Effect of Postoperative Supplemental Oxygen on Nausea and Vomiting After Cesarean Birth

doi:10.1016/j.jopan.2005.03.002

Journal of PeriAnesthesia Nursing

Volume 20, Issue 3, June 2005, Pages 200-205

https://doi.org/10.1016/j.jopan.2005.03.002 Get rights and content

Postoperative nausea and vomiting (PONV) has a significant impact on patients and health care providers. Some nonpharmacologic methods may have an effect on PONV. Administration of supplemental oxygen (80%) during and for 2 hours after surgery has been shown to reduce the incidence of PONV from 44% to 22%. However, the effect of limiting supplemental oxygen to the immediate postoperative period on PONV is unknown. The purpose of this study was to test the efficacy of postoperative supplemental oxygen in reducing the incidence of PONV. Patients (n = 106) undergoing cesarean birth were given general anesthesia with 50% oxygen balanced nitrous oxide and in the postoperative period were randomly assigned to 2 groups. Patients in the experimental group received 8_L/min oxygen by a simple face mask for 6 hours. The control group received routine care of oxygen 5_L/min in the PACU and no supplemental oxygen on the ward. Trained nurses evaluated pulse oximetry and PONV after surgery. The incidence of PONV during the first 6 postoperative hours was 28.3% in the experimental group and 24.5% in the control group (P = .659). There was no statistically significant difference between the 2 groups. In this study, postoperative supplemental oxygen 8_L/min did not prevent PONV in patients undergoing cesarean birth.

Section snippets

Background

One of the most common postoperative complications is nausea and vomiting. The incidence of PONV varies and has been reported to be between 20% and 70%.¹ PONV may increase morbidities such as wound dehiscence, bleeding, pulmonary aspiration of gastric contents, fluid and electrolyte disturbance, delayed hospital discharge, unexpected hospital admission, increased intraocular and intracranial pressure, fatigue, stress,3, 4 and decrease patient satisfaction.² A recent study found that patients

Research Aim

In the study institution, patients receive minimum 30% oxygen in the intraoperative period, but after extubation, they breathe environmental air with FIO₂ at 20%. The researchers hypothesized that this may reduce partial pressure of oxygen in arterial blood (PaO₂) and thus induce intestinal hypoxia. Therefore, this study was designed to evaluate the effects of postoperative supplemental oxygen on nausea and vomiting.

Methods

With approval of the ethics committee of the medical university, a convenience sample of 106 patients undergoing elective cesarean birth consented to participate in the study. The study was restricted to patients who did not have motion sickness and any gastrointestinal or middle ear disease. History was negative for smoking tobacco or drinking alcohol. Patients were orally premedicated with diazepam 5 mg (tablet) the night before surgery and were NPO for 6 to 8 hours before surgery. Anesthesia

Results

One hundred six patients (aged 19 to 41 years) were randomly assigned to 2 groups, (experimental and control group). Fifty-three patients participated in each group. Comparison between groups was performed with the t-test, chi-squared, and Mann-Whitney tests. Data analysis was conducted by using SPSS 10, and the significant P value was .05 or less. Morphometric and demographic factors and hemodynamic responses were comparable in both groups (Table 1). The level of pain perception in the

Discussion

The results of this study showed that the administration of 8 L/min oxygen in the postoperative period may not affect PONV in patients undergoing elective cesarean birth. The incidence of PONV during the 6 hours after surgery was similar to previous studies.2, 12, 13, 14 Greif et al¹ found that the administration of oxygen during and 2 hours after colorectal surgery decreased the incidence of PONV. The difference in operative procedures and physiology of patients (postpartum) in this study, as

Conclusion

The results of this study indicate that postoperative supplemental oxygen for up to 6 hours after cesarean birth may not reduce PONV. The use of higher supplemental oxygen (80%) or supplemental oxygen both during and after surgery together, however, may be useful. Further research with a larger sample size is recommended to better determine the effect of supplemental oxygen on PONV.

Acknowledgments

We thank the Vice-Chancellor of Education and Research of Semnan University of Medical Sciences for financial support of this study. We also thank Dr. R. Ghorbani for his useful comments in statistical analysis of data and Ms. P. Hadian and Ms. M. Izadpanah for their assistance in data collection.

