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Backmund T, Bohlender T, Gaik C, Koch T, Kranke P, Nardi-Hiebl S, Vojnar B, Eberhart LHJ. [Comparison of different prediction models for the occurrence of nausea and vomiting in the postoperative phase : A systematic qualitative comparison based on prospectively defined quality indicators]. DIE ANAESTHESIOLOGIE 2024; 73:251-262. [PMID: 38319326 DOI: 10.1007/s00101-024-01386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Various prognostic prediction models exist for evaluating the risk of nausea and vomiting in the postoperative period (PONV). So far, no systematic comparison of these prognostic scores is available. METHOD A systematic literature search was carried out in seven medical databases to find publications on prognostic PONV models. Identified scores were assessed against prospectively defined quality criteria, including generalizability, validation and clinical relevance of the models. RESULTS The literature search revealed 62 relevant publications with a total of 81,834 patients which could be assigned to 8 prognostic models. The simplified Apfel score performed best, primarily because it was extensively validated. The Van den Bosch score and Sinclair score tied for second place. The simplified Koivuranta score was in third place. CONCLUSION The qualitative analysis highlights the strengths and weaknesses of each prediction system based on predetermined standardized quality criteria.
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Affiliation(s)
- T Backmund
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Baldinger Straße, 35043 Marburg, Deutschland.
| | - T Bohlender
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Baldinger Straße, 35043 Marburg, Deutschland
| | - C Gaik
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Baldinger Straße, 35043 Marburg, Deutschland
| | - T Koch
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Baldinger Straße, 35043 Marburg, Deutschland
| | - P Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Deutschland
| | - S Nardi-Hiebl
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Baldinger Straße, 35043 Marburg, Deutschland
| | - B Vojnar
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Baldinger Straße, 35043 Marburg, Deutschland
| | - L H J Eberhart
- Klinik für Anästhesie und Intensivtherapie, Philipps Universität Marburg, Baldinger Straße, 35043 Marburg, Deutschland
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Ishikawa E, Hojo T, Shibuya M, Teshirogi T, Hashimoto K, Kimura Y, Fujisawa T. Risk factors for postoperative nausea and vomiting in patients of orthognathic surgery according to the initial onset time: a cross-sectional study. J Dent Anesth Pain Med 2023; 23:29-37. [PMID: 36819607 PMCID: PMC9911960 DOI: 10.17245/jdapm.2023.23.1.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
Background A high incidence (40-73%) of postoperative nausea and vomiting (PONV) has been reported following orthognathic surgery, and various risk factors have been associated with it. Identifying PONV risk factors based on initial onset time will help establish preventive measures. This study aimed to identify factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. Methods This study included 590 patients who underwent orthognathic surgery. Multivariate logistic regression analysis was performed to identify the risk factors that are significantly related to PONV. The objective variables were classified into three categories: no PONV, early PONV (initial onset time: 0-2 h after anesthesia), and late PONV (initial onset time: 2-24 h after anesthesia). The explanatory variables included relevant risk factors for PONV, as considered in previous studies. Results Total intravenous anesthesia with propofol was a significant depressant factor for early PONV (adjusted odds ratio [aOR] = 0.340, 95% confidence interval [CI] = 0.209-0.555) and late PONV (aOR = 0.535, 95% CI = 0.352-0.814). The administration of a combination of intraoperative antiemetics (vs. no administration) significantly reduced the risk of early PONV (aOR = 0.464, 95% CI = 0.230-0.961). Female sex and young age were significant risk factors for late PONV (aOR = 1.492, 95% CI = 1.170-1.925 and unit aOR = 1.033, 95% CI = 1.010-1.057, respectively). Conclusion We identified factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. Total intravenous anesthesia with propofol significantly reduced the risk of PONV not only in the early period (0-2 h after anesthesia) but also in the late period (2-24 h after anesthesia).
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Affiliation(s)
- Emi Ishikawa
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Hojo
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Makiko Shibuya
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Takahito Teshirogi
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Keiji Hashimoto
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yukifumi Kimura
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiaki Fujisawa
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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3
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Kim JH, Kim H, Yoo K, Hwang SM, Lim SY, Lee JJ, Kwon YS. Effect of the preoperative physical status on postoperative nausea and vomiting risk: a matched cohort study. Perioper Med (Lond) 2022; 11:31. [PMID: 36064739 PMCID: PMC9446728 DOI: 10.1186/s13741-022-00264-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 05/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The American Society of Anesthesiologists Physical Status Classification System is commonly used for preoperative assessment. Patient physical status before surgery can play an important role in postoperative nausea and vomiting. However, the relationship between the physical status classification and postoperative nausea and vomiting has not been well defined. METHODS Adults aged ≥ 18 years who underwent procedures under anesthesia between 2015 and 2020 were included in the study. We analyzed the relationship of postoperative nausea and vomiting with physical status classification score using propensity score matching and Cox hazard regression. Differences in intraoperative use of vasopressor and inotropes and invasive monitoring were investigated according to the classification. RESULTS A total of 163,500 patients were included in the study. After matching, classification 1 versus 2 included 43,400 patients; 1 versus ≤ 3, 13,287 patients; 2 versus ≤ 3, 23,530 patients (absolute standardized difference, 0-0.06). Patients with physical status classification ≤ 3 had a significantly lower postoperative nausea and vomiting risk than those with classification 1-2 (physical status classification 1 vs. ≤ 3, hazard ratio 0.76 [0.71-0.82], P < 0.001; 2 versus ≤ 3, hazard ratio 0.86 [0.82-0.91], P < 0.001). Intraoperative use of vasopressor or inotrope and invasive monitoring were noted more in the high physical status classification than the low physical status classification (absolute standardized difference [0.19-1.25]). CONCLUSION There were differences in intraoperative invasive monitoring and use of vasopressor or inotrope among the classifications, and a score of 3 or higher reduced the risk of postoperative nausea and vomiting more than a score of 1-2.
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Affiliation(s)
- Jong Ho Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University Medical Center, 77 Sakju-ro, Chuncheon, 24253, South Korea.,Institute of New Frontier Research Team, Hallym University, Chuncheon, South Korea
| | - Haewon Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University Medical Center, 77 Sakju-ro, Chuncheon, 24253, South Korea
| | - Kookhyun Yoo
- Department of Anesthesiology and Pain Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University Medical Center, 77 Sakju-ro, Chuncheon, 24253, South Korea
| | - Sung Mi Hwang
- Department of Anesthesiology and Pain Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University Medical Center, 77 Sakju-ro, Chuncheon, 24253, South Korea
| | - So Young Lim
- Department of Anesthesiology and Pain Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University Medical Center, 77 Sakju-ro, Chuncheon, 24253, South Korea
| | - Jae Jun Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kangwon National University, Chuncheon, South Korea
| | - Young Suk Kwon
- Department of Anesthesiology and Pain Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University Medical Center, 77 Sakju-ro, Chuncheon, 24253, South Korea. .,Institute of New Frontier Research Team, Hallym University, Chuncheon, South Korea.
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4
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Ishikawa E, Iwamoto R, Hojo T, Teshirogi T, Hashimoto K, Shibuya M, Kimura Y, Fujisawa T. Cross-sectional Study of PONV Risk Factors for Oral Surgery After Intubated General Anesthesia With Total Intravenous Anesthesia. Anesth Prog 2022; 69:18-23. [PMID: 35377932 DOI: 10.2344/anpr-68-03-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/14/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The incidence of postoperative nausea and vomiting (PONV) after general anesthesia with total intravenous anesthesia (TIVA) was reported to be significantly lower than with volatile inhalational agents (13.3% vs 25%). However, no investigation of PONV risk factors associated with TIVA has ever been reported. This cross-sectional retrospective study aimed to investigate whether known risk factors influenced PONV in intubated general anesthetics utilizing TIVA for dental or oral and maxillofacial surgery. METHODS Subjects were 761 patients who underwent dental or oral and maxillofacial surgery under TIVA with propofol, fentanyl, and remifentanil. Univariate and multivariable logistic regression analyses were performed using PONV (within 24 hours) as the dependent variable and previously reported risk factors as independent variables. RESULTS Age (odds ratio [OR]: 1.020 per year decrease; 95% confidence interval [CI]: 1.0002-1.0418; P = .047) and female sex (OR: 2.73; 95% CI: 1.60-4.84; P < .001) were positively associated with PONV. Sagittal split ramus osteotomy (SSRO) (OR: 2.28; 95% CI: 1.21-4.33; P = .011) and bimaxillary osteotomy (OR: 5.69; 95% CI: 2.09-15.99; P < .001) were more likely to be associated with PONV than operations that were neither bimaxillary osteotomy nor SSRO. Late PONV (2-24 hours) had an ∼2.7 times higher incidence than early PONV (0-2 hours). CONCLUSION These findings suggest further PONV countermeasures, aside from TIVA with propofol and prophylactic antiemetics for orthognathic surgeries especially bimaxillary osteotomy, are needed.
