Original ContributionDose of intraoperative remifentanil administration is independently associated with increase in the risk of postoperative nausea and vomiting in elective mastectomy under general anesthesia
Introduction
Postoperative nausea and vomiting (PONV) is one of the common complications in patients who have undergone surgery with general anesthesia and may increase patient discomfort and costs [1].
Remifentanil is an opioid with rapid clearance that is used for general anesthesia. Although the use of an opioid is a risk factor for PONV [2], the association between the use of remifentanil and the incidence of PONV is not clear. In some studies, the administration of remifentanil was associated with a decreased incidence of PONV [3], [4], whereas it was shown to be associated with an increased incidence of PONV in other studies [5], [6]. This discrepancy in results may be due to differences in the cases and doses of remifentanil. However, there is little information on the association of difference in the dose of remifentanil with incidence of PONV.
Accordingly, we conducted a retrospective observational study to assess the dose-dependent association of the use of remifentanil with the incidence of PONV. The null hypothesis of this study is that there is no dose-dependent association of administration of remifentanil and incidence of PONV.
Section snippets
Study design
This study was a single-center retrospective observational study. The Ethics Committee of the National Cancer Center approved this investigation. The committee waived the need for informed consent for studies involving the use of the database.
Patients
All female patients who underwent elective mastectomy under general anesthesia between October 2011 and October 2012 were included in this study. We excluded patients with American Society of Anesthesiologists (ASA) physical status III or higher.
Primary outcome
The
Results
During the study period, there were 423 female patients with ASA status I or II who underwent elective mastectomy under general anesthesia. We included all of them in this study. There were no missing data from these patients.
Among the 423 patients, 129 patients (30.5%) had PONV within 3 days after the operation. Table 1 shows a comparison of the characteristics of patients with PONV and those without PONV. Patients with PONV had longer durations of the operation (P = .014) and anesthesia (P =
Key findings
In this retrospective study including 423 female patients who underwent elective mastectomy with general anesthesia, the incidence of PONV within 3 days after the operation was 30.5%. We found that a higher time-weighted average of remifentanil dose was independently associated with higher risk for PONV. We further found that the adjusted odds ratio was increased according to increase of twRem. In our additional multivariate logistic model, twRem greater than 0.2 μg/kg per minute was
Conclusion
In this retrospective observational study conducted in patients who underwent elective mastectomy under general anesthesia, there was a dose-dependent association of the dose of intraoperative remifentanil administration with increase in the risk of PONV. Time-weighted average of remifentanil greater than 0.2 μg/kg per minute was independently associated risk of PONV.
Acknowledgment
The authors declare no conflict of interest. There are no grants for this study.
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