Preoperative orthostatic dysfunction is associated with an increased incidence of postoperative nausea and vomiting

• Published in: Anesthesiology (Philadelphia) 2002-06, Vol.96 (6), p.1381-1385
• Main Authors: PUSCH, Franz, BERGER, Alexander, WILDLING, Eckart, ZIMPFER, Michael, MOSER, Martin, SAM, Christine, KRAFFT, Peter
• Format: Article
• Language: English
• Subjects: Abdominal surgery. Urology. Gynecology. Obstetrics; Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Female; Humans; Incidence; Logistic Models; Medical sciences; Middle Aged; Postoperative Nausea and Vomiting - epidemiology; Postoperative Nausea and Vomiting - etiology; Posture; Prospective Studies
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/00000542-200206000-00017

Postoperative nausea and vomiting (PONV) occurs frequently after gynecologic surgery. Because hemodynamic condition seems to be influential, women presenting with preoperative orthostatic dysregulation may have an increased risk for PONV. The aim of the present study was to assess the relationship between preoperative orthostatic dysregulation and the incidence of PONV. In a prospective observer-blinded clinical trial, 200 women who were scheduled for elective gynecologic surgery underwent an orthostatic test on the day before surgery. Based on the orthostatic test results, women were stratified into orthostatic dysregulation (OR; systolic blood pressure decrease > 20 mmHg on standing up) and nonorthostatic dysregulation (NOR; systolic blood pressure decrease < 20 mmHg) groups. Forty-nine women were stratified to the OR group and 151 to the NOR group. Frequencies of PONV and vomiting during the study period were higher in the OR group compared with the NOR group (77.6% vs. 31.1% and 55.1 vs. 18.5%, respectively; all P < 0.001). Women with hypotension in their history showed a significantly higher frequency of PONV within 24 h (P < 0.05). Women presenting with orthostatic dysregulation and arterial hypotension in their history exhibit an increased risk of PONV.