DOI

10.21007/con.dnp.2025.0120

Faculty Advisor

Dwayne Accardo, DNP, CRNA, FAANA

Document Type

Poster

Publication Date

Spring 5-1-2025

Disciplines

Health and Medical Administration | Investigative Techniques | Medicine and Health Sciences | Nursing | Nursing Administration | Perioperative, Operating Room and Surgical Nursing | Quality Improvement

Abstract

Purpose/Background

Postoperative nausea and vomiting (PONV) is a common adverse event that occurs during the recovery period following anesthesia. PONV has been reported to affect nearly 80% of patients, leading to prolonged hospitalization, increases in cost of care, patient dissatisfaction, dehydration, electrolyte imbalances, acute kidney injury, and pulmonary aspiration. Certain risk factors, including obese patients, female gender, and nonsmoker status, increase the risk of PONV. Traditionally, for all patients going under anesthesia, a prophylactic antiemetic regimen is administered; however, since obese and other high-risk patients are at increased risk of experiencing PONV despite traditional regimens, anesthesia providers should administer multiple medications to help ensure PONV is avoided. Aprepitant, a Neurokinin-1 antagonist, is an effective adjunct in the prevention and treatment of PONV. This scoping review aims to compare the effectiveness of Aprepitant compared to other conventional antiemetics, such as Ondansetron, in treating and preventing PONV in high-risk patients undergoing laparoscopic surgery.

Methods

The synthesis of this scoping review was conducted in September 2023 to March 2024 with a systematic database search to identify articles that met the eligibility criteria. A total of 25 eligible articles were included, and a synthesis table was created to organize the relative qualitative and quantitative data. From these, ten articles were selected for further evaluation through Rapid Critical Appraisal (RCA). Lastly, the ten articles were further reviewed to find whether Aprepitant alone versus in combination with Ondansetron worked better in managing post-operative nausea and vomiting in perioperative obese patients.

Results

The studies generally support the prediction of aprepitant’s effectiveness in reducing post-operative nausea and vomiting, especially in the obese population. The most consistent outcome amongst the ten selected articles showed a significant decrease in PONV with the combination of aprepitant and ondansetron. Data indicated a reduction in nausea, vomiting, and use of rescue medications with aprepitant use alone. One trial showed that the combination delayed PONV but was not more effective than using Ondansetron alone. Another study found that aprepitant was more effective in the long-term recovery period than Ondansetron. While not all studies support the use of combination anti-emetic therapy, the majority supports using aprepitant in the obese population for further PONV prevention.

Implications for Nursing Practice

A summary of the evidence supports the use of aprepitant in reducing postoperative nausea and vomiting in the obese population. The purpose of this scoping review was to condense evidence to support the use of aprepitant in decreasing postoperative nausea and vomiting, reducing hospital stay, and reducing adverse patient outcomes in the bariatric population. Current research indicates that integrating aprepitant for preventing PONV using a multimodal antiemetic approach is rapidly becoming the standard of care.

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