Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.06.007
Brazilian Journal of Anesthesiology
Original Investigation

Impact of extending prevention of postoperative nausea and vomiting for cancer surgical patients in the PACU: a before and after retrospective study

Impacto da extensão da prevenção de náuseas e vômitos pós-operatórios para pacientes cirúrgicos oncológicos na SRPA: um estudo retrospectivo antes e depois

Cyrus Motamed; Grégoire Weil; Jean Louis Bourgain

Downloads: 0
Views: 1023

Abstract

Backgrounds
Procedures for Postoperative Nausea and Vomiting (PONV) prevention are mostly based on identification of the risk factors before administering antiemetic drugs. The purpose of this study was to evaluate the impact of the extended use of antiemetic on the PONV in the Post Anesthetic Care Unit (PACU).

Methods
Two separate four-year periods (2007–2010) (P1) and (2015–2018) (P2) were evaluated. During P1, the protocol consisted of dexamethasone and droperidol for patients with a locally adapted high PONV score, followed by ondansetron for rescue in the PACU. For Period 2, dexamethasone (8 mg) and ondansetron (4 mg) were administered in patients under general or regional anesthesia, or sedation longer than 30 min, while droperidol (1.25 mg) in rescue was injected in cases of PONV in the PACU. An Anesthesia Information Management System was used to evaluate the intensity score of PONV (1 to 5), putative compliance, sedation, and perioperative opioid consumption upon arrival in the PACU.

Results
A total of 27,602 patients were assessed in P1 and 36,100 in P2. The administration of dexamethasone and ondansetron increased several fold (p < 0.0001). The high PONV scores were more improved in P2 than in P1, with scores (3+4+5) for P1 vs. P2, p < 0.0001. Overall, 99.7% of the patients in P2 were asymptomatic at discharge. Morphine consumption decreased from 6.9±1.5 mg in P1 to 3.5 ± 1.5 mg in P2 (p < 0.0001).

Discussion
The extension of pharmacological prevention of PONV was associated with a decrease in the intensity of severe PONV. However, uncertainty regarding confounding factors should not be ignored.

IRB
nº 92012/33465

Keywords

Postoperative nausea and vomiting

Resumo

Justificativa: Os procedimentos de prevenção de náuseas e vômitos pós-operatórios (NVPO) baseiam-se principalmente na identificação dos fatores de risco antes da administração de antieméticos. O objetivo deste estudo foi avaliar o impacto do uso prolongado de antiemético na NVPO na unidade de recuperação pós-anestésica (SRPA). Métodos: Dois períodos separados de quatro anos (2007–2010) (P1) e (2015–2018) (P2) foram avaliados. Durante o P1, o protocolo consistiu em dexametasona e droperidol para pacientes com NVPO localmente adaptado, seguido de ondansetron para resgate na SRPA. Para o Período 2, dexametasona (8 mg) e ondansetrona (4 mg) foram administrados em pacientes sob anestesia geral ou regional, ou sedação por mais de 30 min, enquanto droperidol (1,25 mg) em resgate foi injetado em casos de NVPO na SRPA. Um Sistema de Gerenciamento de Informações Anestésicas foi usado para avaliar o escore de intensidade de NVPO (1 a 5), complacência putativa, sedação e consumo de opioides perioperatórios na chegada à SRPA. Resultados: Foram avaliados 27.602 pacientes em P1 e 36.100 em P2. A administração de dexametasona e ondansetrona aumentou várias vezes (p < 0,0001). Os altos escores de NVPO foram mais melhorados em P2 do que em P1, com escores (3+4+5) para P1 vs. P2, p < 0,0001. No geral, 99,7% dos pacientes em P2 eram assintomáticos na alta. O consumo de morfina diminuiu de 6,9±1,5 mg em P1 para 3,5±1,5 mg em P2 (p < 0,0001). Discussão: A extensão da prevenção farmacológica de NVPO foi associada à diminuição da intensidade de N

Palavras-chave

Idade; Idoso; Transplante de fígado; Complicações pósoperatórias.

