J Dent Anesth Pain Med.  2016 Dec;16(4):273-281. 10.17245/jdapm.2016.16.4.273.

Postoperative nausea and vomiting after general anesthesia for oral and maxillofacial surgery

• Apipan B
• Rummasak D
• Wongsirichat N

• KMID: 2366155
• DOI: http://doi.org/10.17245/jdapm.2016.16.4.273

Abstract

BACKGROUND
Postoperative nausea and vomiting (PONV) is one of the most common postoperative complications. Despite this, few papers have reported the incidence and independent risk factors associated with PONV in the context of oral and maxillofacial surgery (OMFS). Therefore, we sought to determine the incidence of PONV, as well as to identify risk factors for the condition in patients who had undergone OMFS under general anesthesia.
METHODS
A total of 372 patients' charts were reviewed, and the following potential risk factors for PONV were analyzed: age, sex, body mass index, smoking status, history of PONV and/or motion sickness, duration of anesthesia, amount of blood loss, nasogastric tube insertion and retention and postoperative opioid used. Univariate analysis was performed, and variables with a P-value less than 0.1 were entered into a multiple logistic regression analysis, wherein P-values < 0.05 were considered significant.
RESULTS
The overall incidence of PONV was 25.26%. In the multiple logistic regression analysis, the following variables were independent predictors of PONV: age < 30 years, history of PONV and/or motion sickness, and anesthesia duration > 4 h. Furthermore, the number of risk factors was proportional to the incidence of PONV.
CONCLUSIONS
The incidence of PONV in patients who have undergone OMFS varies from center to center depending on patient characteristics, as well as on anesthetic and surgical practice. Identifying the independent risk factors for PONV will allow physicians to optimize prophylactic, antiemetic regimens.

Keyword

Oral surgery; Postoperative complications; Postoperative nausea and vomiting

MeSH Terms

Anesthesia
Anesthesia, General*
Body Mass Index
Humans
Incidence
Logistic Models
Motion Sickness
Postoperative Complications
Postoperative Nausea and Vomiting*
Risk Factors
Smoke
Smoking
Surgery, Oral*
Smoke

Figure

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  Fig. 1 Number of patients and incidence of postoperative nausea and vomiting in each group in this study. PONV: Postoperative nausea and vomiting.

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  Fig. 2 The number of risk factors and the incidence of postoperative nausea and vomiting. PONV: Postoperative nausea vomiting

Reference

1. McCracken G, Houston P, Lefebvre G. Society of Obstetricians and Gynecologists of Canada. Guideline for the management of postoperative nausea and vomiting. J Obstet Gynaecol Can. 2008; 30:600–607.

2. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999; 89:652–658.

3. Eberhart L, Morin AM, Wulf H, Geldner G. Patient preferences for immediate postoperative recovery. Br J Anaesth. 2002; 89:760–761.

4. Gan T, Sloan F, Dear GL, El-Moalem HE, Lubarsky DA. How much are patients willing to pay to avoid postoperative nausea and vomiting? Anesth Analg. 2001; 92:393–400.

5. Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg. 2006; 102:1884–1898.

6. Gan TJ, Meyer T, Apfel CC, Chung F, Davis PJ, Eubanks S, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg. 2003; 97:62–71.

7. Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS, et al. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2007; 105:1615–1628.

8. Islam S, Jain PN. Post-operative nausea and vomiting (PONV): A review article. Indian J Anaesth. 2004; 48:253–258.

9. Rüsch D, Eberhart LHJ, Wallenborn J, Kranke P. Nausea and vomiting after surgery under general anesthesia—An evidence-based review concerning risk assessment, prevention, and treatment. Dtsch Arztebl Int. 2010; 107:733–741.

10. Roberts RG, Jones RM. Paediatric tonsillectomy and PONV-Big little problem remained big! Anaesthesia. 2002; 57:619–620.

11. Tramer MR. A rational approach to the control of postoperative nausea and vomiting: evidence from systematic reviews. Part I. Efficacy and harm of antiemetic interventions, and methodological issues. Acta Anaesthesiol Scand. 2001; 45:4–13.

12. Apfel CC, Kortilla K, Abdalla M, Kerger H, Turan A, Vedder I, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004; 350:2441–2451.

13. Perrott DH, Yuen JP, Anderson RV, Dodson TB. Office-Based Ambulatory Anesthesia: Outcomes of Clinical Practice of Oral and Maxillofacial Surgeons. J Oral Maxillofac Surg. 2003; 61:983–995.

14. Chye EPY, Young IG, Osborne GA, Rudkin GE. Outcomes after same-day oral surgery: A review of 1,180 cases at a major teaching hospital. J Oral Maxillofac Surg. 1993; 51:846–849.

15. Alexander M, Krishnan B, Yuvraj V. Prophylactic antiemetics in oral and maxillofacial surgery- a requiem? J Oral Maxillofac Surg. 2009; 67:1873–1877.

16. Silva AC, O'Ryan F, Poor DB. Postoperative nausea and vomiting (PONV) after orthognathic surgery: a retrospective study and literature review. J Oral Maxillofac Surg. 2006; 64:1385–1397.

17. Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology. 1999; 91:109–118.

18. Van den Bosch JE, Moons KG, Bonsel GJ, Kalkman CJ. Does measurement of preoperative anxiety have added value for predicting postoperative nausea and vomiting? Anesth Analg. 2005; 100:1525–1532.

19. Eberhart LH, Geldner G, Kranke P, Morin AM, Schäuffelen A, Treiber H, et al. The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients. Anesth Analg. 2004; 99:1630–1637.

20. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999; 91:693–700.

21. Koivuranta M, Laara E, Snare L, Alahuhta S. A survey of postoperative nausea and vomiting. Anaesthesia. 1997; 52:443–449.

22. Kranke P, Apfel CC, Papenfuss T, Rauch S, Löbmann U, Rübsam B, et al. An increased body mass index is no risk factor for postoperative nausea and vomiting. A systematic review and results of original data. Acta Anaesthesiol Scand. 2001; 45:160–166.

23. Apfel CC, Rauch S, Goepfert C, Sefrin P, Rower N. The impact of smoking on postoperative vomiting. Anesthesiology. 1997; 87:A25.

24. Chimbira W, Sweeney BP. The effect of smoking on postoperative nausea and vomiting. Anaesthesia. 2000; 55:540–544.

25. Tabrizi R, Eftekharian HR, Langner NJ, Ozkan BT. Comparison of the effect of 2 hypotensive anesthetic techniques on early recovery complications after orthognathic surgery. J Craniofac Surg. 2012; 23:e203–e205.

26. Hovorka J, Korttila K, Erkola O. Gastric aspiration at the end of anesthesia does not decrease post operative nausea and vomiting. Anaesth Intensive Care. 1990; 18:58–61.

27. Jones JE, Glasgold R, Gomillion MC. Efficacy of gastric aspiration in reducing posttonsillectomy vomiting. Arch Otolaryngol Head Neck Surg. 2001; 127:980–984.

28. Bolton CM, Myles PS, Nolan T, Sterne JA. Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis. Br J Anaesth. 2006; 97:593–604.

29. Golembiewski J, Tokumaru S. Pharmacological prophylaxis and management of adult postoperative/postdischarge nausea and vomiting. J Perianesth Nurs. 2006; 21:385–397.