Cumulative incidence and risks factors for postoperative nausea and vomiting in adult patients undergoing cholecystectomy under balanced general anesthesia: a prospective cohort study
Keywords:
Postoperative nausea and vomiting, Incidence, Balanced anesthesia, Cholecystectomy, Risk factors
Abstract
Introduction: Postoperative nausea and vomiting (PONV) are common issues arising after general anesthesia, for which several independent risk factors have been described.
Objective: To determine the accumulated incidence of PONV during the first 24hours of the postoperative period.
Methods: A cohort observational, prospective study was conducted that included all the adults undergoing cholecystectomy under balanced general anesthesia at the EsSalud Talara Hospital from October 2014 until December 2016. The presence of PONV during the first 24hours after surgery was assessed, and univariate, bivariate, and logistic regression analyses were conducted.
Results: 244 patients were included, most of them with two risk factors in the Apfel scale, that represented an accumulated incidence of PONV of 0.51 (95% CI 0.45–0.57) during the observation period, notwithstanding the fact that 85.25% received antiemetic prophylaxis. The logistic regression analysis identified that being a female (OR 3.30, 95% CI 1.66–6.55, p=0.0007) and previous PONV or motion sickness (OR 2.67, 95% CI 1.25–5.68, p= 0.011) were independent risk factors for PONV. The administration of antiemetic prophylaxis and the presence of PONV (p=0.92) were found to be independent.
Conclusions: The high cumulative incidence of PONV could be the result of the type of surgery, the use of volatile anesthetic agents, and errors in the antiemetic pharmacological prophylaxis.
References
1. Dolin SJ, Cashman JN. Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritis, and urinary retention. Evidence from published data. Br J Anaesth 2005;95:584-591.
2. Hines R, Barash PG, Watrous G, et al. Complications occurring in the postanesthesia care unit: a survey. Anesth Analg 1992;74:503-509.
3. Apfel CC. Miller RD, Cohen NH, Eriksson LI, et al. Postoperative nausea and vomiting. Miller’s anesthesia 8th ed.Canada: Elsevier-Saunders; 2015.
4. Apfel CC, Heidrich FM, Jukar-Rao S, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 2012;109:742-753.
5. Veiga-Gil L, Pueyo J, López-Olaondo L. Postoperative nausea and vomiting: physiopathology, risk factors, prophylaxis and treat-ment. Rev Esp Anestesiol Reanim 2017;64:223-232.
6. Myles PS, Williams DL, Hendrata M, et al. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth 2000;84:6-10.
7. Macario A, Weinger M, Carney S, et al. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999;89:652-658.
8. Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery-a prospective study. Can J Anaesth 1998;45:612-619.
9. Gold BS, Kitz DS, Lecky JH, et al. Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989;262:3008-3010.
10. Palazzo MG, Strunin L. Anaesthesia and emesis. I: Etiology. Can Anaesth Soc J 1984;31:178-187.
11. Forrest JB, Cahalan MK, Rehder K, et al. Multicenter study of general anesthesia. II. Results. Anesthesiology 1990;72:262-268.
12. Schumann R, Polaner D. Massive subcutaneous emphysema and sudden airway compromise after postoperative vomiting. Anesth Analg 1999;89:796-797.
13. Bremner WG, Kumar CM. Delayed surgical emphysema, pneumomediastinum and bilateral pneumothoraces after postoperative vomiting. Br J Anaesth 1993;71:296-297.
14. Waters RW. Present status of cyclopropane. Br Med J 1936;2:1013-1017.
15. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 1992;77:162-184.
16. Cohen MM, Duncan PG, DeBoer DP, et al. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg 1994;78:7-16.
17. Gempeler Rueda FE, Miranda Pineda N, Garrido Hartmann A, et al. Incidence of Postoperative Nausea and Vomiting and Associated Factors in Hospital Universitario San Ignacio. Universitas Médica 2016;57:11-21.
18. Pérez CD, Nieto MCG. Náuseas y vómitos postoperatorios en anestesia general para intervención quirurgica electiva. Acta Med Cent 2017;11:39-48.
19. Patti CA, Vieira JE, Benseñor FE. Incidence and prophylaxis of nausea and vomiting in post-anesthetic recovery in a tertiary teaching hospital. Rev Bras Anestesiol 2008;58:466-469. 462-466.
20. Egoavil Santana JC, Ruiz Portilla S. Náuseas y vómitos postoperatorios en pacientes sometidos a colecistectomía laparoscópica vs. colecistectomía abierta en el Hospital Nacional Ramiro Prialé Prialé durante el año 2011”. Thesis Huancayo: Repositorio de la Universidad Nacional del Centro del Peru; 2012.
