Hostname: page-component-76fb5796d-r6qrq Total loading time: 0 Render date: 2024-04-25T15:07:54.668Z Has data issue: false hasContentIssue false
  • English
  • Français

Post-operative vomiting and enhanced recovery after congenital cardiac surgery

Published online by Cambridge University Press:  24 March 2022

M. Fernanda Parra ,
Morgan L. Brown ,
Steven J. Staffa ,
Meena Nathan  and
Nathalie Roy Open the ORCID record for Nathalie Roy [Opens in a new window]
M. Fernanda Parra
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, MA, Boston, USA Harvard Medical School, Boston, MA, USA
Morgan L. Brown
Affiliation:
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, MA, Boston, USA Harvard Medical School, Boston, MA, USA
Steven J. Staffa
Affiliation:
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, MA, Boston, USA
Meena Nathan
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, MA, Boston, USA Harvard Medical School, Boston, MA, USA
Nathalie Roy*
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, MA, Boston, USA Harvard Medical School, Boston, MA, USA
*
Author for correspondence: Nathalie Roy, MD, Department of Cardiac Surgery, 300 Longwood Avenue, Bader 292, Boston, MA 02115, USA. Tel: +1. 617 919 6364; Fax: +1 617 730 0214. Email: nathalie.roy@cardio.chboston.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Post-operative nausea and vomiting is frequent after congenital cardiac surgery.

Aims:

We sought to determine factors associated to severe post-operative vomiting after congenital cardiac surgery and the effect on post-operative outcomes.

Methods:

Patients > 30 days of age who underwent elective cardiac surgical repair as part of an enhanced recovery after congenital cardiac surgery programme were retrospectively reviewed. Patient characteristics and perioperative factors were compared by univariate analysis for patients with severe post-operative vomiting, defined as three events or more, and for patients with no-or-mild post-operative vomiting. All variables with a p-value < 0.1 were included in a multivariable model, and major post-operative outcomes were compared using regression analysis.

Results:

From 1 October, 2018 to 30 September, 2019, 430 consecutive patients were included. The median age was 4.8 years (interquartile range 1.2–12.6). Twenty-one per cent of patients (91/430) experienced severe post-operative vomiting. Total intraoperative opioids > 5.0 mg/kg of oral morphine equivalent (adjusted odds ratio 1.72) and post-operative inotropes infusion(s) (adjusted odds ratio 1.64) were identified as independent predictors of severe post-operative vomiting after surgery. Patients suffering from severe post-operative vomiting had increased pulmonary complications (adjusted odds ratio 5.18) and longer post-operative hospitalisation (adjusted coefficient, 0.89).

Conclusions:

Greater cumulative intraoperative opioids are associated with severe post-operative vomiting after congenital cardiac surgery. Multimodal pain strategies targeting the reduction of intraoperative opioids should be considered during congenital cardiac surgery to enhance recovery after surgery.

