2006年ASA年会新的PONV指南发布
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根据MEDSCAPE的报道（http://www.medscape.com/viewarticle/546186），10月16号在美国芝加哥召开的第57届美国麻醉医师年会上发布了新的治疗术后恶心呕吐（PONV）的指南，新指南包括了预防和针灸。全文如下：
New Guidelines for Post-Op Nausea Include Prophylaxis, Acupuncture
By Martha Kerr
NEW YORK (Reuters Health) Oct 17 - Updated guidelines for managing post-operative nausea and vomiting were announced Monday at the annual meeting of the American Society of Anesthesiologists, underway in Chicago.
Newly included measures include prophylaxis, with an emphasis on the use of the 5-HT3-receptor antagonists such as odansetron, and inclusion of acupuncture to reduce the nausea and vomiting associated with general anesthesia.
Guidelines for adults and for children were presented by Dr. Tong J. Gan of Duke University in Durham, North Carolina, on behalf of a multidisciplinary team, including anesthesiologists, surgeons, pharmacists, nurse anesthetists and biostatisticians, and with the support of the Society for Ambulatory Anesthesia.
The new guidelines identify risk factors for nausea and vomiting from anesthesia. These include female gender, non-smoking status and a history of post-operative nausea and vomiting or motion sickness. The type of anesthesia also plays a role and includes volatile anesthetics and nitrous oxide. Post-operative use of opioids also increases risk of nausea and vomiting.
Odansetron and the other 5-HT3-receptor antagonists, dexamethasone and droperidol are equally effective, Dr. Gan noted, reducing risk of nausea and vomiting by about 25%. Supplemental oxygen does not help control symptoms, and standard doses of 10 mg metoclopramide are ineffective.
Nonpharmacologic prophylaxis with acupuncture also is very effective, Dr. Gan told Reuters Health. "Only one point is needed, the T6 point," he said, which means no extensive knowledge of the technique is required.
Updated guidelines for children were also announced. They state that risk of nausea and vomiting are associated with type of surgery. Surgery lasting longer than 30 minutes, age of 3 years and older, strabismus surgery and a personal history and even a history of post-operative nausea and vomiting in a close relative are also risk factors. The presence of all four factors increases risk by 70%.
The 5-HT3-receptor antagonists are the drug of choice to prevent nausea and vomiting. Droperidol should be a last choice, given to children when other measures fail.
Combination therapy is recommended for both adults and children to prevent and manage post-op nausea and vomiting.
"Physicians don't really realize the high priority that patients place on post-op nausea and vomiting," Dr. Gan commented. "There are studies showing that patients would prefer pain over nausea and vomiting."
DXY内术后恶心呕吐（PONV）的管理指南 可见：http://www.dxy.cn/bbs/actions/archive/post/5536448_1.html
Medscape(www.medscape.com)是免费注册的，资源和信息非常丰富。我们就上面的PONV可以在Medscape找到PONV的对媒体视频演讲：
http://www.medscape.com/viewarticle/522096，PONV Management: Tackling the Practical Issues。
而在http://www.medscape.com/viewprogram/4990，观看幻灯片或者同页面也可下载MP3。
PONV Management: Tackling the Practical Issues
Slides with transcript:
Preventing PONV: Offering Value to Patients and Hospitals
by David A. Lubarsky, MD, MBA
Definitions
Incidence of Postoperative Nausea and Vomiting
Postoperative Nausea and Vomiting: Etiology, Risk Factors, and Consequences
The Value of Treatment for Postoperative Nausea and Vomiting
The Value of Treatment for Postoperative Nausea and Vomiting (cont'd)
Cost-Benefit Analysis
Patients' Willingness to Pay to Avoid Postoperative Nausea and Vomiting
The Hospital Perspective
Conclusions
PONV: Current Management Strategies
by Beverly K. Philip, MD
Introduction
Control of Postoperative Nausea and Vomiting
Control of Postoperative Nausea and Vomiting (cont'd)
Current Consensus Guidelines
Conclusions
A Look at the Future: New Mechanisms, Modalities, and Methods for PONV Management
by Anthony L. Kovac, MD
Introduction
Current and Upcoming Antiemetic Agents
Neurokinin-1 Antagonists
Neurokinin-1 Antagonists (cont'd)
Second-Generation Serotonin Receptor Antagonist
Other Modalities and Methods for Postoperative Nausea and Vomiting Management
Other Modalities and Methods for Postoperative Nausea and Vomiting Management (cont'd)
Is There a Role for Pharmacogenomics in Managing Postoperative Nausea and Vomiting?
