Please use this identifier to cite or link to this item: https://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
Austin 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
Affiliation: Austin Health, Heidelberg, Victoria, Australia
Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, People's Republic of China
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Melbourne, Victoria, Australia
Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia
Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia
Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
Department of Anaesthesia, Intensive Care and Pharmacology, Geneva University Hospitals, University of Geneva, Switzerland
Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
Department of Anesthesia, Perioperative and Acute Pain Management, Barwon Health, Geelong, Victoria, Australia
Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
Issue Date: May-2016
metadata.dc.date: 2016-05
Publication information: 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: https://pubmed.ncbi.nlm.nih.gov/26904965
Type: Journal Article
Subjects: Postoperative Nausea and Vomiting
Nitrous Oxide
Anesthesia, Inhalation
Appears in Collections:Journal articles

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