title: Postoperative nausea and vomiting in the post-anesthetic care unit, a 5-year survey of a quality assurance program in surgical cancer patients.
abstract: BACKGROUND
  PostOperative Nausea and Vomiting (PONV)is a major side effect related to surgery and anesthesia. Our institution is equipped with Anesthesia Information Management System (AIMS). We used this database to assess and follow the effect of our quality assurance program for PONV.
  
  
  METHODS
  Our AIMS system permits automatic storage of vital signs while other information are indexed by anesthesia providers and PACU personnel. Intra-operative and PACU events were extracted from a database by sequential query language (SQL) interrogation from year 2005 to 2010. A new prophylactic antiemetic protocol was issued for high-risk patients in our institution (dexamethasone, droperidol in the operating room and odansetron in the PACU) and initiated in 2006; in parallel, adjuvant measures influencing PONV were taken for anesthetic interventions. PONV scores and related medications, intra- and postoperative opioids and inhalational anesthetics consumption were extracted, and results were regularly shared with anesthesia providers and PACU personnel as part of quality assurance program.
  
  
  RESULTS
  The study concerned 40,045 patients, exhaustivity or completeness was 70% in 2005 but reached 90% in 2010. PONV scores significantly improved during the years after the instauration of the new protocol (31% in 2005 vs. 13% in 2010). Concomitantly, morphine consumption and intra-operative nitrous oxide showed a steady decrease. No significant difference was noticed in the use of inhalational anesthetics.
  
  
  CONCLUSIONS
  Using our AIMS database, we indirectly monitored the effectiveness of our PONV protocol but also other possible component of a multimodal approach toward these side effects.
authors.affiliation: Institut Gustave-Roussy, departement of anesthesia, 38, rue Camille-Desmoulins, 94805 Villejuif cedex, France. Electronic address: motamed@igr.fr.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Motamed
authors.affiliation: Institut Gustave-Roussy, departement of anesthesia, 38, rue Camille-Desmoulins, 94805 Villejuif cedex, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bourgain
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D000776:Anesthesiology; D000777:Anesthetics / Q000009:adverse effects; D000932:Antiemetics / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage; D004329:Droperidol / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D006751:Hospital Information Systems; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D017294:Ondansetron / Q000008:administration & dosage; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000777:Anesthetics; D000932:Antiemetics; D017294:Ondansetron; D003907:Dexamethasone; D004329:Droperidol
keywords: AIMS; Assurance qualité en anesthésie; Base de données informatiques en anesthésie; Cancer surgery; Chirurgie pour cancer; NVPO (nausées vomissements postopératoires); PONV; Quality assurance anesthesia