Release Date: August 1, 2009
Expiration Date: August 1, 2010

ESTIMATED TIME TO COMPLETE ACTIVITY
This activity should take approximately 1.0 hour to complete.

TARGET AUDIENCE
This activity has been designed to meet the educational needs of anesthesiologists involved in the care of postoperative patients with nausea and vomiting.

NEEDS STATEMENT
Perioperative nausea and vomiting (including postoperative and postdischarge nausea and vomiting [PONV/PDNV]) is an ongoing problem among people undergoing general anesthesia. Depending on the number of risk factors, the incidence of nausea and vomiting in surgical patients can exceed 80%. The potential clinical, economic, and patient-related consequences of PONV have been well characterized and reported, but the fact that nausea and vomiting can persist long after the patient has been discharged and has returned home is not as well recognized. Despite the availability of a wide range of antiemetic agents, the use of multimodal interventions, a better understanding of risk factors, and the development of various practice guidelines, PONV/PDNV remains a clinical concern. Even newer antiemetic agents such as serotonin receptor antagonists only offer approximately a 25% reduction in nausea and vomiting when used alone. This underscores the need for new agents that have greater efficacy and safety, as well as an extended duration of action to protect patients against nausea and vomiting over a prolonged time course, thereby improving outcomes. This monograph is intended to provide current information on PONV and PDNV and their prophylaxis, and to explore the practical implications of recent findings on antiemetic practices in order to enable practitioners to make more informed decisions regarding antiemetic use—both at present and in the future.

EDUCATIONAL OBJECTIVES
After completing this activity, the participant should be better able to:

1. Describe the incidence, etiology, and clinical burden of PONV and PDNV.
2. Review the impact of current antiemetic management strategies on patient outcomes.
3. Explain pharmacologic differences among antiemetic agents and the potential clinical implications of these differences.
4. Discuss clinical strategies to improve PONV and PDNV control.

FACULTY
Marcel Durieux, MD, PhD
Professor of Anesthesiology and Neurological Surgery
University of Virginia Health System
Charlottesville, Virginia

Jeff Gadsden, MD, FRCPC, FANZCA
Assistant Professor of Clinical Anesthesiology
Director, Regional Anesthesia Fellowship Program
St Luke's and Roosevelt Hospitals
New York, New York

ACCREDITATION STATEMENT
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine (PIM) and MK Medical Communications, LLC. PIM is accredited by the ACCME to provide continuing medical education for physicians.

CREDIT DESIGNATION
PIM designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

DISCLOSURE OF CONFLICTS OF INTEREST
PIM assesses conflict of interest with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance and scientific objectivity of studies referenced in the activity and patient care recommendations. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements in the quality of health care and not a specific proprietary commercial business interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Marcel Durieux, MD, PhD: Eisai Inc (advisory board).

Jeff Gadsden, MD, FRCPC, FANZCA: B. Braun, GE Healthcare, SonoSite (consultant).

The planners and managers from PIM and MK Medical Communications LLC hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

Linda Graham, RN, BSN, BA: No conflict of interest to report.

Jan Hixon, RN, BSN, MA: No conflict of interest to report.

Trace Hutchison, PharmD: No conflict of interest to report.

Julia Kirkwood, RN, BSN: No conflict of interest to report.

Jan Schultz, RN, MSN, CCMEP: No conflict of interest to report.

Rebecca Bachman, PhD: No conflict of interest to report.

Lyerka Miller, PhD: No conflict of interest to report.

METHOD OF PARTICIPATION
There are no fees for participating in and receiving CME credit for this activity. Participants must 1) read the learning objectives and faculty disclosures, 2) study the educational activity, 3) complete the post-test by recording the best answer to each question in the answer key on the evaluation form, 4) complete the evaluation form, and 5) submit the post-test and evaluation via the Internet. A statement of credit will be made available immediately upon successful completion of the post-test and evaluation. A statement of credit will be issued only upon receipt of a completed activity evaluation form and a post-test with a score of 70% or better. One retake is allowed.

MEDIA
Monograph

DISCLOSURE OF UNLABELED USE
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. PIM, MK Medical Communications, LLC, and Eisai Inc. do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, MK Medical Communications, LLC, or Eisai Inc. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

DISCLAIMER
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and for their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions, possible contraindications or dangers, applicable manufacturer's product information, and the recommendations of other authorities.

NOTE
The content of this activity was provided and factual accuracy confirmed by PIM. Applied Clinical Education (ACE) is responsible for review of the educational format and design only. Although the information included in this activity is believed to be true and accurate at the date of publication, ACE accepts no legal responsibility for any errors or omissions that may have been made. ACE makes no warranty, expressed or implied, with respect to material contained herein.

SOFTWARE REQUIREMENTS
PC
Microsoft Windows 2000 SE or above.
Internet Explorer (v5.5 or greater), or Firefox
Adobe Acrobat Reader*

MAC
MAC OS 10.2.8
Safari
Adobe Acrobat Reader*
Internet Explorer is not supported on the Macintosh.

* Required to view printable (PDF) version of the lesson.

This activity is jointly sponsored by Postgraduate Institute for Medicine and MK Medical Communications, LLC.