The Prevalence of Postoperative Nausea and Vomiting Following Cardiac Surgery and Evidence-Based Guidelines to Prevent

Abstract

Postoperative nausea and vomiting (PONV) continues to cause concern and side effects for patients following general anesthesia. Extensive research and recommendations exist guiding care for non-cardiac surgery patients. Evidence is, however, limited for cardiac surgery patients due to risks of QT prolongation, arrhythmias, and the use of fast-track anesthesia. Cardiac surgery patients present unique challenges due to their increased risk of arrhythmias and opioid requirements. Research supports utilizing the Apfel risk scoring system to determine which cardiac surgery patients should receive prophylactic medication. Routine antiemetics are not appropriate in the cardiac surgery population, but the developed Apfel with cardiac indicators tool can be utilized to treat patients based on their risk level. The study’s purpose was twofold, first to determine the prevalence of PONV and assess for statistically significant relationships and second to develop a risk assessment tool. The following variables were examined for significant effects: opioid dosage, presence of arrhythmias, QT prolongation, and times between postoperative milestones. A retrospective chart review of 100 patients was completed. In total, 46% (n = 46) of patients reported feeling nauseated after surgery, 11% (n = 11) reported to have vomited, and 49% (n = 49) received at least one dose of a rescue antiemetic. Gender was the only significant predictor of PONV (p=.021). Opioid dosage was not found to be associated with reports of nausea (p= .467). Study results coincide with previously published research and identifies a need for prophylactic treatment of PONV in the cardiac surgery population. The authors recommend utilization of the Apfel with cardiac indicators tool to guide risk factor assessment and prophylactic treatment.