Postoperative nausea and vomiting (PONV) is a post-surgical, adverse reaction patients experience after general anaesthesia. It has a negative effect on patients’ recovery, which extends hospital admission time.1
Several perioperative stimuli can trigger PONV, including opioids, volatile anaesthetics, anxiety, adverse drug reactions and motion. Patient factors also influence the PONV: like a history of motion sickness, obesity, or abdominal pathologies.4
In a study of high-risk patients by Apfel et al, 1,180 patients were randomly assigned to receive various combinations of anaesthetics, opioids, and prophylactic antiemetics.5
The study indicated that during the early postoperative period, defined as the first two hours post anaesthesia, the leading risk factor for vomiting was the use of volatile anaesthetics. The study concluded “the use of volatile anaesthetics was the strongest risk factor for the development of PONV”.5
There are different estimations of the impact of PONV. In the USA, the risk of PONV is approximately 30% for the general surgical population and 80% for high-risk surgical procedures and high-risk patients.1 The probability of developing PONV can be unique to the type of surgery. For instance, the frequency varies from 52% to 72 % after laparoscopic cholecystectomy. 2 Some patients experience PONV after hospital discharge (PDNV) 3
Beyond causing patient distress, PONV has secondary effects with financial and workload impacts for hospitals.
PONV can be associated with increased patient care costs, which can significantly impact hospital budgets over time.
A time-motion economic analysis examined the incremental costs of PONV/PDNV in ambulatory patients from the end of anaesthetic period until the third morning after planned day surgery.3 Total of 49% of the 98 patients experienced PONV. Patients affected by PONV spent one hour longer in the PACU in comparison to patients without it.
The study concluded that the total cost of postoperative recovery was significantly greater for patients with PONV/PDNV than for those without (US$730 vs $640, respectively P=0.006).
A second financial impact study compared the direct and indirect costs of anaesthesia with sevoflurane and propofol. 221 patients went under day case procedures ranging from 15-90 minutes. They were divided in three groups. In group one anaesthesia was maintained and induced fully with propofol; in group two with propofol and sevoflurane, and in group three with sevoflurane only.
Patients in group 3 had significantly higher instances of PONV with 31.9%, group 1 had 5.6%, and group 2 had 11.4%. This impacted the costs as two patients from group 3 required an overnight stay. PONV has been shown to increase the workload of hospital staff. In a retrospective database analysis, the duration of PACU stay was longer, by a mean of 25 minutes, in patients who experienced PONV than in those who did not.2
Prolonged patient stays in PACU are a crucial issue as they create bottlenecks that may slow down the surgical schedule, leading to dissatisfaction for surgeons, nurses, patients, and their families.7
Reducing PONV instances is vital to increase patients’ admissions and care efficiency.
Total intravenous anaesthesia (TIVA) induces anaesthesia without using inhalational agents. It has been associated with reduced PONV compared to general anaesthetic combining inhalational and intravenous agents.2
A study of 90 patients examined the effect of anaesthesia on PONV in patients undergoing laparoscopic cholecystectomy. The patients were split into three groups:
The complete response rate (no PONV and no rescue antiemetic) at 2 hours after surgery was 90%, 63%, and 66% in Groups 1, 2, and 3, respectively (P < 0.05, Group 1 versus Group 2). At 24 hours, the complete response rate was 80%, 63%, and 43% in Groups 1, 2, and 3, respectively (P < 0.05, Group 1 versus Group 3).2 Combining TIVA with antiemetics was concluded to be associated with better patient satisfaction.2
Further to this, in a systematic review and meta-analysis of propofol vs inhalation agents, 6,688 studies were identified, and 229 randomised controlled trials were included to examine a total of 20,991 patients. A statistically significant 39% reduction of the relative risk was observed for propofol as compared to volatile agents.8
Aromatherapy scents, such as vanilla bean, have been shown to reduce the impact of PONV on patients.9 A study by Houston Methodist Hospital found there was a 60% reduction in the use of anti-emetic drugs when aromatherapy was used to treat PONV. In the same study, 100% of AOD and PACU nurses recommended inclusion of aromatherapy in the multi-modal therapy for PONV.9
TIVA sets from Mediplus are available in a wide range and were designed with anaesthetists to offer enhanced performance, greater patient comfort and cost savings. The range includes Dual, Triple and Quadruple sets all with anti-siphon valves on drug lines and anti-reflux valves on gravity lines. Bright red end caps also ensure easy visibility at all times.
Capnomask™ is a medium concentration mask that delivers supplemental O2 and measures ETCO2. It is impregnated with a vanilla scent, widely used in aromatherapy to reduce nausea, lower blood pressure and ease anxiety.
Find out more about Capnomask™ by visiting the product website.
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