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Affiliation(s)
- Emi Ishikawa
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Rie Iwamoto
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Hojo
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Takahito Teshirogi
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Keiji Hashimoto
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Makiko Shibuya
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yukifumi Kimura
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiaki Fujisawa
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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5
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Gloor Y, Czarnetzki C, Curtin F, Gil-Wey B, Tramèr MR, Desmeules JA. Genetic Susceptibility Toward Nausea and Vomiting in Surgical Patients. Front Genet 2022; 12:816908. [PMID: 35173765 PMCID: PMC8842269 DOI: 10.3389/fgene.2021.816908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Postoperative nausea and vomiting (PONV) are frequently occurring adverse effects following surgical procedures. Despite predictive risk scores and a pallet of prophylactic antiemetic treatments, it is still estimated to affect around 30% of the patients, reducing their well-being and increasing the burden of post-operative care. The aim of the current study was to characterize selected genetic risk factors of PONV to improve the identification of at risk patients. We genotyped 601 patients followed during the first 24 h after surgery for PONV symptoms in the absence of any antiemetic prophylaxis. These patients were recruited in the frame of a randomized, placebo controlled clinical study aiming to test the efficacy of dexamethasone as a treatment of established PONV. We examined the impact of selected single nucleotide polymorphisms (SNPs) located around 13 different genes and the predicted activity of 6 liver drug metabolizing enzymes from the cytochromes P450 family (CYP) on the occurrence and recurrence of PONV. Our genetic study confirms the importance of genetic variations in the type 3B serotonin receptor in the occurrence of PONV. Our modelling shows that integration of rs3782025 genotype in preoperative risk assessments may help improve the targeting of antiemetic prophylaxis towards patients at risk of PONV.
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Affiliation(s)
- Yvonne Gloor
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Christoph Czarnetzki
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.,Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Emergency Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - François Curtin
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.,Personalized Health Programs, Swiss Federal Institute of Technology Zurich (ETHZ), Zurich, Switzerland
| | - Béatrice Gil-Wey
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Martin R Tramèr
- Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Jules A Desmeules
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
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6
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Risk Factors of Postoperative Vomiting in the Eye of "Real-World Evidence"-Modifiable and Clinical Setting-Dependent Risk Factors in Surgical Trauma Patients. J Pers Med 2021; 11:jpm11050386. [PMID: 34066821 PMCID: PMC8151314 DOI: 10.3390/jpm11050386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
Numerous studies on postoperative nausea and vomiting (PONV) have been carried out since the early days of contemporary surgery. The incidence of PONV has been greatly reduced in recent years and new drugs for PONV keep evolving in the market; however, a substantial number of patients are still under the threat of PONV. Female gender, non-smokers, a history of PONV/motion sickness, and postoperative opioid use are four well-recognized risk factors of PONV. Many potential risk factors reported in previous studies were not consistently presented as predictors for PONV. Two questions then arise; are risk factors clinical setting dependent and are risk factors modifiable? We attempted to answer the questions through a comprehensive review of perioperative records of surgical patients from the Trauma Department of our hospital. As nausea is subjective and no standard is applicable for its measurement, postoperative vomiting (POV) was used as an endpoint in this study. To the best of our knowledge, this is the first study to address the POV issue in surgical trauma patients. A total of 855 patients were enrolled in this study after excluding age below 20 years old, total intravenous anesthesia, desflurane anesthesia, or records with missing data. Our results showed that female gender (OR 4.89) is the strongest predicting factor, followed by a less potent predicting factor—more intraoperative opioid consumption (OR 1.07)—which favor more POV. More intraoperative crystalloid supply (OR 0.71) and a higher body weight (OR 0.9) favor less POV. Other potential risk factors did not reach statistical significance in this study as independent risk factors. Our results also showed that when the intraoperative crystalloid infusion rate is greater than 4 mL/kg/h (OR 0.20), it favors a lower rate of POV; when intraoperative opioid consumption is greater than 12 mg morphine equivalents, MME (OR 1.87), it favors a higher rate of POV. We concluded that dominance of any independent risk factor over other risk factors depends on how individual factors interact with the clinical setting. Some risk factors could be modified, and a cut-off value could be derived to facilitate a better plan for POV prevention.
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7
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Abdel-Kader AK, Eisenkraft JB, Katz DJ. Overview and Limitations of Database Research in Anesthesiology: A Narrative Review. Anesth Analg 2021; 132:1012-1022. [PMID: 33346984 DOI: 10.1213/ane.0000000000005346] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The utilization of large-scale databases for research in medical fields, including anesthesiology, has increased in popularity over the last decade, likely due to their structured content and relative ease of access. These databases have been used in a variety of perioperative studies, including analyses of risk stratification, preoperative testing, complications, and cost. While these databases contain a wealth of information that allows for an abundance of research opportunities, there are unique limitations to their use. A comprehensive understanding will afford the anesthesiology researcher the knowledge and tools to not only better interpret studies that utilized these databases, but also to conduct analyses of their own. This review details the content and composition of these databases, highlights the advantages of and limitations to their use, and offers information about their access and cost.
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Affiliation(s)
- Amir K Abdel-Kader
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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8
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Effect of Body Mass Index on Postoperative Nausea and Vomiting: Propensity Analysis. J Clin Med 2020; 9:jcm9061612. [PMID: 32466515 PMCID: PMC7355557 DOI: 10.3390/jcm9061612] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022] Open
Abstract
The impact of body mass index (BMI) on postoperative nausea and vomiting (PONV) is controversial, and few studies have focused on their relationship. We investigated the effects of BMI on PONV, taking into account other PONV risk factors. We analyzed adults over the age of 18 years who received general anesthesia between 2015 and 2019, using propensity score matching. Before propensity score matching, odds ratios (ORs) for PONV were lower for overweight (OR, 0.91; 95% confidence interval (CI), 0.87–0.96; p < 0.0001) or obese patients (OR, 0.77; 95% CI, 0.71–0.84; p < 0.0001) than for normal-BMI patients. After matching, the ORs for PONV of overweight (OR, 0.89; 95% CI, 0.80–0.98; p = 0.016) and obese patients (OR, 0.71; 95% CI, 0.63–0.79; p < 0.0001) were low. However, the ORs of underweight patients did not differ from those of normal-BMI patients, irrespective of matching. Therefore, the incidence of PONV may be lower among adults with a higher-than-normal BMI.