Ali Asghar Ghods, MSc, is academic staff at the Department of Anesthesiology, Semnan University of Medical Sciences, Semnan, Iran

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Cited by (20)

Longer oxygen administration after surgery dose not reduce postoperative nausea and vomiting: An open label, clinical controlled study
2023, Perioperative Care and Operating Room Management
From previous studies, “intraoperative” supplemental oxygen did not seem to affect postoperative nausea and vomiting (PONV). However, less attention has been directed toward the relationship between “postoperative” oxygen administration and PONV. We have experienced some cases in which PONV was suppressed after oxygen was resupplied, and others in which PONV occurred immediately after stopping oxygen. Therefore, we hypothesized that administering oxygen postoperatively should have an antiemetic effect, and that longer postoperative oxygen administration should reduce PONV.
This study is a single-center, open label, and quasi-randomized controlled trial. Participants were patients undergoing laparoscopic gynecological surgery. They were randomly allocated to either a 1 h (1H) group or 5 h (5H) group according to their hospital ID number. The 1H group received oxygen for 1 h postoperatively; the 5H group received oxygen for 5 h. We investigated whether the duration of postoperative oxygen affects the likelihood of PONV under propofol-based general anesthesia. The primary outcome was the difference in overall incidence of nausea between the two groups.
After excluding 168 patients before and after allocation, 628 patients for 1H patients and 588 patients for 5H were followed up and analyzed. The incidence of nausea was 44.1 % in the 1H group and 45.2 % in the 5H group (p = 0.73). No significant difference in early or late PONV was observed between the groups.
Longer-duration postoperative oxygen administration did not reduce the incidence of PONV in patients undergoing laparoscopic gynecological surgery.
Effect of chamomile aromatherapy with and without oxygen on pain of women in post cesarean section with spinal anesthesia: A randomized clinical trial
2023, Heliyon
Pain is the most common side effect in cesarean section with spinal anesthesia. It seems that oxygen therapy and chamomile aromatherapy may diminish pain. The present study was conducted to examine and compare the effect of chamomile aromatherapy with and without oxygen on the severity of pain of women following cesarean section surgery with spinal anesthesia.
The present randomized clinical trial study was carried out on 136 women undergoing cesarean section surgery with spinal anesthesia at Imam Sajad Hospital, Yasuj, Iran in 2020. The eligible women were assigned into four 34-member groups including oxygen therapy plus aromatherapy, oxygen therapy, aromatherapy, and control via block randomization. Each of these interventions were performed 6, 6.30 and 7 h post operation. In the first intervention group, one drop of chamomile essential oil with distilled water was poured into a small nebulizer using a simple mask connected to 6 L of oxygen. The second intervention group received oxygen without chamomile aromatherapy at similar times, and the third intervention group received chamomile aromatherapy without oxygen. The control group received only routine interventions. The instrument used in the research was visual analog scale which was completed by the researcher 6, 12, 18 h after cesarean section. The data were analyzed by the SPSS software version 20.
There was a significant difference in the intensity of pain of patients between the various groups of study following the interventions (P < 0.001). Pain intensity reduced significantly in the group receiving combined intervention of chamomile aromatherapy plus oxygen compared to the other three groups. Moreover, the pain intensity diminished more in the groups undergoing each of these interventions alone as compared to the control group (P < 0.05).
The combined intervention of chamomile aromatherapy with oxygen was more effective than each of the chamomile aromatherapy and oxygen interventions alone in reducing the pain of cesarean section patients though each intervention alone was still effective in lowering pain post-operation.
Use of intra-operative supplemental oxygen to reduce morbidity and mortality in general anesthesia: Systematic review and meta-analysis of randomized controlled trials
2012, Revista Colombiana de Anestesiologia
Evaluar la efectividad y la seguridad del suministro de oxigeno (fraccion inspirada de oxigeno, FiO₂) en concentraciones altas comparado con concentraciones bajas, para poder disminuir complicaciones en pacientes sometidos a procedimientos quirurgicos bajo anestesia general.
