SATS 2009 Final Program - Scandinavian Association for Thoracic ...

S03
SATNU ORAL ABSTRACT SESSION
THEME: DEALING WITH PATIENTS’ PHYSICAL POSTOPERATIVE PROBLEMS
S03:1
POSTOPERATIVE NAUSEA AND VOMITING AFTER CARDIAC SURGERY: NURSING POINT OF VIEW
Murkka Timo 1 , Niemi Anu 1 , Järvelä Kati 1 , Maaranen Pasi 1 , Huhtala Heini 2 , Sisto Tero 1 ,
1) Heartcenter/ Pirkanmaa hospital district, 2) Tampere University, Finland
Introduction
Postoperative nausea and vomiting (PONV) is a very distressing adverse event. In this study, we tested the use of
Apfel-score in predicting PONV among male cardiac surgery patients. This score consists of four predictors: female
gender, history of motion sickness or PONV, nonsmoking, and the use of postoperative opioids. We also evaluated
how harmful the patients and the nurses experienced PONV after coronary artery bypass grafting (CABG).
Methods
Fifty men undergoing CABG were interviewed preoperatively. PONV was treated according to a protocol. The
patients were interviewed at the end of ICU stay and on the ward 2-5 days later. The ICU nurses answered a
question: Is PONV a nursing problem in these patients?
Results
Total incidence of PONV was 34.7%. The measured incidences of PONV for Apfel-scores 1, 2 and 3 were 22, 41 and
67% while the predicted incidences were 21, 39 and 61%. One third of the patients (32%) did not remember their
ICU stay at all. Only one patient (2%) experienced insufficient treatment for PONV. Most of the ICU nurses (88.2%)
did not consider PONV as a nursing problem in our ICU.
Discussion
Apfel-score predicted PONV very well in male cardiac surgery patients. PONV is common in this patient group, but
the ICU nurses did not find it problematic, because they have sufficient tools to treat the patients. The patients were
also satisfied. Therefore, we are now using even more aggressive treatment protocol.
S03:2
PREDICTION OF THE CONSUMPTION OF OPIOID ANALGESICS FOLLOWING MINIMALLY INVASIVE
CORRECTION OF PECTUS EXCAVATUM
Grosen Kasper 1 , Pilegaard Hans K. 2 , Jensen Mogens P. 3
1) Aarhus University, 2) Aarhus University Hospital, Skejby, 3) Aarhus University Hospital, NBG, Denmark
Background
Minimally invasive correction of pectus excavatum (MIRPE) is primarily performed to obtain cosmetic and
psychological benefits for the patient. MIRPE is often associated with postoperative pain management problems.
This study estimates the effect of the severity of pectus excavatum on the postoperative consumption of opioid
analgesics following the minimally invasive procedure in order to optimize pain management.
Methods
A retrospective study was conducted on 236 consecutive patients undergoing MIRPE from 2005-2008. The collected
data included evaluation of preoperative pectus excavation depth, patient demographics, data for the peri- and
postoperative period, including data on the pain management. The consumption of opioid analgesics was registered
after discontinuation of epidural analgesia and the various types of opioid analgesics used during the study period
were converted to morphine equivalents.
Results
The total morphine consumption following MIRPE ranged between 20 and 370 mg/day. Multiple linear regression
analysis explained approx. 30% of the variation in log(morphine, mg/day) (R2=0.2957). There was a significant positive
linear relationship between pectus severity and daily consumtion of morphine. Thus, postoperative consumption of
morphine increased by 6% (95% CI: 0.3 to 11%) when preoperative pectus excavatum depth deteriorated with 1 cm.
Conclusion
This study confirms that pectus severity plays a significant role for the consumption of opioid analgesics
following MIRPE. We conclude that knowledge of pectus severity might be useful in the prediction of the
expected morphine consumption for future patients, especially in the critical transition period going from
epidural analgesia to oral analgesia.
STOCKHOLM, SWEDEN 41