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Drugs for Postoperative Nausea May Not Help Most Patients

usea and vomiting are usually mild and include headache, sedation, itchiness, constipation and dizziness.

Carlisle estimates that perhaps 10 million surgical patients in the United States and 2 million in the United Kingdom receive prophylactic treatment for nausea and vomiting each year.

The incidence of nausea and vomiting varies depending on the patient and the type of surgery, said Tong J. Gan, M.D., vice chairman of the anesthesiology department at Duke University Medical Center. While it can occur in up to 80 percent of patients, it is more likely to occur in only about 35 percent. Women have three times the risk of developing nausea and vomiting after surgery than do men, he said, and nonsmokers are also more likely to become nauseated than smokers. The problem is more likely to occur after abdominal hysterectomies, breast surgery, surgery of the middle ear and surgery to correct crossed eyes, he added.

A more important factor in determining which patients are at greater risk is whether they have a previous history of nausea and vomiting after surgery, said Gan, who was not involved with the Cochrane review. Patients should also be asked if they are subject to motion sickness, since this can be a predictive factor, he added.

Carlisle said that screening for patients at increased risk can only go so far. “There will always be some patients who do not have an antiemetic who go on to have nausea or vomiting, and conversely there will always be some patients who have had an antiemetic who would not have had nausea or vomiting even without an antiemetic.”

These risk factors can be used to screen patients who are at greatest risk, but are not certain, he said. “By proper screening of patients and proper use of drugs, benefits outweigh the risks.”

Proper use of antiemetic drugs can increase their effectiveness and reduce the incidence of side effects such as sedation and dizziness, Gan said. Sma
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