Risk of severe and refractory postoperative nausea and vomiting in patients undergoing diep flap breast reconstruction

Michele Manahan, Basak Basdag, Christopher L. Kalmar, Sachin M. Shridharani, Michael Magarakis, Lisa Jacobs, Robert W Thomsen, Gedge David Rosson

Research output: Contribution to journalArticle

Abstract

Background Postoperative nausea and vomiting (PONV) are commonly feared after general anesthesia and can impact results. The primary aim of our study was to examine incidence and severity of PONV by investigating complete response, or absence of PONV, to prophylaxis used in patients undergoing DIEP flaps. Our secondary aims were definition of the magnitude of risk, state of the art of interventions, clinical sequelae of PONV, and interaction between these variables, specifically for DIEP patients. Methods A retrospective chart review occurred for 29 patients undergoing DIEP flap breast reconstruction from September 2007 to February 2008. We assessed known patient and procedure-specific risks for PONV after DIEPs, prophylactic antiemetic regimens, incidence, and severity of PONV, postoperative antiemetic rescues, and effects of risks and treatments on symptoms. Results Three or more established risks existed in all patients, with up to seven risks per patient. Although 90% of patients received diverse prophylaxis, 76% of patients experienced PONV, and 66% experienced its severe form, emesis. Early PONV (73%) was frequent; symptoms were long lasting (average 20 hours for nausea and emesis); and multiple rescue medications were frequently required (55% for nausea, 58% for emesis). Length of surgery and nonsmoking statistically significantly impacted PONV. Conclusion We identify previously undocumented high risks for PONV in DIEP patients. High frequency, severity, and refractoriness of PONV occur despite standard prophylaxis. Plastic surgeons and anesthesiologists should further investigate methods to optimize PONV prophylaxis and treatment in DIEP flap patients.

Original languageEnglish (US)
Pages (from-to)112-121
Number of pages10
JournalMicrosurgery
Volume34
Issue number2
DOIs
StatePublished - Feb 2014

Fingerprint

Postoperative Nausea and Vomiting
Mammaplasty
Vomiting
Antiemetics
Nausea
Incidence
General Anesthesia
diclofenac hydroxyethylpyrrolidine

ASJC Scopus subject areas

  • Surgery

Cite this

Risk of severe and refractory postoperative nausea and vomiting in patients undergoing diep flap breast reconstruction. / Manahan, Michele; Basdag, Basak; Kalmar, Christopher L.; Shridharani, Sachin M.; Magarakis, Michael; Jacobs, Lisa; Thomsen, Robert W; Rosson, Gedge David.

In: Microsurgery, Vol. 34, No. 2, 02.2014, p. 112-121.

Research output: Contribution to journalArticle

@article{1fd253fb09bf4853ae2c93a72c2d108b,
title = "Risk of severe and refractory postoperative nausea and vomiting in patients undergoing diep flap breast reconstruction",
abstract = "Background Postoperative nausea and vomiting (PONV) are commonly feared after general anesthesia and can impact results. The primary aim of our study was to examine incidence and severity of PONV by investigating complete response, or absence of PONV, to prophylaxis used in patients undergoing DIEP flaps. Our secondary aims were definition of the magnitude of risk, state of the art of interventions, clinical sequelae of PONV, and interaction between these variables, specifically for DIEP patients. Methods A retrospective chart review occurred for 29 patients undergoing DIEP flap breast reconstruction from September 2007 to February 2008. We assessed known patient and procedure-specific risks for PONV after DIEPs, prophylactic antiemetic regimens, incidence, and severity of PONV, postoperative antiemetic rescues, and effects of risks and treatments on symptoms. Results Three or more established risks existed in all patients, with up to seven risks per patient. Although 90{\%} of patients received diverse prophylaxis, 76{\%} of patients experienced PONV, and 66{\%} experienced its severe form, emesis. Early PONV (73{\%}) was frequent; symptoms were long lasting (average 20 hours for nausea and emesis); and multiple rescue medications were frequently required (55{\%} for nausea, 58{\%} for emesis). Length of surgery and nonsmoking statistically significantly impacted PONV. Conclusion We identify previously undocumented high risks for PONV in DIEP patients. High frequency, severity, and refractoriness of PONV occur despite standard prophylaxis. Plastic surgeons and anesthesiologists should further investigate methods to optimize PONV prophylaxis and treatment in DIEP flap patients.",
author = "Michele Manahan and Basak Basdag and Kalmar, {Christopher L.} and Shridharani, {Sachin M.} and Michael Magarakis and Lisa Jacobs and Thomsen, {Robert W} and Rosson, {Gedge David}",
year = "2014",
month = "2",
doi = "10.1002/micr.22155",
language = "English (US)",
volume = "34",
pages = "112--121",
journal = "Microsurgery",
issn = "0738-1085",
publisher = "Wiley-Liss Inc.",
number = "2",

