Postoperative Nausea and Vomiting in Children undergoing Radiofrequency Catheter Ablation: a 5-Year Review of 475 Patients

Abstract

Background: Postoperative Nausea and Vomiting (PONV) is an important cause of morbidity in children. Radiofrequency Catheter Ablation (RFCA) is established as a key therapy in the management of tachyarrhythmias. In children, the procedure is typically performed under general anaesthesia. The objectives of this study were to quantify the incidence of PONV in the paediatric RFCA population and to identify any factors associated with increased risk of developing PONV. Methods: Following Institutional Ethics Committee approval, a retrospective review of all patients who underwent RFCA over a 5 year period (July 2006-June 2011) was performed. We recorded 4 primary outcomes: Nausea in PACU; Vomiting in PACU; Nausea in first 24 hours post-procedure; Vomiting in first 24 hours post- procedure. In addition we collected extensive data relating to the patient, the type and duration of anaesthetic, the use of anti-emetics and to the procedure itself. The information collected was analysed in order to identify which factors, if any, influenced the development of PONV. Descriptive statistics were used to describe the sample and to calculate the incidence of nausea and vomiting after RFCA. Chi-square and t tests were used to detect factors significantly (p < 0.05) related to these complications. Logistic regression analysis was used to ascertain which of the variables were significantly and independently related to the developing nausea and vomiting. Results: In total, 475 patients scheduled for RFCA were analysed. The overall incidence of nausea in PACU and in the first 24 hours post procedure was 21.3% (101 patients) and 29.5% (140 patients), respectively, while the incidence of vomiting in PACU and in the first 24 hours overall was 26.1% (124 patients) and 35.2% (167 patients), respectively. For all 4 primary outcomes, the use of intra-operative N2O and the omission of an intra-operative anti-emetic were associated with a significant increase in the incidence of nausea and vomiting in the postoperative period. In addition, a longer duration of anaesthetic was associated with an increased incidence of vomiting. Conclusion: Our study confirms a relatively high incidence of PONV in children who undergo general anaesthesia for RFCA, and we have identified factors which significantly increase the risk of developing this significant complication.