Is PONV still a problem in pediatric surgery: a prospective study of what children tell us
BackgroundPostoperative nausea and vomiting (PONV) is an unpleasant complication after surgery that commonly co-occurs with pain. Considering the high prevalence among pediatric patients, it is important to explore the main risk factors leading to PONV in order to optimize treatment strategies. The...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2023.1241304/full |
| _version_ | 1797645788101214208 |
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| author | Brigitte Messerer Marko Stijic Marko Stijic Andreas Sandner-Kiesling Johanna M. Brillinger Jasmin Helm Jacqueline Scheer Christof Stefan Strohmeier Alexander Avian |
| author_facet | Brigitte Messerer Marko Stijic Marko Stijic Andreas Sandner-Kiesling Johanna M. Brillinger Jasmin Helm Jacqueline Scheer Christof Stefan Strohmeier Alexander Avian |
| author_sort | Brigitte Messerer |
| collection | DOAJ |
| description | BackgroundPostoperative nausea and vomiting (PONV) is an unpleasant complication after surgery that commonly co-occurs with pain. Considering the high prevalence among pediatric patients, it is important to explore the main risk factors leading to PONV in order to optimize treatment strategies. The objectives of this study are as follows: (1) to determine the prevalence of PONV on the day of surgery by conducting interviews with pediatric patients, (2) to assess PONV prevalence in the recovery room and on the ward by analyzing nursing records, and (3) to collect information on PONV risk factors on the day of surgery and the following postoperative days. We wanted to investigate real-life scenarios rather than relying on artificially designed studies.MethodsA prospective analysis [according to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines] of PONV on the day of surgery and the following postoperative days was conducted by evaluating demographic and procedural parameters, as well as conducting interviews with the children under study. A total of 626 children and adolescents, ranging in age from 4 to 18 years, were interviewed on the ward following their surgery. The interviews were conducted using a questionnaire, as children aged 4 and above can participate in an outcome-based survey.ResultsOn the day of surgery, several multivariable independent predictors were identified for PONV. The type of surgery was found to be a significant factor (p = 0.040) with the highest odds ratio (OR) in patients with procedural investigations [OR 5.9, 95% confidence interval (CI): 1.8–19.2], followed by abdominal surgery (OR 3.1, 95% CI: 0.9–11.1) when inguinal surgery was used as the reference category. In addition, the study identified several predictors, including the amount of fentanyl administered during anesthesia (µg/kg body weight) (OR 1.4, 95% CI: 1.1–1.8), intraoperative use of piritramide (OR 2.6, 95% CI: 1.5–4.4) and diclofenac (OR 2.0, 95% CI: 1. 3–3.1), opioid administration in the recovery room (OR 3.0, 95% CI: 1.9–4.7), and piritramide use on the ward (OR 4.5, 95% CI: 1.7–11.6).ConclusionsThe main risk factors for PONV include the intraoperative administration of opioids during the recovery room stay and at the ward, the intraoperative use of non-opioids (diclofenac), and the specific type of surgical procedure. Real-life data demonstrated that in clinical praxis, there is a gap between the adherence to established guidelines and the use of antiemetic prophylaxis in surgeries that are generally not associated with a high PONV prevalence. Further efforts are needed to improve the existing procedures and thus improve the overall outcome. |
| first_indexed | 2024-03-11T14:51:56Z |
| format | Article |
| id | doaj.art-8171d84a53914dc0a62e6a7a16500e8c |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-03-11T14:51:56Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-8171d84a53914dc0a62e6a7a16500e8c2023-10-30T09:18:36ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602023-10-011110.3389/fped.2023.12413041241304Is PONV still a problem in pediatric surgery: a prospective study of what children tell usBrigitte Messerer0Marko Stijic1Marko Stijic2Andreas Sandner-Kiesling3Johanna M. Brillinger4Jasmin Helm5Jacqueline Scheer6Christof Stefan Strohmeier7Alexander Avian8Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, AustriaInstitute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, AustriaUniversity Clinic for Neurology, Clinical Department for Neurogeriatrics, Medical University of