P023: INDIVIDUALIZED CONSIDERATION AND APPROACH TO POSTOPERATIVE NAUSEA AND VOMITING (PONV) TO PROVIDE COST-EFFECTIVE ANESTHESIA CARE AND MINIMIZING UNWANTED SIDE EFFECTS
Jonah Zisquit, MD1, Reena John, DO1, Javier Kaplan, MD2; 1Kendall Regional Medical Center, 2Aventura Hospital and Medical Center
Purpose: Postoperative nausea and vomiting (PONV) are two of the most common and unpleasant side effects following anesthesia and surgery. Without prophylactic intervention, PONV will develop in an estimated one third of patients who undergo inhalational anesthesia. The consequences of PONV include delayed discharge from the PACU, unanticipated hospital admission, increased incidence of pulmonary aspiration, and significant postoperative discomfort. Some risk factors that have consistently shown to be predictors for PONV include: female gender, nonsmoking, history of PONV, age, obesity, post-operative opioids and type of surgery. Current recommendations for PONV prophylaxis require estimating the risk for each patient.1 No prophylaxis is recommended for patients at low risk for PONV except if they are at risk for medical consequences from vomiting. Approach to anesthetic management and treatment for PONV is often a knee jerk reaction, given to most patients regardless of risk factors rather than being individualized per patient. Although ondansetron is effective in the prevention and treatment of postoperative nausea and vomiting (PONV) after ambulatory surgery, the optimal timing of its administration, the cost-effectiveness, the cost-benefits, and the effect on the patient's quality of life after discharge have not been established. In this retrospective study, we examined the need for routine administration of ondansetron prior to emergence for patients with low risk factors for PONV.
Methods: We conducted a retrospective study consisting of 18 patients, aged 70 and over undergoing short orthopedic surgeries under general anesthesia for less than 2 hour duration. We evaluated the use of ondansetron prior to emergence and the incidence of PONV in PACU as well as need for PONV treatment during PACU stay. The frequencies of vomiting and nausea and the use of ondansetron were compared using chi-square test or Fisher exact test with Bonferroni correction. P < 0.05 was considered statistically significant.
Results: 7 didn’t receive any antiemetic, 11 received antiemetics. Of the 7, 1 reported PACU nausea but was considered mild and not treated. 11 which received antiemetics reported no PONV in PACU. Based on statistical analysis there was no significant difference between the group who received ondansetron prophylactically and the group which did not.
Conclusion: The ability to identify high-risk patients for prophylactic intervention can significantly improve the quality of patient care and satisfaction. Equally as important is identifying low risk patients and refraining from prophylactically treating these patients. By risk stratifying patients and treating only patients who are at high risk of developing PONV after general anesthesia, we can provide more cost effective anesthesia services and minimize possible side effects such as headache, flushing, constipation, diarrhea, dizziness, fatigue, QT prolongation, and many more. This retrospective study provides evidence that low risk patients do not require routine prophylactic use of ondansetron and should only be treated if PONV occurs in the post-operative setting.