Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/16263
Title: Severe nausea and vomiting in the evaluation of nitrous oxide in the gas mixture for anesthesia II trial
Authors: Myles, Paul S;Chan, Matthew TV;Kasza, Jessica;Paech, Michael J;Leslie, Kate;Peyton, Philip J;Sessler, Daniel I;Haller, Guy;Beattie, W Scott;Osborne, Cameron;Sneyd, J Robert;Forbes, Andrew
Issue Date: May-2016
EDate: 2016-05
Citation: Anesthesiology 2016; 124(5): 1032-1040
Abstract: BACKGROUND: The Evaluation of Nitrous oxide in the Gas Mixture for Anesthesia II trial randomly assigned 7,112 noncardiac surgery patients to a nitrous oxide or nitrous oxide-free anesthetic; severe postoperative nausea and vomiting (PONV) was a prespecified secondary end point. Thus, the authors evaluated the association between nitrous oxide, severe PONV, and effectiveness of PONV prophylaxis in this setting. METHODS: Univariate and multivariate analyses of patient, surgical, and other perioperative characteristics were used to identify the risk factors for severe PONV and to measure the impact of severe PONV on patient outcomes. RESULTS: Avoiding nitrous oxide reduced the risk of severe PONV (11 vs. 15%; risk ratio [RR], 0.74 [95% CI, 0.63 to 0.84]; P < 0.001), with a stronger effect in Asian patients (RR, 0.55 [95% CI, 0.43 to 0.69]; interaction P = 0.004) but lower effect in those who received PONV prophylaxis (RR, 0.89 [95% CI, 0.76 to 1.05]; P = 0.18). Gastrointestinal surgery was associated with an increased risk of severe PONV when compared with most other types of surgery (P < 0.001). Patients with severe PONV had lower quality of recovery scores (10.4 [95% CI, 10.2 to 10.7] vs. 13.1 [95% CI, 13.0 to 13.2], P < 0.0005); severe PONV was associated with postoperative fever (15 vs. 20%, P = 0.001). Patients with severe PONV had a longer hospital stay (adjusted hazard ratio, 1.14 [95% CI, 1.05 to 1.23], P = 0.002). CONCLUSIONS: The increased risk of PONV with nitrous oxide is near eliminated by antiemetic prophylaxis. Severe PONV, which is seen in more than 10% of patients, is associated with postoperative fever, poor quality of recovery, and prolonged hospitalization.
URI: http://ahro.austin.org.au/austinjspui/handle/1/16263
DOI: 10.1097/ALN.0000000000001057
PubMed URL: http://www.ncbi.nlm.nih.gov/pubmed/26904965
Type: Journal Article
Subjects: Postoperative Nausea and Vomiting
Nitrous Oxide
Anesthesia, Inhalation
Appears in Collections:Journal articles

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