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Postoperative nausea and vomiting low in fast track cardiac anaesthesia

Postoperative nausea and vomiting low in fast track cardiac anaesthesia

The incidence of postoperative nausea and vomiting (PONV) is relatively low after fast-track cardiac anaesthesia (FTCA) in the first 24-48 hours in the cardiac intensive care unit (CICU) after open-heart surgery. The prophylactic administration of antiemetic drug before anaesthesia or after extubation is not necessary.

These are the results of a new study published in the Brazilian Journal of Cardiovascular Surgery. 

Emad Mohamed Hijaz, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan, and colleagues conducted the study to evaluate the incidence of PONV after fast-track cardiac anaesthesia in the first 24-48 hours in the CICU after open-heart surgery, risk factors for PONV and its influence on CICU length of stay.

“Postoperative nausea and vomiting (PONV) is defined as any nausea, retching, or vomiting occurring for the first 24-48 hours after surgery in inpatients. The incidence of PONV is about 30% in all post-surgical patients and up to 80% in high-risk patients, it is one of the most common causes of patient dissatisfaction after anesthesia,” write the authors.

The research team performed a prospective observational study from January 1, 2013, to the end of December 2015 in the CICU of a university hospital in the north of Jordan and Queen Alia Heart Institute, Amman, Jordan. Three hundred consecutive patients undergoing fast-track cardiac anaesthesia in elective cardiac surgery were enrolled in the study. Nausea and vomiting were assessed after tracheal extubation, which was performed within 6-10 hours after surgery and during the first 24-48 hours in the CICU.

Metoclopramide 10 mg intravenously was used as the initial antiemetic drug, but ondansetron 4 mg intravenously was also used as the second line of management.

Key Findings:

  • Nausea was reported in 46 (15.3%) patients, and vomiting in 31 (10.3%).
  • Among males, 8 (4.3%) patients developed nausea and 11 (5.9%) developed vomiting.
  • The rates of nausea and vomiting were significantly higher among females compared to males.
  • Sixty-five (21.6%) patients were treated successfully with metoclopramide and in only 12 (4%) metoclopramide failed to manage their symptoms within the first hour of administration but responded well to ondansetron.
  • Female patients and a patient under 60 were more likely to develop postoperative nausea and vomiting and did not prolong CICU stay.

“In our study, the incidence of PONV is relatively low after cardiac anesthesia and the prophylactic administration of antiemetic drug before anesthesia or after extubation is not necessary,” concluded the authors.

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Source: With inputs from Brazilian Journal of Cardiovascular Surgery

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