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9
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Andreae MH, Maman SR, Behnam AJ. An Electronic Medical Record-Derived Individualized Performance Metric to Measure Risk-Adjusted Adherence with Perioperative Prophylactic Bundles for Health Care Disparity Research and Implementation Science. Appl Clin Inform 2020; 11:497-514. [PMID: 32726836 PMCID: PMC7390620 DOI: 10.1055/s-0040-1714692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/01/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Health care disparity persists despite vigorous countermeasures. Clinician performance is paramount for equitable care processes and outcomes. However, precise and valid individual performance measures remain elusive. OBJECTIVES We sought to develop a generalizable, rigorous, risk-adjusted metric for individual clinician performance (MIP) derived directly from the electronic medical record (EMR) to provide visual, personalized feedback. METHODS We conceptualized MIP as risk responsiveness, i.e., administering an increasing number of interventions contingent on patient risk. We embedded MIP in a hierarchical statistical model, reflecting contemporary nested health care delivery. We tested MIP by investigating the adherence with prophylactic bundles to reduce the risk of postoperative nausea and vomiting (PONV), retrieving PONV risk factors and prophylactic antiemetic interventions from the EMR. We explored the impact of social determinants of health on MIP. RESULTS We extracted data from the EMR on 25,980 elective anesthesia cases performed at Penn State Milton S. Hershey Medical Center between June 3, 2018 and March 31, 2019. Limiting the data by anesthesia Current Procedural Terminology code and to complete cases with PONV risk and antiemetic interventions, we evaluated the performance of 83 anesthesia clinicians on 2,211 anesthesia cases. Our metric demonstrated considerable variance between clinicians in the adherence to risk-adjusted utilization of antiemetic interventions. Risk seemed to drive utilization only in few clinicians. We demonstrated the impact of social determinants of health on MIP, illustrating its utility for health science and disparity research. CONCLUSION The strength of our novel measure of individual clinician performance is its generalizability, as well as its intuitive graphical representation of risk-adjusted individual performance. However, accuracy, precision and validity, stability over time, sensitivity to system perturbations, and acceptance among clinicians remain to be evaluated.
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Affiliation(s)
- Michael H. Andreae
- Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Stephan R. Maman
- Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
- Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Abrahm J. Behnam
- Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
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10
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Sheykhotayefeh M, Safdari R, Ghazisaeedi M, Khademi SH, Seyed Farajolah SS, Maserat E, Jebraeily M, Torabi V. Development of a Minimum Data Set (MDS) for C-Section Anesthesia Information Management System (AIMS). Anesth Pain Med 2017; 7:e44132. [PMID: 28824861 PMCID: PMC5556329 DOI: 10.5812/aapm.44132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 12/24/2016] [Accepted: 12/25/2016] [Indexed: 11/17/2022] Open
Abstract
Background Caesarean section, also known as C-section, is a very common procedure in the world. Minimum data set (MDS) is defined as a set of data elements holding information regarding a series of target entities to provide a basis for planning, management, and performance evaluation. MDS has found a great use in health care information systems. Also, it can be considered as a basis for medical information management and has shown a great potential for contributing to the provision of high quality care and disease control measures. Objectives The principal aim of this research was to determine MDS and required capabilities for Anesthesia information management system (AIMS) in C-section in Iran. Methods Data items collected from several selected AIMS were studied to establish an initial set of data. The population of this study composed of 115 anesthesiologists was asked to review the proposed data elements and score them in order of importance by using a five-point Likert scale. The items scored as important or highly important by at least 75% of the experts were included in the final list of minimum data set. Results Overall 8 classes of data (consisted of 81 key data elements) were determined as final set. Also, the most important required capabilities were related to airway management and hypertension and hypotension management. Conclusions In the development of information system (IS) based on MDS and identification, because of the broad involvement of users, IS capabilities must focus on the users’ needs to form a successful system. Therefore, it is essential to assess MDS watchfully by considering the planned uses of data. Also, IS should have essential capabilities to meet the needs of its users.
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Affiliation(s)
- Mostafa Sheykhotayefeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
- Department of Health Information Technology, School of Allied Medical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Reza Safdari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding authors: Reza Safdari, Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-2188985671, E-mail: ; Marjan Ghazisaeedi, Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. E-mail:
| | - Marjan Ghazisaeedi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding authors: Reza Safdari, Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-2188985671, E-mail: ; Marjan Ghazisaeedi, Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. E-mail:
| | - Seyed Hossein Khademi
- Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran
- Department of Anesthesiology, School of Allied Medical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Seyedeh Sedigheh Seyed Farajolah
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Maserat
- Medical Informatics Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohamad Jebraeily
- Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran
| | - Vahid Torabi
- Department of Parasitology, School of Health, Tehran University of Medical Sciences, Tehran, Iran
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11
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Donmez T, Erdem VM, Sunamak O, Erdem DA, Avaroglu HI. Laparoscopic total extraperitoneal repair under spinal anesthesia versus general anesthesia: a randomized prospective study. Ther Clin Risk Manag 2016; 12:1599-1608. [PMID: 27822053 PMCID: PMC5087702 DOI: 10.2147/tcrm.s117891] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is a well-known approach to inguinal hernia repair that is usually performed under general anesthesia (GA). To date, no reports compare the efficacy of spinal anesthesia (SA) with that of GA for laparoscopic hernia repairs. The purpose of this study was to compare the surgical outcome of TEP inguinal hernia repair performed when the patient was treated under SA with that performed under GA. Materials and methods Between July 2015 and July 2016, 50 patients were prospectively randomized to either the GA TEP group (Group I) or the SA TEP group (Group II). Propofol, fentanyl, rocuronium, sevoflurane, and tracheal intubation were used for GA. Hyperbaric bupivacaine (15 mg) and fentanyl (10 µg) were used for SA to achieve a sensorial level of T3. Intraoperative events related to SA, operative and anesthesia times, postoperative complications, and pain scores were recorded. Each patient was asked to evaluate the anesthetic technique by using a direct questionnaire filled in 3 months after the operation. Results All the procedures were completed by the allocated method of anesthesia as there were no conversions from SA to GA. Pain was significantly less for 1 h (P<0.0001) and 4 h (P=0.002) after the procedure for the SA and GA groups, respectively. There was no difference between the two groups regarding complications, hospital stay, recovery, or surgery time. Generally, patients were more satisfied with SA than GA (P<0.020). Conclusion TEP inguinal hernia repair can be safely performed under SA, and SA was associated with less postoperative pain, better recovery, and better patient satisfaction than GA.
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Affiliation(s)
| | - Vuslat Muslu Erdem
- Department of Anesthesiology and Reanimation, Lutfiye Nuri Burat State Hospital
| | - Oguzhan Sunamak
- Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Duygu Ayfer Erdem
- Department of Anesthesiology and Reanimation, Lutfiye Nuri Burat State Hospital
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Anderson BJ, Merry AF. Paperless anesthesia: uses and abuses of these data. Paediatr Anaesth 2015; 25:1184-92. [PMID: 26432199 DOI: 10.1111/pan.12782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 11/30/2022]
Abstract
Demonstrably accurate records facilitate clinical decision making, improve patient safety, provide better defense against frivolous lawsuits, and enable better medical policy decisions. Anesthesia Information Management Systems (AIMS) have the potential to improve on the accuracy and reliability of handwritten records. Interfaces with electronic recording systems within the hospital or wider community allow correlation of anesthesia relevant data with biochemistry laboratory results, billing sections, radiological units, pharmacy, earlier patient records, and other systems. Electronic storage of large and accurate datasets has lent itself to quality assurance, enhancement of patient safety, research, cost containment, scheduling, anesthesia training initiatives, and has even stimulated organizational change. The time for record making may be increased by AIMS, but in some cases has been reduced. The question of impact on vigilance is not entirely settled, but substantial negative effects seem to be unlikely. The usefulness of these large databases depends on the accuracy of data and they may be incorrect or incomplete. Consequent biases are threats to the validity of research results. Data mining of biomedical databases makes it easier for individuals with political, social, or economic agendas to generate misleading research findings for the purpose of manipulating public opinion and swaying policymakers. There remains a fear that accessibility of data may have undesirable regulatory or legal consequences. Increasing regulation of treatment options during the perioperative period through regulated policies could reduce autonomy for clinicians. These fears are as yet unsubstantiated.
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Affiliation(s)
- Brian J Anderson
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Alan F Merry
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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Gálvez JA, Rothman BS, Doyle CA, Morgan S, Simpao AF, Rehman MA. A Narrative Review of Meaningful Use and Anesthesia Information Management Systems. Anesth Analg 2015; 121:693-706. [PMID: 26287298 DOI: 10.1213/ane.0000000000000881] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The US federal government has enacted legislation for a federal incentive program for health care providers and hospitals to implement electronic health records. The primary goal of the Meaningful Use (MU) program is to drive adoption of electronic health records nationwide and set the stage to monitor and guide efforts to improve population health and outcomes. The MU program provides incentives for the adoption and use of electronic health record technology and, in some cases, penalties for hospitals or providers not using the technology. The MU program is administrated by the Department of Health and Human Services and is divided into 3 stages that include specific reporting and compliance metrics. The rationale is that increased use of electronic health records will improve the process of delivering care at the individual level by improving the communication and allow for tracking population health and quality improvement metrics at a national level in the long run. The goal of this narrative review is to describe the MU program as it applies to anesthesiologists in the United States. This narrative review will discuss how anesthesiologists can meet the eligible provider reporting criteria of MU by applying anesthesia information management systems (AIMS) in various contexts in the United States. Subsequently, AIMS will be described in the context of MU criteria. This narrative literature review also will evaluate the evidence supporting the electronic health record technology in the operating room, including AIMS, independent of certification requirements for the electronic health record technology under MU in the United States.
