Designing Optimal Prevention and Management of Postoperative Nausea and Emesis for Patients Undergoing Laparoscopic Sleeve Gastrectomy
Post-operative Nausea and Vomiting, Laparoscopic Sleeve Gastrectomy
About this trial
This is an interventional prevention trial for Post-operative Nausea and Vomiting focused on measuring Bariatric Procedure
Eligibility Criteria
Inclusion Criteria:
- Adult patients (18 years and older) undergoing LSG
Exclusion Criteria:
- Allergy to medications delineated in the protocol (muscle blockade, anesthetics, reversal agents)
- Inability to provide informed consent
- History of chronic nausea and emesis requiring medication
- Poorly controlled diabetes (HgA1c>9 mg/dl),
- History of previous bariatric or gastro-esophageal surgery
Sites / Locations
- Stony Brook University Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Intervention Arm
Control Arm
A) Pre-operatively: aprepitant 80 mg oral capsule and scopolamine transdermal patch. B) Intra-operatively: total intravenous anesthesia (TIVA) will be maintained with IV infusions of propofol, and dexmedetomidine infusion or intermittent bolus dosing of fentanyl after induction. Sugammadex (2-4 mg/Kg IV) will be used for reversal of neuromuscular blockade in both groups. A single dose of dexamethasone 8 mg IV will be administered after induction, and a single dose of ondansetron 4 mg IV will be administered approximately 20 minutes prior to the end of operation. C) Post-operatively: Scheduled ondansetron and Raglan every 6 hours, using Compazine as a rescue medication.
A) Pre-operatively: No intervention B) Intra-operatively: inhalation anesthetics (sevoflurane or desflurane) and intermittent opioid boluses will be used for maintenance of anesthesia, as standard practice in the institution of the investigators and across the country. PONV prevention measures in the control group will be limited to dexamethasone 8 mg and ondansetron 4 mg. C) Post-operatively: Scheduled ondansetron and Raglan every 6 hours, using Compazine as a rescue medication.