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Randomized Controlled Trial
. 2018 Jan-Mar;21(1):8-14.
doi: 10.4103/aca.ACA_122_17.

Prophylaxis of postoperative nausea and vomiting after cardiac surgery in high-risk patients: A randomized controlled study

Sébastien Champion  1 , Laëtitia Zieger  1 , Caroline Hemery  1
Affiliations
Randomized Controlled Trial

Prophylaxis of postoperative nausea and vomiting after cardiac surgery in high-risk patients: A randomized controlled study

Sébastien Champion et al. Ann Card Anaesth. 2018 Jan-Mar.

Abstract

Context: The role of prophylaxis for postoperative nausea and vomiting (PONV) in cardiac surgery is under debate.

Aims: To study the risk factors for PONV after cardiac surgery and the role of betamethasone with or without droperidol for its prevention.

Setting and design: Randomized open-label controlled study comparing standard care with PONV prophylaxis from February to November 2016.

Methods: Five hundred and two patients with planned nonemergent cardiac surgery were included.

Interventions: In the intervention arm, PONV prophylaxis (4 mg betamethasone with/without 0.625 mg droperidol) was administered in high-risk patients (two or more risk factors). Patients in the control arm were treated as per routine hospital practices.

Results: Female sex, past history of PONV, and migraines were associated with a significantly increased risk of PONV, while motion sickness, smoking status, and volatile anesthetics were not. Pain and treatment with nefopam or ketoprofen were associated with an increased risk of PONV. PONV was less frequent in the active arm compared to controls (45.5% vs. 54.0%, P = 0.063; visual analogic scale 10.9 vs. 15.3 mm, P = 0.043). Among the 180 patients (35.6%) with ≥2 risk factors, prophylaxis was associated with reduced PONV (intention-to-treat: 46.8% vs. 67.8%, P = 0.0061; per-protocol: 39.2% vs. 69%, P = 0.0002). In multivariate analysis, prophylaxis was independently associated with PONV (odds ratio [OR]: 0.324, 95% confidence interval: 0.167-0.629, P = 0.0009), as were female sex, past history of PONV, and migraines (OR: 3.027, 3.031, and 2.160 respectively). No drug-related side effects were reported.

Conclusion: Betamethasone with/without droperidol was effective in decreasing PONV in high risk cardiac surgical patients without any side effect.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of patient inclusion and outcome
Figure 2
Figure 2
Proportion of postoperative nausea and vomiting according to the number of risk factors for postoperative nausea and vomiting assessed by Apfel scores (x-axis) of 502 patients after cardiac surgery
Figure 3
Figure 3
Odds ratio for postoperative nausea and vomiting with 95% confidence intervals of values identified as statistically significant in multivariate analysis. PONV: Postoperative nausea and vomiting
See this image and copyright information in PMC

References

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