Food Related Video and the Incidence of Postoperative Nausea and Vomiting

The Putative Role of the Pavlovian Reflex as a Non-pharmacological Preoperative Intervention in the Prevention of Postoperative Nausea and Vomiting

Postoperative nausea/vomiting (PONV) is a common problem following surgery and anesthesia. There are risk factors that increase the incidence of PONV that are related to the patient, to the surgical procedure or to the anesthetic agents. At the subjective level PONV is described as worse and more feared than postoperative pain by many patients. At the objective level it increases the length of stay in the recovery room, it results in unplanned hospital admission and Emergency Room visits, and therefore increased cost of care. A lot of research work has been done to identify pharmacological agents to prevent and treat PONV. The higher the risk of a patient the higher number of these drugs are combined for prophylaxis. However, these drugs have significant side effects of their own. Much less attention has been paid to potential non-pharmacological PONV prevention options. The purpose of our study is to investigate the putative role of the natural stimulation of normal gastrointestinal function via the Pavlovian reflex. We seek to find a natural method with no side effects to improve PONV prophylaxis in patients with risk factors for that postoperative complication.

The study will be conducted in 18-40 years old female volunteers who are undergoing planned, elective, non-cancer surgical procedure as outpatients, and who are identified to have either history or significant risk of PONV. The latter will be calculated by the questionnaire we currently use during our routine preoperative anesthesia evaluation (see in detail below in the Study design section). Patients who meet the study enrollment criteria will be identified on the surgical schedule the day before the planned intervention. The recruitment will occur during the preoperative admission process. These patients will be randomly assigned to either the study group or to the control group. The study group will watch videos of preparation and cooking of their favorite foods while waiting for their surgery. Patients in the control group will watch videos that are not food related. The anesthesia team in the OR and the PACU team who manages the patient's postoperative recovery will be blinded to which group the patient is enrolled to. The intraoperative antiemetics will be provided by the study team as outlined in the Study design section below. The anesthesia protocol will be standardized. All patient who are enrolled in the study will require general anesthesia with endotracheal intubation. After intravenous induction, muscle relaxation with rocuronium and intubation of the trachea anesthesia will be maintained with sevoflurane and opioid boluses for analgesia as deemed necessary by the anesthesia team. Antiemetics (as described below) will be administered 30 minutes prior to planned emergence, residual muscle relaxant will be reversed with sugammadex. The patients will be taken to the recovery room. Beyond their routine vital sign and pain score monitoring and observation the occurrence and degree of nausea and vomiting, as well as the time to discharge to home or unplanned admission due to therapy resistant vomiting will be recorded.

The study group will watch 15 minute long videos of cooking and preparing the food of the patient's preferred type of food prior to be taken to the operating room.

Patients in the study group can watch the preparation of the the type of food she prefers to eat normally.

The type and dose of administered antiemetic drugs will be recorded and analyzed in the patients' charts.

The time between arriving to and discharge from the recovery room will be recorded in the patients' charts.

Inclusion Criteria: 18-40 years old female American Society of Anesthesiologists Physical Status I and II Personal history of postoperative nausea and vomiting Personal history of motion sickness Non-smoker status Undergoing scheduled elective surgical procedures and general anesthesia for non-cancer surgery of: breast gynecology ear, nose and throat eye Duration of surgery less than 3 hours will be enrolled in the study. Exclusion Criteria: Ages older than 40 years and younger than 18 years Morbid obesity (BMI > 35 kg/m2) Uncontrolled gastroesophageal reflux disease (GERD) Smoking Cancer and chemotherapy Vertigo Meniere's disease Pseudotumor cerebri and other central nervous diseases that may induce nausea and vomiting Prolonged (> 15 minutes) intraoperative hypotension Estimated blood loss > 20 % of estimated blood volume Emergency surgery

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