Scale into Spanish and validate it for use in the postoperative period of patients undergoing elective non-cardiac and non-intracranial surgery. MATERIALS AND METHODS: Cross-sectional validation study of a diagnostic test. The NVPO Intensity Scale was culturally adapted to Spanish and administered to 393 adult hospitalized patients at 6 postoperative hours. The data were compared with the Apfel Scale and nausea measured on a visual analogue scale (VAS). Internal consistency and inter-observer concordance were calculated. RESULTS: 59.8% of patients presented NVPO, of which 14.5% were clinically significant. An acceptable internal consistency was obtained for the NVPO Intensity Scale (Cronbach's alpha 0.7) and a high inter-observer correlation (Kappa 0.9, 95% CI 0.86-0.92), statistically significant, for the overall scale. The correlation with VAS was high (Rho Spearman 0.9). The mean VAS and Apfel scale score was significantly higher in patients with clinically significant PONV. CONCLUSIONS: The PONV Intensity Scale adapted to Spanish is a valid and reliable instrument for monitoring and evaluating postoperative nausea and vomiting.

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Introducción: Las náuseas y vómitos postoperatorios representan un problema frecuente tanto para el paciente como para el médico anestesiólogo. Se estima que la incidencia está en un 25 a 30 por ciento de los pacientes postoperados. Objetivo: Profundizar en los conocimientos relacionados con la terapia combinada en la profilaxis de las náuseas y vómitos postoperatorios. Métodos: Se realizó una revisión de los artículos publicados en las bases de datos Pubmed, Scielo, Medline y Cochrane, relacionados con el tema. Desarrollo: La naturaleza multifactorial de las náuseas y vómitos postoperatorios requiere de un enfoque multimodal para su tratamiento, el cual debe ser profiláctico más que terapéutico, con el objetivo de minimizar el riesgo. No es factible modificar sustancialmente las variables dependientes del paciente y de la intervención quirúrgica, pero se puede influir directamente sobre las anestésicas. En varios estudios se han identificado los diferentes factores de riesgo para náuseas y vómitos postoperatorios y a partir de estos se han desarrollado modelos predictivos que permiten evaluar la probabilidad del evento. Conclusiones: Las náuseas y vómitos postoperatorios constituyen un fenómeno frecuente en el postoperatorio. Para su profilaxis es recomendable el uso de terapias combinadas (antidopaminérgicos, antihistamínicos, anticolinérgicos, antagonistas de la serotonina, esteroides y antagonistas de la neurokinina-1) dado su componente multifactorial. Esta forma de afrontar dicho problema permite disminuir la frecuencia de estos síntomas, las complicaciones postoperatorias y facilitar la recuperación más inmediata del paciente(AU)

ABSTRACT Introduction: Postoperative nausea and vomiting represent a frequent problem for both the patient and the anesthesiologist. It is estimated that the incidence of these are present in 25-30 percent of postoperative patients. Objective: To go deepen in the knowledge related to physiopathology and combination therapy in the prophylaxis of postoperative nausea and vomiting. Method: A bibliographic review was made of the articles published in the Pubmed, Scielo, Medline and Cochrane data bases, related to the topic, belonging to authors dedicated to the study of this problem. Development: The multifactorial nature of postoperative nausea and vomiting requires a multimodal approach to its treatment, which should be prophylactic rather than therapeutic, with the objective of minimizing risk. It is not reasonable to modify the dependent variables of the patient and of the surgical intervention, but it is possible to directly influence the anesthetics. In several studies, the different risk factors for PONV have been identified and, from these, predictive models have been developed to evaluate the probability of the event. Conclusions: postoperative nausea and vomiting are a frequent phenomenon in the postoperative period. For its prophylaxis the use of combination therapies (antidopaminergic, antihistaminic, anticholinergic, serotoninantagonists, steroids and neurokinin-1 antagonists) is recommended, givenits multifactorial component. This way of dealing with this problema allows us to reduce the frequency of these symptoms, postoperative complications and facilitate the patient's most immediate recovery(AU)

