Post‐operative nausea and vomiting in bariatric surgery patients: an observational study

Halliday, T. A.; Sundqvist, J.; Hultin, M.; Walldén, J.

doi:10.1111/aas.12884

Post‐operative nausea and vomiting in bariatric surgery patients: an observational study

Journal Article · Mon Apr 03 00:00:00 EDT 2017 · Acta Anaesthesiologica Scandinavica

DOI:https://doi.org/10.1111/aas.12884· OSTI ID:1400624

Halliday, T. A. ^[1]; Sundqvist, J. ^[1]; Hultin, M. ^[2]; ^[1]

Department of Surgical and Perioperative Sciences Anesthesiology and Intensive Care Sundsvall Umeå University Sundsvall Sweden
Department of Surgical and Perioperative Sciences Anesthesiology and Intensive Care Sunderbyn Umeå University Luleå Sweden

Background

The risk of post‐operative nausea and vomiting (PONV) in patients undergoing bariatric surgery is unclear. The aim of the study was to investigate the risk of PONV and the use and effectiveness of PONV prophylaxis.

Methods

This prospective observational study included 74 patients undergoing bariatric surgery with total intravenous anaesthesia. Patients were given PONV prophylaxis based on published guidelines and a simplified PONV risk score. Perioperative data were collected and a questionnaire was used at 2, 4, 6, 24, 48 and 72 h after the operation to evaluate PONV. Data are presented as risk (%) with the 95% confidence interval.

Results

Sixty five per cent (54–75) of the patients experienced PONV in the first 24 post‐operative hours and the risk increased with the number of risk factors for PONV. PONV occurred in 78% (66–87) of women and 26% (12–49) of men during the first 24 h. In relation to the guidelines, one patient received suboptimal PONV prophylaxis, 23% received optimal prophylaxis and 76% supra‐optimal prophylaxis. The risk of PONV was 82% (59–94) with optimal prophylaxis and 59% (46–71) with supra‐optimal prophylaxis. Of all patients, 34% (24–45) experienced severe PONV in the first 24 h that limited their activity.

Conclusions

The incidence of PONV in bariatric surgery patients was high despite a PONV prophylaxis regime following current guidelines. These results cast doubt as to the effectiveness of the usual PONV prophylaxis in this patient group and point to the need for further investigation of PONV prophylaxis and treatment in bariatric surgery patients.

View Accepted Manuscript (Publisher)

Sponsoring Organization:: USDOE

OSTI ID:: 1400624

Journal Information:: Acta Anaesthesiologica Scandinavica, Journal Name: Acta Anaesthesiologica Scandinavica Journal Issue: 5 Vol. 61; ISSN 0001-5172

Publisher:: Wiley-BlackwellCopyright Statement

Country of Publication:: Denmark

Language:: English

References (24)

