Post Discharge Nausea/Vomiting After Ambulatory Anesthesia in Oral Surgery

One of the most common ambulatory oral surgical procedures done today is removal of third molar teeth. However, as with any other surgeries, there are complications associated with oral surgeries. Post discharge nausea and vomiting (PDNV) is one of the complications commonly seen in ambulatory surgeries.¹ PDNV has a negative impact on patient recovery and it would be beneficial to identify the risk factors associated with this condition to improve quality of patient care. While the overall incidence of PDNV after general anesthesia is well established to be about 25%, data on the incidence of PDNV after ambulatory surgery patients are limited and conflicting.² According to the study done by Apfel et al¹, a PDNV prediction model will help clinicians to better identify patients who might benefit from long-acting antiemetics such as transdermal scopolamine, aprepitant, and/or palonosetron. Therefore, finding the incidence of PDNV after third molar extraction and developing a risk-factor model for this complication would not only allow the oral surgeons to understand how to plan individualized treatment for patients, but it would also allow patients to experience a more pleasant and quick recovery.

This study was conducted to measure the incidence of PDNV in patients undergoing third molar extractions under ambulatory anesthesia and, if clinically relevant, identify independent risk factors.

Following IRB approval and written informed consent, this prospective study was conducted to obtain postoperative data from 63 adults who underwent third molar surgery under ambulatory anesthesia. Subjects were provided a questionnaire to be completed for a week following surgery on a daily basis, in regards to development of PDNV and medication use. The primary endpoint was the incidence of nausea and/or vomiting after discharge from the clinic until the second postoperative day. Fisher’s exact test was performed to identify predictors for PDNV: female gender, history of motion sickness, opioid consumption, antibiotic usage and smoking status; a p < 0.05 was considered significant.

35 out of 63 subjects completed and returned the questionnaire (demographics: age 24.29±5.3 years, 54.8% Female, 45.2% Male).  Overall incidence of nausea was 54% and vomiting/retching was 11.49% during the first 48 hours post discharge. None of the predictors (demographics, history of motion sickness, opioid consumption, and antibiotic usage) were found to be significant risk factors for PDNV (p<0.05) in this population (Table 1).

These preliminary results show the incidence of PDNV after third molar extraction; however, this initial data did not show significant predictors. This is an ongoing study and an increase number in the sample size could help to determine if there are any risk factors associated with development of PDNV in patients undergoing ambulatory anesthesia for wisdom teeth extraction.

 Table 1.

	Nausea (P-value)	Vomiting (P-value)
Sex	0.33	0.58
Smoking	0.37	0.58
Motion sickness	0.55	0.56
Antibiotic usage	0.48	0.68
Tylenol usage	0.21	0.31
Ibuprofen usage	0.50	0.57
Oxycodone usage	0.38	0.73

1. Apfel, C., & Kolodzie, K. (2009). Nausea and vomiting after office-based anesthesia in anaesthesiology office-based anesthesia. Current Opinion in Anaesthesiology, 22(4), 532-538. doi: 10.1097/ACO.0b013e32832dba81.

2.  Forren, J. (2009). Post discharge nausea and vomiting in ambulatory surgical patients: Incidence and management strategies. (Doctoral dissertation, University of Kentucky ), Available from UKnowledge. Paper 777.