Postoperative nausea and vomiting with application of postoperative continuous positive airway pressure after laparoscopic gastric bypass.

BACKGROUND: This study was performed to assess postoperative nausea and vomiting (PONV) with application of postoperative continuous positive airway pressure (CPAP) for patients undergoing Roux-en-Y gastric bypass (RYGB).
METHODS: The anesthesia database was searched for patients who underwent RYGB for 5 years. Three hundred fifty-six patients met the inclusive criteria. Wilcoxon two-sample rank test, Fisher's exact test, and multivariate logistic regression were used to analyze the data and identify the potential factors. A p value less than 0.05 was considered significant.
RESULTS: The overall incidence of the PONV (nausea or emesis or both) was 42%during the first 24 h postoperatively. Thirty-six percent and 35% in CPAP and no-CPAP groups respectively had reported nausea in postanesthesia care unit (PACU). There was no difference between groups (p > 0.05). There was a less frequent occurrence of emesis in both groups. The incidence of emesis in PACU was 19% in CPAP group and 17% in no-CPAP group (p > 0.05). No statistically significant differences of PONV in postoperative 24 h could be shown between the groups (p > 0.05). The postoperative hypertension occurred more often and intravenous antihypertensive medications were required more in no-CPAP patients (p = 0.013). More patients in no-CPAP group developed oxygenation disturbances (p = 0.012).The mean length of PACU stay was significantly longer in this group (p = 0.029). Reintubation and intensive care unit admission occurred more frequently in no-CPAP patients; however, the difference did not reach statistical significance.
CONCLUSIONS: There was no significantly increased risk of PONV with the use of postoperative CPAP. We recommend the routine use of postoperative CPAP for patients with obstructive sleep apnea undergoing RYGB to optimize their respiratory function.