JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (50) Citing Articles via Google Scholar Google Scholar Articles by Goll, V. Articles by Sessler, D. I. Search for Related Content PubMed PubMed Citation Articles by Goll, V. Articles by Sessler, D. I. Related Collections Pharmacology

---

ANESTHETIC PHARMACOLOGY

Ondansetron is no More Effective than Supplemental Intraoperative Oxygen for Prevention of Postoperative Nausea and Vomiting

Veronika Goll, MD^*, Ozan Akça, MD, Robert Greif, MD, Helga Freitag, MD^*, Cem F. Arkiliç, MD^§, Thomas Scheck, BS^*, Agnes Zoeggeler, MD^*, Andrea Kurz, MD^§, Gabriella Krieger, MD^*, Rainer Lenhardt, MD^*, and Daniel I. Sessler, MD^||

*Department of Anesthesia and General Intensive Care, University of Vienna, Vienna, Austria; the Outcomes Research^TM Institute and Department of Anesthesiology, University of Louisville, Kentucky; Department of Anesthesiology and Intensive Care Medicine, Donauspital—SMZO, Vienna, Austria; §Department of Anesthesiology, Washington University, St. Louis, MO; and ||the Ludwig Boltzmann Institute, Vienna, Austria

Address correspondence to Daniel I. Sessler, MD, University of Louisville, Abell Administration Center, Room 217, 323 East Chestnut Street, Louisville, KY 40202-3866. Address e-mail to sessler{at}louisville.edu

	Abstract

Top Abstract Introduction Methods Results Discussion References

 
Supplemental oxygen maintained during and for 2 h after colon resection halves the incidence of nausea and vomiting. Whether supplemental oxygen restricted to the intraoperative period is sufficient remains unknown. Similarly, the relative efficacy of supplemental oxygen and ondansetron is unknown. We tested the hypothesis that intraoperative supplemental oxygen reduces the incidence of postoperative nausea and vomiting. Patients (n = 240) undergoing gynecological laparoscopy were given a standardized isoflurane anesthetic. After induction, they were randomly assigned to the following three groups: routine oxygen administration with 30% oxygen, balance nitrogen (30% Oxygen group), supplemental oxygen administration with 80% oxygen, balance nitrogen (80% Oxygen group), and Ondansetron 8 mg (immediately after induction), combined with 30% oxygen, balance nitrogen (Ondansetron group). The overall incidence of nausea and/or vomiting during the initial 24 postoperative h was 44% in the patients assigned to 30% oxygen and 30% in the Ondansetron group, but only 22% in those given 80% oxygen. The incidence was thus halved by supplemental oxygen and was significantly less than with 30% oxygen. There were, however, no significant differences between the 30% oxygen and ondansetron groups, or between the ondansetron and 80% oxygen groups. We conclude that supplemental oxygen effectively prevents postoperative nausea and vomiting after gynecological laparoscopic surgery; furthermore, ondansetron is no more effective than supplemental oxygen.

Implications: Supplemental oxygen reduces the risk of postoperative nausea and vomiting (PONV) as well or better than 8 mg of ondansetron. Because oxygen is inexpensive and essentially risk-free, supplemental oxygen is a preferable method of reducing PONV.

	Introduction

Top Abstract Introduction Methods Results Discussion References

 
Nausea and vomiting are unpleasant for patients; furthermore, they may increase the risk of aspiration pneumonia. Nausea and vomiting are also costly, being the leading cause of unexpected admission after planned day surgery (1).

The incidence of postoperative nausea and vomiting (PONV) depends on numerous nonanesthetic factors, including age, gender, obesity, anxiety, gastroparesis, history of motion sickness, previous PONV, and the duration and type of surgery. Anesthesia-related factors include premedication, ventilation techniques, and postoperative pain management (2–4).

An additional anesthetic factor that influences the incidence of PONV is the inspired oxygen concentration. For example, the incidence of nausea and vomiting was reduced by a factor of two in patients given 80% rather than 30% inspired oxygen during surgery and for 2 h postoperatively (5). That perioperative oxygen proved an effective treatment was surprising, because the peak incidence of nausea and vomiting occurred well after supplemental oxygen was discontinued.