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BACKGROUND: Postoperative nausea and vomiting (PONV) are a frequent problem in surgical patients, with an incidence of 50% and 30% respectively. In patients with the risk of presenting this complication, the incidence frows up to 80%. PONV can extend the length of stay in the postoperative recovery unit with the time of surgery. Each episode of vomiting can increase the stay in a postoperative recovery unit by 20 minutes. In addition, the main cause of hospitalization is not scheduled in the context of outpatient surgery. The anesthesiologist before a mastectomy must determine the strategies according to the pathology, proposing the necessary resources to avoid the presence of postoperative nausea and vomiting. OBJECTIVE: Evaluation of the incidence of postoperative nausea and vomiting in the patient in outpatient surgery of the breast in the ambulatory surgery unit of the National Cancer Institute. MATERIAL AND METHODS: An observational, analytical, cross-sectional and retrospective study was carried out in which the clinical files of the patients of the National Institute of Cancerology were reviewed and a surgical procedure with the diagnosis of breast cancer in the outpatient surgery unit was scheduled. a period comprised between May 1 and October 15, 2017. The descriptive and inferential statistical analysis was performed in SPSS version 23. RESULTS: 165 women with an average age of 52.8 ± 11.2 years were included, 154 were send home (93.4%), the remaining 11 patients (6.7%) required hospitalization for pain (4.2%), pain and hematoma (1.8%). and re intervention (0.6%), none for PONV. A history of nausea and vomiting was observed in 21.2%. Only 3 patients presented postoperative nausea and vomiting (1.8%). Antiemetic treatment was applied in all patients with a combination of any of three drugs (metoclopramide, dexamethasone and ondansetron). A history of nausea and vomiting was found to be a risk factor for PONV with an MRI of 28.1 (1.42 ­ 55.8); the second risk factor was to receive RM-isolated chemotherapy of 22.6 (1.14 ­ 44.8) and the third risk factor was to receive some treatment (QT, RT or QT + RT) MRI of 15.2 (0.77-29.9). CONCLUSIONS: In our study we observed a very low rate of PONV and it was possible to demonstrate that the pre-medication prior to the surgical event in patients with breast cancer significantly decreases the presence and control of postoperative nausea and vomiting, improving comfort during their Hospital stay and immediate discharge. It is necessary to carry out studies that deepen these findings in our population and allow to discriminate in an experimental, prospective and longitudinal design the effectiveness of the pharmacological treatment of PONV.

INTRODUCCIÓN: La náusea y vómito postoperatorio (NVPO) son un problema frecuente en los pacientes quirúrgicos, con una incidencia de 50% y de 30% respectivamente. En pacientes con alto riesgo de presentar esta complicación pueden aumentar la incidencia de hasta 80%. La NVPO puede prolongar significativamente el tiempo de estadía en la Unidad de Recuperación Posoperatoria con incremento de forma relevante en los costos de la cirugía. Cada episodio de vómitos puede llegar a aumentar en 20 min la estadía en una Unidad de Recuperación Posoperatoria. Además, son la principal causa de hospitalización no programada en el contexto de la cirugía ambulatoria. El anestesiólogo ante una cirugía de mama debe determinar las estrategias de acuerdo con la patología, proponiendo los recursos necesarios para evitar la presencia de náusea y vomito posoperatorio. OBJETIVO: Evaluar la incidencia de náusea y vomito posoperatorio en el paciente sometido a cirugía ambulatoria de mama en la unidad de cirugía ambulatoria del Instituto Nacional de Cancerología. MATERIAL Y MÉTODOS: Se realizó un estudio observacional, analítico, transversal y retrospectivo en el que se revisaron los expedientes clínicos de pacientes del Instituto Nacional de Cancerología programadas a procedimiento quirúrgico con diagnóstico de cáncer de mama en la unidad de cirugía ambulatoria, en un período comprendido entre el 1 de mayo al 15 de octubre de 2017. Se realizó el análisis estadístico descriptivo e inferencial en SPSS versión 23. RESULTADOS: Se incluyeron 165 mujeres con edad promedio de 52,8 ± 11,2 años, 154 fueron egresados a su domicilio (93,4%), las restantes 11 pacientes (6,7%) requirieron internamiento por dolor (4,2%), dolor y hematoma (1,8%) y re intervención (0,6%), ninguna por NVPO. Se observó antecedente de náusea y vómito en 21,2%. Solo 3 pacientes se presentaron náuseas y vómito postoperatorios (1,8%). El tratamiento antiemético se aplicó en todas las pacientes con una combinación de cualquiera de tres fármacos (metoclopramida, dexametasona y ondansetrón). El antecedente de náusea y vómito, resultó ser un factor de riesgo para presentar NVPO con una RM de 28,1 (1,42-55,8); el segundo factor de riesgo fue recibir quimioterapia aislada RM de 22,6 (1,14-44,8) y el tercer factor de riesgo fue recibir algún tratamiento (QT, RT o QT + RT) RM de 15,2 (0,77-29,9). CONCLUSIONES: En nuestro estudio observamos una tasa muy baja de NVPO y fue posible demostrar que la pre-medicación previa al evento quirúrgico en pacientes con cáncer de mama disminuye de manera significativa la presencia y control de náusea y vómito post operatorio mejorando el confort durante su estancia hospitalaria y su egreso inmediato. Es necesario realizar estudios que profundicen en estos hallazgos en nuestra población y permitan discriminar en un diseño experimental, prospectivo y longitudinal la efectividad del tratamiento farmacológico de las NVPO.