Pulmonary Function Testing and Complications of Laparoscopic Bariatric Surgery van Huisstede, Astrid; Biter, Laser Ulas; Luitwieler, Ronald Obesity Surgery, Vol. 23, Issue 10 https://doi.org/10.1007/s11695-013-0928-9	journal	March 2013
National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants Finucane, Mariel M.; Stevens, Gretchen A.; Cowan, Melanie J. The Lancet, Vol. 377, Issue 9765 https://doi.org/10.1016/S0140-6736(10)62037-5	journal	February 2011
Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting Horn, Charles C.; Wallisch, William J.; Homanics, Gregg E. European Journal of Pharmacology, Vol. 722 https://doi.org/10.1016/j.ejphar.2013.10.037	journal	January 2014
Studies Comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for Assessment of Pain Intensity in Adults: A Systematic Literature Review Hjermstad, Marianne Jensen; Fayers, Peter M.; Haugen, Dagny F. Journal of Pain and Symptom Management, Vol. 41, Issue 6 https://doi.org/10.1016/j.jpainsymman.2010.08.016	journal	June 2011
Multimodal analgesia reduces narcotic requirements and antiemetic rescue medication in laparoscopic Roux-en-Y gastric bypass surgery Ziemann-Gimmel, Patrick; Hensel, Priscilla; Koppman, John Surgery for Obesity and Related Diseases, Vol. 9, Issue 6 https://doi.org/10.1016/j.soard.2013.02.003	journal	November 2013
A Factorial Trial of Six Interventions for the Prevention of Postoperative Nausea and Vomiting Apfel, Christian C.; Korttila, Kari; Abdalla, Mona New England Journal of Medicine, Vol. 350, Issue 24 https://doi.org/10.1056/NEJMoa032196	journal	June 2004
Single-dose aprepitant vs ondansetron for the prevention of postoperative nausea and vomiting: a randomized, double-blind Phase III trial in patients undergoing open abdominal surgery † Diemunsch, P.; Gan, T. J.; Philip, B. K. British Journal of Anaesthesia, Vol. 99, Issue 2 https://doi.org/10.1093/bja/aem133	journal	August 2007
Simplified postoperative nausea and vomiting impact scale for audit and post-discharge review Myles, P. S.; Wengritzky, R. British Journal of Anaesthesia, Vol. 108, Issue 3 https://doi.org/10.1093/bja/aer505	journal	March 2012
Evidence-based analysis of risk factors for postoperative nausea and vomiting † Apfel, C. C.; Heidrich, F. M.; Jukar-Rao, S. British Journal of Anaesthesia, Vol. 109, Issue 5 https://doi.org/10.1093/bja/aes276	journal	November 2012
Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis Ziemann-Gimmel, P.; Goldfarb, A. A.; Koppman, J. British Journal of Anaesthesia, Vol. 112, Issue 5 https://doi.org/10.1093/bja/aet551	journal	May 2014
Impact of adding therapeutic recommendations to risk assessments from a prediction model for postoperative nausea and vomiting † Kappen, T. H.; Vergouwe, Y.; van Wolfswinkel, L. British Journal of Anaesthesia, Vol. 114, Issue 2 https://doi.org/10.1093/bja/aeu321	journal	February 2015
Postoperative Nausea and Vomiting: Its Etiology, Treatment, and Prevention Watcha, Mehernoor F.; White, Paul F. Anesthesiology, Vol. 77, Issue 1 https://doi.org/10.1097/00000542-199207000-00023	journal	January 1992
A Simplified Risk Score for Predicting Postoperative Nausea and Vomiting: Conclusions from Cross-validations between Two Centers Apfel, Christian C.; Läärä, Esa; Koivuranta, Merja Anesthesiology, Vol. 91, Issue 3 https://doi.org/10.1097/00000542-199909000-00022	journal	January 1999
Impact of Risk Assessments on Prophylactic Antiemetic Prescription and the Incidence of Postoperative Nausea and Vomiting: A Cluster-randomized Trial Kappen, Teus H.; Moons, Karel G. M.; van Wolfswinkel, Leo Anesthesiology, Vol. 120, Issue 2 https://doi.org/10.1097/ALN.0000000000000009	journal	January 2014
Impact of a prophylactic combination of dexamethasone–ondansetron on postoperative nausea and vomiting in obese adult patients undergoing laparoscopic sleeve gastrectomy during closed-loop propofol–remifentanil anaesthesia: A randomised double-blind placebo-controlled study Bataille, Aurélien; Letourneulx, Jacques-Florian; Charmeau, Alain European Journal of Anaesthesiology, Vol. 33, Issue 12 https://doi.org/10.1097/EJA.0000000000000427	journal	January 2016
Validation of a prediction model for post-discharge nausea and vomiting after general anaesthesia in a cohort of Swedish ambulatory surgery patients Walldén, Jakob; Flodin, Jesper; Hultin, Magnus European Journal of Anaesthesiology, Vol. 33, Issue 10 https://doi.org/10.1097/EJA.0000000000000473	journal	January 2016
Predictive risk scores for post-discharge nausea and vomiting: Simple lessons learned for improving clinical practice Jelting, Yvonne; Eberhart, Leopold; Kranke, Peter European Journal of Anaesthesiology, Vol. 33, Issue 10 https://doi.org/10.1097/EJA.0000000000000515	journal	January 2016
Dexamethasone for postoperative nausea and vomiting prophylaxis: effect on glycaemia in obese patients with impaired glucose tolerance Nazar, Claudio E.; Lacassie, Héctor J.; López, Rodrigo A. European Journal of Anaesthesiology, Vol. 26, Issue 4 https://doi.org/10.1097/EJA.0b013e328319c09b	journal	January 2009
Effective management of postoperative nausea and vomiting: let us practise what we preach! Kranke, Peter European Journal of Anaesthesiology, Vol. 28, Issue 3 https://doi.org/10.1097/EJA.0b013e3283435e51	journal	January 2011
Possibilities and limitations in the pharmacological management of postoperative nausea and vomiting Kranke, Peter; Eberhart, Leopold H. J. European Journal of Anaesthesiology, Vol. 28, Issue 11 https://doi.org/10.1097/EJA.0b013e32834a4e1e	journal	January 2011
Effects of fentanyl on gastric myoelectrical activity: a possible association with polymorphisms of the μ-opioid receptor gene?: Effects of Fentanyl on EGG WalldÉN, J.; Lindberg, G.; Sandin, M. Acta Anaesthesiologica Scandinavica, Vol. 52, Issue 5 https://doi.org/10.1111/j.1399-6576.2008.01624.x	journal	April 2008
A Randomized, Double-Blind Comparison of the NK1 Antagonist, Aprepitant, Versus Ondansetron for the Prevention of Postoperative Nausea and Vomiting Gan, Tong J.; Apfel, Christian C.; Kovac, Anthony Anesthesia & Analgesia, Vol. 104, Issue 5 https://doi.org/10.1213/01.ane.0000263277.35140.a3	journal	January 2007
Consensus Guidelines for the Management of Postoperative Nausea and Vomiting Gan, Tong J.; Diemunsch, Pierre; Habib, Ashraf S. Anesthesia & Analgesia, Vol. 118, Issue 1 https://doi.org/10.1213/ANE.0000000000000002	journal	January 2014
Peripherally Acting Mu-Opioid Receptor Antagonists and Postoperative Ileus: Mechanisms of Action and Clinical Applicability Viscusi, Eugene R.; Gan, Tong J.; Leslie, John B. Anesthesia & Analgesia, Vol. 108, Issue 6 https://doi.org/10.1213/ane.0b013e31819e0d3a	journal	January 2009

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