• Anesthesiology · May 2016

    Randomized Controlled Trial

    Severe Nausea and Vomiting in the Elimination of Nitrous Oxide in the Gas Mixture for Anesthesia II Trial.

    • Paul S Myles, Matthew T V Chan, Jessica Kasza, Michael J Paech, Kate Leslie, Philip J Peyton, Daniel I Sessler, Guy Haller, W Scott Beattie, Cameron Osborne, J Robert Sneyd, and Andrew Forbes.
    • From the Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Monash University, Melbourne, Victoria, Australia (P.S.M.); Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, People's Republic of China (M.T.V.C.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.K., A.F.); Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia (M.J.P.); School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia (M.J.P.); Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (K.L.); Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Melbourne, Victoria, Australia (K.L.); Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia (K.L.); Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia (P.J.P.); Institute for Breathing and Sleep, Victoria, Australia (P.J.P.); Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (D.I.S.); Department of Anaesthesia, Intensive Care and Pharmacology, Geneva University Hospitals, University of Geneva, Switzerland (G.H.); Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada (W.S.B.); Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (W.S.B.); Department of Anesthesia, Perioperative and Acute Pain Management, Barwon Health, Geelong, Victoria, Australia (C.O.); and Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, United Kingdom (J.R.S.).
    • Anesthesiology. 2016 May 1; 124 (5): 1032-40.

    BackgroundThe Evaluation of Nitrous oxide in the Gas Mixture for Anesthesia II trial randomly assigned 7,112 noncardiac surgery patients to a nitrous oxide or nitrous oxide-free anesthetic; severe postoperative nausea and vomiting (PONV) was a prespecified secondary end point. Thus, the authors evaluated the association between nitrous oxide, severe PONV, and effectiveness of PONV prophylaxis in this setting.MethodsUnivariate and multivariate analyses of patient, surgical, and other perioperative characteristics were used to identify the risk factors for severe PONV and to measure the impact of severe PONV on patient outcomes.ResultsAvoiding nitrous oxide reduced the risk of severe PONV (11 vs. 15%; risk ratio [RR], 0.74 [95% CI, 0.63 to 0.84]; P < 0.001), with a stronger effect in Asian patients (RR, 0.55 [95% CI, 0.43 to 0.69]; interaction P = 0.004) but lower effect in those who received PONV prophylaxis (RR, 0.89 [95% CI, 0.76 to 1.05]; P = 0.18). Gastrointestinal surgery was associated with an increased risk of severe PONV when compared with most other types of surgery (P < 0.001). Patients with severe PONV had lower quality of recovery scores (10.4 [95% CI, 10.2 to 10.7] vs. 13.1 [95% CI, 13.0 to 13.2], P < 0.0005); severe PONV was associated with postoperative fever (15 vs. 20%, P = 0.001). Patients with severe PONV had a longer hospital stay (adjusted hazard ratio, 1.14 [95% CI, 1.05 to 1.23], P = 0.002).ConclusionsThe increased risk of PONV with nitrous oxide is near eliminated by antiemetic prophylaxis. Severe PONV, which is seen in more than 10% of patients, is associated with postoperative fever, poor quality of recovery, and prolonged hospitalization.

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