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Resumen Las náuseas y vómitos postoperatorios (NVPO) son un problema frecuente en los pacientes quirúrgicos. Cuando no son prevenidos adecuadamente pueden provocar mayor morbilidad, estadía prolongada en la unidad de recuperación postoperatoria y hospitalización no planificada. El objetivo del equipo quirúrgico debe ser la profilaxis de las NVPO más que su tratamiento, con el fin de disminuir significativamente su incidencia y complicaciones asociadas. Los principales factores de riesgo para NVPO son: sexo femenino, historia de NVPO en cirugías previas y/o cinetosis, no fumar, uso de opioides sistémicos en el postoperatorio, someterse a ciertos tipos de cirugía (como colecistectomía, cirugía laparoscópica y cirugía ginecológica), utilizar anestésicos volátiles y/u óxido nitroso intraoperatorios, y duración de la cirugía. Sugerimos objetivar el riesgo de NVPO utilizando las escalas de riesgo de NVPO de Apfel o Koivuranta. Los principales fármacos antieméticos usados como profilaxis y tratamiento en el período perioperatorio son dexametasona, ondansetrón y droperidol. Existen estrategias generales que se pueden utilizar para reducir el riesgo quirúrgico basal de NVPO como evitar la anestesia general, privilegiando la anestesia regional, utilizar propofol para la inducción y mantención de la anestesia, evitar el uso de óxido nitroso y/o anestésicos inhalatorios, minimizar el uso postoperatorio de opioides sistémicos y recibir una hidratación intravenosa abundante durante la cirugía. La etiología de las NVPO es multifactorial, por lo que la prevención y tratamiento deben incluir diferentes clases de antieméticos, que actúen sobre los diferentes receptores de náuseas y/o vómitos hasta el momento conocidos, junto con las estrategias generales antes mencionadas.

Abstract Postoperative nausea and vomiting (PONV) are a common problem in surgical patients. When not properly prevented, they can lead to increased morbidity, prolonged stay in the postoperative recovery unit and unplanned hospitalization. The objective of the surgical team should be the prophylaxis of PONV rather than its treatment, in order to significantly reduce its incidence and associated complications. The main risk factors for PONV are: female sex, history of PONV in prior surgeries and/or motion sickness, non-smoking, use of systemic opioids postoperatively, undergo certain types of surgery (such as cholecystectomy, laparoscopic surgery and gynecological surgery), use volatile anesthetics and/or intraoperative nitrous oxide, and duration of surgery. We suggest to objectify the risk of PONV using the Apfel or Koivuranta PONV risk scales. The main anti-emetic drugs used as prophylaxis and treatment in the perioperative period are dexamethasone, ondansetron and droperidol. There are general strategies that can be used to reduce the baseline surgical risk of PONV such as avoiding general anesthesia, favoring regional anesthesia, using propofol for induction and maintenance of general anesthesia, avoiding the use of nitrous oxide and/or inhalational anesthetics, minimizing the postoperative use of systemic opioids and to receive an abundant intravenous hydration during surgery. The etiology of PONV is multifactorial, so prevention and treatment should include different classes of antiemetics, acting on the different receptors of nausea and/or vomiting so far known, together with the general strategies mentioned above.

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El presente estudio tuvo como objetivo determinar la efectividad de la acupresión en el pliegue de la muñeca para la prevención y tratamiento de náuseas y vómitos post operatorios. La presente investigación es relevante porque ayudará a las enfermeras en centro quirúrgico a lograr un control efectivo de las náuseas y vómitos que se presentan en el post operatorio, utilizando estrategias no farmacológicas útiles para el control de estos síntomas. Formulándose la pregunta clínica: ¿el uso de la acupresión en el pliegue de la muñeca es efectiva para la prevención y el tratamiento de las náuseas y vómitos post operatorio?, para ello, se realizó una búsqueda de la información en base de datos Science Direct, PubMed, Cochrane y Biblioteca Virtual de Salud desarrollado mediante la elección de las palabras claves, registro escrito de búsqueda. Se analizaron 9 artículos de estudio de investigación experimental y revisiones bibliográficas sobre el tema, se seleccionó tres investigaciones mediante la lista de chequeo de validez aparente de Gálvez Toro. Así mismo se estructuró el comentario crítico usando la guía de revisiones sistemáticas y meta-análisis de Prisma; llegando a la respuesta de la pregunta clínica: el uso de la acupresión en el pliegue de la muñeca en pacientes post operados es efectiva porque reduce significativamente los vómitos y náuseas post operatorias.

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