Evidence Based Practice and Quality Assurance
Background and Goal of Study: Postoperative nausea and vomiting (PONV) still remains one of the final therapeutical challenges in anaesthesia with an ongoing inacceptably high incidence of 20 to 60% after general anaesthesia. With the introduction of the APFEL Score there is a way to screen patients preoperatively but therapeutical approaches are still not satisfyingly applicable. After the introduction of new guidelines on preoperative fasting times in many european countries there has been a discussion whether a prolonged preoperative fasting time itself could be a cause for PONV and consequently with applying the new guidelines incidence of PONV should be reduced.
Materials and Methods: 50 healthy women undergoing laparoscopic hysterectomy were randomly divided into two groups. Group I was fastened according to the “old scheme” (nil by mouth for at least 8 hours) and group II was kept nil by mouth for solids for 6 hours and fluids for 2 hours preoperatively. APFEL Score was calculated for every patient.
General anaesthesia was induced using propofol, fentanyl and rocuronium and then maintained using volatile anaesthetics and continuous infusion of remifentanil.
Results and Discussions: Demographical data of the patients did not significantly differ. There were no significant differences in duration of surgery or use of anaesthetics. Average APFEL Score in group I and II were 2.9 ± 0.9 and 3.1 ± 0.7, respectively. Incidence of PONV in group I was 52%. Incidence of PONV in group II was 61%.
Conclusion(s): Incidence of PONV in both groups was high but reflected the expected incidence calculated by the APFEL Score. Preoperative fasting time does not seem to influence the incidence of PONV. There has been hope that a reduced residual gastric volume achieved through drinking clear fluids could also reduce the incidence of PONV, but at least in this group of patients that does not seem to be the case. Since there are no studies on this topic so far, further research is certainly necessary.
1 Spies CD, et al. Preoperative fasting. An update. Anaesthesist 2003; 52:1039-1045.