21. Apfel CC, Láárá E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999;91:693-700.
22. Wijeysundera DN, Sweitzer BJ. Miller RD, Cohen NH, Eriksson LI, et al. Preoperative evaluation. Miller’s anesthesia 8th ed.Canada: Elsevier-Saunders; 2015.
23. Apfel CC, Roewer N, Korttila K. How to study postoperative nausea and vomiting. Acta Anaesthesiol Scand 2002;46:921-928.
24. Boogaerts JG, Vanacker E, Seidel L, et al. Assessment of postoperative nausea using a visual analogue scale. Acta Anaesthesiol Scand 2000;44:470-474.
25. Apfel CC, Kranke P, Eberhart LH. Comparison of surgical site and patient’s history with a simplified risk score for the prediction of postoperative nausea and vomiting. Anaesthesia 2004;59:1078-1082.
26. Apfel CC, Kranke P, Eberhart HJ, et al. Comparison of predictive models for postoperative nausea and vomiting. Br J Anaesth 2002;88:234-240.
27. Habib AS, Chen YT, Taguchi A, et al. Postoperative nausea and vomiting following inpatient surgeries in a teaching hospital: a retrospective database analysis. Curr Med Res Opin 2006;22:1093-1099.
28. Doubravska L, Dostalova K, Fritscherova S, et al. Incidence of postoperative nausea and vomiting in patients at a university hospital. Where are we today? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2010;154:69-76.
29. Moreno C, Veiga D, Pereira H, et al. Postoperative nausea and vomiting: incidence, characteristics and risk factors-a prospective cohort study. Rev Esp Anestesiol Reanim 2013;60:249-256.
30. Morino R, Ozaki M, Nagata O, et al. Incidence of and risk factors for postoperative nausea and vomiting at a Japanese Cancer Center: first large-scale study in Japan. J Anesth 2013;27:18-24.
31. De Hert S, Staender S, Fritsch G, et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery. EurJ Anaesthesiol 2018;35:407-465.
32. Cao X, White PF, Ma H. An update on the management of postoperative nausea and vomiting. J Anesth 2017;31:617-626.
33. Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2014;118:85-113.
34. Peduzzi P, Concato J, Kemper E, et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996;49:1373-1379.
35. Morgan BW, Leifheit KM, Romero KM, et al. Low cigarette smoking prevalence in peri-urban Peru: results from a population-based study of tobacco use by self-report and urine cotinine. Tob Induc Dis 2017;15:32.
36. Comisión Nacional para el Desarrollo y Vida sin Droga- DEVIDA Estrategia Nacional de Lucha contra las Drogas 2017-2021. Lima: Editorial Super Gráfica. 2017. [Cited 2018 Nov 16]. Disponible at: http://www.devida.gob.pe/documents/20182/314196/Estrategia_FINAL_castellano2.pdf.
37. Scott LJ, Perry CM. Tramadol: a review of its use in perioperative pain. Drugs 2000;60:139-176.
2. Hines R, Barash PG, Watrous G, et al. Complications occurring in the postanesthesia care unit: a survey. Anesth Analg 1992;74:503-509.
3. Apfel CC. Miller RD, Cohen NH, Eriksson LI, et al. Postoperative nausea and vomiting. Miller’s anesthesia 8th ed.Canada: Elsevier-Saunders; 2015.
4. Apfel CC, Heidrich FM, Jukar-Rao S, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 2012;109:742-753.
5. Veiga-Gil L, Pueyo J, López-Olaondo L. Postoperative nausea and vomiting: physiopathology, risk factors, prophylaxis and treat-ment. Rev Esp Anestesiol Reanim 2017;64:223-232.
6. Myles PS, Williams DL, Hendrata M, et al. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth 2000;84:6-10.
7. Macario A, Weinger M, Carney S, et al. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999;89:652-658.
8. Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery-a prospective study. Can J Anaesth 1998;45:612-619.
9. Gold BS, Kitz DS, Lecky JH, et al. Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989;262:3008-3010.
10. Palazzo MG, Strunin L. Anaesthesia and emesis. I: Etiology. Can Anaesth Soc J 1984;31:178-187.
11. Forrest JB, Cahalan MK, Rehder K, et al. Multicenter study of general anesthesia. II. Results. Anesthesiology 1990;72:262-268.
12. Schumann R, Polaner D. Massive subcutaneous emphysema and sudden airway compromise after postoperative vomiting. Anesth Analg 1999;89:796-797.
13. Bremner WG, Kumar CM. Delayed surgical emphysema, pneumomediastinum and bilateral pneumothoraces after postoperative vomiting. Br J Anaesth 1993;71:296-297.
14. Waters RW. Present status of cyclopropane. Br Med J 1936;2:1013-1017.
15. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 1992;77:162-184.
