전신 마취 환자의 수술 후 오심과 구토에 영향을 주는 위험인자 (한국형 위험모형의 개발) = Risk Factors of Postoperative Nausea and Vomiting: Development of Korean Risk Model

다국어 초록 (Multilingual Abstract)

Background: Postoperative nausea and vomiting (PONV) along with postoperative pain is one of the most frequently encountered complaints after the surgery. The goal of this study is to elucidate the probable high risks factors of PONV by making 24 hr-observations on 4008 patients undergone general anesthesia.
Methods: PONV scores (0: no PONV; 1, nausea; 2, retching; 3, vomiting) and characteristics of patient, surgery, anesthesia were recorded by patient interview and chart review at post anesthesia care unit and at ward 24 hours after operation. Risk factors of PONV were investigated by Odds ratio and P value. Multiple regression analysis was performed to produce the provability of PONV.
Results: Incidence of PONV was 26.1% at PACU and 22.9% at ward. Total incidence of PONV during 24 hrs was 39.3. High risk factors of PONV were as follows in decreasing order: 1) female, 2) history of PONV or motion sickness, 3) nonsmoker, 4) operative time of longer than 60 minutes and 5) patient controlled analgesia. P (probability of PONV) = 1/1 + e-Z Z = -1.928 + 0.899 (Gender) + 0.664 (Hx) + 0.558 (OP-duration) + 0.261 (Smoking Status) + 0.184 (Postop-opioid).
Conclusions: We could identify 5 risk factors and developed a Korean PONV risk model enabling to predict the probability of PONV by this study of 4008 patients.

참고문헌 (Reference)

1 "factors related to postoperative nausea and vomiting" anesthesiology1960186-93

2 "Volatile anaesthetics may be the main cause for early but not delayed postoperative nausea and vomiting:a randomized controlled trial of factorial design" 88 : 659-68, 2002

3 "Twenty-four of twenty-seven studies show a greater incidence of emesis associated with nitrous oxide than with alternative anesthetics" 83 : 114-6, 1996

4 "The role of 5-HT in postoperative nausea and vomiting" 69 : 60-2, 1992

5 "The postoperative interview:assessing risk factors for nausea and vomiting" 78 : 7-16, 1994

6 "The odds ratio" 320 : 1468-, 2000

7 "The influence of smoking on postoperative nausea and vomiting" 53 : 932-3, 1998

8 "The effect of smoking on postoperative nausea and vomiting" 55 : 540-4, 2000

9 "The discriminating power of a risk score for postoperative vomiting in adults undergoing various types of surgery" 42 : 502-9, 1998

10 "The cost-effective management of postoperative nausea and vomiting" 92 : 931-3, 2000

11 "Surgical and patient factors involved in postoperative nausea and vomiting" 69 : 24-32, 1992

12 "Risk assessment of postoperative nausea and vomiting" 41 : 13-32, 2003

13 "Recovery profiles of outpatients undergoing unilateral inguinal herniorraphy:a comparison of three anesthetic techniques" 88 : 1999

14 "Rational control of PONV-the rule of three" 51 : 280-5, 2004

15 "Prevention and treatment of postoperative nausea and vomiting" 59 : 213-43, 2000

16 "Postoperative vomiting.A score for prediction of vomiting risk following inhalation anesthesia" 47 : 732-40, 1998

17 "Postoperative vomiting-some factors affecting its incidence" 29 : 114-23, 1957

18 "Postoperative vomiting in children.A persisting unsolved problem" 3 : 206-8, 1993

19 "Postoperative vomiting in children" 10 : 309-13, 1982

20 "Postoperative nausea and vomiting-can it be eliminated?" 1233-6, 2002

21 "Postoperative nausea and vomiting in paediatric patients" 83 : 104-17, 1999

22 "Postoperative nausea and emesis" 20 : 709-22, 2002

23 "Omission of nitrous oxide during anesthesia reduces the incidence of postoperative nausea and vomiting.A meta-analysis" 85 : 1055-62, 1996

24 "Nitrous oxide-it's enough to make you vomit [letter]" 78 : 403-6, 1993

25 "Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy" 91 : 1408-14, 2000

26 "Logistic regression analysis of fixed patient factors for postoperative sickness:a model for risk assessment" 70 : 135-40, 1993

27 "Evidence-based management of postoperative nausea and vomiting:a review" 51 : 326-41, 2004

28 "Consensus guidelines for managing postoperative nausea and vomiting" 97 : 62-71, 2003

29 "Comparison of predictive models for postoperative nausea and vomiting" 88 : 234-40, 2002

30 "Can the risk of postoperative nausea and vomiting be identified and lowered during the preoperative assessment" 47-62, 2002

31 "Can postoperative nausea and vomiting be predicted?" Sinclair DR 109-18, 1999

32 "Antiemetic prophylaxis does not improve outcomes after outpatient surgery when compared to symptomatic treatment" 90 : 360-71, 1999

33 "Anesthesia and emesis" 31 : 178-87, 1984

34 "Anaesthetic factors contributing to postoperative nausea and vomiting" 69 : 40-5, 1992

35 "A survey of postoperative nausea and vomiting" 52 : 443-9, 1997

36 "A survey of postoperative nausea and vomiting" 53 : 413-4, 1998

37 "A risk score to predict the probability of postoperative vomiting in adults" 42 : 495-501, 1998

38 "A risk adapted approach reduces the overall institutional incidence of postoperative nausea and vomiting" 51 : 13-9, 2004

39 "A rational approach to the control of postoperative nausea and vomiting evidence from systematic reviews efficacy and harm of antiemetic interventions" 4-13, 2001

40 "A meta-analysis of nausea and vomiting following maintenance of anaesthesia with propofol or inhalational agents" 15 : 433-45, 1998