Incidence and risk factors for postoperative nausea and vomiting in orthognathic surgery: a 10-year retrospective study

Ghosh, Subhabrata; Kumar, Kirthi; Shivakumar, H.R.; Upasi, Amarnath P.; Naik, Vinayak G.; Bharat, Avijit

doi:10.5125/jkaoms.2020.46.2.116

Cited by 21 publications

(28 citation statements)

References 54 publications

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“…This was in accordance with the results of a previous meta-analysis [ 36 ], showing that liberal intraoperative fluid regimens had lower odds of developing PONV as compared with restrictive fluid regimens. However, a recent study [ 51 ] showed that a higher occurrence of PONV was found in patients undergoing orthognathic surgery with more intraoperative fluid supply than those with less (≥25 mL/kg vs. <25 mL/kg). Although this study was a 10-year retrospective study, only 101 patients were included, and all factors were considered individually as in our basic statistics ( Table 1 ) which did not detect interactions of different potential risk factors.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Postoperative Vomiting in the Eye of “Real-World Evidence”—Modifiable and Clinical Setting-Dependent Risk Factors in Surgical Trauma Patients

Poon

Hung

et al. 2021

JPM

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Numerous studies on postoperative nausea and vomiting (PONV) have been carried out since the early days of contemporary surgery. The incidence of PONV has been greatly reduced in recent years and new drugs for PONV keep evolving in the market; however, a substantial number of patients are still under the threat of PONV. Female gender, non-smokers, a history of PONV/motion sickness, and postoperative opioid use are four well-recognized risk factors of PONV. Many potential risk factors reported in previous studies were not consistently presented as predictors for PONV. Two questions then arise; are risk factors clinical setting dependent and are risk factors modifiable? We attempted to answer the questions through a comprehensive review of perioperative records of surgical patients from the Trauma Department of our hospital. As nausea is subjective and no standard is applicable for its measurement, postoperative vomiting (POV) was used as an endpoint in this study. To the best of our knowledge, this is the first study to address the POV issue in surgical trauma patients. A total of 855 patients were enrolled in this study after excluding age below 20 years old, total intravenous anesthesia, desflurane anesthesia, or records with missing data. Our results showed that female gender (OR 4.89) is the strongest predicting factor, followed by a less potent predicting factor—more intraoperative opioid consumption (OR 1.07)—which favor more POV. More intraoperative crystalloid supply (OR 0.71) and a higher body weight (OR 0.9) favor less POV. Other potential risk factors did not reach statistical significance in this study as independent risk factors. Our results also showed that when the intraoperative crystalloid infusion rate is greater than 4 mL/kg/h (OR 0.20), it favors a lower rate of POV; when intraoperative opioid consumption is greater than 12 mg morphine equivalents, MME (OR 1.87), it favors a higher rate of POV. We concluded that dominance of any independent risk factor over other risk factors depends on how individual factors interact with the clinical setting. Some risk factors could be modified, and a cut-off value could be derived to facilitate a better plan for POV prevention.

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Section: Discussionmentioning

confidence: 99%

Risk Factors of Postoperative Vomiting in the Eye of “Real-World Evidence”—Modifiable and Clinical Setting-Dependent Risk Factors in Surgical Trauma Patients

Poon

Hung

et al. 2021

JPM

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“…In accord with its elimination half-life, the antiemetic effect of penehyclidine is diminished or disappeared after 24 h [ 14 , 15 ]. However, PONV following orthognathic surgery may persist for up to 96 h [ 16 ]. We, therefore, tested the hypothesis that a bolus plus infusion administration of penehyclidine could be more effective in reducing PONV.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies showed that prophylactic penehyclidine administered before surgery helped to prevent PONV [ 14 , 15 ]. Since the mean elimination half-life of a single-dose penehyclidine is about 10.35 h, whereas high frequent PONV may persist for up to 96 h after orthognathic surgery [ 16 ], we hypothesize that a low-dose bolus plus continuous infusion of penehyclidine may be more effective for PONV prevention. The purpose of this study is to investigate the efficacy and safety of single-dose plus continuously administrated penehyclidine in preventing PONV in patients undergoing bimaxillary surgery.…”

