title: Association of Postoperative Nausea and Vomiting Incidence With Neutrophil-Lymphocyte Ratio in Ambulatory Maxillofacial Surgery.
abstract: OBJECTIVE
  Postoperative nausea and vomiting (PONV) constitutes an important factor in ambulatory surgery. The mechanisms of the antiemetic action of potent anti-inflammatory corticosteroids, which are used extensively for the treatment of PONV, as well as the association between PONV and inflammation, have not been investigated sufficiently. We aimed to establish the association between the neutrophil-lymphocyte ratio (NLR) and postoperative antiemetic administration, as well as to investigate whether the NLR would be a biomarker for PONV.
  
  
  METHODS
  The anesthesia records of American Society of Anesthesiologists (ASA) physical status I or II patients who underwent ambulatory routine oral surgery under general anesthesia were evaluated after we obtained ethical approval from the faculty ethics committee. A 5-point scale was used to score PONV. Metoclopramide (Metpamid, Istanbul, Turkey) was used as the first choice in patients who had a PONV scale score of 1 or higher. Data regarding metoclopramide administration during extubation and discharge periods were analyzed. Sixty-four patients were randomized and enrolled in the study with an NLR less than 2 (group I, n = 37) or an NLR greater than 2 (group II, n = 27), and metoclopramide administration was evaluated in each case. The association between the NLR and metoclopramide administration was analyzed statistically by a descriptive statistical method in detecting frequencies; the χ2test was used in comparison of the groups and the t test in independent groups.
  
  
  RESULTS
  The metoclopramide administration frequency for PONV was 5.4% in group I and 96.3% in group II. The metoclopramide administration frequency in group II was statistically higher than that in group I (P < .001).
  
  
  CONCLUSIONS
  We are of the opinion that the NLR can be easily calculated with data obtained from the complete blood count and could be a marker for PONV. Antiemetic prophylaxis could be given after evaluation of the NLR. However, we suggest that this result should be supported with further prospective studies using larger series.
authors.affiliation: Assistant Professor, Anesthesiology and Reanimation Specialist, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Ankara, Turkey. Electronic address: handarpaci@yahoo.com.
authors.forename: Ayşe Hande
authors.initials: AH
authors.lastname: Arpaci
authors.affiliation: Professor, Department of Anesthesiology and Reanimation, Faculty of Medicine, Gazi University, Ankara, Turkey.
authors.forename: Berrin
authors.initials: B
authors.lastname: Işik
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Ankara, Turkey.
authors.forename: Eren
authors.initials: E
authors.lastname: Ilhan
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Ankara, Turkey.
authors.forename: Erdal
authors.initials: E
authors.lastname: Erdem
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000932:Antiemetics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D007958:Leukocyte Count; D008214:Lymphocytes; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use; D008875:Middle Aged; D009504:Neutrophils; D019647:Oral Surgical Procedures; D011182:Postoperative Care; D020250:Postoperative Nausea and Vomiting / Q000097:blood* / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000932:Antiemetics; D008787:Metoclopramide