Se realizaron una revision sistematica y un meta-analisis siguiendo la metodologia propuesta por la Colaboracion Cochrane. Se incluyeron experimentos clinicos controlados llevados a cabo en pacientes adultos sometidos a procedimientos quirurgicos bajo anestesia general. Se hizo una busqueda en bases de datos (PUBMED, CENTRAL y LILACS) y, con los estudios pertinentes identificados, se complemento con una nueva busqueda ambispectiva en bola de nieve y en fuentes de literatura gris.
Se incluyeron 17 experimentos clinicos (4.844 pacientes), de los cuales siete fueron considerados de bajo riesgo de sesgo. Las FiO₂ altas disminuyen la nausea y el vomito posoperatorio solo en cirugias de manipulacion intestinal extensa (odds ratio [OR] 0,40; intervalo de confianza [IC] 95%, 0,20 a 0,80). En este mismo escenario clinico, tambien disminuyen el riesgo de infeccion del sitio operatorio (OR 0,46; IC 95%, 0,29 a 0,74) y la mortalidad (OR 0,17; IC 95%, 0,03 a 0,99). La necesidad de antiemetico de rescate, tiempo de estancia en la unidad de cuidado postanestesico, admision no esperada a la unidad de cuidados intensivos y tiempo de estancia hospitalaria posoperatoria no se afectan en ningun tipo de poblacion quirurgica.
El oxigeno suplementario intraoperatorio en concentraciones altas (≥ 60%) podria disminuir el riesgo de infeccion del sitio operatorio y la mortalidad en cirugias en las que se produce manipulacion intestinal extensa
To evaluate the effectiveness and safety of oxygen supplementation (inspired fraction of oxygen, FiO₂) in high concentrations versus low concentrations, given with the aim of reducing complications in patients undergoing surgical procedures under general anesthesia.
A systematic review and a meta-analysis were performed following the methodology proposed by the Cochrane Collaboration. The review included controlled clinical trials conducted in patients undergoing surgical procedures under general anesthesia. After conducting data base searches (PUBMED, CENTRAL y LILACS), and once the relevant studies were identified, additional snowballing ambispective and grey literature searches were done.
Of the 17 clinical trials finally included (4844 patients), 7 were considered to a have a low risk of bias. High FiO₂ levels reduce post-operative nausea and vomiting only in surgeries with extensive intestinal manipulation (odds ratio [OR] 0.40; 95% confidence interval [CI], 0.20 to 0.80). In this same clinical setting, the risk of surgical site infection (OR 0.46; 95% CI, 0.29 to 0.74), and mortality (OR 0.17; 95% CI, 0.03 to 0.99) are also reduced. There was no impact on the need for rescue anti-emetic administration, length of stay in the post-anesthetic care unit, unexpected admission to the intensive care unit, or postoperative hospital stay in any of the surgical populations.
Intra-operative oxygen supplementation in high concentrations (≥ 60%) might reduce the risk of surgical site infection and mortality in surgeries with extensive intestinal manipulation.
Myths hardly ever die, but even if they do, one cannot be sure about it
2010, Journal of Clinical Anesthesia
Supplemental oxygen and the incidence of perioperative nausea and vomiting in cesarean sections under subarachnoid block
2009, Revista Brasileira de Anestesiologia
Supplemental oxygen can reduce the incidence of postoperative nausea and vomiting in patients under general anesthesia. The objective of the present study was to determine the efficacy of supplemental oxygen to reduce the incidence of perioperative nausea and vomiting in elective cesareans under subarachnoid block.
After induction of standardized subarachnoid block, 94 parturients undergoing surgical delivery were randomly divided to receive 4 L.min^-1 of oxygen (Group O) or medical air (Group S) under nasal cannula throughout the procedure. Patients were questioned on the development of nausea and vomiting during the surgery and in the first six and 24 hours after the procedure.
Demographic and perioperative parameters, as well as the data on the newborn, were comparable in both groups. In Group O, the incidence of nausea during the surgery, in the first 6 hours afterwards, and between 6 and 24 hours was 35%, 30%, and 19%, respectively, while in Group S, it was 35%, 30%, and 19%, respectively. In Group O, the incidence of vomiting was 9%, 11% and 6% in the corresponding periods, and in Group S, 21%, 7% and 7%, respectively. Those differences were not statistically significant.
The administration of supplemental oxygen from anesthetic induction until the end of the surgery did not reduce the incidence of intra- and postoperative nausea or vomiting in women undergoing cesarean section under subarachnoid block.
Oxigênio suplementar pode reduzir a incidência de náuseas e vômitos pós-operatórios em pacientes submetidos à anestesia geral. O objetivo deste estudo foi testar a eficácia do oxigênio suplementar durante a cesariana eletiva sob anestesia subaracnoidea em diminuir a incidência de náuseas e vômitos perioperatórios.
