Post-Operative Nausea and Vomiting after Cardiac Surgery
Date First Published:
January 18, 2011
Last Updated:
March 30, 2011
Report by:
Jamit Dhaliwal, Resident (University of Manitoba)
Three-Part Question:
What is the [incidence of post-operative nausea and vomiting] in [fast track patients] after [cardiac surgery]?
Clinical Scenario:
PONV is a common problem after general anesthetic and has the possibility to cause delays from the recovery room. What is the incidence of post-operative nausea and vomiting (PONV) in fast-track patients after cardiac surgery?
Search Strategy:
PubMed (no date limitations).
References from selected articles.
References from selected articles.
Search Details:
("nausea"[MeSH Terms] OR "nausea"[All Fields]) AND ("heart"[MeSH Terms] OR "heart"[All Fields] OR "cardiac"[All Fields]) AND bypass[All Fields]
Outcome:
58 articles found, 5 appropriate for question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Nausea and vomiting after fast-track cardiac anaesthesia A. Kogan 2003 Israel | 1221 patients undergoing coronary artery bypass grafting, valve-related and combined procedures who are were undergoing fast-track cardiac anesthesia. | To assess the incidence of post-operative nausea and vomiting in fast-track patients after cardiac surgery. | Nausea | 19.70% | Morphine used for post-operative pain control. Good study with large numbers. |
| Vomiting | 4.30% | ||||
| Nausea and vomiting after fast-track cardiac anaesthesia G. Morton 2004 London | 106 cardiac surgery patients (fast-track and non fast-track) | Prospective audit of PONV after "on-pump" cardiac surgery | Nausea | 10.40% | Use propofol for sedation post-operatively which could explain the lower rate of nausea. Small, prospective audit. |
| Vomiting | 15.10% | ||||
| Antiemetic prophylaxis in cardiac surgery: comparison of metaclopramide and ondansetron D. K. Woodward 1999 United Kingdom | 216 patients post cardiopulmonary bypass for first time elective cardiac surgery. Must be extubated within 12 hours of procedure to be included. | Examining the effects of Ondansetron vs. Metoclopramide on post operative nausea and vomiting. | Nausea at any time | Overall = 42% | Patients were given Morphine plus the study drug (either Ondansetron or Metaclopramide) 1-2 hours pre-operatively thus not a true indication of unprophylaxed nausea and vomiting. |
| Vomiting at any time | Overall = 34.3% | ||||
| Nausea and vomiting after cardiac surgery Grebenik 1996 England | 442 patients undergoing elective or urgent open heart surgery. | To determine the incidence of PONV during intensive care stay after cardiac surgery, and to study the effect of addition of droperidol to an infusion of morphine used for postoperative analgesia. | Nausea in the post op morphine group | 46.50% | The incidence of nausea is confounded by postoperative morphine infusion. Patient's were not all fast track patients. Propofol used to sedate if patient not extubatable; Propofol is an antiemetic (no mention of how many patients received propofol and for what duration). |
| Nausea in post op morphine + droperidol | 23% | ||||
| Vomiting in the post op morphine group | 36.90% | ||||
| Vimiting in the post op morphine + droperidol | 22% | ||||
| PONV in cardiac surgery [abstract] Riha, H. 2004 Czech Republic | 142 patients post CABG with CPB. Preserved EF >45% | Prospective double-blind randomized trial examining the incidence of PONV in cardiac surgery, its relation to cardiopulmonary bypass duration, and the efficacy of different antiemetic drugs for PONV prevention (given 30 min before end of procedure). | PONV | placebo = 27.1% | Post-operative pain was controlled with Morphine which is known to be pro-emetic. The abstract was published but insufficient information about whether the patients were truly fast-track is not available. |
| PONV | droperidol 1.25mg = 18.5% (p>0.05) | ||||
| PONV | thiethylperazine 6.5mg= 18% (p>0.05) | ||||
| PONV | ondansetron 4mg = 18% (p>0.05) |
Author Commentary:
Only one study examines the incidence of PONV in fast track patients after cardiac surgery and bypass.
Other evidence is inferred from trials in which the patient population is not truly "fast-track" or in patients which have received medications that confound the incidence of nausea and vomiting post-operatively.
Other evidence is inferred from trials in which the patient population is not truly "fast-track" or in patients which have received medications that confound the incidence of nausea and vomiting post-operatively.
Bottom Line:
According to the best available evidence for the population group of fast-track patients post cardiac surgery, the incidence of post-op nausea is 19.7% and vomiting is 4.3%.
References:
- A. Kogan. Nausea and vomiting after fast-track cardiac anaesthesia
- G. Morton. Nausea and vomiting after fast-track cardiac anaesthesia
- D. K. Woodward. Antiemetic prophylaxis in cardiac surgery: comparison of metaclopramide and ondansetron
- Grebenik. Nausea and vomiting after cardiac surgery
- Riha, H.. PONV in cardiac surgery [abstract]