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Publication Date
8-2020
Keywords
School of Anesthesia
Disciplines
Anesthesiology | Medical Education | Nursing
Abstract
Background Postoperative nausea and vomiting (PONV) is a common complication following surgery. It remains the most important determinant of length of stay and leading cause of dissatisfaction in anesthesia.4 Females undergoing gynecological laparoscopic surgery have the highest rates.8 Apfel’s baseline risk factors for PONV include female gender, history of motion sickness and/or PONV, non-smoking status and administration of postoperative opioids.1 Propofol has antiemetic properties and Gan’s evidence supports the use of an intraoperative low-dose infusion to reduce baseline risk factors for PONV.6 This project aims to describe the rates of intraoperative low-dose propofol infusions in female patients undergoing gynecological surgery and baseline characteristics associated with its use.
Methods • A retrospective, observational evidence-based practice project was conducted at Providence Sacred Heart Medical Center (PSHMC) and Providence Holy Family Hospital (PHFH) in Spokane, WA. • CIRC approval was obtained by the facility and IRB exemption granted. All patient data was securely extracted by a Providence sponsor and stored in a HIPAA compliant REDCap database. Patient data was fully de-identified. • Inclusion criteria consisted of adult patients ≥18 to 90 years of age undergoing general anesthesia with volatile anesthetics in gynecological surgeries that were hospitalized for at least 24 hours and no more than 14 days at PSHMC and PHFH from January 2014 to December 2019. Patients receiving intraoperative low-dose propofol infusions of ≤25 mcg/kg/min were identified. • Exclusion criteria consisted of patients <18 and >90 years of age, infusions >25 mcg/kg/min, and any patient hospitalized for <24 hours and >14 days. • 24-hour PONV outcome was determined by PACU nurse assessment of PONV in EPIC or administration of antiemetic medication in the EMR. • Statistical data analysis was conducted and stratified by the number of Apfel risk factors. • Univariate and bivariate analysis were conducted on categorical and continuous data. • Multivariable analysis was conducted through binary logistic regression controlling for variables that contributed to the use of a propofol infusion.
Discussion This multi-year evidence-based practice project examined 499 cases and found that intraoperative low-dose propofol infusions were used 45 times accounting for 9% of the total sample. Current research literature supports the utilization of low-dose propofol infusions for patients at high-risk of developing PONV. 3,6,7 Age, BMI, case duration, ASA status, smoking status and post-op opioids did not influence whether a patient received an intraoperative low-dose propofol infusion. Bivariate analysis only showed a statistical significance with history of PONV (P=0.04). Similar findings were demonstrated in a multivariable model. This project focused on a clinically vulnerable population with low-dose propofol infusions and PONV. Overall rates for 24-hour PONV in this patient sample were 76% (N=499). 24-hour rates for patients that received an infusion were 84% (n=45) which may be explained by treatment by indication in this high-risk sample. Overall, results from this project identify areas for care improvement and CRNA education.
Area of Special Interest
Women & Children
Specialty/Research Institute
Anesthesiology
Specialty/Research Institute
Nursing
Conference / Event Name
AANA 2020 Virtual Congress
Location
Virtual Conference