Após indução de anestesia subaracnoidea padronizada, noventa e quatro parturientes submetidas ao parto operatório foram distribuídas de forma aleatória para receberem, através de cateter nasal tipo óculos, 4 L.min^-1 de oxigênio (Grupo O) ou ar comprimido (Grupo S) até o final do procedimento. As pacientes foram inquiridas acerca da ocorrência de náuseas e vômitos durante a operação e nas primeiras seis e 24 horas de pós-parto.
Os dois grupos mostraram-se comparáveis quanto às variáveis demográficas, perioperatórias e quanto aos dados do recém-nascido. No Grupo O, a incidência de náusea durante a operação nas primeiras 6 horas de pós-operatório e entre 6 e 24 horas de pós-operatório foi de 35%, 20% e 13%, respectivamente, enquanto no Grupo S foi de 35%, 30% e 19%, respectivamente. A incidência de vômito no Grupo O foi de 9%, 11% e 6% nos períodos correspondentes e no Grupo S 21%, 7% e 7%, respectivamente. Essas diferenças não foram significativas.
Na população estudada, a oxigenoterapia suplementar desde a indução da anestesia até o término da operação não reduziu a incidência de náuseas ou vômitos intraoperatórios e pós-operatórios em mulheres submetidas ao parto cesariano sob anestesia subaracnoidea.
El oxígeno suplementario puede reducir la incidencia de náuseas y vómitos postoperatorios en pacientes sometidos a la anestesia general. El objetivo de este estudio, fue comprobar la eficacia del oxígeno suplementario durante la cesárea electiva bajo anestesia subaracnoidea, para reducir la incidencia de náuseas y vómitos perioperatorios.
Después de la inducción de anestesia subaracnoidea estandarizada, noventa y cuatro parturientas sometidas al parto en quirófano, se distribuyeron de forma aleatoria para recibir, a través de catéter nasal tipo gafas, 4 L.min^-1 de oxígeno (Grupo O), o aire comprimido (Grupo S), hasta el final del procedimiento. Se les preguntó sobre el aparecimiento de náuseas y vómitos durante la operación y en las primeras 6 y 24 horas del posparto.
Los dos grupos fueron comparables en cuanto a las variables demográficas, perioperatorias y en cuanto a los datos del recién nacido. En el Grupo O, la incidencia de náuseas durante la operación en las primeras 6 horas del postoperatorio y entre las 6 y 24 horas del postoperatorio, fue de un 35%, 20% y 13%, respectivamente, mientras que en el Grupo S, fue de un 35%, 30% y 19%, respectivamente. La incidencia de vómitos en el Grupo O fue de un 9%, 11% y 6% en los períodos correspondientes, y en el Grupo S, 21%, 7% y 7%, respectivamente. Esas diferencias no fueron significativas.
En la población estudiada, la oxigenoterapia suplementaria desde la inducción de la anestesia hasta el término de la operación, no redujo la incidencia de náuseas o vómitos intraoperatorios y postoperatorios en mujeres sometidas al parto por cesárea bajo anestesia subaracnoidea.
Inspired oxygen fraction of 0.8 compared with 0.4 does not further reduce postoperative nausea and vomiting in dolasetron-treated patients undergoing laparoscopic cholecystectomy
2006, British Journal of Anaesthesia
Institutional Review Board (IRB) approval of this research could not be verified during an investigation by the Landesärztekammer Rheinland-Pfalz (the State Medical Association of Rheinland-Pfalz in Germany). As a result, this article has been retracted, in accordance with the Journal's regulations, at the request of the Directors and Board of the British Journal of Anaesthesia. Lack of IRB approval means that the research was unethical, and that IRB approval for the research was misrepresented in the published article. It does not mean that the research results per se are fraudulent. For further information please see Retraction.

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Ali Asghar Ghods, MSc, is academic staff at the Department of Anesthesiology, Semnan University of Medical Sciences, Semnan, Iran

Mohsen Soleimani, MSc, is academic staff at the Department of Medical-Surgical Nursing, Semnan University of Medical Sciences, Semnan, Iran

Mahnaz Narimani, MD, is academic staff at the Department of Anesthesiology, Azad University of Tehran (central unit), Tehran, Iran.

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Original researchEffect of Postoperative Supplemental Oxygen on Nausea and Vomiting After Cesarean Birth

Section snippets

Background

Research Aim

Methods

Results

Discussion

Conclusion

Acknowledgments

Br J Anaesth

Br J Anaesth

Supplemental oxygen reduces the incidence of postoperative nausea and vomiting

Anesthesiology

Postoperative nausea and vomitingA review of current literature

Singapore Med J

Managing nausea and vomitingCurrent strategies

Crit Care Nurse

How much are patients willing to pay to avoid postoperative nausea and vomiting?

Anesth Analg

Original research
Effect of Postoperative Supplemental Oxygen on Nausea and Vomiting After Cesarean Birth