The efficacy of oxygen may be related to ameliorating subtle intestinal ischemia with its consequent release of emetogenic substances, including serotonin. Intestinal ischemia seems more likely during surgery than postoperatively because that is when the bowel is manipulated and compressed by retractors. To the extent that this theory is correct, intraoperative oxygen presumably contributed more to reducing the incidence of PONV than the 2 h of postoperative oxygen.

Selective 5-hydroxytryptamin 3 (5-HT₃, serotonin) receptor antagonists are effective for preventing and treating PONV (3,6). Ondansetron is either more effective or as effective as other antiemetics such as metoclopramide, promethazine, or droperidol (7–10). We therefore tested the hypothesis that supplemental oxygen restricted to the intraoperative period reduces the incidence of PONV, and that the reduction is comparable to that produced by 8 mg of ondansetron.

	Methods

Top Abstract Introduction Methods Results Discussion References

 
With approval of the IRB at the University of Vienna and written informed consent, we studied patients undergoing gynecological laparoscopy with an expected surgical duration exceeding 1 h and anticipated overnight hospitalization. Sample size for this study was based on the observed incidence of PONV during a 3-mo preliminary study in laparoscopy patients. These data indicated that 216 patients would provide a 90% power for detecting a 50% reduction in nausea and vomiting (from 45% to 22%) with each treatment at an level of 0.05. We therefore prospectively set the sample size at 240 patients, divided equally among three groups.

The study was restricted to patients aged from 19 to 70 yr who were ASA physical status I-II. The exclusion criteria were pregnancy, breast-feeding, menopausal status, obesity (>150% normal weight), eating disorder, renal or liver malfunction, central nervous system injury, vertebrobasilar artery insufficiency, vestibular disease, cytostatic therapy, and preoperative vomiting or antiemetic therapy.

Patients were premedicated with 7.5 mg oral midazolam on the morning of surgery. Anesthesia was induced with sodium thiopental (3–5 mg/kg), vecuronium bromide (0.1 mg/kg), and fentanyl citrate (1–3 µg/kg). Anesthesia was subsequently maintained with isoflurane (1.2–1.8%) in the carrier gas described below. A gastric tube was positioned, left on low suction throughout surgery, and then removed just before the end of anesthesia.

After induction of anesthesia, patients were randomly assigned to the following three groups: routine oxygen administration with 30% oxygen, balance nitrogen, not nitrous oxide (30% Oxygen group), supplemental oxygen administration with 80% oxygen, balance nitrogen (80% Oxygen group), and Ondansetron 8 mg IV immediately after induction of anesthesia, combined with 30% oxygen, balance nitrogen (Ondansetron group). The computer-generated assignments were kept in sealed envelopes until used. Patients were not informed of their group assignments. Investigator blinding was maintained by providing separate teams to manage the intraoperative and postoperative aspects of the study.

Isoflurane administration was adjusted by the attending anesthesiologist with the goal of maintaining arterial blood pressure within 20% of preinduction values. Mechanical ventilation was controlled to maintain end-tidal carbon dioxide tension near 35 mm Hg. Forced-air warming was used as necessary to keep distal esophageal temperature near 36°C. Neuromuscular relaxation was antagonized at the end of surgery with 2.5 mg neostigmine and 0.4 mg glycopyrrolate. Crystalloids were administered at a rate of 15 mL · kg^-1 · h^-1 throughout surgery.

Intraoperative administration of the study gas continued until immediately before tracheal extubation and was then increased to 100% oxygen for extubation. During postanesthetic recovery, oxygen was given to all patients via face masks for 2 h at a rate of 2 L/min. The patients subsequently breathed room air as tolerated (SaO₂ 92%).