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Affiliation(s)
- Jorge A Gálvez
- From the Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; and Coast Anesthesia Medical Group, O'Connor Hospital, San Jose, California
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Mouton A, Le Strat V, Medevielle D, Kerroumi Y, Graff W. Patient's satisfaction after outpatient forefoot surgery: Study of 619 cases. Orthop Traumatol Surg Res 2015; 101:S217-20. [PMID: 26278024 DOI: 10.1016/j.otsr.2015.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/21/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The number of outpatient surgical procedures performed in France on the forefoot has grown rapidly in recent years. OBJECTIVES The goal of this study was to evaluate experience and satisfaction of patients undergoing outpatient foot surgery using a telephone questionnaire developed for this purpose. MATERIAL AND METHODS In 2012 and 2013, every patient who was admitted to the day surgery unit at our hospital for an open procedure on their forefoot was called the morning after the procedure. A nurse went through the 14-item questionnaire with the patient. The same perioperative protocol, written instructions and treatment were used for all patients. RESULTS Six hundred nineteen patients were included. The questionnaire response rate was 89% (n=540). Isolated hallux valgus surgery was performed on 319 patients (61%); 107 patients (20%) underwent hallux valgus surgery with lateral metatarsal osteotomy; 57 patients (10.5%) underwent first metatarsophalangeal fusion and 47 patients (8.5%) underwent a procedure on the lateral rays only. In the postoperative phase, 65% reported having satisfactory sleep quality, 32% had experienced nausea, 16% had experienced vomiting and 17% had experienced bleeding. Eighty percent of patients experienced pain (VAS ≥ 1); 80% of these patients had their pain relieved by the prescribed treatment and 4% had not taken it. Nearly all the patients (99%) were satisfied with the outpatient care; the overall satisfaction score was 9.4 out of 10. There was a significant relationship between the type of procedure and vomiting, pain, bleeding and fever. DISCUSSION Outpatient care is becoming more common in response to economic challenges. The development of outpatient foot surgery appears to have satisfied the vast majority of operated patients. However, adjustments should be made to improve their tolerance to the pain management protocol. Although the logistics of performing follow-up call can be complicated, the patients appreciate receiving this call the next day. The call also seems to reassure both the patients and care providers.
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Affiliation(s)
- A Mouton
- Groupe hospitalier Diaconesses Croix Saint-Simon, 12-18, rue du Sergent-Bauchat, 75012 Paris, France.
| | - V Le Strat
- Groupe hospitalier Diaconesses Croix Saint-Simon, 12-18, rue du Sergent-Bauchat, 75012 Paris, France
| | - D Medevielle
- Groupe hospitalier Diaconesses Croix Saint-Simon, 12-18, rue du Sergent-Bauchat, 75012 Paris, France
| | - Y Kerroumi
- Groupe hospitalier Diaconesses Croix Saint-Simon, 12-18, rue du Sergent-Bauchat, 75012 Paris, France
| | - W Graff
- Groupe hospitalier Diaconesses Croix Saint-Simon, 12-18, rue du Sergent-Bauchat, 75012 Paris, France
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Fei Y, Zong GQ, Chen J, Liu RM. Fast-track protocols in devascularization for cirrhotic portal hypertension. Rev Assoc Med Bras (1992) 2015; 61:250-7. [PMID: 26248248 DOI: 10.1590/1806-9282.61.03.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 10/22/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION/OBJECTIVE fast-tract surgery (FTS) has been rapidly embraced by surgeons as a mechanism for improving patient care and driving down complications and costs. The aim of this study was to determine if any improvement in outcomes occurred after FTS protocol for selective double portazygous disconnection with preserving vagus (SDPDPV) compared with non-FTS postoperative care. METHODS patients eligible for SDPDPV in the period January 2012-April 2014 were randomly selected for the FTS group or non-FTS group. A designed protocol was used in the FTS group with emphasis on an interdisciplinary approach. The non-FTS group was treated using previously established standard procedures. The number of postoperative complications, time of functional recovery and duration of hospital stay were recorded. RESULTS patients in the FTS group (n=59) and non-FTS group (n=57) did not differ in terms of preoperative data and operative details (p>0.05). The FTS procedure led to significantly better control and faster restoration of gastrointestinal functions, food tolerance, rehabilitation and hospital discharge (p<0.05). Postoperative complications, including nausea/vomiting, severe ascites, wound infection, urinary tract infection and pulmonary infection were all significantly lower in the FTS group (p<0.05). According to the postoperative morbidity classification used by Clavien, overall complications and grade I complications were both significantly lower in the FTS group compared with the non-FTS group (p<0.05). CONCLUSION adopting the FTS protocol helped to recover gastrointestinal functions, to reduce frequency of postoperative complications and to reduce hospital stay. The FTS strategy is safe and effective in improving postoperative outcomes.
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Affiliation(s)
- Yang Fei
- Department of General Surgery, 81st Hospital of P.L.A., Nanjing, China
| | - Guang-quan Zong
- Department of General Surgery, 81st Hospital of P.L.A., Nanjing, China
| | - Jian Chen
- Department of General Surgery, 81st Hospital of P.L.A., Nanjing, China
| | - Ren-min Liu
- Department of General Surgery, 81st Hospital of P.L.A., Nanjing, China
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NİTRÖZ OKSİDİN POSTOPERATİF BULANTI VE KUSMA ÜZERİNE ETKİSİ. MARMARA MEDICAL JOURNAL 2015. [DOI: 10.5472/marumj.3047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Weil G, Motamed C, Eghiaian A, Guye ML, Bourgain JL. The use of a clinical database in an anesthesia unit: focus on its limits. J Clin Monit Comput 2014; 29:163-7. [PMID: 24838488 DOI: 10.1007/s10877-014-9581-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/07/2014] [Indexed: 11/30/2022]
Abstract
Anesthesia information management system (AIMS) can be used a part of quality assurance program to improve patient care, however erroneous or missing data entries may lead to misinterpretation. This study assesses the accuracy of information extracted for six consecutive years from a database linked to an automatic anesthesia record-keeping system. An observational study was conducted on a database linked AIMS system. The database was filled in real time during surgical/anesthesia procedure and in the post-anesthesia care unit. The following items: name of the anesthetist, duration of anesthesia, duration of monitoring, ventilatory status upon arrival in postoperative care unit, pain scores, nausea and vomiting scores, pain medication (morphine) and anti nausea and vomiting drug consumption (ondansetron) were extracted and analysed in order to determine exhaustivity (percentage of missing data) and accuracy of the database. The analysis covered 55,946 anaesthetic procedures. The rate of missing data was initially high upon installation but decreased over time. It was limited to 5% after 3 years for items such as start of anesthesia or name of the anesthetist. However exhaustivity/completeness of some other variable, such as nausea and vomiting started as low as 50% to reach 20% at 2008. After cross analysing pain and post-operative nausea and vomiting scores with related medication consumption, (morphine and ondansetron) we conclude that missing data was due to omission of a zero score rather than human error. The follow-up of quality assurance program may use data from AIMS provided that missing or erroneous values be mentioned and their impact on calculations accurately analysed.
