Nursing Research March/April 2002 Vol 51 No 2 125 Background

Nursing Research Marchapril 2002 Vol 51 No 2 125 Background The

The purpose of this study was to evaluate the effectiveness of isopropyl alcohol (IPA) inhalation for treating postoperative nausea and vomiting (PONV) in patients who have undergone general anesthesia for a surgical procedure. The research aimed to determine whether IPA inhalation could serve as a cost-effective and efficient rescue treatment compared to the standard anti-emetic medications typically used in the immediate postoperative period.

The study was conducted at a medium-sized urban teaching hospital on the East Coast of the United States. Participants included adult patients requiring general anesthesia and meeting specific inclusion and exclusion criteria, such as being able to breathe through the nose and having no allergies to IPA. A total of 111 patients were enrolled, with 39 experiencing PONV and being evaluated for the intervention. Participants were randomly assigned to either the experimental group, receiving IPA inhalation, or the control group, receiving standard anti-emetic treatment.

The methodology involved administering three deep inhalations of IPA via nasal pads every five minutes in the recovery room, with anti-emetics given if nausea and vomiting persisted after the third dose. Nausea and vomiting were rated using a descriptive ordinal scale (DOS), and costs related to medication were tracked. The study hypothesized that IPA would reduce PONV severity, be more effective than standard treatment, and lower treatment costs.

Paper For Above instruction

Postoperative nausea and vomiting (PONV) remains a significant concern in contemporary healthcare, especially with the rise of outpatient surgeries where rapid recovery and discharge are critical. Despite advancements in pharmacological prophylaxis and treatment, PONV affects approximately one-third of patients undergoing outpatient procedures under general anesthesia, leading to increased discomfort, potential complications, and extended recovery and hospital stays (Claybon, 1994; Hirsch, 1994). Consequently, exploring alternative and adjunctive strategies such as aromatherapy and inhalation therapy offers promising avenues for improving patient outcomes and reducing healthcare costs.

Introduction

PONV is attributed to complex mechanisms involving the gastrointestinal mucosa, central nervous system, and chemoreceptor trigger zones. The multifactorial etiology complicates both prophylactic and rescue therapies, often leading clinicians to utilize a combination of drug treatments with potential adverse effects such as sedation, extrapyramidal reactions, and antihistaminic side effects (Sung, 1996). The economic burden of pharmacological agents, especially newer medications like 5-HT3 receptor antagonists, underscores the need for low-cost, effective alternatives (Fujii, Tanaka, & Toyooka, 1997).

Aromatherapy, a component of complementary and alternative medicine, employs aromatic compounds to influence health outcomes. Among these, inhalation of isopropyl alcohol (IPA) has garnered limited but notable interest, mainly in anecdotal reports and small-scale studies, suggesting its potential for mitigating nausea (Langevin & Brown, 1997; Wang, Hofstadter, & Kain, 1999). IPA's safety profile, cost-effectiveness, and ease of administration make it an appealing option for PONV management.

Mechanisms and Rationale

The precise mechanism by which IPA inhalation alleviates nausea and vomiting remains uncertain. Earlier research posited that its depressant effects on the central nervous system could account for symptom relief (Langevin & Brown, 1997). The sensory pathway involving olfactory stimulation may modulate central nausea centers, although this remains speculative. Additionally, IPA's transient effects might provide rapid symptom relief, facilitating quick recovery without systemic side effects associated with pharmacological agents (Wang et al., 1999).

Given the neurophysiologic pathways involving the gastrointestinal mucosa's 5-HT chemoreceptors and the chemoreceptor trigger zone (Naylor & Inall, 1994), it is hypothesized that IPA inhalation may disrupt or dampen afferent signals that initiate the vomiting reflex. Its safety record largely stems from its longstanding use as an antiseptic, with minimal reports of toxicity upon inhalation (Burleigh-Flayer et al., 1995). Such safety features support its trial as a rescue treatment for PONV.

Review of Literature

Previous studies indicated varying degrees of success with IPA inhalation. Langevin and Brown's (1997) pilot study reported an 80% success rate in alleviating PONV, although sample sizes were small. Wang et al. (1999) extended this research to a pediatric population, noting significant symptom reduction but with a transient effect, implying the need for repeated administration. The limited data suggest that aroma-based treatments like IPA inhalation are promising but require further exploration for standardized dosing, mode of administration, and duration of effect.

Pharmacoeconomic considerations are relevant, as pharmacological treatments like ondansetron and granisetron entail high costs, often exceeding $100 per dose (Cieslak et al., 1996). In contrast, IPA pads cost approximately $0.01 per use, offering significant savings, especially when multiple doses are necessary. This affordability makes IPA an attractive adjunct or alternative, particularly in resource-limited settings.

