Nausea & Vomiting

Created: October 01, 2023

Last Updated: November 18, 2023

Contributor(s):

Michael Grant MD

Editor(s):

Cheryl Crisafi MSN RN CNL

Amanda Rea DNP CRNP AGACNP-BC CCRN CMC CSC E-AEC

Gina McConnell RN BSN CCRN

Shannon Crotwell RN BSN CCRN

Alexander Gregory MD FRCPC

Summary

Post-Operative Nausea and Vomiting (PONV) after cardiac surgery can have a range of negative impacts on patients, including poor patient experience and prolonged length of stay. Preventive measures, including the use of antiemetic medications, minimizing opioid use, early mobilization, and patient education, are essential to reduce the incidence and severity of PONV and enhance the overall post-operative experience for cardiac surgery patients.

The impact of nausea and vomiting after cardiac surgery can be substantial, in some cases this may cause more distress to patients than pain.

Post-Operative Nausea and Vomiting (PONV) can lead to several complications that inhibit an optimal recovery after cardiac surgery:

Compromised Respiratory Function:

  • PONV can strain incisions, potentially leading to increased pain and discomfort. This can discourage deep breathing and coughing, which are vital for maintaining optimal respiratory function post-surgery.

Delayed Gastrointestinal Recovery:

  • Can hinder a patient's ability to tolerate oral intake and medications, leading to delayed resumption of normal gastrointestinal function, poorer nutrition, dehydration, reduced mobility, and extended hospital stays.

Increased Risk of Aspiration:

  • Vomiting increases the risk of aspirating stomach contents into the lungs, potentially causing pneumonia or other respiratory complications.

Decreased Patient Comfort:

  • Significantly reduces patient comfort and overall satisfaction with the surgical experience.

Prevention Strategies for PONV after cardiac surgery include:

  • Identification of patients at elevated risk for PONV.
  • Prophylactic antiemetic medications, especially in those at higher risk.
  • Minimizing opioid use through multimodal analgesia, including regional anesthesia.
  • Encouraging patients to mobilize and engage in activities as soon as possible after surgery.
  • Educating patients about the risk of PONV and its prevention strategies can help reduce anxiety and improve adherence to post-operative care plans.

______________________________________________________________________________________________________________________________


This summary was written with assistance from artificial intelligence. All text was reviewed, edited, and supplemented by the listed editor(s). Reference: OpenAI. (2023). ChatGPT (Sept 25 version) [Large language model]. https://chat.openai.com/chat

ERAS Cardiac VTC Disclaimer:

The VTC, and all included content, is intended to inform ERAS Cardiac Members in a multitude of topics related to enhanced recovery. The information included has been provided by other enhanced recovery experts and should be used for educational purposes only. It is not intended to describe, recommend, or suggest any specific medical practice or intervention, nor should it be considered as formal medical advice or consultation. The ERAS Cardiac Society cannot guarantee that the information on the VTC is accurate or complete in every respect. Therefore, ERAS Cardiac Society is not responsible for any errors or omissions in the content, or medical results that occur with the application of the information obtained while using the VTC. All healthcare professionals should continue to use sound clinical judgment and prescribe therapies based on the best medical knowledge at their disposal.

All the material presented on the VTC is the intellectual property of the ERAS Cardiac Society, its contributors, and its sponsors. Unless explicitly stated, the information, images, audio, video, and other content may not be reproduced (in whole or in part) in any way without the written permission of the ERAS Cardiac Society.

If you have any questions or comments about the ERAS Cardiac VTC, please email: VTC@erascardiac.org

Educational Materials

Risk Assessment & Prevention: Post-Operative Nausea and Vomiting
This video by Dr. Grant from Johns Hopkins University reviews how to identify patients at risk for post-operative nausea and vomiting (PONV). It also reviews the various for preventing and treating PONV following cardiac surgery.

References:

  1. Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000;84(1):6-10.
  2. Mace L. An audit of post-operative nausea and vomiting, following cardiac surgery: scope of the problem. Nurs Crit Care. 2003;8(5):187-96.
  3. Sawatzky JA, Rivet M, Ariano RE, Hiebert B, Arora RC. Post-operative nausea and vomiting in the cardiac surgery population: who is at risk? Heart Lung. 2014;43(6):550
  4. Hijazi EM, Edwan H, Al-Zoubi N, Radaideh H. Incidence of Nausea and Vomiting After Fast-Track Anaesthesia for Heart Surgery. Braz J Cardiovasc Surg. 2018;33(4):371-5.
  5. Grebenik CR, Allman C. Nausea and vomiting after cardiac surgery. Br J Anaesth. 1996;77(3):356-9.
  6. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91(3):693-700.
  7. Wang EHZ, Sunderland S, Edwards NY, Chima NS, Yarnold CH, Schwarz SKW, et al. A Single Prophylactic Dose of Ondansetron Given at Cessation of Postoperative Propofol Sedation Decreases Postoperative Nausea and Vomiting in Cardiac Surgery Patients: A Randomized Controlled Trial. Anesth Analg. 2020;131(4):1164-72.
  8. Champion S, Zieger L, Hemery C. Prophylaxis of postoperative nausea and vomiting after cardiac surgery in high-risk patients: A randomized controlled study. Ann Card Anaesth. 2018 Jan-Mar;21(1):8-14.
  9. Hasheminejad E, Forner AF, Meineri M, Ender J, Zakhary WZ. Postoperative Nausea and Vomiting Prophylaxis in Fast-Track Cardiac Anesthesia: A Patient Matched Retrospective Before and After Study. International J of Anesthesiology and Pain Medicine. 2022; 8 (5): 78.
  10. Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020;131(2):411-48.
Next