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Affiliation(s)
- Grégoire Weil
- Service d'Anesthésie, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
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Kim SH, Shin YS, Oh YJ, Lee JR, Chung SC, Choi YS. Risk assessment of postoperative nausea and vomiting in the intravenous patient-controlled analgesia environment: predictive values of the Apfel's simplified risk score for identification of high-risk patients. Yonsei Med J 2013; 54:1273-81. [PMID: 23918581 PMCID: PMC3743191 DOI: 10.3349/ymj.2013.54.5.1273] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Opioid-based intravenous patient-controlled analgesia (IV PCA) is popular method of postoperative pain control, but many patients suffer from IV PCA-related postoperative nausea and vomiting (PONV). In this retrospective observational study, we have determined independent predictors of IV PCA-related PONV and predictive values of the Apfel's simplified risk score in pursuance of identifying high-risk patients. MATERIALS AND METHODS We analyzed 7000 patients who received IV PCA with background infusion after elective surgery. Patients who maintained IV PCA for a postoperative period of 48 hr (completion group, n=6128) were compared with those who have discontinued IV PCA within 48 hr of surgery due to intractable PONV (cessation group, n=872). Patients, anesthetics, and surgical factors known for predicting PONV were evaluated by logistic regression analysis to identify independent predictors of IV PCA related intractable PONV. RESULTS In a stepwise multivariate analysis, weight, background infusion dose of fentanyl, addition of ketolorac to PCA, duration of anesthesia, general anesthesia, head and neck surgery, and Apfel's simplified risk score were revealed as independent risk factors for intractable PONV followed by the cessation of IV PCA. In addition, Apfel's simplified risk score, which demonstrated the highest odds ratio among the predictors, was strongly correlated with the cessation rate of IV PCA. CONCLUSION Multimodal prophylactic antiemetic strategies and dose reduction of opioids may be considered as strategies for the prevention of PONV with the use of IV PCA, especially in patients with high Apfel's simplified risk scores.
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Affiliation(s)
- Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yang-Sik Shin
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Jun Oh
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Rim Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Chan Chung
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Seon Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Sung TY, Kim MS, Cho CK, Park DH, Kang PS, Lee SE, Kwon WK, Woo NS, Kim SH. Clinical effects of intrathecal fentanyl on shoulder tip pain in laparoscopic total extraperitoneal inguinal hernia repair under spinal anaesthesia: a double-blind, prospective, randomized controlled trial. J Int Med Res 2013; 41:1160-70. [PMID: 23839277 DOI: 10.1177/0300060513490083] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The study evaluated the clinical intraoperative effects of intrathecal administration of fentanyl on shoulder tip pain in patients undergoing laparoscopic total extraperitoneal inguinal hernia repair (TEP) under spinal anaesthesia. METHODS Patients undergoing TEP were allocated in a double-blinded, prospective, randomized manner to two groups. Spinal anaesthesia was induced by intrathecal administration of 2.8 ml of 0.5% hyperbaric bupivacaine (14 mg) in the control group and with 2.6 ml of 0.5% hyperbaric bupivacaine (13 mg) and 10 µg fentanyl (0.2 ml) in the experimental group. RESULTS The quality of muscle relaxation, adequacy of operative space and incidence of pneumoperitoneum were similar in the two groups (n = 36 per group). Compared with the control group, the experimental group had significantly fewer cases of hypotension (12 [33.3%]) versus 23 [63.9%]) and shoulder tip pain (nine [25%] versus 18 [50%]). Intraoperative shoulder tip pain was more severe in the control group than in the experimental group. CONCLUSIONS Addition of intrathecal fentanyl to local anaesthetic can relieve shoulder tip pain with no change in complications, especially hypotension, during TEP under spinal anaesthesia.
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Affiliation(s)
- Tae-Yun Sung
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
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Apfel C, Heidrich F, Jukar-Rao S, Jalota L, Hornuss C, Whelan R, Zhang K, Cakmakkaya O. Evidence-based analysis of risk factors for postoperative nausea and vomiting †. Br J Anaesth 2012; 109:742-53. [DOI: 10.1093/bja/aes276] [Citation(s) in RCA: 400] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jang JS, Lee JH, Lee JJ, Park WJ, Hwang SM, Lee SK, Lim SY. Postoperative nausea and vomiting after myringoplasty under continuous sedation using midazolam with or without remifentanil. Yonsei Med J 2012; 53:1010-3. [PMID: 22869486 PMCID: PMC3423846 DOI: 10.3349/ymj.2012.53.5.1010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This prospective study evaluated the effects of continuous sedation using midazolam, with or without remifentanil, on postoperative nausea and vomiting (PONV) in patients undergoing myringoplasty. MATERIALS AND METHODS Sixty patients undergoing myringoplasty were sedated with midazolam in the presence of remifentanil (group MR), or after saline injection instead of remifentanil (group M). RESULTS Three patients (10%) in group M complained of nausea; two vomited. Four patients (13%) in group MR complained of nausea and vomited within 24 h after surgery. Rescue drugs were given to the six patients who vomited. No significant difference was detected between the two groups regarding the incidence or severity of nausea, incidence of vomiting, or need for rescue drugs. CONCLUSION Midazolam-based continuous sedation can reduce PONV after myringoplasty. Compared with midazolam alone, midazolam with remifentanil produced no difference in the incidence or severity of nausea, incidence of vomiting, or need for rescue drugs.
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Affiliation(s)
- Ji Su Jang
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hallym University, Chuncheon, Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Hallym University, Chuncheon, Korea
| | - Jae Jun Lee
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hallym University, Chuncheon, Korea
| | - Won Jae Park
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hallym University, Chuncheon, Korea
| | - Sung Mi Hwang
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hallym University, Chuncheon, Korea
| | - Soo Kyung Lee
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hallym University, Chuncheon, Korea
| | - So Young Lim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Hallym University, Chuncheon, Korea
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Morino R, Ozaki M, Nagata O, Yokota M. Incidence of and risk factors for postoperative nausea and vomiting at a Japanese Cancer Center: first large-scale study in Japan. J Anesth 2012; 27:18-24. [PMID: 22923285 PMCID: PMC3574566 DOI: 10.1007/s00540-012-1468-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/29/2012] [Indexed: 11/30/2022]
Abstract
Purpose The first purpose of this study was to determine the incidence of postoperative nausea and/or vomiting (PONV) 0–48 h after anesthesia at a Japanese cancer center. The second purpose of this study was to collect information on PONV risk factors, independently, in the categories of patient-related, anesthesia-related, and surgery-related factors. Methods The frequency of nausea and vomiting was prospectively investigated from 0 to 48 h after anesthesia in 1645 patients (11–94 years of age) at a single medical institution. The occurrence of nausea and vomiting and the use of antiemetics were recorded up to 48 h after anesthesia. Patient-related, anesthesia-related, and surgery-related factors were also recorded and submitted to multiple logistic regression analysis to determine the relationship of these factors to nausea and vomiting. Results The incidences of nausea and vomiting from 0 to 24 h after anesthesia were 40 and 22 %, respectively. The incidences 24–48 h after anesthesia were 10 and 3 %, respectively. Female sex, previous history of PONV, prolonged anesthesia, and remifentanil use during surgery were identified as risk factors for both nausea and vomiting. The use of a volatile anesthetic, use of fentanyl during surgery, postoperative use of opioids, nonsmoking status, and drinking alcohol on 4 or fewer days per week were identified as risk factors for nausea alone. Conclusion The incidence of and risk factors for PONV at a Japanese cancer center according to this study are comparable to those reported elsewhere.
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Affiliation(s)
- Ryozo Morino
- Department of Anesthesiology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.
