Cross-sectional Study of PONV Risk Factors for Oral Surgery After Intubated General Anesthesia With Total Intravenous Anesthesia
The incidence of postoperative nausea and vomiting (PONV) after general anesthesia with total intravenous anesthesia (TIVA) was reported to be significantly lower than with volatile inhalational agents (13.3% vs 25%). However, no investigation of PONV risk factors associated with TIVA has ever been reported. This cross-sectional retrospective study aimed to investigate whether known risk factors influenced PONV in intubated general anesthetics utilizing TIVA for dental or oral and maxillofacial surgery. Subjects were 761 patients who underwent dental or oral and maxillofacial surgery under TIVA with propofol, fentanyl, and remifentanil. Univariate and multivariable logistic regression analyses were performed using PONV (within 24 hours) as the dependent variable and previously reported risk factors as independent variables. Age (odds ratio [OR]: 1.020 per year decrease; 95% confidence interval [CI]: 1.0002–1.0418; P = .047) and female sex (OR: 2.73; 95% CI: 1.60–4.84; P < .001) were positively associated with PONV. Sagittal split ramus osteotomy (SSRO) (OR: 2.28; 95% CI: 1.21–4.33; P = .011) and bimaxillary osteotomy (OR: 5.69; 95% CI: 2.09–15.99; P < .001) were more likely to be associated with PONV than operations that were neither bimaxillary osteotomy nor SSRO. Late PONV (2–24 hours) had an ∼2.7 times higher incidence than early PONV (0–2 hours). These findings suggest further PONV countermeasures, aside from TIVA with propofol and prophylactic antiemetics for orthognathic surgeries especially bimaxillary osteotomy, are needed.
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Selection criterion and breakdown of study cases. Of the 791 patients who underwent general anesthesia with total intravenous anesthesia (TIVA) using propofol, fentanyl, and remifentanil, 761 patients without any of the exclusion criteria were enrolled. A total of 121 patients had postoperative nausea and vomiting (PONV), whereas 640 did not.
Risk factors for postoperative nausea and vomiting (PONV; 0–24 h) after intubated general anesthesia using total intravenous anesthesia (TIVA). Arrows illustrate factors with increased PONV risk. Arrow thickness illustrates size of the factor's adjusted odds ratio (OR) per study data. The strongest PONV risk factor was bimaxillary osteotomy (OR 5.69) followed by female sex (OR 2.73) and sagittal split ramus osteotomy (SSRO; OR 2.28). Factors lacking arrows were not significantly associated with PONV.
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