Severe nausea and vomiting in the evaluation of nitrous oxide in the gas mixture for Anesthesia II trial

Paul S. Myles, Matthew T V Chan, Jessica Kasza, Michael J. Paech, Kate Leslie, Philip J. Peyton, Daniel I. Sessler, Guy Haller, W. Scott Beattie, Cameron Osborne, J. Robert Sneyd, Andrew Forbes

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
Pages (from-to)1032-1040
Number of pages9
JournalAnesthesiology
Volume124
Issue number5
DOIs
Publication statusPublished - 1 May 2016

Cite this

Myles, Paul S. ; Chan, Matthew T V ; Kasza, Jessica ; Paech, Michael J. ; Leslie, Kate ; Peyton, Philip J. ; Sessler, Daniel I. ; Haller, Guy ; Beattie, W. Scott ; Osborne, Cameron ; Sneyd, J. Robert ; Forbes, Andrew. / Severe nausea and vomiting in the evaluation of nitrous oxide in the gas mixture for Anesthesia II trial. In: Anesthesiology. 2016 ; Vol. 124, No. 5. pp. 1032-1040.
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title = "Severe nausea and vomiting in the evaluation of nitrous oxide in the gas mixture for Anesthesia II trial",
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.",
author = "Myles, {Paul S.} and Chan, {Matthew T V} and Jessica Kasza and Paech, {Michael J.} and Kate Leslie and Peyton, {Philip J.} and Sessler, {Daniel I.} and Guy Haller and Beattie, {W. Scott} and Cameron Osborne and Sneyd, {J. Robert} and Andrew Forbes",
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Severe nausea and vomiting in the evaluation of nitrous oxide in the gas mixture for Anesthesia II trial. / Myles, Paul S.; Chan, Matthew T V; Kasza, Jessica; Paech, Michael J.; Leslie, Kate; Peyton, Philip J.; Sessler, Daniel I.; Haller, Guy; Beattie, W. Scott; Osborne, Cameron; Sneyd, J. Robert; Forbes, Andrew.

In: Anesthesiology, Vol. 124, No. 5, 01.05.2016, p. 1032-1040.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Severe nausea and vomiting in the evaluation of nitrous oxide in the gas mixture for Anesthesia II trial

AU - Myles, Paul S.

AU - Chan, Matthew T V

AU - Kasza, Jessica

AU - Paech, Michael J.

AU - Leslie, Kate

AU - Peyton, Philip J.

AU - Sessler, Daniel I.

AU - Haller, Guy

AU - Beattie, W. Scott

AU - Osborne, Cameron

AU - Sneyd, J. Robert

AU - Forbes, Andrew

PY - 2016/5/1

Y1 - 2016/5/1

N2 - 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.

AB - 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.

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DO - 10.1097/ALN.0000000000001057

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