Department of Anaesthesiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Department of Anaesthesiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
Br J Anaesth. 2018 Jan;120(1):156-163. doi: 10.1016/j.bja.2017.08.003. Epub 2017 Nov 23.
Poor adherence to guidelines aimed at reducing the incidence of postoperative nausea and vomiting (PONV) is well known. In a before-and-after study, we tested the effectiveness of a simplified algorithm for PONV prophylaxis on the incidence of PONV.
In the first audit, we examined the adherence to our institutional guidelines for PONV prevention. In response to the results of this audit, we introduced a simplified algorithm for PONV prevention [female patients receiving triple prophylaxis (dexamethasone and ondansetron plus either a target-controlled infusion with propofol or droperidol) and male patients receiving double prophylaxis, dexamethasone, and ondansetron]. The impact of the simplification of the PONV algorithm was evaluated in a second audit. In both audits, we reviewed the medical records of all adult patients undergoing elective non-cardiac non-day-case surgery under general anaesthesia and being admitted to our post-anaesthesia care unit during two arbitrarily chosen weeks. We assessed the incidence of nausea, vomiting, and PONV after 1 and 24 h, and the compliance with the departmental algorithm for PONV prophylaxis.
After simplification of the PONV algorithm, the overall incidence of PONV within 24 h after surgery was significantly lower than before the implementation of the simplified PONV algorithm (22% vs 33%, P=0.02). The PONV incidence within 1 h was comparable between the audits (11% vs 14%, P=0.45). The adherence to departmental guidelines for PONV prophylaxis was significantly higher after the implementation of the simplified PONV algorithm (46% vs 18%, P=0.0001).
A simplified algorithm for PONV prophylaxis resulted in a significant reduction in the PONV incidence and better compliance with the PONV algorithm.
众所周知，人们普遍不能严格遵循旨在降低术后恶心呕吐（PONV）发生率的指南。在一项前后对照研究中，我们测试了简化 PONV 预防算法对 PONV 发生率的有效性。
在第一次审核中，我们检查了我们机构 PONV 预防指南的遵守情况。针对这次审核的结果，我们引入了一种简化的 PONV 预防算法[女性患者接受三联预防（地塞米松和昂丹司琼，加上依托咪酯或氟哌利多的靶控输注），男性患者接受二联预防，地塞米松和昂丹司琼]。在第二次审核中评估了 PONV 算法简化的影响。在两次审核中，我们回顾了在两个任意选择的周内在全身麻醉下接受择期非心脏非日间手术并在麻醉后护理单元住院的所有成年患者的病历。我们评估了术后 1 小时和 24 小时后恶心、呕吐和 PONV 的发生率，以及对部门 PONV 预防算法的依从性。
简化 PONV 算法后，术后 24 小时内 PONV 的总体发生率明显低于简化 PONV 算法实施前（22% vs 33%，P=0.02）。两次审核中，术后 1 小时内 PONV 的发生率相似（11% vs 14%，P=0.45）。简化 PONV 算法实施后，对部门 PONV 预防指南的遵循明显更高（46% vs 18%，P=0.0001）。
简化的 PONV 预防算法可显著降低 PONV 的发生率，并提高对 PONV 算法的依从性。