Summary
编辑：西门吹血
New Guidelines for Post-Op Nausea Include Prophylaxis, Acupuncture
By Martha Kerr
NEW YORK (Reuters Health) Oct 17 - Updated guidelines for managing post-operative nausea and vomiting were announced Monday at the annual meeting of the American Society of Anesthesiologists, underway in Chicago.
Newly included measures include prophylaxis, with an emphasis on the use of the 5-HT3-receptor antagonists such as odansetron, and inclusion of acupuncture to reduce the nausea and vomiting associated with general anesthesia.
Guidelines for adults and for children were presented by Dr. Tong J. Gan of Duke University in Durham, North Carolina, on behalf of a multidisciplinary team, including anesthesiologists, surgeons, pharmacists, nurse anesthetists and biostatisticians, and with the support of the Society for Ambulatory Anesthesia.
The new guidelines identify risk factors for nausea and vomiting from anesthesia. These include female gender, non-smoking status and a history of post-operative nausea and vomiting or motion sickness. The type of anesthesia also plays a role and includes volatile anesthetics and nitrous oxide. Post-operative use of opioids also increases risk of nausea and vomiting.
Odansetron and the other 5-HT3-receptor antagonists, dexamethasone and droperidol are equally effective, Dr. Gan noted, reducing risk of nausea and vomiting by about 25%. Supplemental oxygen does not help control symptoms, and standard doses of 10 mg metoclopramide are ineffective.
Nonpharmacologic prophylaxis with acupuncture also is very effective, Dr. Gan told Reuters Health. "Only one point is needed, the T6 point," he said, which means no extensive knowledge of the technique is required.
Updated guidelines for children were also announced. They state that risk of nausea and vomiting are associated with type of surgery. Surgery lasting longer than 30 minutes, age of 3 years and older, strabismus surgery and a personal history and even a history of post-operative nausea and vomiting in a close relative are also risk factors. The presence of all four factors increases risk by 70%.
The 5-HT3-receptor antagonists are the drug of choice to prevent nausea and vomiting. Droperidol should be a last choice, given to children when other measures fail.
Combination therapy is recommended for both adults and children to prevent and manage post-op nausea and vomiting.
"Physicians don't really realize the high priority that patients place on post-op nausea and vomiting," Dr. Gan commented. "There are studies showing that patients would prefer pain over nausea and vomiting."
DXY内术后恶心呕吐（PONV）的管理指南 可见：http://www.dxy.cn/bbs/actions/archive/post/5536448_1.html
Medscape(www.medscape.com)是免费注册的，资源和信息非常丰富。我们就上面的PONV可以在Medscape找到PONV的对媒体视频演讲：
http://www.medscape.com/viewarticle/522096，PONV Management: Tackling the Practical Issues。
而在http://www.medscape.com/viewprogram/4990，观看幻灯片或者同页面也可下载MP3。
PONV Management: Tackling the Practical Issues
Slides with transcript:
Preventing PONV: Offering Value to Patients and Hospitals
by David A. Lubarsky, MD, MBA
Definitions
Incidence of Postoperative Nausea and Vomiting
Postoperative Nausea and Vomiting: Etiology, Risk Factors, and Consequences
The Value of Treatment for Postoperative Nausea and Vomiting
The Value of Treatment for Postoperative Nausea and Vomiting (cont'd)
Cost-Benefit Analysis
Patients' Willingness to Pay to Avoid Postoperative Nausea and Vomiting
The Hospital Perspective
Conclusions
PONV: Current Management Strategies
by Beverly K. Philip, MD
Introduction
Control of Postoperative Nausea and Vomiting
Control of Postoperative Nausea and Vomiting (cont'd)
Current Consensus Guidelines
Conclusions
A Look at the Future: New Mechanisms, Modalities, and Methods for PONV Management
by Anthony L. Kovac, MD
Introduction
Current and Upcoming Antiemetic Agents
Neurokinin-1 Antagonists
Neurokinin-1 Antagonists (cont'd)
Second-Generation Serotonin Receptor Antagonist
Other Modalities and Methods for Postoperative Nausea and Vomiting Management
Other Modalities and Methods for Postoperative Nausea and Vomiting Management (cont'd)
Is There a Role for Pharmacogenomics in Managing Postoperative Nausea and Vomiting?
Summary
编辑：西门吹血
作者: huangwei98
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