Graz, Graz, AustriaDepartment of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, AustriaInstitute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, AustriaInstitute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, AustriaInstitute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, AustriaInstitute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, AustriaInstitute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, AustriaBackgroundPostoperative nausea and vomiting (PONV) is an unpleasant complication after surgery that commonly co-occurs with pain. Considering the high prevalence among pediatric patients, it is important to explore the main risk factors leading to PONV in order to optimize treatment strategies. The objectives of this study are as follows: (1) to determine the prevalence of PONV on the day of surgery by conducting interviews with pediatric patients, (2) to assess PONV prevalence in the recovery room and on the ward by analyzing nursing records, and (3) to collect information on PONV risk factors on the day of surgery and the following postoperative days. We wanted to investigate real-life scenarios rather than relying on artificially designed studies.MethodsA prospective analysis [according to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines] of PONV on the day of surgery and the following postoperative days was conducted by evaluating demographic and procedural parameters, as well as conducting interviews with the children under study. A total of 626 children and adolescents, ranging in age from 4 to 18 years, were interviewed on the ward following their surgery. The interviews were conducted using a questionnaire, as children aged 4 and above can participate in an outcome-based survey.ResultsOn the day of surgery, several multivariable independent predictors were identified for PONV. The type of surgery was found to be a significant factor (p = 0.040) with the highest odds ratio (OR) in patients with procedural investigations [OR 5.9, 95% confidence interval (CI): 1.8–19.2], followed by abdominal surgery (OR 3.1, 95% CI: 0.9–11.1) when inguinal surgery was used as the reference category. In addition, the study identified several predictors, including the amount of fentanyl administered during anesthesia (µg/kg body weight) (OR 1.4, 95% CI: 1.1–1.8), intraoperative use of piritramide (OR 2.6, 95% CI: 1.5–4.4) and diclofenac (OR 2.0, 95% CI: 1. 3–3.1), opioid administration in the recovery room (OR 3.0, 95% CI: 1.9–4.7), and piritramide use on the ward (OR 4.5, 95% CI: 1.7–11.6).ConclusionsThe main risk factors for PONV include the intraoperative administration of opioids during the recovery room stay and at the ward, the intraoperative use of non-opioids (diclofenac), and the specific type of surgical procedure. Real-life data demonstrated that in clinical praxis, there is a gap between the adherence to established guidelines and the use of antiemetic prophylaxis in surgeries that are generally not associated with a high PONV prevalence. Further efforts are needed to improve the existing procedures and thus improve the overall outcome.https://www.frontiersin.org/articles/10.3389/fped.2023.1241304/fullpediatricspostoperative nausea and vomitingprevalencerisk factorsanalgesicsantiemetic |
| spellingShingle | Brigitte Messerer Marko Stijic Marko Stijic Andreas Sandner-Kiesling Johanna M. Brillinger Jasmin Helm Jacqueline Scheer Christof Stefan Strohmeier Alexander Avian Is PONV still a problem in pediatric surgery: a prospective study of what children tell us Frontiers in Pediatrics pediatrics postoperative nausea and vomiting prevalence risk factors analgesics antiemetic |
| title | Is PONV still a problem in pediatric surgery: a prospective study of what children tell us |
| title_full | Is PONV still a problem in pediatric surgery: a prospective study of what children tell us |
| title_fullStr | Is PONV still a problem in pediatric surgery: a prospective study of what children tell us |
| title_full_unstemmed | Is PONV still a problem in pediatric surgery: a prospective study of what children tell us |
| title_short | Is PONV still a problem in pediatric surgery: a prospective study of what children tell us |
| title_sort | is ponv still a problem in pediatric surgery a prospective study of what children tell us |
| topic | pediatrics postoperative nausea and vomiting prevalence risk factors analgesics antiemetic |
| url | https://www.frontiersin.org/articles/10.3389/fped.2023.1241304/full |
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