Hyperoxia therapy for prevention of postoperative nausea and vomiting after breast cancer surgery

Nora Mihalek; Dragana Radovanović; Sanja Starčević; Jelena Vukoje; Daniel Juhas

doi:10.2298/VSP230522059M

Nora Mihalek Oncology Institute of Vojvodina, Department of Anesthesiology with Reanimatology, Sremska Kamenica, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Dragana Radovanović Oncology Institute of Vojvodina, Department of Anesthesiology with Reanimatology, Sremska Kamenica, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Sanja Starčević Oncology Institute of Vojvodina, Department of Anesthesiology with Reanimatology, Sremska Kamenica, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Jelena Vukoje Oncology Institute of Vojvodina, Department of Anesthesiology with Reanimatology, Sremska Kamenica, Serbia
Daniel Juhas Oncology Institute of Vojvodina, Department of Anesthesiology with Reanimatology, Sremska Kamenica, Serbia

DOI: https://doi.org/10.2298/VSP230522059M

Keywords: anesthesia, general, breast neoplasms, hyperoxia, nausea, oxygen inhalation therapy, postoperative period, surgical procedures, operative, vomiting

Abstract

Background/Aim. Postoperative nausea and vomiting (PONV) are one of the most common causes of patient dissatisfaction in the postoperative period after general anesthesia. Hyperoxia may prevent PONV after abdominal surgery, but the effectiveness of intraoperative and early postoperative hyperoxia in preventing PONV after breast cancer surgery has not been fully elucidated. The aim of this study was to assess if the application of intraoperative hyperoxia during surgery could prevent PONV. Methods. Forty female patients with breast cancer were recruited for the study, all of whom underwent surgical treatment of breast cancer with axillary sentinel node sampling or axillary lymph node dissection. A balanced general anesthesia was conducted, which was induced with propofol and maintained with sevofluran. Out of the 40 patients, 20 (intervention group) received a volatile gas mixture with a fraction of inspired oxygen (FiO₂) of 0.8 L/min intraoperatively and, afterward, 3 L/min of oxygen via face mask for two hours after surgery. The other 20 patients (control group) received a FiO₂ of 0.4 L/min during the surgery without further administration of oxygen in the early postoperative period. The presence and severity of PONV were assessed at 30 min, 4, 24, 32, 48, and 56 hrs after surgery with the use of the PONV numerical Intensity Scale by Wengritzky for evaluating clinically significant PONV in the first six hours after surgery. Data were collected in an Excel spreadsheet and analyzed using the independent Student’s t-test. Results. The overall incidence of PONV during the 30 min after the surgery was 17.5% (15% in the group of patients receiving FiO₂of 0.8 L/min and 20% in the group of patients receiving FiO₂ of 0.4 L/min intraoperatively). There was no statistically significant difference between the two groups in the frequency of PONV, as well as in the severity of PONV, measured with the PONV Intensity Scale by Wengritzky (p ≥ 0.05). Conclusion. We found no benefit of intra- and post-operative hyperoxia in reducing the incidence of PONV. The data do not support routine administration of hyperoxia, in addition to antiemetics, for the prevention of PONV in patients undergoing breast cancer surgery.

References

Macario A, Weinger S, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89(3): 652–8.

Sizemore DC, Singh A, Dua A, Singh K, Grose BW. Postoperative Nausea [updated 2022 Nov 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500029/

Franck M, Radtke FM, Apfel CC, Kuhly R, Baumeyer A, Brandt C, et al. Documentation of post-operative nausea and vomiting in routine clinical practice. J Int Med Res 2010; 38(3): 1034–41.

Pierre S, Whelan R. Nausea and vomiting after surgery. Cont Edu Anaesth Crit Care Pain Med 2013; 13(1): 28–32.

Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A sim-plified risk score for predicting postoperative nausea and vom-iting: conclusions from cross-validations between two centers. Anesthesiology 1999; 91(3): 693–700.

Elvir-Lazo OL, White PF, Yumul R, Cruz Eng H. Management strategies for the treatment and prevention of postopera-tive/postdischarge nausea and vomiting: an updated review. F1000Res 2020; 9: F1000 Faculty Rev-983.