The anesthesiologists were not blinded as to group assignment. However, patients, surgeons, and the nurses reporting PONV were blinded as to group assignments and intraoperative management. To this end, cardboard shields were positioned over the flowmeters on the anesthetic machine. Irrespective of group assignment, oxygen was administered as necessary to maintain intraoperative oxyhemoglobin saturation (SaO₂) 95% in all patients. Ondansetron 4 mg, as a rescue medication, was given in cases where nausea persisted for more than 15–20 min or vomiting was observed.

Morphometric and demographic characteristics of each treatment group were recorded. Historical factors likely to influence PONV were recorded. These factors included previous PONV, smoking history, preoperative hemoglobin, coexisting systemic diseases, and substantial alcohol use (more than two drinks/day).

Hemodynamic responses, oxygen saturation, end-tidal PCO₂ and anesthetic concentrations, inspired oxygen concentration (FIO₂), and esophageal temperature were measured during anesthesia at 15-min intervals. In the postanesthesia care unit (PACU), hemodynamic responses and oxygen saturation were recorded at 30-min intervals. Nausea and vomiting incidence and severity were determined by blinded observers at intervals over a 24-h period starting at arrival in the postoperative care unit. Nausea and vomiting were evaluated from 0 to 6 h and from 6 to 24 h postoperatively. Patients were asked to rate nausea on a four-point scale as none, mild, moderate, or severe.

The amount of rescue medication and postoperative pain therapy were recorded. Time to oral intake, time to discharge from recovery room and discharge home, and patient satisfaction were also recorded (11). Twenty-four hours after surgery, patient function was evaluated by the MOS 36-item Short-Form health survey (SF-36) (12). Additionally, the patients’ overall satisfaction with their anesthetic management was evaluated by asking if they would choose the same type of anesthesia for a future surgery.

Our primary, prospectively defined outcome was the incidence of nausea and/or vomiting over the initial 24 postoperative hours. The incidence of nausea and vomiting and potential confounding factors were evaluated by both univariate and multivariate statistics. One-way analysis of variance and ² analyses were used for the univariate analyses. End-tidal isoflurane and PCO₂, fentanyl dose, fluid volume, SpO₂, and intraoperative mean arterial pressure were first averaged over the anesthetic period in each patient. Subsequently, these values were averaged among the patients in each group.

Nausea severity was evaluated with Kruskal-Wallis tests. The incidence of nausea and combined nausea and vomiting (PONV) were compared by ² analyses. For the combined nausea and vomiting analysis, any score for nausea or vomiting exceeding "none" was considered positive. Finally, we used a multivariate regression to evaluate the contributions of potential confounding factors on the combined incidence of nausea and vomiting. Potential confounding factors that were entered into this regression included motion sickness, nausea-vomiting history, alcohol intake, and smoking.

Results are presented as means ± SD, percentages, or odds ratios and 95% confidence intervals. P < 0.05 was considered statistically significant.

	Results

Top Abstract Introduction Methods Results Discussion References

 
Morphometric and demographic factors, hemodynamic responses, and anesthetic management, including intraoperative fluid regimen and duration of anesthesia, were comparable in all three groups ( Table 1). Potential confounding factors, including smoking history, alcohol intake, history of motion sickness and PONV, were also comparable in the three treatment groups. Overall postoperative pain scores were slightly larger in the 30% oxygen group than in the patients given 80% oxygen.

	Discussion

Top Abstract Introduction Methods Results Discussion References

 
Our previous study demonstrated that 80% oxygen during and for two hours after colon resection reduces the incidence of PONV by a factor of two (5). This result is surprising because there is no established mechanism by which oxygen given only during and shortly after surgery influences nausea and vomiting many hours after patients leave the PACU. Our current results nonetheless confirm the previous ones, suggesting that they did not result simply from a statistical fluke or inadequate control of confounding factors.

Our current results also extend our initial findings by showing that supplemental oxygen is effective even when restricted to the intraoperative period, rather than being continued for two postoperative hours. Neither study directly compared supplemental intraoperative oxygen with the combination of intraoperative and postoperative oxygen. However, each provided a strikingly similar two-fold reduction in nausea and vomiting. These data suggest that supplemental postoperative oxygen is less important than intraoperative administration.