Keywords

Enhanced recovery after surgerypost-operative nausea and vomitingopioidsanesthesiacongenital cardiac surgery
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 2 , February 2023 , pp. 260 - 265
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Höhne, C. Postoperative nausea and vomiting in pediatric anesthesia. Curr Opin Anaesthesiol 2014; 27: 303–308.CrossRefGoogle ScholarPubMed
Gan, TJ, Belani, KG, Bergese, S, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2020; 131: 411–448.CrossRefGoogle ScholarPubMed
Lee, J, Faraoni, D, Lee, S, et al. Incidence and risk factors for postoperative vomiting following atrial septal defect repair in children. Paediatr Anaesth 2016; 26: 644–648.CrossRefGoogle ScholarPubMed
Roy, N, Parra, MF, Brown, ML, et al. Initial experience introducing an enhanced recovery program in congenital cardiac surgery. J Thorac Cardiovasc Surg 2020; 160: 1313–1321.CrossRefGoogle ScholarPubMed
Fuller, S, Kumar, SR, Roy, N, et al. The American Association for Thoracic Surgery Congenital Cardiac Surgery Working Group 2021 consensus document on a comprehensive perioperative approach to enhanced recovery after pediatric cardiac surgery. J Thorac Cardiovasc Surg 2021; 162: 931–954.CrossRefGoogle Scholar
Centers for Medicare & Medicaid Services Cms.gov. https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Oral-MME-CFs-vFeb-2018.pdf Google Scholar
Rose, JB, Watcha, MF. Postoperative nausea and vomiting in paediatric patients. Br J Anaesth 1999; 83: 104–117.CrossRefGoogle ScholarPubMed
Woodward, DK, Sherry, KM, Harrison, D. Antiemetic prophylaxis in cardiac surgery: comparison of metoclopramide and ondansetron. Br J Anaesth 1999; 83: 933–935.CrossRefGoogle ScholarPubMed
Eberhart, LH, Geldner, G, Kranke, P, et al. The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients. Anesth Analg 2004; 99: 1630–1637.CrossRefGoogle ScholarPubMed
Bourdaud, N, Devys, JM, Bientz, J, et al. Development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients: the VPOP score. Paediatr Anaesth 2014; 24: 945–952.CrossRefGoogle Scholar
Nakagawa, M, Kuri, M, Kambara, N, et al. Dopamine D2 receptor Taq IA polymorphism is associated with postoperative nausea and vomiting. J Anesth 2008; 22: 397–403.CrossRefGoogle ScholarPubMed
Roeleveld, PP, de Klerk, JCA. The perspective of the intensivist on inotropes and postoperative care following pediatric heart surgery: an international survey and systematic review of the literature. World J Pediatr Congenit Heart Surg 2018; 9: 10–21.CrossRefGoogle ScholarPubMed
Kern, FH, Hickey, PR. Anesthesia for cardiac surgery in newborns with congenital heart disease. J Intensive Care Med 1991; 6: 153–166.CrossRefGoogle Scholar
Gruber, EM, Laussen, PC, Casta, A, et al. Stress response in infants undergoing cardiac surgery: a randomized study of fentanyl bolus, fentanyl infusion, and fentanyl-midazolam infusion. Anesth Analg 2001; 92: 882–890.CrossRefGoogle ScholarPubMed
Frankel, WC, Maul, TM, Chrysostomou, C, et al. A minimal opioid postoperative management protocol in congenital cardiac surgery: safe and effective. Semin Thorac Cardiovasc Surg 2020; (In the Press).Google ScholarPubMed
Monahan, A, Guay, J, Hajduk, J, Suresh, S. Regional analgesia added to general anesthesia compared with general anesthesia plus systemic analgesia for cardiac surgery in children: a systematic review and meta-analysis of randomized clinical trials. Anesth Analg 2019; 128: 130–136.CrossRefGoogle ScholarPubMed
Peterson, KL, DeCampli, WM, Pike, NA, Robbins, RC, Reitz, BA. A report of two hundred twenty cases of regional anesthesia in pediatric cardiac surgery. Anesth Analg 2000; 90: 1014–1019.CrossRefGoogle ScholarPubMed
Roy, N, Brown, ML, Parra, MF, et al. Bilateral erector spinae blocks decrease perioperative opioid use after pediatric cardiac surgery. J Cardiothorac Vasc Anesth 2021; 35: 2082–2087.CrossRefGoogle ScholarPubMed
Caruso, TJ, Lin, C, O’Connell, C, et al. Systemic absorption of lidocaine from continuous erector spinae plane catheters after congenital cardiac surgery: a retrospective study. J Cardiothorac Vasc Anesth 2020; 34: 2986–2993.CrossRefGoogle ScholarPubMed
Macaire, P, Ho, N, Nguyen, T, et al. Ultrasound-guided continuous thoracic erector spinae plane block within an enhanced recovery program is associated with decreased opioid consumption and improved patient postoperative rehabilitation after open cardiac surgery-a patient-matched, controlled before-and-after study. J Cardiothorac Vasc Anesth 2019; 33: 1659–1667.CrossRefGoogle ScholarPubMed
Kogan, A, Eidelman, LA, Raanani, E, Orlov, B, Shenkin, O, Vidne, BA. Nausea and vomiting after fast-track cardiac anaesthesia. Br J Anaesth 2003; 91: 214–217.CrossRefGoogle ScholarPubMed
Sawatzky, JA, Rivet, M, Ariano, RE, Hiebert, B, Arora, RC. Post-operative nausea and vomiting in the cardiac surgery population: who is at risk? Heart Lung 2014; 43: 550–554.CrossRefGoogle ScholarPubMed
Grebenik, CR, Allman, C. Nausea and vomiting after cardiac surgery. Br J Anaesth 1996; 77: 356–359.CrossRefGoogle ScholarPubMed
Choi, DK, Chin, JH, Lee, EH, et al. Prophylactic control of post-operative nausea and vomiting using ondansetron and ramosetron after cardiac surgery. Acta Anaesthesiol Scand 2010; 54: 962–969.CrossRefGoogle ScholarPubMed