Incidence and predictors of postoperative nausea and vomiting in children undergoing electrophysiology ablation procedures

Lee, Ye; Banooni, Andrew; Yuki, Koichi; Staffa, Steven J.; DiNardo, James A.; Brown, Morgan L.

doi:10.1111/pan.13797

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…Although we expected that subanesthetic propofol could also prevent POV, there was no significant difference in the incidence of POV between the combination and sevoflurane groups. Several studies reported an association of subanesthetic propofol infusion in children with a lower incidence of POV, particularly early POV [ 11 , 26 ]. Our study also suggested a potential preventive effect of subanesthetic propofol infusion with the point estimate of the OR for early POV being less than one; however, this association lacked statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…The main exposure was the anesthesia maintenance methods: sevoflurane alone (sevoflurane group) or subanesthetic propofol infusion with sevoflurane (combination group). We defined a subanesthetic propofol infusion as an infusion of 6 mg/kg/h or less [ 11 ]. The following patient data were collected from the medical records: age, sex, body weight, American Society of Anesthesiologists physical status, comorbidities, history of motion sickness or POV, surgical procedures, premedication, anesthesia induction, perioperatively administered drugs and their dosages, anesthesia and surgical times, duration of recovery room stay, and attending anesthesiologists.…”

Section: Methodsmentioning

confidence: 99%

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Subanesthetic-dose propofol infusion for preventing emergence agitation in children: a retrospective observational study

2023

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Purpose Anesthesia maintenance using propofol and a propofol bolus dose at the end of surgery have been shown to prevent emergence agitation (EA). However, the preventive effect of subanesthetic propofol infusion during sevoflurane anesthesia on EA remains unknown. We aimed to evaluate the effect of subanesthetic propofol infusion on EA in children. Methods We retrospectively compared the incidences of severe EA requiring pharmacological intervention in children who underwent adenoidectomy, tonsillectomy with or without adenoidectomy, or strabismus surgery between maintenance with sevoflurane alone (sevoflurane group) and maintenance with subanesthetic propofol with sevoflurane (combination group). A multivariable logistic regression model adjusted for confounders was used to assess the association between anesthesia methods and the occurrence of EA. Additionally, we estimated the direct effect of anesthesia methods by a mediation analysis, excluding the indirect effects of intraoperative fentanyl and droperidol administration. Results Among 244 eligible patients, 132 and 112 were in the sevoflurane and combination groups, respectively. The crude incidence of EA was significantly lower in the combination group (17.0% [ n = 19]) than in the sevoflurane group (33.3% [ n = 44]) ( P = 0.005). After adjusting for confounders, the incidence of EA was still significantly lower in the combination group (adjusted odds ratio [aOR]: 0.48, 95% confidence interval [CI] 0.25–0.91). The mediation analysis revealed a direct association of anesthesia methods with a lower EA incidence in the combination group (aOR: 0.48, 95% CI 0.24–0.93) than in the sevoflurane group. Conclusion Subanesthetic propofol infusion may effectively prevent severe EA requiring the administration of opioids or sedatives.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Subanesthetic-dose propofol infusion for preventing emergence agitation in children: a retrospective observational study

2023

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“…On the first and second postoperative day, the occurrence of PONV with 3.8% (n = 12) and 3.6% (n = 7) frequency, respectively, no longer played a major role. Many of the previous studies on the issue of POV/PONV in children evaluated the impact of predictors mostly in the post-anesthetic care unit (40, 41) and within 24 h following the administration of general anesthesia (6,9,26,(42)(43)(44)(45)(46)(47)(48)(49)(50). Data up to 48 h are rare (51), particularly in pediatric inpatients and after general surgery.…”

Section: Discussionmentioning

confidence: 99%

Is PONV still a problem in pediatric surgery: a prospective study of what children tell us

Messerer,

Stijic,

Sandner-Kiesling

et al. 2023

Front. Pediatr.