16. Cohen MM, Duncan PG, DeBoer DP, et al. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg 1994;78:7-16.
17. Gempeler Rueda FE, Miranda Pineda N, Garrido Hartmann A, et al. Incidence of Postoperative Nausea and Vomiting and Associated Factors in Hospital Universitario San Ignacio. Universitas Médica 2016;57:11-21.
18. Pérez CD, Nieto MCG. Náuseas y vómitos postoperatorios en anestesia general para intervención quirurgica electiva. Acta Med Cent 2017;11:39-48.
19. Patti CA, Vieira JE, Benseñor FE. Incidence and prophylaxis of nausea and vomiting in post-anesthetic recovery in a tertiary teaching hospital. Rev Bras Anestesiol 2008;58:466-469. 462-466.
20. Egoavil Santana JC, Ruiz Portilla S. Náuseas y vómitos postoperatorios en pacientes sometidos a colecistectomía laparoscópica vs. colecistectomía abierta en el Hospital Nacional Ramiro Prialé Prialé durante el año 2011”. Thesis Huancayo: Repositorio de la Universidad Nacional del Centro del Peru; 2012.
21. Apfel CC, Láárá E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999;91:693-700.
22. Wijeysundera DN, Sweitzer BJ. Miller RD, Cohen NH, Eriksson LI, et al. Preoperative evaluation. Miller’s anesthesia 8th ed.Canada: Elsevier-Saunders; 2015.
23. Apfel CC, Roewer N, Korttila K. How to study postoperative nausea and vomiting. Acta Anaesthesiol Scand 2002;46:921-928.
24. Boogaerts JG, Vanacker E, Seidel L, et al. Assessment of postoperative nausea using a visual analogue scale. Acta Anaesthesiol Scand 2000;44:470-474.
25. Apfel CC, Kranke P, Eberhart LH. Comparison of surgical site and patient’s history with a simplified risk score for the prediction of postoperative nausea and vomiting. Anaesthesia 2004;59:1078-1082.
26. Apfel CC, Kranke P, Eberhart HJ, et al. Comparison of predictive models for postoperative nausea and vomiting. Br J Anaesth 2002;88:234-240.
27. Habib AS, Chen YT, Taguchi A, et al. Postoperative nausea and vomiting following inpatient surgeries in a teaching hospital: a retrospective database analysis. Curr Med Res Opin 2006;22:1093-1099.
28. Doubravska L, Dostalova K, Fritscherova S, et al. Incidence of postoperative nausea and vomiting in patients at a university hospital. Where are we today? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2010;154:69-76.
29. Moreno C, Veiga D, Pereira H, et al. Postoperative nausea and vomiting: incidence, characteristics and risk factors-a prospective cohort study. Rev Esp Anestesiol Reanim 2013;60:249-256.
30. Morino R, Ozaki M, Nagata O, et al. Incidence of and risk factors for postoperative nausea and vomiting at a Japanese Cancer Center: first large-scale study in Japan. J Anesth 2013;27:18-24.
31. De Hert S, Staender S, Fritsch G, et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery. EurJ Anaesthesiol 2018;35:407-465.
32. Cao X, White PF, Ma H. An update on the management of postoperative nausea and vomiting. J Anesth 2017;31:617-626.
33. Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2014;118:85-113.
34. Peduzzi P, Concato J, Kemper E, et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996;49:1373-1379.
35. Morgan BW, Leifheit KM, Romero KM, et al. Low cigarette smoking prevalence in peri-urban Peru: results from a population-based study of tobacco use by self-report and urine cotinine. Tob Induc Dis 2017;15:32.
36. Comisión Nacional para el Desarrollo y Vida sin Droga- DEVIDA Estrategia Nacional de Lucha contra las Drogas 2017-2021. Lima: Editorial Super Gráfica. 2017. [Cited 2018 Nov 16]. Disponible at: http://www.devida.gob.pe/documents/20182/314196/Estrategia_FINAL_castellano2.pdf.
37. Scott LJ, Perry CM. Tramadol: a review of its use in perioperative pain. Drugs 2000;60:139-176.
How to Cite
1.
Shiraishi-Zapata CJ, Arellano-Adrianzén SJ, Rodríguez-Velarde GJ. Cumulative incidence and risks factors for postoperative nausea and vomiting in adult patients undergoing cholecystectomy under balanced general anesthesia: a prospective cohort study. Colomb. J. Anesthesiol. [Internet]. 2020 Jan. 1 [cited 2024 Apr. 20];48(1):3-11. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/107
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2020-01-01
How to Cite
1.
Shiraishi-Zapata CJ, Arellano-Adrianzén SJ, Rodríguez-Velarde GJ. Cumulative incidence and risks factors for postoperative nausea and vomiting in adult patients undergoing cholecystectomy under balanced general anesthesia: a prospective cohort study. Colomb. J. Anesthesiol. [Internet]. 2020 Jan. 1 [cited 2024 Apr. 20];48(1):3-11. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/107
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