Section: Introductionmentioning

confidence: 99%

Penehyclidine for prevention of postoperative nausea and vomiting following bimaxillary orthognathic surgery: a randomized, double-blind, controlled trial

et al. 2021

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Purpose To investigate the efficacy and safety of low-dose bolus plus continuous infusion of penehyclidine in preventing postoperative nausea and vomiting (PONV) following bimaxillary surgery. Methods Three hundred fifty-four patients were randomly allocated into three groups. In the Control group, placebo (normal saline) was injected before anesthesia and infused over 48 h after surgery; in the Bolus group, 0.5 mg penehyclidine was injected before anesthesia, whereas placebo was infused after surgery; in the Infusion group, 0.25 mg penehyclidine were injected before anesthesia, another 0.25 mg penehyclidine was infused after surgery. The primary endpoint was the incidence of PONV within 72 h. Results A total of 353 patients were included in intention-to-treat analysis. The PONV incidence was 61.0% (72/118) in the Control group, 40.2% (47/117) in the Bolus group, and 28.0% (33/118) in the Infusion group. The incidence was significantly lower in the Bolus group than in the Control group (RR 0.66; 95% CI 0.51–0.86; adjusted P = 0.003) and in the Infusion group than in the Control group (RR 0.46; 95% CI 0.33–0.63; adjusted P < 0.001); the difference between the Infusion and Bolus groups was not statistically significant (RR 0.70; 95% CI 0.48–1.00; adjusted P = 0.144). Emergence agitation occurred more frequently in the Bolus group than in the Control group (36.8% [43/117] vs. 21.2% [25/118], adjusted P = 0.027), but did not differ significantly between the Infusion and Control groups. Conclusions A low-dose bolus plus continuous infusion of penehyclidine was effective in preventing PONV without increasing emergence agitation. Trial registration Clinicaltrials.gov. Identifier: NCT04454866.

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“…The impact of intraoperative fluid therapy on PONV remains inconclusive. A large number of studies in a 10-year retrospective study in orthognathic surgery in Asia revealed that the more the intraoperative intravenous fluids administered, the higher the occurrence of PONV [ 9 ]. A systematic review and meta-analysis of 41 studies from the Cochrane Database showed that perioperative intravenous crystalloid supplementation could reduce PONV [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Vomiting Following Laparoscopic Cholecystectomy Is Associated with Intraoperative Fluid Administration: A Retrospective Cohort Study

Hsieh

Poon

et al. 2021

IJERPH

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Potential risk factors for postoperative vomiting (POV) are important for daily anesthesia practice. To identify the risk factors associated with POV we retrospectively reviewed 553 adult patients who underwent scheduled simple laparoscopic cholecystectomy under sevoflurane-based general anesthesia between January and December 2018. Patients who experienced POV were predominantly women, had lower body weight, and higher ASA (American Society of Anesthesiologists) physical status. The POV group showed female sex predominance, lower body weight, and higher ASA physical status, with a significant difference when compared with the non-POV group. In univariate analysis, female sex and Apfel scores of 2, 3, and 4 were associated with a higher POV incidence. Age > 70 years, higher body weight, and ASA physical status III were associated with a lower POV incidence. In multivariate logistic regression, sex, age, Apfel score, and intraoperative crystalloid infusion rate were POV predictive factors. Receiver operating characteristic analysis showed a negative association between the intraoperative crystalloid infusion rate and POV occurrence with an area under the curve of 0.73 (p = 0.001). The cutoff intraoperative crystalloid infusion rate was 2 mL/kg/h with 82% sensitivity and 49% specificity (≥2 mL/kg/h was associated with a lower POV incidence vs. <2 mL/kg/h (OR, 95% CI; 0.52 [0.33–0.83])). To decrease POV in these patients, identifying high-risk factors and an intraoperative crystalloid administration of ≥2 mL/kg/h should be considered in patients undergoing LC under sevoflurane-based general anesthesia.

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Incidence and risk factors for postoperative nausea and vomiting in orthognathic surgery: a 10-year retrospective study

Cited by 21 publications

References 54 publications

Risk Factors of Postoperative Vomiting in the Eye of “Real-World Evidence”—Modifiable and Clinical Setting-Dependent Risk Factors in Surgical Trauma Patients

Risk Factors of Postoperative Vomiting in the Eye of “Real-World Evidence”—Modifiable and Clinical Setting-Dependent Risk Factors in Surgical Trauma Patients

Penehyclidine for prevention of postoperative nausea and vomiting following bimaxillary orthognathic surgery: a randomized, double-blind, controlled trial

Postoperative Vomiting Following Laparoscopic Cholecystectomy Is Associated with Intraoperative Fluid Administration: A Retrospective Cohort Study

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