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
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
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
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References
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