title: Avoidance of nitrous oxide and increased isoflurane during alfentanil based anesthesia decreases the incidence of postoperative nausea.
abstract: Postoperative nausea and vomiting have been associated with the use of nitrous oxide. Alfentanil, when combined with nitrous oxide, also results in a high incidence of postoperative nausea and vomiting. To further define this emesis-potentiating effect of N2O, 119 patients were chosen for study and divided into two groups: group A (n = 59) was administered a mixture of alfentanil, N2O, and O2 with 0.25% isoflurane, group B (n = 60) was administered a mixture of oxygen, room air, isofluorane, and alfentanil. The incidence of postoperative nausea and vomiting was ascertained by a blinded observer in the recovery room. All 119 patients were scheduled for extra-abdominal procedures (excluding thoracotomial, intracranial, ophthalmologic, and middle ear surgery). Patients with a previous history of nausea and vomiting, hiatal hernias, reflux esophagitis, or morbid obesity were excluded. The incidence of vomiting was 5% (3/60) in group B and 15% (8/59) in group A (P = 0.067). Forty-four percent (26/59) of the patients in group A and 20% (12/59) in group B were nauseated postoperatively (P = 0.005). Our data suggest that elimination of N2O from alfentanil-based anesthetics lessens the incidence of nausea.
authors.affiliation: Division of Anesthesiology, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: E
authors.initials: E
authors.lastname: Bloomfield
authors.forename: D
authors.initials: D
authors.lastname: Porembka
authors.forename: M
authors.initials: M
authors.lastname: Grimes-Rice
mesh_terms: D000293:Adolescent; D000328:Adult; D015760:Alfentanil; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D018686:Anesthetics, Intravenous; D005260:Female; D006801:Humans; D015994:Incidence; D007530:Isoflurane; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D009609:Nitrous Oxide / Q000009:adverse effects; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D016037:Single-Blind Method
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D015760:Alfentanil; D007530:Isoflurane; D009609:Nitrous Oxide