Risk of severe and refractory postoperative nausea and vomiting in patients undergoing diep flap breast reconstruction

Abstract

Background Postoperative nausea and vomiting (PONV) are commonly feared after general anesthesia and can impact results. The primary aim of our study was to examine incidence and severity of PONV by investigating complete response, or absence of PONV, to prophylaxis used in patients undergoing DIEP flaps. Our secondary aims were definition of the magnitude of risk, state of the art of interventions, clinical sequelae of PONV, and interaction between these variables, specifically for DIEP patients. Methods A retrospective chart review occurred for 29 patients undergoing DIEP flap breast reconstruction from September 2007 to February 2008. We assessed known patient and procedure-specific risks for PONV after DIEPs, prophylactic antiemetic regimens, incidence, and severity of PONV, postoperative antiemetic rescues, and effects of risks and treatments on symptoms. Results Three or more established risks existed in all patients, with up to seven risks per patient. Although 90% of patients received diverse prophylaxis, 76% of patients experienced PONV, and 66% experienced its severe form, emesis. Early PONV (73%) was frequent; symptoms were long lasting (average 20 hours for nausea and emesis); and multiple rescue medications were frequently required (55% for nausea, 58% for emesis). Length of surgery and nonsmoking statistically significantly impacted PONV. Conclusion We identify previously undocumented high risks for PONV in DIEP patients. High frequency, severity, and refractoriness of PONV occur despite standard prophylaxis. Plastic surgeons and anesthesiologists should further investigate methods to optimize PONV prophylaxis and treatment in DIEP flap patients.

The Effect of Preoperative Zintoma Capsule on Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy

“…The problems associated with preventive anti-vomiting prescriptions typically include increased costs, especially if serotonin antagonists are prescribed, orthostatic hypotension, and vomiting with or without prophylaxis of vomiting ( 3 - 6 ). However, it should be noted the use of anti-nausea and vomiting drugs is not merely suitable for patients, but the routine use of these drugs causes complications leading to more required drug interference and prolonged length of stay ( 6 - 8 ). Restlessness, dry mouth, drowsiness, tachycardia, hypotension, and fatigue are among the other complications of the drug therapy ( 6 , 7 ).…”

Epidural Combined with General Anesthesia versus General Anesthesia Alone in Patients Undergoing Free Flap Breast Reconstruction

“…18 A retrospective study carried out in 29 DIEP patients showed that 76 percent of patients experienced postoperative nausea and vomiting. 19 Several risk factors have been identified: female sex, nonsmoking status, certain operative sites (i.e., breast), prolonged surgery time, specific surgical procedure (i.e., plastic surgery), and perioperative opioid use. 19 A study by Chatterjee et al showed that increasing the operative duration by 30 minutes increased the risk of postoperative nausea and vomiting by 60 percent.…”

“…19 Several risk factors have been identified: female sex, nonsmoking status, certain operative sites (i.e., breast), prolonged surgery time, specific surgical procedure (i.e., plastic surgery), and perioperative opioid use. 19 A study by Chatterjee et al showed that increasing the operative duration by 30 minutes increased the risk of postoperative nausea and vomiting by 60 percent. 20 The average duration of surgery in the epidural anesthesia/general anesthesia group and general anesthesia group was 481.32 minutes and 480.65 minutes, respectively.…”

Pectoral nerve block (Pecs block) with sedation for breast conserving surgery without general anesthesia

“…Despite the reportedly better outcomes of Pecs block with GA than GA alone, we selected Pecs block as the primary anesthesia with MAC for better patient satisfaction, reduced PONV, and avoidance of GA-associated complications. In breast surgeries under GA, patients showed 48%–72% incidence of PONV with inhalational anesthetics; and utilization of total intravenous anesthesia caused a further decrease to only 43.8% [ 6 7 ]. Only few cases of Pecs blocks have been reported as the primary anesthesia for breast surgery.…”