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Postoperative Nausea and Vomiting: A Practical Guide

Grant, Michael C. MD

doi: 10.1213/ANE.0000000000002365
Books, Multimedia, and Meeting Reviews

Published ahead of print July 28, 2017.

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland,

Published ahead of print July 28, 2017.

Postoperative Nausea and Vomiting: A Practical Guide, as its name suggests, is a guide to the practical application of knowledge and expertise garnered from decades of research into the phenomenon of postoperative nausea and vomiting (PONV). Its editors and included authors are among the world’s experts in the field of perioperative medicine, with particular emphasis placed on the importance of PONV within the perioperative period. As the preface of the book asserts, PONV represents one of “the most common and distressing problems facing patients after surgery” and it “causes extreme patient discomfort, prolonged recovery, a decrease in satisfaction with surgery, an increase in the length of stay in the recovery room, and unexpected hospital admission after day surgery and healthcare costs.” The foreword further confirms the importance of the topic and includes an excerpt from Dr Henrik Kehlet, considered the father of enhanced recovery after surgery, outlining the critical importance of comprehensive management of PONV, especially in the setting of enhanced recovery after surgery and fast-track surgical programs.

The text is organized into 15 chapters, the first of which begins somewhat unexpectedly, but convincingly, with the argument for PONV as an early evolutionary survival mechanism. From there, more traditional prose describes the history of the scientific approach to studying PONV and the discovery of early antiemetic medications. The book introduces further discussion of PONV outcomes, the benefits of formal PONV management on anesthesia training, and the overarching economic implications of both PONV and the selection of various antiemetic medications. The text provides an excellent synopsis not only of the risk factors but also the mechanism of PONV, including a brief but informative review of receptor-specific PONV interventions. The chosen tables and graphics provide an effective demonstration of the information to the reader and the language is straightforward and concise. A comprehensive review of the relevant literature yields an inordinate number of citations and the authors have done an excellent job of distilling this information into digestible sections without omitting critical aspects. Ultimately, individual chapters are devoted to specific medications, wherein the evidence for individual agents is examined and presented. Included is an excellent review of the nonpharmacologic interventions, which are often an underappreciated aspect of PONV management. Recognition is provided to the nuances of caring for different patient populations, eg, pediatric patients, in addition to various operative arenas such as the ambulatory setting, which is discussed in a separate chapter.

While the book is generally a success, there is a handful of areas that have opportunities for improvement. The book includes a chapter entitled “Patient’s Experience and Nursing Perspective” that provides an important nod toward the social dynamics associated with how PONV and its management impact the patient encounter. This area requires a great deal more investigation, which is reflected in the relative brevity and superficial approach to the topic compared with the rest of the text. In subsequent iterations, it may be expanded on as further study warrants. The authors additionally include a chapter on the involvement of genomics and its applicability to PONV research and intervention. The verbiage here is denser and lacks both the fluidity and translatability associated with other sections of the book. Finally, although a comprehensive review is provided of more established antiemetics, the literature has evolved in the last calendar year to include a number of agents not formally explored in the text. This is likely secondary to the timing of the publication and subsequent editions will almost certainly address this shortcoming.

The small miscalculations above notwithstanding, Postoperative Nausea and Vomiting: A Practical Guide provides the reader with a concise yet comprehensive understanding of where we were, where we are, and potentially where we are going with the management of PONV. There are clear areas for expansion presented toward the end of the book, where the concepts of cost-effectiveness, strength of evidence, and opportunities for lengthening the list of viable interventions are reviewed. In sum, the authors of Postoperative Nausea and Vomiting: A Practical Guide should be commended for establishing one of the higher quality evidence-based references for the evaluation and management of PONV.

Michael C. Grant, MDDepartment of Anesthesiology and Critical Care MedicineThe Johns Hopkins UniversityBaltimore,

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