M S Schaefer1, C C Apfel2, H-J Sachs3, R Stuttmann4, B Bein5, P H Tonner6, M Hein7, M Neukirchen8, M Reyle-Hahn3, P Kienbaum8. 1. Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Germany maximilian.schaefer@med.uni-duesseldorf.de. 2. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. 3. Klinik für Anästhesie und Perioperative Medizin, Interdisziplinäre Intensivmedizin, Evangelisches Waldkrankenhaus Berlin-Spandau, Germany. 4. Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Schmerztherapie Berufsgenossenschaftliche Kliniken Bergmannstrost, Halle, Germany. 5. Klinik für Anästhesiologie und Operative Intensivmedizin, Asklepios Klinik St Georg, Hamburg, Germany. 6. Klinik für Anästhesie, Operative und Allgemeine Intensivmedizin, Notfallmedizin, Klinikum Links der Weser, Bremen, Germany. 7. Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Aachen, Germany. 8. Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Germany.
Abstract
BACKGROUND: In contrast to volatile anaesthetics, xenon acts by antagonism at N-methyl-d-aspartate receptors and antagonizes 5-hydroxytryptamine type 3 receptors that mediate nausea and vomiting. Therefore, it is unknown whether the same risk factors for postoperative nausea and vomiting (PONV) after volatile anaesthetics apply to xenon-based anaesthesia. METHODS: With ethics committee approval and written informed consent, 502 consecutive patients undergoing xenon-based anaesthesia were included in a multicentre prospective observational study. Antiemetic prophylaxis was administered at the discretion of the attending anaesthetists. Postoperative nausea and vomiting and need for antiemetic rescue medication were assessed for 24 h after anaesthesia. Multivariate logistic regression analysis was performed to quantify risk factors for PONV and need for rescue medication. RESULTS: Four hundred and eighty-eight subjects were available for the final analysis. The incidence of PONV in subjects without prophylaxis was lower than expected according to the Apfel Score (28% observed; 42% expected, P<0.001). Independent predictors for PONV were (adjusted odds ratio; 95% confidence interval) female sex (1.76; 1.08-2.89), younger patient age (0.82 per 10 yr; 0.69-0.97), and longer duration of anaesthesia (1.36 per hour; 1.17-1.59). CONCLUSIONS: The incidence of PONV was significantly lower than predicted by the Apfel Score. Female sex, younger age, and longer duration of anaesthesia are risk factors for PONV after xenon-based anaesthesia. CLINICAL TRIAL REGISTRATION: German Federal Institute for Drugs and Medical Devices number AL-PMS-01/07GER.
BACKGROUND: In contrast to volatile anaesthetics, xenon acts by antagonism at N-methyl-d-aspartate receptors and antagonizes 5-hydroxytryptamine type 3 receptors that mediate nausea and vomiting. Therefore, it is unknown whether the same risk factors for postoperative nausea and vomiting (PONV) after volatile anaesthetics apply to xenon-based anaesthesia. METHODS: With ethics committee approval and written informed consent, 502 consecutive patients undergoing xenon-based anaesthesia were included in a multicentre prospective observational study. Antiemetic prophylaxis was administered at the discretion of the attending anaesthetists. Postoperative nausea and vomiting and need for antiemetic rescue medication were assessed for 24 h after anaesthesia. Multivariate logistic regression analysis was performed to quantify risk factors for PONV and need for rescue medication. RESULTS: Four hundred and eighty-eight subjects were available for the final analysis. The incidence of PONV in subjects without prophylaxis was lower than expected according to the Apfel Score (28% observed; 42% expected, P<0.001). Independent predictors for PONV were (adjusted odds ratio; 95% confidence interval) female sex (1.76; 1.08-2.89), younger patient age (0.82 per 10 yr; 0.69-0.97), and longer duration of anaesthesia (1.36 per hour; 1.17-1.59). CONCLUSIONS: The incidence of PONV was significantly lower than predicted by the Apfel Score. Female sex, younger age, and longer duration of anaesthesia are risk factors for PONV after xenon-based anaesthesia. CLINICAL TRIAL REGISTRATION: German Federal Institute for Drugs and Medical Devices number AL-PMS-01/07GER.
Authors: Astrid V Fahlenkamp; Christian Stoppe; Jan Cremer; Ingeborg A Biener; Dirk Peters; Ricarda Leuchter; Albrecht Eisert; Christian C Apfel; Rolf Rossaint; Mark Coburn Journal: PLoS One Date: 2016-04-25 Impact factor: 3.240