The study was approved by the Institutional Review Board of Kaohsiung Chang Gung Memorial Hospital (IRB number: 202001106B0). Informed consent was waived because of the retrospective nature of the study. All methods were performed in accordance with the relevant guidelines and regulations. A total of 1407 surgical patients from the Trauma Department, from January 2018 to December 2018, were enrolled in the study. Information including medical records, anesthesia records retrieved from the hospital’s electronic database, data during a stay in the post-anesthesia recovery unit (PACU), and data from routine postoperative daily visits were collected. A postoperative visit was performed by well-trained nurse anesthetists within 24 h after surgery. Exclusion criteria included age below 20 years old (the legal threshold of adulthood is 20 in Taiwan), total intravenous anesthesia, desflurane anesthesia, or records with missing data. Finally, 855 patients were included in the study for analyses (Figure 1 ).
Nausea is a subjective and unpleasant sensation, of which no standard is applicable for its measurement. Postoperative vomiting (POV) was used as an endpoint and expressed as a dichotomous unit (vomiters or non-vomiters) in the study. POV was defined as vomiting within 24 h of surgery. Individual variables were stratified into three major categories: patient-related variables, anesthesia-related variables, and postoperative course-related variables. Gender, age, body weight, Apfel score, and ASA physical status were assigned to the patient-related category. The type of surgery, duration of anesthesia, sevoflurane consumption, intraoperative fluid supply, red cell transfusion, urine output, intraoperative opioid consumption, use of antiemetic agents and use of antihypertensive agents were assigned to the anesthesia-related category. Opioid consumption at PACU, opioid consumption at ward, and the use of patient-controlled analgesia (PCA) were assigned to the postoperative course-related category.
All general anesthesia were carried out according to the standard procedure suggested by the hospital [48 (link)]. Briefly, anesthesia was induced with propofol (1 to 2 mg/kg). Use of rocuronium (1 mg/kg) or cis-atracurium (0.2 mg/kg), fentanyl (1 mcg/kg) or alfentanil (10 mcg/kg), sevoflurane (1 to 1.3 MAC) depended on the anesthesiologists’ preferences. We excluded desflurane anesthesia because of the limited number performed. Sevoflurane concentration was titrated against blood pressure and heart rate changes during anesthesia to maintain stable blood pressure and heart rate within 20% of the patient’s normal range or BIS score was kept in the range of 40 to 60 during anesthesia. A fresh gas flow of 50% oxygen with air was kept at 1 L/min. Maintenance of neuromuscular blocking agents or opioids depended on surgical stimulus, anesthesiologists’ preferences, and objective vital signs. The choice and use of antiemetics were determined by anesthesiologists in charge of the anesthesia. Dexamethasone (5 mg) given at induction or Ondansetron (8 mg) given at 30 min at the end of surgery was the standard antiemetic prescription.
Nausea is a subjective and unpleasant sensation, of which no standard is applicable for its measurement. Postoperative vomiting (POV) was used as an endpoint and expressed as a dichotomous unit (vomiters or non-vomiters) in the study. POV was defined as vomiting within 24 h of surgery. Individual variables were stratified into three major categories: patient-related variables, anesthesia-related variables, and postoperative course-related variables. Gender, age, body weight, Apfel score, and ASA physical status were assigned to the patient-related category. The type of surgery, duration of anesthesia, sevoflurane consumption, intraoperative fluid supply, red cell transfusion, urine output, intraoperative opioid consumption, use of antiemetic agents and use of antihypertensive agents were assigned to the anesthesia-related category. Opioid consumption at PACU, opioid consumption at ward, and the use of patient-controlled analgesia (PCA) were assigned to the postoperative course-related category.
All general anesthesia were carried out according to the standard procedure suggested by the hospital [48 (link)]. Briefly, anesthesia was induced with propofol (1 to 2 mg/kg). Use of rocuronium (1 mg/kg) or cis-atracurium (0.2 mg/kg), fentanyl (1 mcg/kg) or alfentanil (10 mcg/kg), sevoflurane (1 to 1.3 MAC) depended on the anesthesiologists’ preferences. We excluded desflurane anesthesia because of the limited number performed. Sevoflurane concentration was titrated against blood pressure and heart rate changes during anesthesia to maintain stable blood pressure and heart rate within 20% of the patient’s normal range or BIS score was kept in the range of 40 to 60 during anesthesia. A fresh gas flow of 50% oxygen with air was kept at 1 L/min. Maintenance of neuromuscular blocking agents or opioids depended on surgical stimulus, anesthesiologists’ preferences, and objective vital signs. The choice and use of antiemetics were determined by anesthesiologists in charge of the anesthesia. Dexamethasone (5 mg) given at induction or Ondansetron (8 mg) given at 30 min at the end of surgery was the standard antiemetic prescription.
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