Efficacy of Aprepitant and Ondansetron in Managing Postoperative Nausea and Vomiting in Perioperative Obese Patients

Purpose/Background Postoperative nausea and vomiting (PONV) is a common adverse event that occurs during the recovery period following anesthesia. PONV has been reported to affect nearly 80% of patients, leading to prolonged hospitalization, increases in cost of care, patient dissatisfaction, dehydration, electrolyte imbalances, acute kidney injury, and pulmonary aspiration. Certain risk factors, including obese patients, female gender, and nonsmoker status, increase the risk of PONV. Traditionally, for all patients going under anesthesia, a prophylactic antiemetic regimen is administered; however, since obese and other high-risk patients are at increased risk of experiencing PONV despite traditional regimens, anesthesia providers should administer multiple medications to help ensure PONV is avoided. Aprepitant, a Neurokinin-1 antagonist, is an effective adjunct in the prevention and treatment of PONV. This scoping review aims to compare the effectiveness of Aprepitant compared to other conventional antiemetics, such as Ondansetron, in treating and preventing PONV in high-risk patients undergoing laparoscopic surgery. Methods The synthesis of this scoping review was conducted in September 2023 to March 2024 with a systematic database search to identify articles that met the eligibility criteria. A total of 25 eligible articles were included, and a synthesis table was created to organize the relative qualitative and quantitative data. From these, ten articles were selected for further evaluation through Rapid Critical Appraisal (RCA). Lastly, the ten articles were further reviewed to find whether Aprepitant alone versus in combination with Ondansetron worked better in managing post-operative nausea and vomiting in perioperative obese patients. Results The studies generally support the prediction of aprepitant’s effectiveness in reducing post-operative nausea and vomiting, especially in the obese population. The most consistent outcome amongst the ten selected articles showed a significant decrease in PONV with the combination of aprepitant and ondansetron. Data indicated a reduction in nausea, vomiting, and use of rescue medications with aprepitant use alone. One trial showed that the combination delayed PONV but was not more effective than using Ondansetron alone. Another study found that aprepitant was more effective in the long-term recovery period than Ondansetron. While not all studies support the use of combination anti-emetic therapy, the majority supports using aprepitant in the obese population for further PONV prevention. Implications for Nursing Practice A summary of the evidence supports the use of aprepitant in reducing postoperative nausea and vomiting in the obese population. The purpose of this scoping review was to condense evidence to support the use of aprepitant in decreasing postoperative nausea and vomiting, reducing hospital stay, and reducing adverse patient outcomes in the bariatric population. Current research indicates that integrating aprepitant for preventing PONV using a multimodal antiemetic approach is rapidly becoming the standard of care

Deformation-related volcanism in the Pacific Ocean linked to the Hawaiian-Emperor bend

Ocean islands, seamounts and volcanic ridges are thought to form above mantle plumes. Yet, this mechanism cannot explain many volcanic features on the Pacific Ocean floor and some might instead be caused by cracks in the oceanic crust linked to the reorganization of plate motions. A distinctive bend in the Hawaiian–Emperor volcanic chain has been linked to changes in the direction of motion of the Pacific Plate, movement of the Hawaiian plume, or a combination of both. However, these links are uncertain because there is no independent record that precisely dates tectonic events that affected the Pacific Plate. Here we analyse the geochemical characteristics of lava samples collected from the Musicians Ridges, lines of volcanic seamounts formed close to the Hawaiian–Emperor bend. We find that the geochemical signature of these lavas is unlike typical ocean island basalts and instead resembles mid-ocean ridge basalts. We infer that the seamounts are unrelated to mantle plume activity and instead formed in an extensional setting, due to deformation of the Pacific Plate. 40Ar/39Ar dating reveals that the Musicians Ridges formed during two time windows that bracket the time of formation of the Hawaiian–Emperor bend, 53–52 and 48–47 million years ago. We conclude that the Hawaiian–Emperor bend was formed by plate–mantle reorganization, potentially triggered by a series of subduction events at the Pacific Plate margins