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Dynamic predictive model for postoperative nausea and vomiting for intravenous fentanyl patient-controlled analgesia

Authors
 D. Chae  ;  S. Y. Kim  ;  Y. Song  ;  W. Baek  ;  H. Shin  ;  K. Park  ;  D. W. Han 
Citation
 ANAESTHESIA, Vol.75(2) : 218-226, 2020 
Journal Title
 ANAESTHESIA 
ISSN
 0003-2409 
Issue Date
2020
MeSH
Analgesia, Patient-Controlled/adverse effects* ; Analgesics, Opioid ; Anesthetics, Intravenous/adverse effects* ; Comorbidity ; Female ; Fentanyl/adverse effects* ; Humans ; Male ; Middle Aged ; Motion Sickness/epidemiology ; Postoperative Nausea and Vomiting/diagnosis* ; Postoperative Nausea and Vomiting/epidemiology ; Risk Factors ; Sex Factors ; Smoking/epidemiology ; Surveys and Questionnaires*
Keywords
fentanyl ; intravenous patient-controlled analgesia ; postoperative nausea and vomiting ; predictive model
Abstract
Postoperative nausea and vomiting is the most common side-effect of opioid-based intravenous patient-controlled analgesia. Apfel's simplified risk score is popular but it has some limitations. We developed and validated a dynamic predictive model for nausea or vomiting up to 48 postoperative hours, available as an online web application. Fentanyl was used by 22,144 adult patients for analgesia after non-cardiac surgery under general anaesthesia: we randomly divided them into development (80%) and validation (20%) cohorts, repeated 100 times. We used linear discriminant analysis to select variables for multivariate logistic regression. The incidences of postoperative nausea or vomiting were: 0-48 h, 5691/22,144 (26%); 0-6 h, 2749/22,144 (12%); 6-12 h, 2687/22,144 (12%); 12-18 h, 2624/22,144 (12%); 18-24 h, 1884/22,144 (9%); and 24-48 h, 1082/22,144 (5%). The median (95%CI) area under the receiver operating characteristic curve was 0.72 (0.71-0.73) up to 48 postoperative hours compared with 0.65 (0.64-0.66) for the Apfel model, p < 0.001. The equivalent areas for 0-6 h, 6-12 h, 12-18 h, 18-24 h and 24-48 h were: 0.70 (0.69-0.72); 0.71 (0.69-0.73); 0.69 (0.68-0.71); 0.70 (0.67-0.72); and 0.69 (0.66-0.71), respectively. Our web application allows clinicians to calculate incidences of nausea and vomiting in patients receiving intravenous fentanyl for patient-controlled analgesia.
Full Text
https://onlinelibrary.wiley.com/doi/full/10.1111/anae.14849
DOI
10.1111/anae.14849
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pharmacology (약리학교실) > 1. Journal Papers
Yonsei Authors
Kim, So Yeon(김소연) ORCID logo https://orcid.org/0000-0001-5352-157X
Park, Kyungsoo(박경수) ORCID logo https://orcid.org/0000-0002-6972-1143
Song, Young(송영) ORCID logo https://orcid.org/0000-0003-4597-387X
Chae, Dong Woo(채동우) ORCID logo https://orcid.org/0000-0002-7675-3821
Han, Dong Woo(한동우) ORCID logo https://orcid.org/0000-0002-8757-663X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/175233
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