title: Risk of severe and refractory postoperative nausea and vomiting in patients undergoing diep flap breast reconstruction.
abstract: BACKGROUND
  Postoperative nausea and vomiting (PONV) are commonly feared after general anesthesia and can impact results. The primary aim of our study was to examine incidence and severity of PONV by investigating complete response, or absence of PONV, to prophylaxis used in patients undergoing DIEP flaps. Our secondary aims were definition of the magnitude of risk, state of the art of interventions, clinical sequelae of PONV, and interaction between these variables, specifically for DIEP patients.
  
  
  METHODS
  A retrospective chart review occurred for 29 patients undergoing DIEP flap breast reconstruction from September 2007 to February 2008. We assessed known patient and procedure-specific risks for PONV after DIEPs, prophylactic antiemetic regimens, incidence, and severity of PONV, postoperative antiemetic rescues, and effects of risks and treatments on symptoms.
  
  
  RESULTS
  Three or more established risks existed in all patients, with up to seven risks per patient. Although 90% of patients received diverse prophylaxis, 76% of patients experienced PONV, and 66% experienced its severe form, emesis. Early PONV (73%) was frequent; symptoms were long lasting (average 20 hours for nausea and emesis); and multiple rescue medications were frequently required (55% for nausea, 58% for emesis). Length of surgery and nonsmoking statistically significantly impacted PONV.
  
  
  CONCLUSIONS
  We identify previously undocumented high risks for PONV in DIEP patients. High frequency, severity, and refractoriness of PONV occur despite standard prophylaxis. Plastic surgeons and anesthesiologists should further investigate methods to optimize PONV prophylaxis and treatment in DIEP flap patients.
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Michele A
authors.initials: MA
authors.lastname: Manahan
authors.forename: Basak
authors.initials: B
authors.lastname: Basdag
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Kalmar
authors.forename: Sachin M
authors.initials: SM
authors.lastname: Shridharani
authors.forename: Michael
authors.initials: M
authors.lastname: Magarakis
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Jacobs
authors.forename: Robert W
authors.initials: RW
authors.lastname: Thomsen
authors.forename: Gedge D
authors.initials: GD
authors.lastname: Rosson
mesh_terms: D000328:Adult; D019074:Epigastric Arteries; D005260:Female; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D061525:Perforator Flap; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index
references.citation: Anesth Analg. 2004 Jul;99(1):77-81
references.pmid: 15281507
references.citation: Anesthesiol Clin North Am. 2002 Sep;20(3):709-722
references.pmid: 12298314
references.citation: Anesthesiology. 2003 Aug;99(2):488-95
references.pmid: 12883424
references.citation: Anesthesiology. 1996 Nov;85(5):1036-42
references.pmid: 8916820
references.citation: Br J Plast Surg. 1999 Mar;52(2):104-11
references.pmid: 10434888
references.citation: Anesth Analg. 2008 Aug;107(2):452-8
references.pmid: 18633023
references.citation: Anesthesiology. 2002 Mar;96(3):742-52
references.pmid: 11873052
references.citation: Drugs. 2000 Feb;59(2):213-43
references.pmid: 10730546
references.citation: Anesth Analg. 2008 Aug;107(2):439-44
references.pmid: 18633021
references.citation: Anesthesiology. 1999 Sep;91(3):693-700
references.pmid: 10485781
references.citation: Anesthesiology. 1992 Jul;77(1):162-84
references.pmid: 1609990
references.citation: Microsurgery. 2012 May;32(4):275-80
references.pmid: 22371212
references.citation: Anesth Analg. 1994 Jan;78(1):7-16
references.pmid: 8267183
references.citation: J Perianesth Nurs. 2006 Aug;21(4):230-50
references.pmid: 16935735
references.citation: Curr Med Res Opin. 2006 Jun;22(6):1093-9
references.pmid: 16846542
references.citation: Anesth Analg. 2008 Aug;107(2):429-38
references.pmid: 18633020
references.citation: Plast Reconstr Surg. 2002 Aug;110(2):466-75; discussion 476-7
references.pmid: 12142662
references.citation: Anesthesiology. 1988 Jul;69(1):63-71
references.pmid: 3291646
references.citation: Microsurgery. 2013 Jan;33(1):24-31
references.pmid: 22438209
references.citation: Acta Anaesthesiol Scand. 2002 Mar;46(3):232-7
references.pmid: 11939911
references.citation: N Engl J Med. 2004 Jun 10;350(24):2441-51
references.pmid: 15190136
references.citation: Br J Anaesth. 2008 Oct;101(4):498-505
references.pmid: 18682411
references.citation: Anaesthesia. 1988 Mar;43 Suppl:84-7
references.pmid: 3259108
references.citation: JAMA. 2002 Mar 13;287(10):1233-6
references.pmid: 11886298
references.citation: N Engl J Med. 2004 Jun 10;350(24):2511-2
references.pmid: 15190144
references.citation: Anesth Analg. 1999 Sep;89(3):652-8
references.pmid: 10475299
references.citation: Br J Plast Surg. 1973 Oct;26(4):336-9
references.pmid: 4759973
references.citation: Anesth Analg. 1993 May;76(5):936-41
references.pmid: 8484548
references.citation: Anaesthesia. 1997 Apr;52(4):300-6
references.pmid: 9135179
references.citation: Anesth Analg. 1999 Dec;89(6):1340-5
references.pmid: 10589605
references.citation: Acta Anaesthesiol Scand. 1994 Jan;38(1):52-6
references.pmid: 8140874
references.citation: Am J Surg. 2006 Jun;191(6):767-72
references.pmid: 16720146