Bhargava V Devarakonda1, Akhil Goel2, Shivinder Singh3, Deepak Kumar Sreevastava4, Kiranmai Vadapalli5, Murali Mohan Reddy6. 1. Classified Specialist (Anaesthesiology), Cardiothoracic & Vascular Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences, Trivandrum, Kerala 695011, India. 2. Classified Specialist (Anaesthesiology), Paediatric Anaesthesiology, Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India. 3. Brig AFMS (P&T), O/o DGAFMS, MoD, New Delhi, India. 4. Consultant & Head (Anaesthesiology), Base Hospital, Delhi Cantt, India. 5. Associate Professor (Physiology), Chattisgarh Institute of Medical Sciences, Bilaspur, Chattisgarh, India. 6. Associate Professor (Community Medicine), Chettinad Hospital and Research Institute, Chennai, India.
Abstract
BACKGROUND: Postoperative nausea and vomiting (PONV) is the second most common complaint in the postoperative period, often resulting in increased post anaesthesia care unit (PACU) and hospital stay. Translation of knowledge into consistent practice was considered a major gap. Hence, the present study was undertaken to test the efficacy of locally developed evidence-based institutional protocol for prevention of PONV. METHODS: Phase I consisted of determining the baseline incidence of PONV before introduction of the institutional protocol for PONV prophylaxis. In phase II, educational sessions for anaesthesiologists for PONV prevention and treatment were conducted, after which an institutional protocol was introduced. In phase III, this protocol was implemented, and the incidence of PONV was recorded using the same methodology as in phase I. The rate of adherence to the institutional protocol was also recorded. RESULTS: The incidence of postoperative nausea (PON) dropped significantly from 32.5% in phase I to 20% in phase III (p = 0.033). Similarly, the incidence of postoperative vomiting (POV) decreased from 20.5% in phase I to 9.1% in phase III (p = 0.016). Of all anaesthesiologists, 78.18% were noted to adhere to the protocol in phase III. Incidence of PON and POV was significantly less in patients in whom PONV prophylaxis was administered in adherence to protocol (8.3% vs 57.7%, p < 0.001; 3.6% vs 26.9%, p < 0.001, respectively). CONCLUSION: Evidence-based institutional protocols are effective in significantly reducing the incidence of PONV in adults undergoing noncardiac surgery under anaesthesia. CLINICAL TRIAL NUMBER AND REGISTRY URL: The trial was registered with Clinical Trials Registry of India (http:/ctri.nic.in) (CTRI/2015/12/006432).
BACKGROUND: Postoperative nausea and vomiting (PONV) is the second most common complaint in the postoperative period, often resulting in increased post anaesthesia care unit (PACU) and hospital stay. Translation of knowledge into consistent practice was considered a major gap. Hence, the present study was undertaken to test the efficacy of locally developed evidence-based institutional protocol for prevention of PONV. METHODS: Phase I consisted of determining the baseline incidence of PONV before introduction of the institutional protocol for PONV prophylaxis. In phase II, educational sessions for anaesthesiologists for PONV prevention and treatment were conducted, after which an institutional protocol was introduced. In phase III, this protocol was implemented, and the incidence of PONV was recorded using the same methodology as in phase I. The rate of adherence to the institutional protocol was also recorded. RESULTS: The incidence of postoperative nausea (PON) dropped significantly from 32.5% in phase I to 20% in phase III (p = 0.033). Similarly, the incidence of postoperative vomiting (POV) decreased from 20.5% in phase I to 9.1% in phase III (p = 0.016). Of all anaesthesiologists, 78.18% were noted to adhere to the protocol in phase III. Incidence of PON and POV was significantly less in patients in whom PONV prophylaxis was administered in adherence to protocol (8.3% vs 57.7%, p < 0.001; 3.6% vs 26.9%, p < 0.001, respectively). CONCLUSION: Evidence-based institutional protocols are effective in significantly reducing the incidence of PONV in adults undergoing noncardiac surgery under anaesthesia. CLINICAL TRIAL NUMBER AND REGISTRY URL: The trial was registered with Clinical Trials Registry of India (http:/ctri.nic.in) (CTRI/2015/12/006432).
Authors: Tong J Gan; Tricia A Meyer; Christian C Apfel; Frances Chung; Peter J Davis; Ashraf S Habib; Vallire D Hooper; Anthony L Kovac; Peter Kranke; Paul Myles; Beverly K Philip; Gregory Samsa; Daniel I Sessler; James Temo; Martin R Tramèr; Craig Vander Kolk; Mehernoor Watcha Journal: Anesth Analg Date: 2007-12 Impact factor: 5.108