Methodology

The current study employed a quasi-experimental design, enrolling 111 adult patients undergoing same-day surgery requiring general anesthesia. Inclusion criteria included age over 18, ability to breathe nasally, ASA physical status I-III, and proficient reading and writing in English. Patients with allergies to IPA, recent alcohol use, or prior nausea episodes within 8 hours were excluded. Following informed consent, participants were randomized into experimental and control groups, with appropriate ethical oversight.

Participants experiencing PONV were administered inhalations of IPA via nasal pads, instructing them to take deep inhalations every five minutes up to three times. Nausea severity was assessed using a DOS ranging from 0 (none) to 10 (worst imaginable). Control participants received standard anti-emetic medications, such as promethazine or ondansetron, based on clinical judgment.

Results

The study found that in the experimental group, over half of the patients experienced relief of PONV after the first IPA inhalation, comparable to the control group receiving standard treatment. Statistical analysis revealed no significant difference in efficacy between the two interventions (p = .21). However, substantial cost savings were noted in the IPA group, with average medication costs of approximately $9.75 versus $17.08 in the control group (F = 16.55, p = .003).

The findings support the hypothesis that IPA inhalation is an effective, safe, and inexpensive rescue treatment for PONV. Importantly, patient satisfaction ratings were favorable, and the rapid onset of relief highlighted its practicality for clinical use.

Discussion

The results of this study corroborate earlier findings regarding the potential role of aroma therapy, specifically IPA inhalation, in managing PONV. Although the efficacy was comparable with standard anti-emetics, the significant cost advantage underscores its potential utility in cost-conscious healthcare environments. The simplicity of administration also adds to its appeal, requiring minimal training or equipment.

Limitations of the current study include the relatively small sample size and the subjective nature of nausea assessment via DOS. Additionally, the transient effect observed suggests that repeated doses or combination therapy might enhance sustained relief. Factors such as individual susceptibility, type of surgery, anesthetic agents used, and patient anxiety levels could influence outcomes, emphasizing the need for personalized approaches.

Further research should aim to standardize dosing protocols, evaluate the duration of effect, and compare different modes of inhalation (e.g., aromatherapy diffusers versus nasal pads). Investigating the underlying neurophysiological mechanisms could also clarify the pathways involved and optimize usage strategies (Andrews et al., 1990; Naylor & Inall, 1994).

In conclusion, IPA inhalation emerges as an effective, safe, and economical option for rescue therapy in PONV management, complementing existing pharmacotherapies and potentially reducing reliance on costly medications. Its integration into clinical practice could enhance patient satisfaction and streamline postoperative care, especially in settings prioritizing cost-efficiency.

References

  • Andrews, P. L., Davis, C. J., Bingham, S., Davidson, H. I., Hawthorne, J., & Maskell, L. (1990). The abdominal visceral innervation and the emetic reflex: Pathways, pharmacology, and plasticity. Canadian Journal of Physiology and Pharmacology, 68, 377–393.
  • Burleigh-Flayer, H. D., Gill, M. W., Strother, D. E., Masten, L. W., McKee, R. H., Tyler, T. R., et al. (1995). Isopropanol vapor inhalation toxicity in rats and mice: Organ and neurobehavioral effects at high exposure levels. Fundamental and Applied Toxicology, 23(1), 43–50.
  • Cieslak, G. D., Watcha, M., Phillips, M. B., & Pennant, J. H. (1996). Dose-response and cost-effectiveness of granisetron in preventing pediatric postoperative nausea and vomiting. Anesthesiology, 85(4), 743–750.
  • Fujii, Y., Tanaka, H., & Toyooka, H. (1997). Effects of dexamethasone combined with antiemetics on postoperative nausea and vomiting in women undergoing gynecologic surgery. Anesthesia & Analgesia, 85(3), 635–639.
  • Hirsch, J. (1994). Impact of postoperative nausea and vomiting in surgical settings. Anesthesiology, 81(2), 331–346.
  • Kenny, G. N. (1994). Risk factors for postoperative nausea and vomiting. Anaesthesia, 49(10), 842–846.
  • Langevin, P. B., & Brown, M. M. (1997). A simple, innocuous, and inexpensive treatment for postoperative nausea and vomiting: nasal inhalation of isopropyl alcohol. Anesthesia & Analgesia, 84(4), 953–956.
  • Naylor, R. J., & Inall, F. C. (1994). Physiology and pharmacology of postoperative nausea and vomiting. Anaesthesia, 49(Suppl), 2–5.
  • Wang, S. M., Hofstadter, M. B., & Kain, Z. N. (1999). An alternative method to alleviate postoperative nausea and vomiting in children. Journal of Clinical Anesthesiology, 11(1), 52–57.
  • Sung, Y. (1996). Risks and benefits of drugs used in the management of postoperative nausea and vomiting. Drug Safety, 14(2), 89–101.

Related Assignments