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CARDIOVASCULAR ANESTHESIA

Continuous Gastric Decompression for Postoperative Nausea and Vomiting After Coronary Revascularization Surgery

Crina L. Burlacu, FCAI^*, David Healy, MRCSI, Donal J. Buggy, MD, MSc, DME, FRCPI, FCAI, FRCA^*, Ciaran Twomey, FCAI^*, David Veerasingam, FRCSI, Andrew Tierney, FCAI^*, and Denis C. Moriarty, FCAI, FRCA^*

* Department of Anaesthesia and Intensive Care Medicine, and Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland, and Outcomes Research Institute^TM, University of Louisville, Louisville, Kentucky

Address correspondence and reprint requests to D. J. Buggy, Department of Anaesthesia & Intensive Care Medicine, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland. Address email to donal.buggy{at}nbsp.ie or crina{at}ireland.com.

Postoperative nausea and vomiting is common after cardiac surgery and may contribute to significant morbidity. Gastric decompression during anesthesia has been used for postoperative nausea and vomiting prophylaxis in shorter duration noncardiac surgery with conflicting results. We tested the hypothesis that gastric decompression during elective coronary revascularization surgery with cardiopulmonary bypass and continued afterwards until tracheal extubation would reduce the incidence of vomiting or retching and nausea. In a prospective, randomized, cohort study, 104 patients with at least 2 Apfel’s risk factors for postoperative nausea and vomiting were allocated to receive a gastric tube on free gravity drainage after induction of anesthesia (n = 52) or to a control group (n = 52). The gastric tube was removed simultaneously with tracheal extubation postoperatively. The primary outcome measure was the incidence of vomiting or retching. Secondary outcomes included the incidence and severity of nausea measured on a visual analog scale. The incidence of vomiting or retching was 13.4% in patients with gastric decompression, compared with 11.5% in the control group (P = 0.7). Similarly, there was no statistically significant difference between the two groups in the incidence of nausea (32.7% versus 25.0%, P = 0.6), median severity of nausea on a visual analog scale at 12 h (25; range, 0–55 mm versus 30; range, 0–60 mm, P = 0.4), or antiemetics administration (38.5% versus 28.8%, P = 0.3). Continuous gastric decompression during coronary revascularization surgery and afterwards until tracheal extubation did not reduce the incidence of vomiting or retching or the incidence and severity of nausea in these patients.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999