Patients participating in this study presumably experienced little vestibulocochlear stimulation, and there is no reason to assume that oxygen administration reduced nausea and vomiting by influencing this region. Hyperoxia decreases dopamine release by the carotid bodies (13). This is potentially important because the chemotactic trigger zone is sensitive to dopamine as well as serotonin (14). Hyperoxia per se may thus reduce nausea and vomiting mediated by dopamine. However, any effect on this region would presumably apply only during oxygen administration. It therefore seems unlikely that an action at the chemoreceptor trigger zone reduced nausea and vomiting many hours after oxygen administration ceased.

Intestinal tissue is highly metabolically active and has a notoriously poor tolerance for even brief periods of hypoxia or ischemia (15). An important intestinal response to ischemia is release of serotonin (16)—a highly emetogenic substance. Supplemental oxygen may thus reduce PONV by ameliorating subtle intestinal ischemia, thereby reducing release of emetogenic substances from compromised bowel.

Colon resection is surely associated with at least some intestinal ischemia because perfusion is reduced by gut manipulation, especially when retractors distort the normal gut configuration. Insufflation of the abdomen during laparoscopy significantly increases peritoneal pressure and thus also reduces intestinal blood flow (17,18). Patients undergoing colon resection or laparoscopy are thus similarly subject to subtle intestinal ischemia that supplemental oxygen might ameliorate.

The conventional method of preventing PONV is administration of 5-HT₃ antagonists. However, these drugs are quite expensive and cause occasional complications (19). In contrast, 80% perioperative oxygen is not associated with clinically important complications, including atelectasis (20). Oxygen is also remarkably inexpensive, costing only a few cents per patient. Oxygen thus seems preferable to 5-HT₃ antagonists for prevention of PONV.

Although supplemental intraoperative oxygen produced a statistically significant and clinically important reduction in PONV, there were no differences in longer-term outcomes. Patients in each of the three treatment groups had comparable physical function and mental status scores 24 hours after surgery and were equally willing to have the same anesthetic for future surgery. These data suggest that PONV did not have any serious or long-term impact on our patients. Our patients began liquid and solid food and were discharged from the PACU and hospital at similar times. We note that all these patients remained in the hospital for at least 24 hours after minor laparoscopy per local policy, not because hospitalization was medically required.

In planning our study, we assumed that efficacy of the two treatment groups (oxygen and ondansetron) would be comparable. That is, that each would reduce the incidence of PONV by a factor of two. This assumption seemed reasonable because numerous publications support this degree of efficacy for ondansetron (4,6,8,21) and because our previous study demonstrated supplemental oxygen reduced the risk of PONV by a factor of two (5). Had this assumption been confirmed, our study would have been adequately powered.

However, the actual efficacy of ondansetron proved to be much less than expected. We were therefore easily able to demonstrate that supplemental oxygen was effective, but failed to statistically distinguish ondansetron from either the control or oxygen groups. Increasing our sample size to 1000 would presumably provide sufficient statistical power to statistically distinguish among all three groups. However, there are several compelling reason not to pursue this course. The first is that the sample size was prospectively determined based on reasonable estimates of treatment effect. It would be inappropriate to extend the study. The second issue is that it does not really matter whether ondansetron is as good as oxygen: the important point is that it clearly is not superior to oxygen.

We used 8 mg of ondansetron, which is twice the usual dose. However, this dose has been used in a number of previous studies (22,23,24). We used this large dose to forestall the conclusion that ondansetron might have been more effective than oxygen had we given a larger dose.

In summary, 80% intraoperative oxygen halved the incidence of PONV in gynecological laparoscopic surgery. Prophylactic administration of 8 mg ondansetron also somewhat reduced the incidence of nausea and vomiting, but by an amount that did not differ significantly from 30% oxygen or from 80% oxygen. Because supplemental oxygen is inexpensive and essentially risk-free, it appears preferable to pharmacologic antiemetics.

	Acknowledgments

 
The authors greatly appreciate the assistance of Alexander Kober, MD, Reza Taslimi, MD, Franz X. Lackner, MD, and Volke Seibt, MD.

