1. Health Care Promotion: Better Method for Preventing Postoperative Nausea and Vomiting
Prof. Jhi-Joung Wang, M.D., Ph.D, Jen-Yin Chen M.D., Ph.D.
Chi-Mei Medical Center, Tainan, Taiwan
2016/11/7-9

2. Standford university medical center, questionnaire 101 patients
Which Clinical Anesthesia Outcomes Are Important to Avoid? The Perspective of Patients
Standford university medical center, questionnaire 101 patients

4. Chi-Mei Publications on Prevention of PONV
Dexamethasone effectively prevent PONV。
21 publications
SCI：19 publications
Non-SCI: 2 publications
Original clinical paper:17
Basic research:1
Review:1
Original clinical paper: 2

5. List of 21 publications

6. 17 publications were cited in an important meta-analysis paper
＊60 high-quality trials selected.
＊17/60 =28% from our studies

7. ＊60 RCTs were enrolled
＊17/60 =28% from our team

8. Our works contribute to the consensus guideline for PONV prevention
Anesthesia & Analgesia 2014

10. This set of guidelines have been officially endorsed by the following societies：
American Academy of Anesthesiologist Assistants
American Association of Nurse Anesthetists
American Society of Anesthesiologists
American Society of Health Systems Pharmacists
American Society of PeriAnesthesia Nurses
Australian and New Zealand College of Anaesthetists
Chinese Society of Anesthesiology
CongresoLationoamericano de Sociedades de Anestesia
European Society of Anaesthesiology
Hong Kong College of Anaesthesiologists
Malaysian Society of Anaesthesiologists
Singapore Society of Anaesthesiologists
South African Society of Anaesthesiologists

11. Cited by Miller’s Anesthesia PONV Chapter

12. 4/9 citations in this section

13. 163. Ho CM, et al. : Dexamethasone has a central antiemetic mechanism in decerebrated cats, Anesth Analg 99: , 2004.
166. Wang JJ, et al: The use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: a dose-ranging study, Anesth Analg 91: , 2000.
167. Wang JJ, et al: Dexamethasone prophylaxis of nausea and vomiting after epidural morphine for post-cesarean analgesia, Can J Anaesth 48: , 2001.
168. Wang JJ, et al: The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting, Anesth Analg 91: , 2000.

14. Invited to write an review article by EJP

15. Application to clinical service for patient controlled analgesia associated nausea and vomiting
Target patients：those who using PCA after surgeries
Significant Improvement after 4 PDCA（Plan-Do-Check-Action） cycles

16. Application of CICARE program to our PCA service
Connect with Compassion Introduce Communicate Ask with Discovery Respond with Respect to patient Exit with Excellence

17. Preanesthetic visit： Apfel risk factor score

18. Anesthetic planning
Droperidol、Ondansetron
PCA

20. Flow chart for visiting PCA patients
Patients using PCA
Twice visits per day
Stable
If SpO2＜94﹪ ,RR<=8/min，heart rate ≧110 beats/min)
Continue 2 visits/ day as schedule
Inform anesthesiologist, ward nurse and surgeon
Stable
Close follow up
Follow up
Close case after 3 day service
Assessment and treatment
Input to database

21. Dexamethasone and Droperidol Apfel score and Ondansetron
CICARE

22. Lower PONV incidence than other medical centers:

23. Chi-Mei Medical Center : 15.8 %
Author year
PONV %
Center
Koh et al., 2016
22.4
Yonsei University
Yang, et al., 2012 33
Seoul University
Tetsunaga et al., 2012
26.7
Okayama University
Wakasugi et al., 2015
26.5
Far-Eastern, TPE

24. Chi-Mei Medical Center : 15.8 %
Author year
PONV %
Center
Dagtekin et al., 2014 23
Cologne University
Apfel, et al., 2004 22
Europe
Apfel et al., 2012 37
USA, 12 centers
Gan et al., 2009 32
Duke University
Jellish et al., 2009 29
Loyola University

25. Taiwan: PCA associated PONV
2012 NTU
2010 Far Eastern
25.7%

26. PONV in Yonsei University
2015 Korean
PONV 22.4%

27. PONV Yonsei University
2013 Korean
PONV 25%

28. PONV in Seoul University
2013 Korean

29. PONV in Osaka University
period
Placebo
Prevention
0-6
31%
22%
6-24
18%
15%
0-24
49%
37%

30. Christian C. Apfel
Europe
PONV: 1731 of 5161 patients (34%)
28%
22%

31. USA: PONV in PCA

32. Duke university: Gan, Tong J
31.4% PONV after combiantion prophylaxis

33. A prospective multicenter study of 2,170 adults undergoing general anesthesia at ambulatory surgery centers in the United States. The overall incidence of PONV was. 37%
Apfel CC, Philip BK, Cakmakkaya OS, et al: Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? Anesthesiology 117: , 2012.

34. Conclusion

35. Thank you