}

TY - JOUR

T1 - Risk of severe and refractory postoperative nausea and vomiting in patients undergoing diep flap breast reconstruction

AU - Manahan, Michele

AU - Basdag, Basak

AU - Kalmar, Christopher L.

AU - Shridharani, Sachin M.

AU - Magarakis, Michael

AU - Jacobs, Lisa

AU - Thomsen, Robert W

AU - Rosson, Gedge David

PY - 2014/2

Y1 - 2014/2

N2 - Background Postoperative nausea and vomiting (PONV) are commonly feared after general anesthesia and can impact results. The primary aim of our study was to examine incidence and severity of PONV by investigating complete response, or absence of PONV, to prophylaxis used in patients undergoing DIEP flaps. Our secondary aims were definition of the magnitude of risk, state of the art of interventions, clinical sequelae of PONV, and interaction between these variables, specifically for DIEP patients. Methods A retrospective chart review occurred for 29 patients undergoing DIEP flap breast reconstruction from September 2007 to February 2008. We assessed known patient and procedure-specific risks for PONV after DIEPs, prophylactic antiemetic regimens, incidence, and severity of PONV, postoperative antiemetic rescues, and effects of risks and treatments on symptoms. Results Three or more established risks existed in all patients, with up to seven risks per patient. Although 90% of patients received diverse prophylaxis, 76% of patients experienced PONV, and 66% experienced its severe form, emesis. Early PONV (73%) was frequent; symptoms were long lasting (average 20 hours for nausea and emesis); and multiple rescue medications were frequently required (55% for nausea, 58% for emesis). Length of surgery and nonsmoking statistically significantly impacted PONV. Conclusion We identify previously undocumented high risks for PONV in DIEP patients. High frequency, severity, and refractoriness of PONV occur despite standard prophylaxis. Plastic surgeons and anesthesiologists should further investigate methods to optimize PONV prophylaxis and treatment in DIEP flap patients.

AB - Background Postoperative nausea and vomiting (PONV) are commonly feared after general anesthesia and can impact results. The primary aim of our study was to examine incidence and severity of PONV by investigating complete response, or absence of PONV, to prophylaxis used in patients undergoing DIEP flaps. Our secondary aims were definition of the magnitude of risk, state of the art of interventions, clinical sequelae of PONV, and interaction between these variables, specifically for DIEP patients. Methods A retrospective chart review occurred for 29 patients undergoing DIEP flap breast reconstruction from September 2007 to February 2008. We assessed known patient and procedure-specific risks for PONV after DIEPs, prophylactic antiemetic regimens, incidence, and severity of PONV, postoperative antiemetic rescues, and effects of risks and treatments on symptoms. Results Three or more established risks existed in all patients, with up to seven risks per patient. Although 90% of patients received diverse prophylaxis, 76% of patients experienced PONV, and 66% experienced its severe form, emesis. Early PONV (73%) was frequent; symptoms were long lasting (average 20 hours for nausea and emesis); and multiple rescue medications were frequently required (55% for nausea, 58% for emesis). Length of surgery and nonsmoking statistically significantly impacted PONV. Conclusion We identify previously undocumented high risks for PONV in DIEP patients. High frequency, severity, and refractoriness of PONV occur despite standard prophylaxis. Plastic surgeons and anesthesiologists should further investigate methods to optimize PONV prophylaxis and treatment in DIEP flap patients.

UR - http://www.scopus.com/inward/record.url?scp=84893822295&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893822295&partnerID=8YFLogxK

U2 - 10.1002/micr.22155

DO - 10.1002/micr.22155

M3 - Article

C2 - 24038427

AN - SCOPUS:84893822295

VL - 34

SP - 112

EP - 121

JO - Microsurgery

JF - Microsurgery

SN - 0738-1085

IS - 2

ER -