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Wesmiller SW, Henker RA, Sereika SM, Donovan HS, Meng L, Gruen GS, Tarkin IS, Conley YP. The association of CYP2D6 genotype and postoperative nausea and vomiting in orthopedic trauma patients. Biol Res Nurs 2012; 15:382-9. [PMID: 22718526 DOI: 10.1177/1099800412449181] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The CYP2D6 gene encodes for an enzyme that is involved in the metabolism of more than 25% of all medications, including many opioids and antiemetics. It may contribute to the risk of postoperative nausea and vomiting (PONV), a common surgical complication. However, little research has been conducted in this area. The purpose of this study was to explore the association of CYP2D6 genotypes with PONV in adult surgical trauma patients. Data from 112 patients (28% female) with single extremity fractures, aged 18-70 years, were analyzed. PONV was defined as present if patients reported nausea, were observed vomiting, or received medication for PONV. Saliva samples collected for DNA extraction and Taqman(®) allele discrimination and quantitative real time polymerase chain reaction (qRT-PCR) were used to collect genotype data that were then used to assign CYP2D6 phenotype classification. The incidence of PONV was 38% in the postanesthesia care unit and increased to 50% when assessed at 48 hr. CYP2D6 classification results were 7 (6%) poor metabolizers, 34 (30%) intermediate metabolizers, and 71 (63%) extensive metabolizers. No ultrarapid metabolizers were identified. Patients who were classified as poor metabolizers had less PONV and higher pain scores. Gender and history of PONV, but not smoking, were also significant risk factors. Findings suggest variability in CYP2D6 impacts susceptibility to PONV.
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Jin HS, Kim MH, Lee SY, Jeong HY, Choi SJ, Lee HW. A survey of user acceptance of electronic patient anesthesia records. Korean J Anesthesiol 2012; 62:350-7. [PMID: 22558502 PMCID: PMC3337382 DOI: 10.4097/kjae.2012.62.4.350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/27/2011] [Accepted: 07/31/2011] [Indexed: 12/03/2022] Open
Abstract
Background An anesthesia information management system (AIMS), although not widely used in Korea, will eventually replace handwritten records. This hospital began using AIMS in April 2010. The purpose of this study was to evaluate users' attitudes concerning AIMS and to compare them with manual documentation in the operating room (OR). Methods A structured questionnaire focused on satisfaction with electronic anesthetic records and comparison with handwritten anesthesia records was administered to anesthesiologists, trainees, and nurses during February 2011 and the responses were collected anonymously during March 2011. Results A total of 28 anesthesiologists, 27 trainees, and 47 nurses responded to this survey. Most participants involved in this survey were satisfied with AIMS (96.3%, 82.2%, and 89.3% of trainees, anesthesiologists, and nurses, respectively) and preferred AIMS over handwritten anesthesia records in 96.3%, 71.4%, and 97.9% of trainees, anesthesiologists, and nurses, respectively. However, there were also criticisms of AIMS related to user-discomfort during short, simple or emergency surgeries, doubtful legal status, and inconvenient placement of the system. Conclusions Overall, most of the anesthetic practitioners in this hospital quickly accepted and prefer AIMS over the handwritten anesthetic records in the OR.
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Affiliation(s)
- Hyun Seung Jin
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kadry B, Feaster WW, Macario A, Ehrenfeld JM. Anesthesia Information Management Systems: Past, Present, and Future of Anesthesia Records. ACTA ACUST UNITED AC 2012; 79:154-65. [DOI: 10.1002/msj.21281] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bhukal I, Srinivas N, Solanki SL, Yaddanapudi LN, Jain A. A randomized study to compare the efficacy of two intravenous fluid regimens of normal saline on the incidence of postoperative nausea and vomiting. Anesth Essays Res 2012; 6:21-4. [PMID: 25885496 PMCID: PMC4173421 DOI: 10.4103/0259-1162.103366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of two different volume of crystalloid given intraoperatively on postoperative nausea and vomiting (PONV). MATERIALS AND METHODS Eighty adult patients of either sex belonging to ASA I and II class undergoing elective surgeries under general anesthesia for 1-2 h were studied in this prospective, randomized double blinded study. First group (group L) (n=40) received normal saline 4 mL/kg and second group (group H) (n=40) received 10 mL/kg of normal saline. This was in excess of the fasting requirement of the patients. No propofol or antiemetic drugs were given. PONV was evaluated by verbal descriptive score (VDS) [0 = none, 1 = mild, 2 = moderate, 3 = severe, and 4 = unbearable]. Ondansetron (4 mg i.v.) was given if VDS score was 3 or more. RESULTS The median immediate PONV score was 2 and 1 in group L and H, respectively. The median 2 h PONV score in group L was 3 and in group H was 1. The median 6 h PONV score in group L was 3 and in group H was 1. The 24 h median postoperative PONV score was 1 and 0 in group L and H, respectively. In all these period of time the differences were statistically significant. The incidence of vomiting was more in group L [72.5% (29/40)] than in group H [30% (12/40)]. This was statistically significant (P=0.0003). CONCLUSION From the current study it was concluded that patients who received larger volume of crystalloid intraoperatively have lesser incidence of PONV.
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Affiliation(s)
- Ishwar Bhukal
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - N. Srinivas
- Department of Anesthesia, Alchemist Hospitals Ltd, Panchkula, Haryana, India
| | - Sohan Lal Solanki
- Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (At the time of work, all authors were affiliated to Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India), India
- Corresponding author: Dr. Sohan Lal Solanki, Department of Anesthesiology, SGPGIMS, Rae-Bareilly Road, Lucknow, India. E-mail:
| | - L. N. Yaddanapudi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Jain
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
The Anesthesia Quality Institute has created the National Anesthesia Clinical Outcomes Registry to automatically capture electronic data specific to anesthesia cases. Data come from billing systems, quality management systems, hospital electronic health care records, and anesthesia information management systems. Aggregation of this data will allow for calculation of national and cohort-specific benchmarks for anesthesia outcomes of interest. Provision of this data to anesthesia practitioners through periodic private reports will motivate improvements in the quality of care.
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Risk scores for predicting postoperative nausea and vomiting are clinically useful tools and should be used in every patient: con--'life is really simple, but we insist on making it complicated'. Eur J Anaesthesiol 2011; 28:155-9. [PMID: 21192269 DOI: 10.1097/eja.0b013e3283427f4f] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:733-41. [PMID: 21079721 DOI: 10.3238/arztebl.2010.0733] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 04/13/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND The German-language recommendations for the management of postoperative nausea and vomiting (PONV) have been revised by an expert committee. Major aspects of this revision are presented here in the form of an evidence-based review article. METHODS The literature was systematically reviewed with the goal of revising the existing recommendations. New evidence-based recommendations for the management of PONV were developed, approved by consensus, and graded according to the scheme of the Scottish Intercollegiate Guidelines Network (SIGN). RESULTS The relevant risk factors for PONV include female sex, nonsmoker status, prior history of PONV, motion sickness, use of opioids during and after surgery, use of inhalational anesthetics and nitrous oxide, and the duration of anesthesia. PONV scoring systems provide a rough assessment of risk that can serve as the basis for a risk-adapted approach. Risk-adapted prophylaxis, however, has not been shown to provide any greater benefit than fixed (combination) prophylaxis, and PONV risk scores have inherent limitations; thus, fixed prophylaxis may be advantageous. Whichever of these two approaches to manage PONV is chosen, high-risk patients must be given multimodal prophylaxis, involving both the avoidance of known risk factors and the application of multiple validated and effective antiemetic interventions. PONV should be treated as soon as it arises, to minimize patient discomfort, the risk of medical complications, and the costs involved. CONCLUSION PONV lowers patient satisfaction but is treatable. The effective, evidence-based measures of preventing and treating it should be implemented in routine practice.
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Affiliation(s)
- Dirk Rüsch
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Gießen und Marburg GmbH
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Zamper RPC, Torres MLA, Ferraz JL, Neto SM, Holzhacker R, Shimada V, Carmona MJC. Evaluation of a computerized anesthesia report. Rev Bras Anestesiol 2010; 60:285-301. [PMID: 20682160 DOI: 10.1016/s0034-7094(10)70036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 01/20/2010] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In Brazil, the use of information systems that allows filling out anesthesia reports automatically is still in its initial stages. The objective of this study was to validate an automated anesthesia record. METHODS This study was approved by the Ethics Commission of the institution; an industry-university partnership (Dixtal, São Paulo, Brazil and Universidade de São Paulo) was developed, and the study received a grant from FINEP (Financiadora de Estudos e Projetos do Ministério de Ciência e Tecnologia). The integration of hospital information systems for recovery of data regarding identification, preoperative evaluation, and laboratorial exams was the premise of this study. The applicability of the final version of the prototype of the automated system was evaluated by applying a semi-structured tool to 33 physicians, residents, and/or anesthesiologists during surgery procedures in 66 patients. Descriptive evaluation of the data was undertaken. RESULTS The computerized system was considered reliable even for large surgeries by 81% of the participants. The majority of the anesthesiologists considered the prototype of great value for future studies and capable of meeting the requirements of anesthesia reports, bringing benefits for anesthesiologists, patients, and hospitals. The full use of the system requires training and some of its aspects can be improved. CONCLUSIONS Validation of this prototype of a computerized system for elaboration of anesthesia reports showed the viability of this type of solution to help anesthesiologists in their daily tasks, increasing the reliability of the data. Besides, when evaluating the applicability, anesthesiologists considered that the prototype could be useful for patients, physicians, and hospitals.