References

1 K. Sridharan, G. Sivaramakrishnan Drugs for preventing post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: network meta-analysis of randomized clinical trials and trial sequential analysis Int J Surg., 69 (2019), pp. 1-12

2 A.L. Ngo, V. Orhurhu, I. Urits, et al. Extended release granisetron: review of pharmacologic considerations and clinical role in the perioperative setting Saudi J Anaesth., 13 (2019), pp. 231-236

3 S. Jeyabalan, S.M. Thampi, R. Karuppusami, K. Samuel Comparing the efficacy of aprepitant and ondansetron for the prevention of Postoperative Nausea and Vomiting (PONV): a double blinded, randomised control trial in patients undergoing breast and thyroid surgeries Indian J Anaesth., 63 (2019), pp. 289-294

4 M.M. Hossain, M. Begum, M.M. Hossain, et al. Efficacy of palonosetron as antiemetic prophylaxis for post operative patients Mymensingh Med J., 28 (2019), pp. 222-229

5 L.C. de Morais, A.M. Sousa, G.F. Flora, T.R. Grigio, G.M.N. Guimaraes, H.A. Ashmawi Aprepitant as a fourth antiemetic prophylactic strategy in high-risk patients: a double-blind, randomized trial Acta Anaesthesiol Scand., 62 (2018), pp. 483-492

6 C Motamed, JL Bourgain Benefits and possible improvements of an anaesthesia information management system in a quality assurance programme Br J Anaesth, 113 (2014), pp. 885-886

7 C Motamed, JL Bourgain Postoperative nausea and vomiting in the post-anesthetic care unit, a 5-year survey of a quality assurance program in surgical cancer patients Bull Cancer, 102 (2015), pp. 405-410

8 J.L. Apfelbaum, J.H. Silverstein, F.F. Chung, et al. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care Anesthesiology., 118 (2013), pp. 291-307

9 P Bailey, PF White Droperidol editorial: making a mountain out of a mole hill! Anesthesiology, 99 (2003), pp. 760-761 author reply 1

10 B. Charbit, P. Albaladejo, C. Funck-Brentano, M. Legrand, E. Samain, J. Marty Prolongation of QTc interval after postoperative nausea and vomiting treatment by droperidol or ondansetron Anesthesiology., 102 (2005), pp. 1094-1100

11 B. Charbit, J.C. Alvarez, E. Dasque, E. Abe, J.L. Demolis, C. Funck-Brentano Droperidol and ondansetron-induced QT interval prolongation: a clinical drug interaction study Anesthesiology., 109 (2008), pp. 206-212

12 K Kolodzie, CC Apfel Nausea and vomiting after office-based anesthesia Curr Opin Anaesthesiol., 22 (2009), pp. 532-538

13 G. Dewinter, W. Staelens, E. Veef, A. Teunkens, M. Van de Velde, S. Rex Simplified algorithm for the prevention of postoperative nausea and vomiting: a before-and-after study Br J Anaesth., 120 (2018), pp. 156-163

14 C.C. Apfel, E. Laara, M. Koivuranta, C.A. Greim, N. Roewer A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers Anesthesiology., 91 (1999), pp. 693-700

15 C.C. Apfel, K. Stoecklein, P Lipfert PONV: a problem of inhalational anaesthesia? Best Pract Res Clin Anaesthesiol, 19 (2005), pp. 485-500

16 A.S. Arif, A.D. Kaye, E. Frost Postoperative nausea and vomiting—a review Middle East J Anaesthesiol., 16 (2001), pp. 127-154

17 S.J. Collins, A.L. Robinson, H.F. Holland A comparison between total intravenous anaesthesia using a propofol/alfentanil mixture and an inhalational technique for laparoscopic gynaecological sterilization Eur J Anaesthesiol., 13 (1996), pp. 33-37

18 F. Camu, M.H. Lauwers, D. Verbessem Incidence and aetiology of postoperative nausea and vomiting Eur J Anaesthesiol., 6 (1992), pp. 25-31

19 GN Kenny Risk factors for postoperative nausea and vomiting Anaesthesia. (49 Suppl) (1994), pp. 6-10

20 C Motamed, JL Bourgain Trend of analgesic consumption and pain scores in the post anesthetic care unit (A 9-year survey in surgical cancer patients) Bull Cancer., 9 (2011), pp. E90-E94

21 F. Aubrun, C. Ecoffey, D. Benhamou, et al. Perioperative pain and post-operative nausea and vomiting (PONV) management after day-case surgery: The SFAR-OPERA national study Anaesth Crit Care Pain Med., 38 (2019), pp. 223-229
 

60e70046a9539509e25f4b84 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections