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Children's vomiting following posterior fossa surgery: A retrospective study.

Neufeld SM, Newburn-Cook CV, Schopflocher D, Dundon B, Yu H, Drummond JE - BMC Nurs (2009)

Bottom Line: A six year retrospective chart audit at two Canadian children's hospitals was conducted.Children who had intraoperative ondansetron were more likely to vomit in the final multivariable model (perhaps because of its use, in the clinical judgment of the anesthesiologist, for children considered at risk).Children who started vomiting in the first 24 hours were more likely to be school age (groups 4 to <7 and 7 to <12) and receive desflurane.

View Article: PubMed Central - HTML - PubMed

Affiliation: Faculty of Nursing, University of Alberta, Edmonton, Canada. cgrapel@shaw.ca

ABSTRACT

Background: Nausea and vomiting is a problem for children after neurosurgery and those requiring posterior fossa procedures appear to have a high incidence. This clinical observation has not been quantified nor have risk factors unique to this group of children been elucidated.

Methods: A six year retrospective chart audit at two Canadian children's hospitals was conducted. The incidence of nausea and vomiting was extracted. Hierarchical multivariable logistic regression was used to quantify risk and protective factors at 120 hours after surgery and early vs. late vomiting.

Results: The incidence of vomiting over a ten day postoperative period was 76.7%. Documented vomiting ranged from single events to greater than 20 over the same period. In the final multivariable model: adolescents (age 12 to <17) were less likely to vomit by 120 hours after surgery than other age groups; those who received desflurane, when compared to all other volatile anesthetics, were more likely to vomit, yet the use of ondansetron with desflurane decre kelihood. Children who had intraoperative ondansetron were more likely to vomit in the final multivariable model (perhaps because of its use, in the clinical judgment of the anesthesiologist, for children considered at risk). Children who started vomiting in the first 24 hours were more likely to be school age (groups 4 to <7 and 7 to <12) and receive desflurane. Nausea was not well documented and was therefore not analyzed.

Conclusion: The incidence of vomiting in children after posterior fossa surgery is sufficient to consider all children requiring these procedures to be at high risk for POV. Nausea requires better assessment and documentation.

No MeSH data available.


Related in: MedlinePlus

Hours from first recorded retching or vomiting to last in the 240 hours.
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Figure 2: Hours from first recorded retching or vomiting to last in the 240 hours.

Mentions: The cumulative incidence of PON, POV and PONV over the first ten days is presented in Table 2. As shown in this table, there was a discrepancy in the documentation of PON and POV. Because we felt that PON was not reliably measured and documented, the remainder of the data analysis was refocused to examine POV. The frequency distribution of the time from first recorded POV to last recorded POV is presented in Figure 2. The frequency distribution of POV events that were recorded over the study period is shown in Figure 3. These figures indicate that there was considerable variation in length of time that children experienced vomiting as well as number of recorded events. Close to 47% of children experienced vomiting over a time course greater than 24 hours, while 20% continued to vomit over a time course greater than 120 hours. Recorded events, shown in Figure 3, show a positively skewed distribution with 23% children with no events, 36% of children with only one to three recorded events, and 41% with over three events.


Children's vomiting following posterior fossa surgery: A retrospective study.

Neufeld SM, Newburn-Cook CV, Schopflocher D, Dundon B, Yu H, Drummond JE - BMC Nurs (2009)

Hours from first recorded retching or vomiting to last in the 240 hours.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2724508&req=5

Figure 2: Hours from first recorded retching or vomiting to last in the 240 hours.
Mentions: The cumulative incidence of PON, POV and PONV over the first ten days is presented in Table 2. As shown in this table, there was a discrepancy in the documentation of PON and POV. Because we felt that PON was not reliably measured and documented, the remainder of the data analysis was refocused to examine POV. The frequency distribution of the time from first recorded POV to last recorded POV is presented in Figure 2. The frequency distribution of POV events that were recorded over the study period is shown in Figure 3. These figures indicate that there was considerable variation in length of time that children experienced vomiting as well as number of recorded events. Close to 47% of children experienced vomiting over a time course greater than 24 hours, while 20% continued to vomit over a time course greater than 120 hours. Recorded events, shown in Figure 3, show a positively skewed distribution with 23% children with no events, 36% of children with only one to three recorded events, and 41% with over three events.

Bottom Line: A six year retrospective chart audit at two Canadian children's hospitals was conducted.Children who had intraoperative ondansetron were more likely to vomit in the final multivariable model (perhaps because of its use, in the clinical judgment of the anesthesiologist, for children considered at risk).Children who started vomiting in the first 24 hours were more likely to be school age (groups 4 to <7 and 7 to <12) and receive desflurane.

View Article: PubMed Central - HTML - PubMed

Affiliation: Faculty of Nursing, University of Alberta, Edmonton, Canada. cgrapel@shaw.ca

ABSTRACT

Background: Nausea and vomiting is a problem for children after neurosurgery and those requiring posterior fossa procedures appear to have a high incidence. This clinical observation has not been quantified nor have risk factors unique to this group of children been elucidated.

Methods: A six year retrospective chart audit at two Canadian children's hospitals was conducted. The incidence of nausea and vomiting was extracted. Hierarchical multivariable logistic regression was used to quantify risk and protective factors at 120 hours after surgery and early vs. late vomiting.

Results: The incidence of vomiting over a ten day postoperative period was 76.7%. Documented vomiting ranged from single events to greater than 20 over the same period. In the final multivariable model: adolescents (age 12 to <17) were less likely to vomit by 120 hours after surgery than other age groups; those who received desflurane, when compared to all other volatile anesthetics, were more likely to vomit, yet the use of ondansetron with desflurane decre kelihood. Children who had intraoperative ondansetron were more likely to vomit in the final multivariable model (perhaps because of its use, in the clinical judgment of the anesthesiologist, for children considered at risk). Children who started vomiting in the first 24 hours were more likely to be school age (groups 4 to <7 and 7 to <12) and receive desflurane. Nausea was not well documented and was therefore not analyzed.

Conclusion: The incidence of vomiting in children after posterior fossa surgery is sufficient to consider all children requiring these procedures to be at high risk for POV. Nausea requires better assessment and documentation.

No MeSH data available.


Related in: MedlinePlus