Evidence Based Practice and Quality Assurance
Background and Goal of Study: Postoperative nausea and vomiting (PONV) is one of the most frequent complications after surgery. The incidence is 20-30% in patients undergoing balanced anesthesia. Several clinical studies had been carried out to determine the risk factors of PONV. After certain surgical interventions, like laparoscopic cholecystectomy - after which the incidence of nausea and vomiting is 25-75% according to the literature - special factors could contribute to the onset of PONV. In our study we attempted to clarify the role of several components which are related to laparoscopic cholecystectomy.
Materials and Methods: In the present study 100 patients (27 male, 73 female; average age: 49.95 ± 12.4 years) undergoing elective laparoscopic cholecystectomy were investigated. Every patient with nausea or vomiting within the postoperative 24 hours deemed to have PONV. At the preoperative assessment we recorded age, gender, BMI and the Apfel score. We also recorded the intra- and postoperative medication, the duration of surgery and anesthesia, and LC related factors, like the amount of consumed CO2, the maximal intraabdominal pressure during pneumoperitoneum, and the occurrence of bile leakage. The evaluation of PONV was done by verbal analog scale (0-10).
Results and Discussions: We detected postoperative nausea and vomiting in 33 cases. The mean of the Apfel score value was 2.31 in all patients and 2.58 in patients who had PONV. In the cases of PONV the mean duration of surgery and the mean duration of anesthesia proved to be longer (56.5 vs. 49 min. and 72 vs. 65 min.). Regarding the consumed carbon dioxide, the intraabdominal pressure and bile leakage, there were no substantive differences between the two cohorts.
Conclusion(s): In our study we did not find any factor related to laparascopic choloecystectomy which could elevate the risk of postoperative nausea and vomiting. The incidence of PONV in the high risk cohort was lower than the anticipated occurrence determined by the Apfel score.