Incidence and risk factors for postoperative nausea and vomiting in orthognathic surgery: a 10-year retrospective study

Abstract

Objectives: Postoperative nausea and vomiting (PONV) is considered as one of the most incessant and anguishing factors for patients who have surgery under general anesthesia. The occurrence of PONV after orthognathic surgery can lead to dehydration, infection, bleeding at the surgical site, and patient discomfort, all of which leave a patient with a negative impression of anesthesia and surgery. The purpose of this study is to assess the incidence of PONV after orthognathic surgery and to correlate it with factors related to patient, anesthesia, and surgery. Materials and Methods: A 10-year retrospective survey was done for patients who underwent orthognathic surgery between January 2008 and March 2018. The incidence of PONV was evaluated, correlations with factors related to patient, anesthesia, and surgery were studied, and the duration between the end of surgery and the occurrence of the first episode of PONV was tabulated. Results: The medical records of 109 patients were screened, out of which 101 satisfied the inclusion criteria. Amongst these patients, 60 patients (59.4%) suffered from PONV. Patient's sex, induction agent used, intravenous fluids administered intraoperatively, duration and type of surgery, and the presence of a nasogastric tube were seen to have a significant influence on precipitating PONV. It was noted that among the patients who suffered from PONV, 61.7% of them experienced it 48-96 hours after the end of surgery. Conclusion: Despite the improved anesthetic equipments, drugs, and surgical techniques currently used, the incidence of PONV was high in our study. Certain factors that were seen to influence PONV in this study need to be considered in order to develop an efficacious protocol to reduce PONV in orthognathic surgeries.

Risk Factors of Postoperative Vomiting in the Eye of “Real-World Evidence”—Modifiable and Clinical Setting-Dependent Risk Factors in Surgical Trauma Patients

“…This was in accordance with the results of a previous meta-analysis [ 36 ], showing that liberal intraoperative fluid regimens had lower odds of developing PONV as compared with restrictive fluid regimens. However, a recent study [ 51 ] showed that a higher occurrence of PONV was found in patients undergoing orthognathic surgery with more intraoperative fluid supply than those with less (≥25 mL/kg vs. <25 mL/kg). Although this study was a 10-year retrospective study, only 101 patients were included, and all factors were considered individually as in our basic statistics ( Table 1 ) which did not detect interactions of different potential risk factors.…”

Penehyclidine for prevention of postoperative nausea and vomiting following bimaxillary orthognathic surgery: a randomized, double-blind, controlled trial

“…In accord with its elimination half-life, the antiemetic effect of penehyclidine is diminished or disappeared after 24 h [ 14 , 15 ]. However, PONV following orthognathic surgery may persist for up to 96 h [ 16 ]. We, therefore, tested the hypothesis that a bolus plus infusion administration of penehyclidine could be more effective in reducing PONV.…”

“…Previous studies showed that prophylactic penehyclidine administered before surgery helped to prevent PONV [ 14 , 15 ]. Since the mean elimination half-life of a single-dose penehyclidine is about 10.35 h, whereas high frequent PONV may persist for up to 96 h after orthognathic surgery [ 16 ], we hypothesize that a low-dose bolus plus continuous infusion of penehyclidine may be more effective for PONV prevention. The purpose of this study is to investigate the efficacy and safety of single-dose plus continuously administrated penehyclidine in preventing PONV in patients undergoing bimaxillary surgery.…”

Postoperative Vomiting Following Laparoscopic Cholecystectomy Is Associated with Intraoperative Fluid Administration: A Retrospective Cohort Study

“…The impact of intraoperative fluid therapy on PONV remains inconclusive. A large number of studies in a 10-year retrospective study in orthognathic surgery in Asia revealed that the more the intraoperative intravenous fluids administered, the higher the occurrence of PONV [ 9 ]. A systematic review and meta-analysis of 41 studies from the Cochrane Database showed that perioperative intravenous crystalloid supplementation could reduce PONV [ 10 ].…”