Background: Postoperative nausea and vomiting (PONV) is an important cause of postoperative morbidity and can delay patient recovery. The aim of this study was to evaluate the efficacy of PONV prophylaxis according to risk factors in ultrafast-track cardiac anesthesia and its influence in fast-track recovery.
Methods: A three phases cohort study was designed (n=90 in each phase). A protocol of PONV prophylaxis according to Apfel risk score modified for cardiac anesthesia was designed (inhalatory anesthesia, female under 65, nonactive smoker, PONV antecedents). During 1st phase the prophylaxis given was: 1 point no treatment; 2 points dexamethasone (DXM) 4mg in induction; 3 points DXM 4mg + haloperidol (HAL) 1mg in induction; 4 points DXM 4mg + HAL 1mg in induction + ondansetron 4mg at the end of the surgery. During the 2nd and 3rd phase prophylaxis was increased by one point. The anaesthetic protocol was: induction with sevoflurane 2%, fentanyl (2-4mcg/Kg) and rocuronium (0.6mg/Kg). Maintenance with sevoflurane and remifentanil (0.15-0.3mcg/Kg/min). At the end of extracorporeal circulation, morphine (0.1mg/Kg), dexketoprofen and metamizol were given. Local anesthetic perfusion was used as postoperative analgesia. All patients were extubated in the operating room. Incidence of PONV before (BOF) and after (AOF) oral feeding and the hours between extubation and oral feeding were evaluated. Data are presented as mean ±SD and percentages (X2 test for qualitative and t student for quantitative data, p< 0.05).
Results: A total of 197 patients were enrolled (21 in 1st phase, 89 in 2nd phase and 87 in 3rd phase). The 1st phase was abandoned because of the high incidence of PONV. All groups were comparable regarding demographics, comorbidities, type of surgery, operation time and total amount of opioid doses. Table shows incidence of PONV. There was a statistically significant difference between 1st phase and 2nd and 3rd, but there were no significant differences between 2nd and 3rd phase.
Hours from extubation to oral feeding were 6.4h in patients without PONV and 9.7h in patients with PONV (p< 0.05).
Conclusion: Prophylactic PONV treatment according to risk factors in ultrafast-track cardiac anesthesia decreases the incidence of PONV. Oral tolerance was earlier in patients without PONV facilitating fast-track recovery.