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Risk factors for postoperative nausea and vomiting in patients of orthognathic surgery according to the initial onset time: a cross-sectional study

  • Emi Ishikawa (Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University) ;
  • Takayuki Hojo (Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University) ;
  • Makiko Shibuya (Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University) ;
  • Takahito Teshirogi (Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University) ;
  • Keiji Hashimoto (Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University) ;
  • Yukifumi Kimura (Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University) ;
  • Toshiaki Fujisawa (Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University)
  • Received : 2022.11.23
  • Accepted : 2023.01.27
  • Published : 2023.02.01

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).

Keywords

Acknowledgement

We would like to thank Editage (www.editage.com) for the English language editing service.

References

  1. Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 2012; 109: 742-53. https://doi.org/10.1093/bja/aes276
  2. Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2020; 131: 411-48. https://doi.org/10.1213/ANE.0000000000004833
  3. Apfel CC, Stoecklein K, Lipfert P. PONV: a problem of inhalational anaesthesia? Best Pract Res Clin Anaesthesiol 2005; 19: 485-500. https://doi.org/10.1016/j.bpa.2005.03.001
  4. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999; 91: 693-700. https://doi.org/10.1097/00000542-199909000-00022
  5. Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 2012; 109: 742-53. https://doi.org/10.1093/bja/aes276
  6. Junger A, Hartmann B, Benson M, Schindler E, Dietrich G, Jost A, et al. The use of an anesthesia information management system for prediction of antiemetic rescue treatment at the postanesthesia care unit. Anesth Analg 2001; 92: 1203-9. https://doi.org/10.1097/00000539-200105000-00023
  7. Dobbeleir M, De Coster J, Coucke W, Politis C. Postoperative nausea and vomiting after oral and maxillofacial surgery: a prospective study. Int J Oral Maxillofac Surg 2018; 47: 721-5. https://doi.org/10.1016/j.ijom.2017.11.018
  8. Ghosh S, Rai KK, Shivakumar HR, Upasi AP, Naik VG, Bharat A. Incidence and risk factors for postoperative nausea and vomiting in orthognathic surgery: a 10-year retrospective study. J Korean Assoc Oral Maxillofac Surg 2020; 46: 116-24. https://doi.org/10.5125/jkaoms.2020.46.2.116
  9. Laskin DM, Carrico CK, Wood J. Predicting postoperative nausea and vomiting in patients undergoing oral and maxillofacial surgery. Int J Oral Maxillofac Surg 2020; 49: 22-7. https://doi.org/10.1016/j.ijom.2019.06.016
  10. Silva AC, O'Ryan F, Poor DB. Postoperative nausea and vomiting (PONV) after orthognathic surgery: a retrospective study and literature review. J Oral Maxillofac Surg 2006; 64: 1385-97. https://doi.org/10.1016/j.joms.2006.05.024
  11. Yamamuro T, Ueki S, Nakai D, Itoh T, Goto T. Risk factors for nausea and vomiting after sagittal splitting ramus osteotomy. J Jpn Dent Soc Anesthesiol 2012; 40: 298-303.
  12. Ooi K, Inoue N, Kaneko M, Donen M, Matsushita K, Yamaguchi H, et al. Examination of the postoperative nausea and vomiting in patients with a jaw deformity. Jpn J Jaw Deform 2010; 20: 1-7. https://doi.org/10.5927/jjjd.20.1
  13. Phillips C, Brookes CD, Rich J, Arbon J, Turvey TA. Postoperative nausea and vomiting following orthognathic surgery. Int J Oral Maxillofac Surg 2015; 44: 745-51. https://doi.org/10.1016/j.ijom.2015.01.006
  14. Inoue A, Taniyama K, Ishida M, Ogawa S, Yukawa J,  Shibutani T. Examination of the PONV after general anesthesia for orthognathic surgery. Matsumoto shigaku 2017; 43: 10-4.
  15. Apipan B, Rummasak D, Wongsirichat N. Postoperative nausea and vomiting after general anesthesia for oral and maxillofacial surgery. J Dent Anesth Pain Med 2016; 16: 273-81. https://doi.org/10.17245/jdapm.2016.16.4.273
  16. Gecaj-Gashi A, Hashimi M, Sada F, Baftiu N, Salihu S, Terziqi H, et al. Propofol vs isoflurane anesthesia-incidence of PONV in patients at maxillofacial surgery. Adv Med Sci 2010; 55: 308-12. https://doi.org/10.2478/v10039-010-0033-4
  17. Visser K, Hassink EA, Bonsel GJ, Moen J, Kalkman CJ. Randomized controlled trial of total intravenous anesthesia with propofol versus inhalation anesthesia with isoflurane-nitrous oxide: postoperative nausea with vomiting and economic analysis. Anesthesiology 2001; 95: 616-26. https://doi.org/10.1097/00000542-200109000-00012