Stoops S, Kovac A. New insights into the pathophysiology and risk factors for PONV. Best Pract Res Clin Anaesthesiol 2020; 34(4): 667–79.

Vari A, Gazzanelli S, Cavallaro G, De Toma G, Tarquini S, Guerra C, et al. Post-operative nausea and vomiting (PONV) after thyroid surgery: a prospective, randomized study comparing totally intravenous versus inhalational anesthetics. Am Surg 2010; 76(3): 325–8.

Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T, Rauch S, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth 2002; 88(5): 659–68.

Gecaj-Gashi A, Hashimi M, Sada F, Baftiu N, Salihu S, Terziqi H, et al. Propofol vs isoflurane anesthesia-incidence of PONV in patients at maxillofacial surgery. Adv Med Sci 2010; 55(2): 308–12.

Jewer JK, Wong MJ, Bird SJ, Habib AS, Parker R, George RB. Supplemental perioperative intravenous crystalloids for postoperative nausea and vomiting. Cochrane Database Syst Rev 2019; 3(3): CD012212.

Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg 2006; 102(6): 1884–98.

Morita T, Yamamoto M, Sakamoto A. What are the factors affecting postoperative nausea and vomiting following breast cancer surgery with inhalation anesthesia? J Nippon Med Sch 2020; 88(5): 418–22.

Temple-Oberle C, Shea-Budgell MA, Tan M, Semple JL, Schrag C, Barreto M, et al. Consensus Review of Optimal Perioperative Care in Breast Reconstruction: Enhanced Recovery after Sur-gery (ERAS) Society Recommendations. Plast Reconstr Surg 2017; 139(5): 1056e–71e.

Xie J, Huang X, Gao M, Wei L, Wang R, Chen J, et al. Surgical Pharmacy for Optimizing Medication Therapy Management Services within Enhanced Recovery after Surgery (ERAS®) Programs. J Clin Med 2023; 12(2): 631.

Rajan N, Joshi GP. Management of postoperative nausea and vomiting in adults: current controversies. Curr Opin Anesthesiol 2021; 34(6): 695–702.

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. Erratum in: Anesth Analg 2020; 131(5): e241.

Kienbaum P, Schaefer MS, Weibel S, Schlesinger T, Meybohm P, Eberhart LH, et al. Update on PONV-What is new in prophylaxis and treatment of postoperative nausea and vomiting? Summary of recent consensus recommendations and Cochrane reviews on prophylaxis and treatment of postoperative nausea and vomiting. Anaesthesist 2022; 71(2): 123–8. (German)

Wenk M, Van Aken H, Zarbock A. The new World Health Or-ganization recommendations on perioperative administration of oxygen to prevent surgical site infections: A dangerous re-ductionist approach? Anesth Analg 2017; 125(2): 682–7.

Weenink RP, de Jonge SW, van Hulst RA, Wingelaar TT, van Ooij PAM, Immink RV, et al. Perioperative Hyperoxyphobia: Justi-fied or Not? Benefits and Harms of Hyperoxia during Surgery. J Clin Med 2020; 9(3): 642.

Akça O, Sessler DI. Supplemental oxygen reduces the incidence of postoperative nausea and vomiting. Minerva Anesthesiol 2002; 68(4): 166–70.

Mercadante S. Nutrition in cancer patients. Support Care Cancer 1996; 4(1): 10–20.

Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100(10): 1043–9.

Norderud K, Egholm G, Thim T, Olesen KKW, Madsen M, Jensen LO, et al. Validation of the European Society of Cardiology and European Society of Anaesthesiology non-cardiac surgery risk score in patients treated with coronary drug-eluting stent implantation. Eur Heart J Qual Care ClinOutcomes 2019; 5(1): 22–7.

Motamed C, Weil GG, Bourgain JL. Impact of extending prevention of postoperative nausea and vomiting for cancer surgical patients in the PACU: a before and after retrospective study. Braz J Anesthesiol 2022; 72(6): 762–7.