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BackgroundPostoperative nausea and vomiting (PONV) is an unpleasant complication after surgery that commonly co-occurs with pain. Considering the high prevalence among pediatric patients, it is important to explore the main risk factors leading to PONV in order to optimize treatment strategies. The objectives of this study are as follows: (1) to determine the prevalence of PONV on the day of surgery by conducting interviews with pediatric patients, (2) to assess PONV prevalence in the recovery room and on the ward by analyzing nursing records, and (3) to collect information on PONV risk factors on the day of surgery and the following postoperative days. We wanted to investigate real-life scenarios rather than relying on artificially designed studies.MethodsA prospective analysis [according to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines] of PONV on the day of surgery and the following postoperative days was conducted by evaluating demographic and procedural parameters, as well as conducting interviews with the children under study. A total of 626 children and adolescents, ranging in age from 4 to 18 years, were interviewed on the ward following their surgery. The interviews were conducted using a questionnaire, as children aged 4 and above can participate in an outcome-based survey.ResultsOn the day of surgery, several multivariable independent predictors were identified for PONV. The type of surgery was found to be a significant factor (p = 0.040) with the highest odds ratio (OR) in patients with procedural investigations [OR 5.9, 95% confidence interval (CI): 1.8–19.2], followed by abdominal surgery (OR 3.1, 95% CI: 0.9–11.1) when inguinal surgery was used as the reference category. In addition, the study identified several predictors, including the amount of fentanyl administered during anesthesia (µg/kg body weight) (OR 1.4, 95% CI: 1.1–1.8), intraoperative use of piritramide (OR 2.6, 95% CI: 1.5–4.4) and diclofenac (OR 2.0, 95% CI: 1. 3–3.1), opioid administration in the recovery room (OR 3.0, 95% CI: 1.9–4.7), and piritramide use on the ward (OR 4.5, 95% CI: 1.7–11.6).ConclusionsThe main risk factors for PONV include the intraoperative administration of opioids during the recovery room stay and at the ward, the intraoperative use of non-opioids (diclofenac), and the specific type of surgical procedure. Real-life data demonstrated that in clinical praxis, there is a gap between the adherence to established guidelines and the use of antiemetic prophylaxis in surgeries that are generally not associated with a high PONV prevalence. Further efforts are needed to improve the existing procedures and thus improve the overall outcome.

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“…We use propofol or a propofol-ketamine combination for procedural sedation in pediatric patients. In the case of deep sedation, propofol is preferred because of its fast onset and short duration and because it causes less postoperative nausea and vomiting [27][28][29]. However, proper management is required because it may result in hemodynamic instability and respiratory depression [30,31].…”

Section: Discussionmentioning

confidence: 99%

Delayed Adverse Events after Procedural Sedation in Pediatric Patients with Hematologic Malignancies

Joo

Yu²,

Koh³

2022

Medicina

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Background and objectives: Procedural sedation for bone marrow examination (BME) and intrathecal chemotherapy (ITC) is necessary for pediatric patients with hematological malignancies. There has been no report on adverse events after discharge from the recovery room. This retrospective study evaluated the types and incidences of delayed adverse events among pediatric patients scheduled for BME or ITC under deep sedation in a single center for 3 years. Materials and Methods: The patients were divided into two groups: inpatients (group I) and outpatients (group O). All patients were managed during the procedures and the recovery period. In total, 10 adverse events were assessed; these occurred 2 h (T1, acute), 12 h (T2, early), and 24 h (T3, delayed) after the procedure. The duration of each adverse event was also recorded and was classified as 2 h (D1), 12 h (D2), or 24 h (D3). The data of 263 patients (147 inpatients and 116 outpatients) who met the inclusion criteria were analyzed. Results: The overall incidence of adverse events was statistically significant difference: 48.3% in group I and 33.6% in group O (p = 0.011). The rates of adverse events at T1 and T2 were significantly different between groups I and O (42.8% vs. 11.2% and 7.5% vs. 20.7%, respectively) (p < 0.001). The adverse events were mostly of D1 or D2 duration in both groups. Patients with a higher proportion of ketamine in a propofol–ketamine mixture had a significantly higher proportion of adverse events at T1 (34.6%), as compared with those with a mixture with a lower proportion of ketamine (21.1%) or propofol alone (17.9%) (p = 0.012). Conclusions: The most common adverse events were dizziness or headache; typically, they did not last longer than 12 h. The propofol-ketamine combination with a higher proportion of ketamine seems to produce more adverse events within 2 h after the procedure. Nevertheless, all sedative types appear safe to use without additional management.

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Incidence and predictors of postoperative nausea and vomiting in children undergoing electrophysiology ablation procedures

Cited by 7 publications

References 16 publications

Subanesthetic-dose propofol infusion for preventing emergence agitation in children: a retrospective observational study

Subanesthetic-dose propofol infusion for preventing emergence agitation in children: a retrospective observational study

Is PONV still a problem in pediatric surgery: a prospective study of what children tell us

Delayed Adverse Events after Procedural Sedation in Pediatric Patients with Hematologic Malignancies

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