  18. Hofer CK, Zollinger A, Buchi S, Klaghofer R, Serafino D, Buhlmann S, et al. Patient well-being after general anaesthesia: a prospective, randomized, controlled multi-centre trial comparing intravenous and inhalation anaesthesia. Br J Anaesth 2003; 91: 631-7. https://doi.org/10.1093/bja/aeg243
  19. 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 2013; 27: 18-24. https://doi.org/10.1007/s00540-012-1468-5
  20. Gauger PG, Shanks A, Morris M, Greenfield MLVH, Burney RE, O'Reilly M. Propofol decreases early postoperative nausea and vomiting in patients undergoing thyroid and parathyroid operations. World J Surg 2008; 32: 1525-34. https://doi.org/10.1007/s00268-008-9472-5
  21. Tramer M, Moore A, McQuay H. Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies. Br J Anaesth 1997; 78: 247-55. https://doi.org/10.1093/bja/78.3.247
  22. Khalid A, Siddiqui SZ, Aftab S, Sabbar S, Haider S. Recovery profile - a comparison of isoflurane and propofol anesthesia for laparoscopic cholecystectomy. J Coll Physicians Surg Pak 2008; 18: 329-33.
  23. Gan TJ, Glass PS, Howell ST, Canada AT, Grant AP, Ginsberg B. Determination of plasma concentrations of propofol associated with 50% reduction in postoperative nausea. Anesthesiology 1997; 87: 779-84. https://doi.org/10.1097/00000542-199710000-00010
  24. Soppitt AJ, Glass PS, Howell S, Weatherwax K, Gan TJ. The use of propofol for its antiemetic effect: a survey of clinical practice in the United States. J Clin Anesth 2000; 12: 265-9. https://doi.org/10.1016/S0952-8180(00)00151-3
  25. Apfel CC, Cakmakkaya OS, Frings G, Kranke P, Malhotra A, Stader A, et al. Droperidol has comparable clinical efficacy against both nausea and vomiting. Br J Anaesth 2009; 103: 359-63. https://doi.org/10.1093/bja/aep177
  26. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 1992; 77: 162-84. https://doi.org/10.1097/00000542-199207000-00023
  27. Agur AM, Dalley AF 2nd. Grant's Atlas of anatomy. 14th ed. Philadelphia, Wolters Kluwer 2017; pp654-7.
  28. Ishida S, Narihira K, Kita R, Yoshino A, Aoyagi N, Ohgawara T, et al. Application of multiple clinical tools, qSOFA criteria, CECT assessment, and Flynn's inflammatory scoring systems for diagnosis and management in a case with deep neck infection of odontogenic origin. Med Bull Fukuoka Univ 2019; 46: 85-90.
  29. Flynn TR, Shanti RM, Hayes C. Severe odontogenic infections, part 2: prospective outcomes study. J Oral Maxillofac Surg 2006; 64: 1104-13. https://doi.org/10.1016/j.joms.2006.03.031
  30. Rimon E, Kagansky N, Kagansky M, Mechnick L, Mashiah T, Namir M, et al. Are we giving too much iron? Low-dose iron therapy is effective in octogenarians. Am J Med 2005; 118: 1142-7. https://doi.org/10.1016/j.amjmed.2005.01.065
  31. Lerman J. Surgical and patient factors involved in postoperative nausea and vomiting. Br J Anaesth 1992; 69: 24S-32S. https://doi.org/10.1093/bja/69.supplement_1.24S
  32. Brookes CD, Berry J, Rich J, Golden BA, Turvey TA, Blakey G 3rd, et al. Multimodal protocol reduces postoperative nausea and vomiting in patients undergoing Le fort I osteotomy. J Oral Maxillofac Surg 2015; 73: 324-32. https://doi.org/10.1016/j.joms.2014.08.007
  33. Apfel CC, Philip BK, Cakmakkaya OS, Shilling A, Shi YY, Leslie JB, et al. Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? Anesthesiology 2012; 117: 475-86. https://doi.org/10.1097/ALN.0b013e318267ef31
  34. Leslie K, Myles PS, Chan MT, Paech MJ, Peyton P, Forbes A, et al. 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. https://doi.org/10.1093/bja/aen230
  35. Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology 1999; 91: 109-18. https://doi.org/10.1097/00000542-199907000-00018
  36. Sneyd JR, Carr A, Byrom WD, Bilski AJ. A meta-analysis of nausea and vomiting following maintenance of anesthesia with propofol or inhalational agents. Eur J Anaesthesiol 1998; 15: 433-45. https://doi.org/10.1097/00003643-199807000-00009
  37. Stadler M, Bardiau F, Seidel L, Albert A, Boogaerts JG. Difference in risk factors for postoperative nausea and vomiting. Anesthesiology 2003; 98: 46-52. https://doi.org/10.1097/00000542-200301000-00011
  38. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89: 652-8. https://doi.org/10.1213/00000539-199909000-00022