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Canadian Journal of Anesthesia 51:320-325 (2004)
© Canadian Anesthesiologists' Society, 2004
General Anesthesia

A risk score-dependent antiemetic approach effectively reduces postoperative nausea and vomiting – a continuous quality improvement initiative

[Un traitement antiémétique relié au score de risque réduit efficacement les nausées et les vomissements postopératoires - une initiative d’amélioration continue de la qualité]

Sébastien Pierre, MD*, Gaelle Corno, MD*, Hervé Benais, MD* and Christian C. Apfel, MD{dagger}

* From the Department of Anesthesiology, Institut Claudius Regaud, Toulouse, France; and
{dagger} The Department of Anesthesiology and Perioperative Medicine, and OUTCOMES RESEARCHTM Institute, University of Louisville, Louisville, Kentucky, USA.

Address correspondence to: Dr. Sébastien Pierre, Department of Anesthesiology, Institut Claudius Regaud, 20-24 rue du Pont Saint Pierre, 31000 Toulouse, France. Phone: +33 5 61 42 46 11; Fax: +33 5 61 42 41 17; E-mail: pierre{at}icr.fnclcc.fr

Purpose: In a previous survey, patients at risk for postoperative nausea and vomiting (PONV) were best identified by a simplified risk score. Consequently, we investigated whether a risk score-dependent antiemetic strategy could effectively reduce the incidence of PONV in our department.

Methods: Adult in-patients (n = 428) scheduled for throat, thyroid, breast or gynecological surgery under general anesthesia were prospectively classified in three risk groups (L = low, M = medium, H = high) by using a simplified risk score. Patients in the L group did not receive any antiemetic prophylaxis. Patients in the M group received volatile anesthesia with 0.625 mg droperidol or an iv propofol anesthesia without droperidol. Patients in the H group received iv anesthesia supplemented with 4 mg dexamethasone and 0.625 mg droperidol.

Results: Compared with the data from our previous survey, the overall incidence of PONV decreased from 49.5% to 14.3% (P < 0.001). The incidence decreased from 34% to 13.2% (P < 0.001) in the M group and from 64.3% to 15.5% (P < 0.001) in the H group. Mean postanesthesia care unit time decreased from 99 to 82 min (P < 0.04).

Conclusion: This is the first survey which suggests that the departmental incidence of PONV can be significantly lowered by a risk score-dependent antiemetic strategy through a quality improvement initiative.




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