	Footnotes

 
Supported by National Institutes of Health Grant GM58273, the Bürgermeister Fond der Stadt Wien (Vienna, Austria), the Austrian National Bank Fund (Vienna, Austria), and the Joseph Drown Foundation (Los Angeles, California).

Presented in part at the European Society of Anesthesiology Annual Meeting, April 1-4, 2000, Vienna.

	References

Top Abstract Introduction Methods Results Discussion References

 

1. Wetchler BV. Postoperative nausea and vomiting in day-case surgery. Br J Anaesth 1992; 69: 33S-9S.
2. Kenny GN. Risk factors for postoperative nausea and vomiting. Anaesthesia 1994; 49 Suppl: 6–10.
3. Watcha MF, White PF. Postoperative nausea and vomiting: its etiology, treatment, and prevention. Anesthesiology 1992; 77: 162–84.[ISI][Medline]
4. Koivuranta M, Laara E, Snare L, et al. A survey of postoperative nausea and vomiting. Anaesthesia 1997; 52: 443–9.[ISI][Medline]
5. Greif T, Laciny S, Rapf B, et al. Supplemental oxygen reduces the incidence of postoperative nausea and vomiting. Anesthesiology 1999; 91: 1246–52.[ISI][Medline]
6. Liberman M, Howe S, Lane M. Ondansetron versus placebo for prophylaxis of nausea and vomiting in patients undergoing ambulatory laparoscopic cholecystectomy. Am J Surg 2000; 179: 60–2.[Medline]
7. Domino K, Anderson E, Polissar N, et al. Comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting: a meta-analysis. Anesth Analg 1999; 88: 1370–9.[Abstract/Free Full Text]
8. Cholwill J, Wright W, Hobbs G, et al. Comparison of ondansetron and cyclizine for prevention of nausea and vomiting after day-case gynecological laparoscopy. Br J Anaesth 1999; 83: 611–4.[Abstract/Free Full Text]
9. Koivuranta M, Jokela R, Kiviluoma K, et al. The anti-emetic efficacy of a combination of ondansetron and droperidol. Anaesthesia 1997; 52: 863–8.[Medline]
10. Bugedo G, Gonzales J, Asenjo C, et al. Ondansetron and droperidol in the prevention of postoperative nausea and vomiting. Br J Anaesth 1999; 83: 813–4.[Abstract/Free Full Text]
11. Korttila K. The study of postoperative nausea and vomiting. Br J Anaesth 1992; 69: 20S-3S.
12. Ware J, J E, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Med Care 1992;30:473–83.
13. Buerk DG, Osanai S, Mokashi A, et al. Dopamine, sensory discharge, and stimulus interaction with CO2 and O2 in cat carotid body. J Appl Physiol 1998; 85: 1719–26.[Abstract/Free Full Text]
14. Shen WW, Baig MS, Sata LS, et al. Dopamine receptor supersensitivity and the chemoreceptor trigger zone. Biol Psychiatry 1983; 18: 917–21.[ISI][Medline]
15. Beuk RJ, Heineman E, Tangelder GJ, et al. Effects of different durations of total warm ischemia of the gut on rat mesenteric microcirculation. J Surg Res 1997; 73: 14–23.[Medline]
16. Marston A. Responses of the splanchnic circulation to ischaemia. J Clin Pathol Suppl (R Coll Pathol) 1977;11:59–67.
17. Caldwell CB, Ricotta JJ. Changes in visceral blood flow with elevated intraabdominal pressure. J Surg Res 1987; 43: 14–20.[ISI][Medline]
18. Diebel LN, Dulchavsky SA, Wilson RF. Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J Trauma 1992;33:45–8; discussion 48–9.
19. Sung YF. Risks and benefits of drugs used in the management of postoperative nausea and vomiting. Drug Saf 1996; 14: 181–97.[ISI][Medline]
20. Akça O, Podolsky A, Eisenhuber E, et al. Comparable postoperative pulmonary atelectasis in patients given 30% or 80% oxygen during and for two hours after colon resection. Anesthesiology 1999; 91: 991–8.[ISI][Medline]
21. Tsui S, Ng K, Wong L, et al. Prevention of postoperative nausea and vomiting in gynaecological. Anaesth Intensive Care 1999; 27: 471–6.[ISI][Medline]
22. Tramer MR, Moore RA, Reynolds DJ, et al. A quantitative systematic review of ondansetron in treatment of established postoperative nausea and vomiting. BMJ 1997; 314: 1088–92.[Abstract/Free Full Text]
23. Tramer MR, Reynolds DJ, Moore RA, et al. Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials. Anesthesiology 1997; 87: 1277–89.[ISI][Medline]
24. Kovac A, McKenzie R, O’Connor T, et al. Prophylactic intravenous ondansetron in female outpatients undergoing gynaecological surgery: a multicentre dose-comparison study. Eur J Anaesthesiol 1992; 9 Suppl Suppl 6: 37–47.