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Affiliation(s)
- Raffael Pereira Cezar Zamper
- Anesthesiology Subject and Anesthesia Division of Instituto Central do Hospital das Clínicas (HC) of Faculdade de Medicina da Universidade de São Paulo (FMUSP), SP
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Franck M, Radtke FM, Apfel CC, Kuhly R, Baumeyer A, Brandt C, Wernecke KD, Spies CD. Documentation of Post-operative Nausea and Vomiting in Routine Clinical Practice. J Int Med Res 2010; 38:1034-41. [DOI: 10.1177/147323001003800330] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated the quality of documentation of post-operative nausea and vomiting (PONV) by comparing incidences collected by a research team with those reported routinely by nursing personnel. A total of 560 patients passing through an interdisciplinary recovery room were included in the study. The overall recorded incidence of PONV over 24 h was 30.7%, which was in agreement with the predicted value of 32% calculated using incidences from published randomized controlled trials. Out of the total number of 86 cases of PONV in the recovery room only 36 (42%) were detected by nursing staff. Similarly, out of the total number of 129 cases of PONV on the ward over 24 h, only 37 (29%) were recognized by nursing staff during routine care. In conclusion, PONV in routine clinical care is likely to be under-reported. To use PONV as a valid quality measure, patients need to be actively asked about nausea and vomiting at frequent intervals in a standardized fashion. A considerable proportion of patients experience PONV after discharge from the recovery room, so the assessment of PONV should cover at least 24 h post-operatively
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Affiliation(s)
- M Franck
- Department of Anaesthesia and Intensive Care, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - FM Radtke
- Department of Anaesthesia and Intensive Care, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - CC Apfel
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, California, USA
| | - R Kuhly
- Department of Anaesthesia and Intensive Care, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - A Baumeyer
- Department of Anaesthesia and Intensive Care, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - C Brandt
- Department of Anaesthesia and Intensive Care, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | | | - CD Spies
- Department of Anaesthesia and Intensive Care, Charité - Universitaetsmedizin Berlin, Berlin, Germany
- Sostana GmbH, Berlin, Germany
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Fast-track hysterectomy: a randomised, controlled study. Eur J Obstet Gynecol Reprod Biol 2010; 151:203-7. [PMID: 20452716 DOI: 10.1016/j.ejogrb.2010.04.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 03/25/2010] [Accepted: 04/01/2010] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate if intrathecally administered morphine combined with a low-dose mode of total intravenous anaesthesia (TIVA) accelerates recovery after abdominal surgery as compared, to patient-controlled analgesia (PCA) combined with anaesthesia, based on volatile anaesthetics. STUDY DESIGN Fifty-three patients who were hysterectomised abdominally were randomised to TIVA or PCA. Their per- and post-operative course was strictly monitored and their pain score was evaluated with a visual analogue scale at repeated time intervals. RESULTS Patients with TIVA had a significantly shorter stay on the post-operative ward, 180 (105-330)min, compared with the PCA group, 237 (120-1140)min (p<0.01). The start of peroral fluid also differed significantly between groups, 4h (2-6) for TIVA versus 5h (2-24) for the PCA group (p<0.01). The removal of the indwelling catheter took place significantly earlier in the TIVA group, 9h (5-23) versus 22h (17-24) in the PCA group (p<0.0001). There was significantly less post-operative nausea in the TIVA group compared with the PCA group on the first post-operative day (p<0.01). The length of stay was shorter, 2 days (1-3) compared with 3 days (1-6) for the TIVA group versus PCA (p<0.001). There was no difference in complications between groups. One patient in each group was re-admitted to hospital because of a vaginal cuff infection. CONCLUSION The TIVA per- and post-operative care was an advantage over PCA in most respects.
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Ruiz JR, Kee SS, Frenzel JC, Ensor JE, Selvan M, Riedel BJ, Apfel C. The Effect of an Anatomically Classified Procedure on Antiemetic Administration in the Postanesthesia Care Unit. Anesth Analg 2010; 110:403-9. [DOI: 10.1213/ane.0b013e3181a9d076] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Diemunsch P, Joshi G, Brichant JF. Neurokinin-1 receptor antagonists in the prevention of postoperative nausea and vomiting. Br J Anaesth 2009; 103:7-13. [DOI: 10.1093/bja/aep125] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Egger Halbeis CB, Epstein RH. The value proposition of anesthesia information management systems. Anesthesiol Clin 2008; 26:665-vi. [PMID: 19041622 DOI: 10.1016/j.anclin.2008.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Anesthesia information management systems add value to the anesthesiologist and the hospital above that which is provided by manual anesthesia records. The more complete documentation and less biased recording of vital signs in this system, relative to manual records, provide data needed for quality initiatives and operating room management and for clinical research. The system can improve the ability to increase anesthesia charge capture, meet the requirements of pay-for-performance programs, and assist in the defense of malpractice allegations. Realization of value from the anesthesia information management systems requires additional expenditures of resources to adapt the systems to meet specific institutional requirements.
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Affiliation(s)
- Christoph B Egger Halbeis
- Department of Anesthesia, Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Drive H3580, Stanford, CA 94305, USA.
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Muravchick S, Caldwell JE, Epstein RH, Galati M, Levy WJ, O'Reilly M, Plagenhoef JS, Rehman M, Reich DL, Vigoda MM. Anesthesia Information Management System Implementation: A Practical Guide. Anesth Analg 2008; 107:1598-608. [DOI: 10.1213/ane.0b013e318187bc8f] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Leslie K, Myles P, Chan M, Paech M, Peyton P, Forbes A, McKenzie D. Risk factors for severe postoperative nausea and vomiting in a randomized trial of nitrous oxide-based vs nitrous oxide-free anaesthesia. Br J Anaesth 2008; 101:498-505. [DOI: 10.1093/bja/aen230] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Vigoda MM, Rodríguez LI, Wu E, Perry K, Duncan R, Birnbach DJ, Lubarsky DA. The Use of an Anesthesia Information System to Identify and Trend Gender Disparities in Outpatient Medical Management of Patients with Coronary Artery Disease. Anesth Analg 2008; 107:185-92. [DOI: 10.1213/01.ane.0000289651.65047.3b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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41
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Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS, Hooper VD, Kovac AL, Kranke P, Myles P, Philip BK, Samsa G, Sessler DI, Temo J, Tramèr MR, Vander Kolk C, Watcha M. Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg 2007; 105:1615-28, table of contents. [DOI: 10.1213/01.ane.0000295230.55439.f4] [Citation(s) in RCA: 467] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gardner M. Computerized anaesthesia information management systems: are we on the threshold of widespread use? Curr Opin Anaesthesiol 2007; 14:643-7. [PMID: 17019159 DOI: 10.1097/00001503-200112000-00008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite a recognition that they are essential for the future progress of anaesthesia, computerized anaesthesia information management systems are not in widespread use. In this article, relevant recent publications are summarized with a view to identifying the reasons for the current situation. Several developments which might promote the wider use of such systems in the near future are also presented.
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Affiliation(s)
- M Gardner
- Department of Computing Science, University of Glasgow, Glasgow, Scotland, UK.
