AIRR - ANZCA Institutional Research Repository
Skip navigation
Please use this identifier to cite or link to this item: http://hdl.handle.net/11055/909
Title: Severe Nausea and Vomiting in the Evaluation of Nitrous Oxide in the Gas Mixture for Anesthesia II Trial
Authors: Myles PS
Chan MT
Kasza J
Paech MJ
Leslie K
Peyton PJ
Sessler DI
Haller G
Beattie WS
Osborne C
Sneyd JR
Forbes A
ANZCA/FPM Author: Myles, PS
Keywords: aged
anesthesia recovery period
anesthesia, inhalation/adverse effects
Kaplan-Meier Estimate
nitrous oxide/adverse effects
postoperative complications/epidemiology
treatment outcome
postoperative nausea and vomiting/prevention & control
Issue Date: May-2016
Citation: 124(5):1032-40
Abstract: BACKGROUND: The Evaluation of Nitrous oxide in the Gas Mixture for Anesthesia II trial randomly assigned 7,112 noncardiac surgery patients to a nitrous oxide or nitrous oxide-free anesthetic; severe postoperative nausea and vomiting (PONV) was a prespecified secondary end point. Thus, the authors evaluated the association between nitrous oxide, severe PONV, and effectiveness of PONV prophylaxis in this setting. METHODS: Univariate and multivariate analyses of patient, surgical, and other perioperative characteristics were used to identify the risk factors for severe PONV and to measure the impact of severe PONV on patient outcomes. RESULTS: Avoiding nitrous oxide reduced the risk of severe PONV (11 vs. 15%; risk ratio [RR], 0.74 [95% CI, 0.63 to 0.84]; P < 0.001), with a stronger effect in Asian patients (RR, 0.55 [95% CI, 0.43 to 0.69]; interaction P = 0.004) but lower effect in those who received PONV prophylaxis (RR, 0.89 [95% CI, 0.76 to 1.05]; P = 0.18). Gastrointestinal surgery was associated with an increased risk of severe PONV when compared with most other types of surgery (P < 0.001). Patients with severe PONV had lower quality of recovery scores (10.4 [95% CI, 10.2 to 10.7] vs. 13.1 [95% CI, 13.0 to 13.2], P < 0.0005); severe PONV was associated with postoperative fever (15 vs. 20%, P = 0.001). Patients with severe PONV had a longer hospital stay (adjusted hazard ratio, 1.14 [95% CI, 1.05 to 1.23], P = 0.002). CONCLUSIONS: The increased risk of PONV with nitrous oxide is near eliminated by antiemetic prophylaxis. Severe PONV, which is seen in more than 10% of patients, is associated with postoperative fever, poor quality of recovery, and prolonged hospitalization.
URI: http://hdl.handle.net/11055/909
DOI: 10.1097/ALN.0000000000001057
Journal Title: Anesthesiology
Type: Journal Article
Study/Trial: Randomized Controlled Clinical Trial/Controlled Clinical Trial
Appears in Collections:Scholarly and Clinical

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.