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British Journal of Anaesthesia, 2003, Vol. 91, No. 2 214-217
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Nausea and vomiting after fast-track cardiac anaesthesia

A. Kogan*,1, L. A. Eidelman2, E. Raanani1, B. Orlov1, O. Shenkin2 and B. A. Vidne1

1 Department of Cardiothoracic Surgery and 2 Department of Anesthesiology, Rabin Medical Center, Beilinson Campus, Petah-Tiqva 49100, Israel.Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Corresponding author. E-mail: akogan@clalit.org.il

Background. The aim of this study was to determine the prevalence of postoperative nausea and vomiting (PONV) after fast-track cardiac anaesthesia, risk factors for PONV and its influence on the length of stay in the intensive care unit (ICU).

Methods. A prospective study was performed in the cardiothoracic ICU (CTICU) of a university hospital; 1221 consecutive patients undergoing fast-track anaesthesia (FTCA) in cardiac surgery were enrolled in the study. Severity of PONV was assessed immediately after extubation and then every hour until discharge from the CTICU. Metoclopramide 10 mg i.v. was used as a first-line rescue medication and ondansetron 4 mg i.v. as second-line rescue medication for PONV.

Results. Nausea was reported in 240 (19.7%) patients, and vomiting in 53 (4.3%). A total of 269 (22%) patients were treated with metoclopramide and 38 (3.1%) with metoclopramide and ondansetron. The latter was effective in all cases. Risk factors for PONV were age less than 60 yr, female gender and previous history of PONV. Discharge from the CTICU was delayed for a few hours because of PONV in eight patients, all of whom were discharged the same day.

Conclusions. The incidence of PONV is relatively low after FTCA and does not prolong ICU stay. Prophylactic administration of anti-emetic drugs before FTCA is not necessary.

Br J Anaesth 2003; 91: 214–17


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