This article has been cited by other articles:

				B. Mraovic, T. Simurina, Z. Sonicki, N. Skitarelic, and T. J. Gan The Dose-Response of Nitrous Oxide in Postoperative Nausea in Patients Undergoing Gynecologic Laparoscopic Surgery: A Preliminary Study Anesth. Analg., September 1, 2008; 107(3): 818 - 823. [Abstract] [Full Text] [PDF]

				M. Orhan-Sungur, P. Kranke, D. Sessler, and C. C. Apfel Does Supplemental Oxygen Reduce Postoperative Nausea and Vomiting? A Meta-Analysis of Randomized Controlled Trials Anesth. Analg., June 1, 2008; 106(6): 1733 - 1738. [Abstract] [Full Text] [PDF]

				T. W. Phillips Jr, D. M. Broussard, W. D. Sumrall III, and S. R. Hart Intraoperative Oxygen Administration Does Not Reduce the Incidence or Severity of Nausea or Vomiting Associated with Neuraxial Anesthesia for Cesarean Delivery Anesth. Analg., October 1, 2007; 105(4): 1113 - 1117. [Abstract] [Full Text] [PDF]

				S. M Wilhelm, M. L Dehoorne-Smith, and P. B Kale-Pradhan Prevention of Postoperative Nausea and Vomiting Ann. Pharmacother., January 1, 2007; 41(1): 68 - 78. [Abstract] [Full Text] [PDF]

				S. N. Piper, K. D. Rohm, J. Boldt, K. L. Faust, W. H. Maleck, P. Kranke, and S. W. Suttner Inspired oxygen fraction of 0.8 compared with 0.4 does not further reduce postoperative nausea and vomiting in dolasetron-treated patients undergoing laparoscopic cholecystectomy Br. J. Anaesth., November 1, 2006; 97(5): 647 - 653. [Abstract] [Full Text] [PDF]

				T. J. Gan Risk factors for postoperative nausea and vomiting. Anesth. Analg., June 1, 2006; 102(6): 1884 - 1898. [Abstract] [Full Text] [PDF]

				J. Golembiewski, E. Chernin, and T. Chopra Prevention and treatment of postoperative nausea and vomiting Am. J. Health Syst. Pharm., June 15, 2005; 62(12): 1247 - 1260. [Abstract] [Full Text] [PDF]

				A. Goldfaden and J. D. Birkmeyer Evidence-Based Practice in Laparoscopic Surgery: Perioperative Care Surgical Innovation, March 1, 2005; 12(1): 51 - 61. [Abstract] [PDF]

				J. J. Magner, C. McCaul, E. Carton, J. Gardiner, and D. Buggy Effect of intraoperative intravenous crystalloid infusion on postoperative nausea and vomiting after gynaecological laparoscopy: comparison of 30 and 10 ml kg-1 Br. J. Anaesth., September 1, 2004; 93(3): 381 - 385. [Abstract] [Full Text] [PDF]

				C. C. Apfel, K. Korttila, M. Abdalla, H. Kerger, A. Turan, I. Vedder, C. Zernak, K. Danner, R. Jokela, S. J. Pocock, et al. A Factorial Trial of Six Interventions for the Prevention of Postoperative Nausea and Vomiting N. Engl. J. Med., June 10, 2004; 350(24): 2441 - 2451. [Abstract] [Full Text] [PDF]

