Food Related Video and the Incidence of Postoperative Nausea and Vomiting
Condition: Postoperative Nausea and Vomiting
MeSH terms: Nausea; Vomiting; Postoperative Nausea and Vomiting
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Visual exposure to taped food preparation; Visual exposure to topics not related to food
Intervention type(s): Other; Other
Intervention description(s): Patients in the study group can watch the preparation of the the type of food she prefers to eat normally.; Patients in the placebo group can choose a video that is relaxing but not related to food.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Care Provider, Outcomes Assessor)
Primary purpose: Prevention