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INCIDENCE OF NAUSEA AND VOMITING AFTER CORONARY ARTERY BYPASS GRAFTING

Taenzer, A.H. MD; Clark, C. V MD

doi: 10.1097/00000539-199902001-00104
Abstracts of Posters; Presented at the International Anesthesia Research Society; 73rd Clinical and Scientific Congress; Los Angeles, CA; March 12-16, 1999: Cardiovascular Anesthesia
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Department of Anesthesiology, Maine Medical Center, Portland, ME.

Abstract S104

INTRODUCTION: Coronary Artery Bypass Grafting (CABG) is a common procedure (over 1,600 cases per year) at our institution. Anecdotally, it is known among Cardiothoracic Surgeons as well as Anesthesiologists that despite the routine use and administration of anti-emetics the incidence of nausea and vomiting is high. This survey was done to evaluate the magnitude of the problem. Atrial fibrillation and nausea are the two most common reasons for delayed discharge from hospital after CABG. [1]

METHODS: 62 patients were asked to rate their degree of nausea on a Visual Analog Scale(VAS) from 0-10 during the first five postoperative days. All episodes of emesis were recorded. Patients received a variety of po analgesics. All patients received standard anti-emetics and we did not interfere with the routine administration of any drug. Droperidol 0.625mg, metoclopramide 10 mg, and odansentron 4mg were administered on a prn-basis, starting with droperidol and then advancing to the next listed drug if nausea persisted. All patients were placed on a propofol infusion immediately postoperatively and received a fentanyl-PCA for 24-48 hours postoperatively.

RESULTS: 58% of all patients had postoperative nausea or vomiting (PONV) on at least one day postoperatively. After the second day the incidence of PONV improved but was still almost 30% on postoperative day (POD) four and five. In the subgroup of those patients who had PONV the worst day was POD 2 with an average VAS score of 4.03. This improved to 1.50 on POD 5.

(Table 1) below includes all patients (n=62)

Table 1

Table 1

DISCUSSION: We found that the incidence of PONV is quite significant in patients undergoing CABG (58%). For many patients nausea and vomiting are a significant problem and it does contribute to a prolonged hospital stay. The question whether prophylactic administration of anti-emetics or a different class of anti-emetic can reduce this problem is currently being investigated.

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REFERENCES

1. Chest 1998, 113(6): 1489-91.
© 1999 International Anesthesia Research Society