				A. S. Habib and T. J. Gan Evidence-based management of postoperative nausea and vomiting: a review: [Le traitement des nausees et des vomissements postoperatoires fonde sur des donnees probantes : une revue] Can J Anesth, April 1, 2004; 51(4): 326 - 341. [Abstract] [Full Text] [PDF]

				K. O. Pryor, T. J. Fahey III, C. A. Lien, and P. A. Goldstein Surgical Site Infection and the Routine Use of Perioperative Hyperoxia in a General Surgical Population: A Randomized Controlled Trial JAMA, January 7, 2004; 291(1): 79 - 87. [Abstract] [Full Text] [PDF]

				J. L. Joris, N. J. Poth, A. M. Djamadar, D. I. Sessler, E. E. Hamoir, T. R. Defechereux, M. R. Meurisse, and M. L. Lamy Supplemental oxygen does not reduce postoperative nausea and vomiting after thyroidectomy{dagger} Br. J. Anaesth., December 1, 2003; 91(6): 857 - 861. [Abstract] [Full Text] [PDF]

				S. Purhonen, M. Niskanen, M. Wustefeld, P. Mustonen, and M. Hynynen Supplemental oxygen for prevention of nausea and vomiting after breast surgery Br. J. Anaesth., August 1, 2003; 91(2): 284 - 287. [Abstract] [Full Text] [PDF]

				L. Magnusson and D. R. Spahn New concepts of atelectasis during general anaesthesia Br. J. Anaesth., July 1, 2003; 91(1): 61 - 72. [Full Text] [PDF]

				T. J. Gan, T. Meyer, C. C. Apfel, F. Chung, P. J. Davis, S. Eubanks, A. Kovac, B. K. Philip, D. I. Sessler, J. Temo, et al. Consensus Guidelines for Managing Postoperative Nausea and Vomiting Anesth. Analg., July 1, 2003; 97(1): 62 - 71. [Abstract] [Full Text] [PDF]

				S. Purhonen, M. Turunen, U.-M. Ruohoaho, M. Niskanen, and M. Hynynen Supplemental Oxygen Does Not Reduce the Incidence of Postoperative Nausea and Vomiting After Ambulatory Gynecologic Laparoscopy Anesth. Analg., January 1, 2003; 96(1): 91 - 96. [Abstract] [Full Text] [PDF]

				A. Agarwal, N. Bose, A. Gaur, U. Singh, M. K. Gupta, and D. Singh Acupressure and ondansetron for postoperative nausea and vomiting after laparoscopic cholecystectomy: [L'acupression et l'ondansetron contre les nausees et les vomissements suivant la cholecystectomie laparoscopique] Can J Anesth, June 1, 2002; 49(6): 554 - 560. [Abstract] [Full Text] [PDF]

				P. C. Nicole, C. A. Trepanier, and M. R. Lessard Nausea and vomiting after laparoscopic surgery are not associated with an increased peripheral release of serotonin: [Les nausees et vomissements suite a une chirurgie laparoscopique ne sont pas associes a une secretion peripherique accrue de serotonine] Can J Anesth, May 1, 2002; 49(5): 453 - 457. [Abstract] [Full Text] [PDF]

				T. J. Gan Postoperative Nausea and Vomiting--Can It Be Eliminated? JAMA, March 13, 2002; 287(10): 1233 - 1236. [Full Text] [PDF]

				D. Harmon, J. Gardiner, O. Akca, and D. I. Sessler Postoperative Nausea and Vomiting in Female Patients Anesth. Analg., August 1, 2001; 93(2): 518 - 519. [Full Text] [PDF]

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (50) Citing Articles via Google Scholar Google Scholar Articles by Goll, V. Articles by Sessler, D. I. Search for Related Content PubMed PubMed Citation Articles by Goll, V. Articles by Sessler, D. I. Related Collections Pharmacology

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999