Early Rehydration in Surgical Patients With Prolonged Fasting Decreases Postoperative Nausea and Vomiting

Abstract

The purpose of the project was to reduce the incidence of postoperative nausea and vomiting (PONV) in adult surgical patients who fasted for more than 12hours with the administration of a preinduction intravenous fluid (IVF) bolus. This interdisciplinary project used the Plan-Do-Study-Act model for quality improvement. After institutional approval, 381 consecutive adult surgical patients were evaluated for participation; 148 patients fasted more than 12hours and met inclusion criteria to receive a 1 liter, IV fluid bolus before anesthesia induction. All patients received general inhalational anesthesia and prophylactic doses of dexamethasone and ondansetron, along with peripheral nerve blocks appropriate for surgical case type. Only 96 (64%) qualified patients received the complete bolus before anesthesia induction. In this group, the incidence of PONV was 4.25%. The use of a simple rehydration protocol reduced the incidence of PONV in patients with prolonged fasting times. Time and personnel constraints were identified as barriers that prevented full compliance with the protocol.