Journal of Anaesthesiology Clinical Pharmacology

LETTER TO EDITOR
Year
: 2014  |  Volume : 30  |  Issue : 4  |  Page : 577-

Caffeine for the prevention of postoperative nausea and vomiting - Few comments


Shriram Vaidya1, PV Sai Saran2, Kush A Goyal1, Deependra Kamble1,  
1 Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India
2 Department of Anaesthesiology and Critical Care, Fortis Hospital, Chandigarh, India

Correspondence Address:
Shriram Vaidya
Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka
India




How to cite this article:
Vaidya S, Saran PS, Goyal KA, Kamble D. Caffeine for the prevention of postoperative nausea and vomiting - Few comments .J Anaesthesiol Clin Pharmacol 2014;30:577-577


How to cite this URL:
Vaidya S, Saran PS, Goyal KA, Kamble D. Caffeine for the prevention of postoperative nausea and vomiting - Few comments . J Anaesthesiol Clin Pharmacol [serial online] 2014 [cited 2021 Feb 27 ];30:577-577
Available from: https://www.joacp.org/text.asp?2014/30/4/577/142876


Full Text

Sir,

We found the article "caffeine for the prevention of postoperative nausea and vomiting (PONV)" [1] by Steinbrook et al. interesting as well as pleasing because of authors' humility to report a finding which may not fit into popular belief (read: Increased incidence of PONV after intravenous caffeine). Not to take away the credit from authors but as critics, we would like to raise few comments, which we consider relevant.

The readers would benefit if authors could clearly state whether the type of surgeries considered as surgical risk factors for PONV were included in the study, e.g., laparoscopy, laparotomy, maxillofacial surgeries etc. [2] Authors have rightly chosen propofol as an induction agent and administered routine as well as additional antiemetic prophylaxis for patients at high risk for PONV. In fact, patients with two of the four risk factors for PONV as per Apfel score were included in the study. Additional strategies to reduce baseline risk - use of propofol for maintenance of anesthesia, avoidance of nitrous oxide, avoidance of volatile anesthetics, [3] use of nonsteroidal antiinflammatory drugs [4] to spare opioids, etc., as suggested in the "Society for Ambulatory Anesthesia Guidelines for the Management of PONV" - If adopted, would probably influence the outcome. In addition, the emetogenic effect of inhaled anesthetics appears to be dose related. [3] Hence, a comment regarding comparability of volatile anesthetic consumption between the groups would be relevant. Lastly, a comment about intraoperative hydration would be apt as it has been found to have a bearing on PONV. [5]

References

1Steinbrook RA, Garfield F, Batista SH, Urman RD. Caffeine for the prevention of postoperative nausea and vomiting. J Anaesthesiol Clin Pharmacol 2013;29:526-9.
2Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS, et al. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2007;105:1615-28.
3Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T, Rauch S, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: A randomized controlled trial of factorial design. Br J Anaesth 2002;88:659-68.
4Gan TJ, Joshi GP, Zhao SZ, Hanna DB, Cheung RY, Chen C. Presurgical intravenous parecoxib sodium and follow-up oral valdecoxib for pain management after laparoscopic cholecystectomy surgery reduces opioid requirements and opioid-related adverse effects. Acta Anaesthesiol Scand 2004;48: 1194-207.
5Maharaj CH, Kallam SR, Malik A, Hassett P, Grady D, Laffey JG. Preoperative intravenous fluid therapy decreases postoperative nausea and pain in high risk patients. Anesth Analg 2005;100: 675-82.