Location
Central Division
Start Date
26-10-2023 10:25 AM
End Date
26-10-2023 10:30 AM
Description
Abstract:
Background:
Nitrous oxide is an inexpensive and fast-acting gas used in a variety of inpatient and outpatient perioperative settings to hasten the onset of and emergence from general anesthesia. Problematically, nitrous oxide has been identified as a risk factor for postoperative nausea and vomiting (PONV), one of the most common adverse events after anesthesia. Unresolved PONV is linked to increased pain, wound dehiscence, aspiration, and longer stays in the recovery area and/or hospital. An Apfel Simplified Risk Score can be calculated to predict PONV based on four patient characteristics: female sex, non-smoker, history of PONV or motion sickness, and postoperative administration of opioids. Use of nitrous oxide during surgeries requiring general anesthesia when stratified by Apfel Risk Score in two Eastern Washington hospitals was not known.
Purpose/Aims:
To describe nitrous oxide use among patients undergoing general anesthesia stratified by Apfel Risk Scores across two hospitals in Eastern Washington.
Methods/Approach:
Retrospective data were extracted from the electronic medical records of a large medical center and a mid-sized, community-based hospital in Eastern Washington, encompassing the years 2014-2020 to provide a large sample size. In all, 115,949 cases involving adult patients ≥ 18 years of age undergoing general anesthesia with a laryngeal mask airway (LMA) or endotracheal tube (ETT) were included. The frequency, timing, and duration of nitrous oxide were analyzed and examined by the Apfel Risk Score utilizing descriptive statistics. Of note, the Apfel risk factor of postoperative opioid administration was not assessed, given inability to control for clinical variations in this practice.
Results:
Nitrous oxide was used in 27% of all general anesthesia cases in the two hospitals between 2014-2020. In patients who received intraoperative nitrous oxide, the median administration time was 23 minutes, with 83.34% of cases utilizing nitrous oxide during the emergence phase of anesthesia. The median time of nitrous oxide administration during the induction, maintenance, and emergence phases of anesthesia was 2, 7, and 13 minutes, respectively. An inverse relationship was observed between the number of Apfel risk factors and median time in minutes of nitrous oxide administration, with a median time of 26, 22, 21, and 18 minutes for zero, one, two, and three Apfel risk factors, respectively.
Conclusion:
This project demonstrates clinical practice is consistent with literature recommendations in two Eastern Washington hospitals as an inverse relationship was noted between the median time of nitrous oxide administration and number of Apfel risk factors. Further exploration should be done to examine prophylactic antiemetic use in patients with identified Apfel risk factors.
Implications for Practice:
Nurses working in perioperative and postoperative settings should be aware of the adverse implications of PONV and advocate to reduce the use of gases such as nitrous oxide which are linked to PONV, particularly when patients are assessed to have multiple Apfel risk factors. Additionally, advocating for the administration of prophylactic antiemetics can be beneficial in patients who have undergone general anesthesia that included nitrous oxide.
Recommended Citation
Smith, Kaley; Colorafi, Karen; Daratha, Kenn; and Hemingway, Braden, "Nitrous Oxide Administration in General Anesthesia Patients" (2023). Central Division Nurse Clinical Inquiry Conference. 22.
https://digitalcommons.providence.org/central_nurs_conf/2023/agenda/22
Included in
Nitrous Oxide Administration in General Anesthesia Patients
Central Division
Abstract:
Background:
Nitrous oxide is an inexpensive and fast-acting gas used in a variety of inpatient and outpatient perioperative settings to hasten the onset of and emergence from general anesthesia. Problematically, nitrous oxide has been identified as a risk factor for postoperative nausea and vomiting (PONV), one of the most common adverse events after anesthesia. Unresolved PONV is linked to increased pain, wound dehiscence, aspiration, and longer stays in the recovery area and/or hospital. An Apfel Simplified Risk Score can be calculated to predict PONV based on four patient characteristics: female sex, non-smoker, history of PONV or motion sickness, and postoperative administration of opioids. Use of nitrous oxide during surgeries requiring general anesthesia when stratified by Apfel Risk Score in two Eastern Washington hospitals was not known.
Purpose/Aims:
To describe nitrous oxide use among patients undergoing general anesthesia stratified by Apfel Risk Scores across two hospitals in Eastern Washington.
Methods/Approach:
Retrospective data were extracted from the electronic medical records of a large medical center and a mid-sized, community-based hospital in Eastern Washington, encompassing the years 2014-2020 to provide a large sample size. In all, 115,949 cases involving adult patients ≥ 18 years of age undergoing general anesthesia with a laryngeal mask airway (LMA) or endotracheal tube (ETT) were included. The frequency, timing, and duration of nitrous oxide were analyzed and examined by the Apfel Risk Score utilizing descriptive statistics. Of note, the Apfel risk factor of postoperative opioid administration was not assessed, given inability to control for clinical variations in this practice.
Results:
Nitrous oxide was used in 27% of all general anesthesia cases in the two hospitals between 2014-2020. In patients who received intraoperative nitrous oxide, the median administration time was 23 minutes, with 83.34% of cases utilizing nitrous oxide during the emergence phase of anesthesia. The median time of nitrous oxide administration during the induction, maintenance, and emergence phases of anesthesia was 2, 7, and 13 minutes, respectively. An inverse relationship was observed between the number of Apfel risk factors and median time in minutes of nitrous oxide administration, with a median time of 26, 22, 21, and 18 minutes for zero, one, two, and three Apfel risk factors, respectively.
Conclusion:
This project demonstrates clinical practice is consistent with literature recommendations in two Eastern Washington hospitals as an inverse relationship was noted between the median time of nitrous oxide administration and number of Apfel risk factors. Further exploration should be done to examine prophylactic antiemetic use in patients with identified Apfel risk factors.
Implications for Practice:
Nurses working in perioperative and postoperative settings should be aware of the adverse implications of PONV and advocate to reduce the use of gases such as nitrous oxide which are linked to PONV, particularly when patients are assessed to have multiple Apfel risk factors. Additionally, advocating for the administration of prophylactic antiemetics can be beneficial in patients who have undergone general anesthesia that included nitrous oxide.
