Incidence of Nausea and Vomiting After Fast-Track Anaesthesia for Heart Surgery

Emad Mohamed Hijazi,Hadi Radaideh,Nabil Al-Zoubi,Hayel Edwan

doi:10.21470/1678-9741-2018-0040

Emad Mohamed Hijazi, Hadi Radaideh + Show 2 more

Open Access

https://doi.org/10.21470/1678-9741-2018-0040

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Abstract

ObjectiveThe aim of this study was to evaluate the incidence of postoperative nausea and vomiting (PONV) after fast-track cardiac anesthesia (FTCA) in the first 24-48 hours in the cardiac intensive care unit (CICU) after open-heart surgery, risk factors for PONV and its influence on CICU length of stay.MethodsA prospective observational study from January 1, 2013 to the end of December 2015 was performed in the CICU of a university hospital in the north of Jordan and Queen Alia Heart Institute, Amman, Jordan. Three hundred consecutive patients undergoing fast-track cardiac anesthesia in elective cardiac surgery were enrolled in the study. Nausea and vomiting were assessed after tracheal extubation, which was performed within 6-10 hours after surgery and during the first 24-48 hours in the CICU. Metoclopramide 10 mg intravenously was used as the initial antiemetic drug, but ondansetron 4 mg intravenously was also used as second line of management.ResultsNausea was reported in 46 (15.3%) patients, and vomiting in 31 (10.3%). Among females, 38 (33.9%) patients developed nausea and 20 (17.9%) developed vomiting. Among males, 8 (4.3%) patients developed nausea and 11 (5.9%) developed vomiting.ConclusionPONV are relatively low after FTCA and the prophylactic administration of antiemetic drug before anesthesia or after extubation is not necessary.

Highlights

Postoperative nausea and vomiting (PONV) is defined as any nausea, retching, or vomiting occurring for the first 24-48 hours after surgery in inpatients
PONV are relatively low after fast-track cardiac anesthesia (FTCA) and the prophylactic administration of antiemetic drug before anesthesia or after extubation is not necessary
Regarding PONV, enterochromaffin cells in the stomach and intestine release serotonin, which binds to 5-hydroxytryptamine type 3 (5-HT3) receptors in the gastrointestinal tract? This binding will lead to stimulation of vagal afferents in the gastrointestinal tract that conduct impulses reaching brainstem structures located between the obex levels and the nucleus ambiguus, such as the area postrema

Summary

Introduction

Postoperative nausea and vomiting (PONV) is defined as any nausea, retching, or vomiting occurring for the first 24-48 hours after surgery in inpatients. The brain structures involved in the pathophysiology of vomiting are distributed throughout the medulla oblongata of the brainstem, not centralized in an anatomically defined center of vomiting[2]. Regarding PONV, enterochromaffin cells in the stomach and intestine release serotonin, which binds to 5-hydroxytryptamine type 3 (5-HT3) receptors in the gastrointestinal tract? This binding will lead to stimulation of vagal afferents in the gastrointestinal tract that conduct impulses reaching brainstem structures located between the obex levels and the nucleus ambiguus, such as the area postrema. Located on the dorsal surface of the medulla oblongata at the caudal end of the fourth ventricle, the area postrema has a critical role in the central mechanism of vomiting[2]

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