Wengritzky R, Mettho T, Myles PS, Burke J, Kakos A. Develop-ment and validation of a postoperative nausea and vomiting intensity scale. Br J Anaesth 2010; 104(2): 158–66.

Fasquel C, Huet O, Ozier Y, Quesnel C, Garnier M. Effects of intraoperative high versus low inspiratory oxygen fraction (FiO2) on patient's outcome: A systematic review of evidence from the last 20 years. Anaesth Crit Care Pain Med 2020; 39(6): 847–58.

Hovaguimian F, Lysakowski C, Elia N, Tramér MR. Effect of in-traoperative high inspired oxygen fraction on surgical site in-fection, postoperative nausea and vomiting, and pulmonary function: systematic review and meta-analysis of randomized controlled trials. Anesthesiology 2013; 119(2): 303–16.

Orhan-Sungur M, Kranke P, Sessler D, Apfel CC. Does supple-mental oxygen reduce postoperative nausea and vomiting? A meta-analysis of randomized controlled trials. Anesth Analg 2008; 106(6): 1733–8.

Rincón DA, Valero JF. Supplemental oxygen for the prevention of postoperative nausea and vomiting: a meta-analysis of randomized clinical trials. Rev Esp Anestesiol Reanim 2008; 55(2): 101–9. (Spanish)

Holst JM, Klitholm MP, Henriksen J, Vallentin MF, Jessen MK, Bolther M, et al. Intraoperative respiratory and hemodynamic strategies for reducing nausea, vomiting, and pain after sur-gery: Systematic review and meta-analysis. Acta Anaesthesiol Scand 2022; 66(9): 1051–60.

Markwei MT, Babatunde IO, Kutlu-Yalcin E, Essber HA, Mascha EJ, Liu L, et al. Perioperative Supplemental Oxygen and Postoperative Nausea and Vomiting: Subanalysis of a Trial, Systematic Review and Meta-analysis. Anesthesiology 2023; 138(1): 56–70.

Greif R, Laciny S, Rapf B, Hickle RS, Sessler DI. Supplemental oxygen reduces the incidence of postoperative nausea and vomiting. Anesthesiology 1999; 91(5): 1246–52.

Purhonen S, Niskanen M, Wüstefeld M, Mustonen P, Hynynen M. Supplemental oxygen for prevention of nausea and vomiting after breast surgery. Br J Anaesth 2003; 91(2): 284–7.

Zhou Q, Cai M, Gou J, Ning N. Effect of Postoperative High-Concentration Oxygen on Recovery After Thyroid Surgery: A Prospective, Open, Randomized, Controlled Study. Front En-docrinol (Lausanne) 2021; 12: 595571.

Chiu C, Aleshi P, Esserman LJ, Inglis-Arkell C, Yap E, Whitlock EL, et al. Improved analgesia and reduced post-operative nau-sea and vomiting after implementation of an enhanced recov-ery after surgery (ERAS) pathway for total mastectomy. BMC Anesthesiol 2018; 18(1): 41.

Tripathy S, Mandal I, Rao PB, Panda A, Mishra T, Kar M. Opi-oid-free anesthesia for breast cancer surgery: a comparison of ultrasound guided paravertebral and pectoral nerve blocks. A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2019; 35(4): 475–80.

Tabrizi S, Malhotra V, Turnbull ZA, Goode V. Implementation of postoperative nausea and vomiting guidelines for female adult patients undergoing anesthesia during gynecologic and breast surgery in an ambulatory setting. J Perianesth Nurs 2019; 34(4): 851–60.

Krieser KA, Riley JB, Baus JE, Hoffman JT, Sullivan JN, Lobato RL. PONV Prophylaxis failure disproportionately affects fe-male patients, despite intraoperative computerized decision support guidance. Graduate Med Edu Res J 2020; 2(1): 6.

Jin Z, GanTJ, Bergese SD. Prevention and Treatment of Postoperative Nausea and Vomiting (PONV): A Review of Current Recommendations and Emerging Therapies. Ther Clin Risk Manag 2020; 16: 1305–17.