Dose of intraoperative remifentanil administration is independently associated with increase in the risk of postoperative nausea and vomiting in elective mastectomy under general anesthesia.
BACKGROUND
Postoperative nausea and vomiting (PONV) is one of the common complications in patients who have undergone surgery with general anesthesia. The association of intraoperative use of remifentanil with PONV has remained controversial. The aim of the current study was to determine the association of dose of intraoperative remifentanil administration with incidence of PONV.


METHODS
The present study was a single-center retrospective observational study and included 423 female patients with American Society of Anesthesiologists physical status I or II who underwent elective mastectomy under general anesthesia between October 2011 and October 2012. The incidence of PONV within 3 days after the operation was prospectively assessed. The time-weighted average of remifentanil during the operation (twRem) was calculated. We used a multivariate regression model to assess the independent association of the twRem with the incidence of PONV.


RESULTS
Among 423 patients, 129 patients (30.5%) had PONV during the study period. Remifentanil was administrated in 355 patients (83.9%). In the multivariate logistic regression model using categories of twRem, we found that increased twRem was independently associated with increase in the risk of PONV (P=.01). There was an independent association between twRem greater than 0.2 μg/kg per minute and increase in the risk of PONV.


CONCLUSIONS
This retrospective observational study revealed a dose-dependent association between dose of intraoperative remifentanil administration and increase in the risk of PONV. Time-weighted average of remifentanil greater than 0.2 μg/kg per minute was independently associated with risk of PONV.
Department of Anesthesia and Intensive Care, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Jun
J
Hozumi
Department of Anesthesiology, Kobe University Hospital, 7-5-2, Kusunoki cho, Chuo-ku, Kobe City, Hyogo 650-0017, Japan. Electronic address: moriori@tg8.so-net.ne.jp.
Moritoki
M
Egi
Department of Anesthesiology and Pain Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan.
Shinji
S
Sugita
Department of Anesthesiology and Pain Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan.
Tetsufumi
T
Sato
D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D000768:Anesthesia, General / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000379:methods; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced* / Q000453:epidemiology; D000077208:Remifentanil; D012189:Retrospective Studies; D012307:Risk Factors
D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil
Female patients; General anesthesia; Mastectomy; Postoperative nausea and vomiting; Remifentanil; Single center retrospective observational study