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Incidence and Risk Factors of Postoperative Nausea and Vomiting in Patients with Fentanyl-Based Intravenous Patient-Controlled Analgesia and Single Antiemetic Prophylaxis

Authors
 Jong Bum Choi  ;  Yon Hee Shim  ;  Youn-Woo Lee  ;  Jeong Soo Lee  ;  Jong-Rim Choi  ;  Chul Ho Chang 
Citation
 YONSEI MEDICAL JOURNAL, Vol.55(5) : 1430-1435, 2014 
Journal Title
YONSEI MEDICAL JOURNAL
ISSN
 0513-5796 
Issue Date
2014
MeSH
Adult ; Aged ; Analgesia, Patient-Controlled/adverse effects* ; Analgesics, Opioid/adverse effects* ; Analgesics, Opioid/therapeutic use ; Antiemetics/administration & dosage ; Antiemetics/therapeutic use ; Female ; Fentanyl/adverse effects* ; Fentanyl/therapeutic use ; Humans ; Incidence ; Isoflurane/adverse effects ; Isoflurane/analogs & derivatives* ; Isoflurane/therapeutic use ; Male ; Middle Aged ; Piperidines/adverse effects* ; Piperidines/therapeutic use ; Postoperative Nausea and Vomiting/chemically induced ; Postoperative Nausea and Vomiting/epidemiology* ; Retrospective Studies ; Risk Factors
Keywords
Analgesia ; antiemetics ; fentanyl ; patient-controlled ; postoperative nausea and vomiting
Abstract
PURPOSE:
We evaluated the incidence and risk factors of postoperative nausea and vomiting (PONV) in patients with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and single antiemetic prophylaxis of 5-hydroxytryptamine type 3 (5 HT₃)-receptor antagonist after the general anesthesia.
MATERIALS AND METHODS:
In this retrospective study, incidence and risk factors for PONV were evaluated with fentanyl IV-PCA during postoperative 48 hours after various surgeries.
RESULTS:
Four hundred-forty patients (23%) of 1878 had showed PONV. PCA was discontinued temporarily in 268 patients (14%), mostly due to PONV (88% of 268 patients). In multivariate analysis, female, non-smoker, history of motion sickness or PONV, long duration of anesthesia (>180 min), use of desflurane and intraoperative remifentanil infusion were independent risk factors for PONV. If one, two, three, four, five, or six of these risk factors were present, the incidences of PONV were 18%, 19%, 22%, 31%, 42%, or 50%. Laparoscopic surgery and higher dose of fentanyl were not risk factors for PONV.
CONCLUSION:
Despite antiemetic prophylaxis with 5 HT₃-receptor antagonist, 23% of patients with fentanyl-based IV-PCA after general anesthesia showed PONV. Long duration of anesthesia and use of desflurane were identified as risk factors, in addition to risk factors of Apfel's score (female, non-smoker, history of motion sickness or PONV). Also, intraoperative remifentanil infusion was risk factor independent of postoperative opioid use. As the incidence of PONV was up to 50% according to the number of risk factors, risk-adapted, multimodal or combination therapy should be applied.
Files in This Item:
T201403164.pdf Download
DOI
10.3349/ymj.2014.55.5.1430
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Shim, Yon Hee(심연희) ORCID logo https://orcid.org/0000-0003-1921-3391
Lee, Youn Woo(이윤우)
Lee, Jeong Soo(이정수) ORCID logo https://orcid.org/0000-0002-8947-3706
Chang, Chul Ho(장철호) ORCID logo https://orcid.org/0000-0001-5647-8298
Choi, Jong Bum(최종범)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99761
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