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Post-operative nausea and vomiting after enhanced recovery cardiac surgery in the Cardiac Intensive Care Unit - Is it still a problem?


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Post-operative nausea and vomiting after enhanced recovery cardiac surgery in the Cardiac Intensive Care Unit - Is it still a problem?

Timothy AC Snow, Anne Campbell & Sibtain Anwar

Department of Perioperative Medicine, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE


Despite our understanding of post-operative nausea and vomiting (PONV) risk factors suggesting cardiac surgery should be low risk, previous studies suggest that the incidence is surprisingly common, albeit wide ranging. This may be partly explained by inter-study variations in anaesthetic practice e.g. use of propofol infusions.

Enhanced recovery pathways aim to improve patient experience whilst enabling efficient health care resource utilisation such as reducing Cardiac Intensive Care Unit (CICU) length of stay. Minimising PONV is a key component of these pathways. Anecdotal evidence suggested the incidence of PONV in our CICUs remains high, thus we wished to understand current prevention strategies used and the incidence of PONV in our enhanced recovery cardiac surgery patients.


We undertook a week long prospective audit on our single centre tertiary referral CICUs. Enhanced recovery patients underwent anaesthesia, surgery and cardiac bypass as per surgical and anaesthetic preference. Following closure patients were transferred sedated to the CICU on a propofol infusion. On arrival, demographic and intra-operative PONV risk factor data was collected. Once haemodynamics, clotting and temperature was optimised, sedation was stopped, the patient woken and extubated once following commands.  For the first 24hours of admission, data was collected on time until extubation, presence of 1st episode of nausea or vomiting, time from extubation until symptoms and rescue anti-emetic given.


19 patients were identified. Patient characteristics are shown in table 1. Only 1 (5%) patient received a prophylactic anti-emetic whilst the incidence of PONV was 13 (68%) & 8 (42%) respectively. All patients with PONV received ondansetron 4mg for treatment.


On the basis of this audit, the incidence of PONV in the CICU following enhanced recovery cardiac surgery remains high and few patients receive routine prophylaxis. We aim to investigate the benefit of using routine prophylaxis in a further study.

Key Points

1. Patient satisfaction & experience is becoming a key metric for ICU stays
2. Minimising PONV could enhance patient experience and improve health care resource utilisation
3. This audit showed .that PONV in CICU following cardiac bypass surgery remains high  (68% & 42%)
4. We aim to build on this audit by investigating the benefit of using routine PONV prophylaxis

No conflict of interest to declare and no funding sources used

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