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43
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Murphy MJ, Hooper VD, Sullivan E, Clifford T, Apfel CC. Identification of risk factors for postoperative nausea and vomiting in the perianesthesia adult patient. J Perianesth Nurs 2007; 21:377-84. [PMID: 17169747 DOI: 10.1016/j.jopan.2006.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Revised: 09/11/2006] [Accepted: 09/18/2006] [Indexed: 11/26/2022]
Abstract
Postoperative nausea and vomiting (PONV) is a common and potentially debilitating complication of surgery. The preoperative assessment of PONV using established risk assessment tools enables the identification of patients at risk and potentially decreases the incidence of PONV in adult surgical patients. The identification of risk factors associated with PONV and the factors that are independent predictors of PONV preoperatively can facilitate the effective prophylactic treatment and management of PONV in adult surgical patients.
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44
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Lee IO. The Postoperative Adverse Effects of Inhalational Anesthetics: Emergence Delirium and PONV. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.52.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Il-Ok Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea
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45
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Kovac AL. Prophylaxis of postoperative nausea and vomiting: controversies in the use of serotonin 5-hydroxytryptamine subtype 3 receptor antagonists. J Clin Anesth 2006; 18:304-18. [PMID: 16797435 DOI: 10.1016/j.jclinane.2005.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Accepted: 06/22/2005] [Indexed: 12/24/2022]
Abstract
Postoperative nausea and vomiting (PONV) continues to be a "big little problem" despite recent advances in anesthesia. Because of an increased interest in, and the abundant publications on this topic, guidelines for the management of PONV were published in 2003. Several key but controversial issues regarding PONV prophylaxis were left unaddressed, however. These included whether clinical differences exist between the 5-hydroxytryptamine subtype 3 (5-HT3) receptor antagonists, concern over optimal dosage and timing of administration, optimal 5-HT3 receptor antagonist combination therapy, and whether rescue therapy is effective after prior administration of the same or a different 5-HT3 receptor antagonist. The application of these antiemetics in clinical practice has raised questions regarding the role of the 5-HT3 receptor antagonists in the treatment of postdischarge nausea and vomiting and opioid-induced nausea and vomiting. A brief overview of the incidence, risk factors and current management recommendations for PONV and current controversies with special emphasis on the 5-HT3 receptor antagonists, is discussed.
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Affiliation(s)
- Anthony L Kovac
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Engel JM, Junger A, Hartmann B, Little S, Schnöbel R, Mann V, Jost A, Welters ID, Hempelmann G. Performance and customization of 4 prognostic models for postoperative onset of nausea and vomiting in ear, nose, and throat surgery. J Clin Anesth 2006; 18:256-63. [PMID: 16797426 DOI: 10.1016/j.jclinane.2005.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2004] [Accepted: 10/05/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the performance of 4 published prognostic models for postoperative onset of nausea and vomiting (PONV) by means of discrimination and calibration and the possible impact of customization on these models. DESIGN Prospective, observational study. SETTING Tertiary care university hospital. PATIENTS 748 adult patients (>18 years old) enrolled in this study. Severe obesity (weight > 150 kg or body mass index > 40 kg/m) was an exclusion criterion. INTERVENTIONS All perioperative data were recorded with an anesthesia information management system. A standardized patient interview was performed on the postoperative morning and afternoon. MEASUREMENTS Individual PONV risk was calculated using 4 original regression equations by Koivuranta et al, Apfel et al, Sinclair et al, and Junger et al Discrimination was assessed using receiver operating characteristic (ROC) curves. Calibration was tested using Hosmer-Lemeshow goodness-of-fit statistics. New predictive equations for the 4 models were derived by means of logistic regression (customization). The prognostic performance of the customized models was validated using the "leaving-one-out" technique. MAIN RESULTS Postoperative onset of nausea and vomiting was observed in 11.2% of the specialized patient population. Discrimination could be demonstrated as shown by areas under the receiver operating characteristic curve of 0.62 for the Koivuranta et al model, 0.63 for the Apfel et al model, 0.70 for the Sinclair et al model, and 0.70 for the Junger et al model. Calibration was poor for all 4 original models, indicated by a P value lower than 0.01 in the C and H statistics. Customization improved the accuracy of the prediction for all 4 models. However, the simplified risk scores of the Koivuranta et al model and the Apfel et al model did not show the same efficiency as those of the Sinclair et al model and the Junger et al model. This is possibly a result of having relatively few patients at high risk for PONV in combination with an information loss caused by too few dichotomous variables in the simplified scores. CONCLUSIONS The original models were not well validated in our study. An antiemetic therapy based on the results of these scores seems therefore unsatisfactory. Customization improved the accuracy of the prediction in our specialized patient population, more so for the Sinclair et al model and the Junger et al model than for the Koivuranta et al model and the Apfel et al model.
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Affiliation(s)
- Jörg M Engel
- Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Giessen, D-35392 Giessen, Germany
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ASPAN'S evidence-based clinical practice guideline for the prevention and/or management of PONV/PDNV. J Perianesth Nurs 2006; 21:230-50. [PMID: 16935735 DOI: 10.1016/j.jopan.2006.06.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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48
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Abstract
In pursuit of preventing or rapidly rescuing patients from postoperative nausea and vomiting, new clinical studies provide revised postoperative nausea and vomiting risk prediction tools, risk stratification formulae, comparative trials to identify the most appropriate cost-effective anti-emetics, and several trials recommending the addition of steroids in anti-emetic prophylactic multimodal approaches. Common variables that identify high-risk postoperative nausea and vomiting patients include female sex, a history of postoperative nausea and vomiting or motion sickness, young age, volatile anesthetic agents, nitrous oxide, and the administration of opioids. The most successful approach to the prevention of postoperative nausea and vomiting is multimodal, with combination anti-emetics, dexamethasone, aggressive hydration, the avoidance of opioids, and aggressive pain control.
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Affiliation(s)
- J B Leslie
- Department of Anesthesiology, Mayo Clinic Scottsdale, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA.
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49
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Eden A, Grach M, Goldik Z, Shnaider I, Lazarovici H, Barnett-Griness O, Perel A, Pizov R. The implementation of an anesthesia information management system. Eur J Anaesthesiol 2006; 23:882-9. [PMID: 16780614 DOI: 10.1017/s0265021506000834] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2006] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Anaesthesia information management systems, though still not used widely, will inevitably replace handwritten records and may eventually serve as a core for the development of computerized decision support. We investigated staff expectations and the accuracy of data entry in a recently implemented commercially available anaesthesia information management system. METHODS A structured questionnaire was administered to the staff before and 1 week and 3 months after implementation in order to assess their opinion. The quality of manual data entry, and of automatic data record was evaluated by looking for missing data and the prevalence of artefacts. RESULTS Despite initial fears the users quickly accepted the system. Both automatic and manual data entry were found to be accurate and reliable while the prevalence of artefacts was relatively low. CONCLUSIONS A commercially available anaesthesia information management system can be easily implemented and used instead of paper charts.
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Affiliation(s)
- A Eden
- Lady Davis Carmel Medical Center, Department of Anesthesiology and Critical Care Medicine, Haifa, Israel.
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50
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Abstract
Knowledge of postoperative nausea and vomiting (PONV) risk factors allows anesthesiologists to optimize the use of prophylactic regimens. Modern PONV risk research began in the 1990s with publication of studies using logistic regression analysis to simultaneously identify multiple independent PONV predictors and publication of meta-analyses and systematic reviews. This literature shows that female gender post-puberty, nonsmoking status, history of PONV or motion sickness, childhood after infancy and younger adulthood, increasing duration of surgery, and use of volatile anesthetics, nitrous oxide, large-dose neostigmine, or intraoperative or postoperative opioids are well established PONV risk factors. Possible risk factors include history of migraine, history of PONV or motion sickness in a child's parent or sibling, better ASA physical status, intense preoperative anxiety, certain ethnicities or surgery types, decreased perioperative fluids, crystalloid versus colloid administration, increasing duration of anesthesia, general versus regional anesthesia or sedation, balanced versus total IV anesthesia, and use of longer-acting versus shorter-acting opioids. Early-phase menstruation, obesity and lack of supplemental oxygen are disproved risk factors. Current risk scoring systems have approximately 55%-80% accuracy in predicting which patient groups will suffer PONV. Further research examining genetic and under-investigated clinical patient characteristics as potential risk factors, and involving outpatients and children, should improve predictive systems.
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Affiliation(s)
- Tong J Gan
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
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