A study by Dr. PE Scuderi suggests that vomiting in ambulatory surgery patients (in-hospital, post-operatively) can be virtually abolished with the use of an aggressive protocol of currently available therapies.

Dr. Scuderi, Professor of Anesthesia at Bowman Gray School of Medicine, examined one hundred and thirty nine patients undergoing laparoscopic surgery on an outpatient basis. The patients randomized (sixty patients in total) to receive protocol had a zero incidence of vomiting in the post-anesthesia care unit. Four of the sixty patients had nausea - and one patient requested treatment for the nausea. Patient satisfaction was 100%.

In addition, preliminary results for additional patients were reported. The total number of patients that have received the study protocol now numbers approximately 200. This group of patients continues to show good results with the incidence of vomiting remaining at zero. This is truly an amazing result.

Some patients did have nausea and vomiting at home - the study stated that it is difficult to control what patients do at home and that all patients received narcotic pain medicine for pain control at home.

The actual protocol involves avoiding agents known to cause a higher incidence of vomiting as well as the use of triple anti-emetic prophylaxis. The details are as follows:

• Total intravenous anesthesia with propofol and remifentanil
• No use of nitrous oxide
• No neuromuscular blockade (and therefore no reversal agents)
• Aggressive intravenous hydration (25 cc/kg)
• Prophylaxis with ondansetron 1 mg, droperidol 0.625 mg and dexamethasone 10 mg
• Toradol 30 mg IV for analgesia

The question remains - what does this all mean? Is this a desirable protocol to follow? Should we institute it right away in everyone? Read on to find out my thoughts on the issue...