Effect of modified rapid sequence induction on postoperative nausea and vomiting in patients undergoing gynecologic...

The incidence of postoperative nausea and vomiting (PONV) ranges between 30% and 80%, and face mask ventilation (FMV) prior to intubation may be a significant risk factor. The primary aim of this study was to investigate the effect of rapid sequence induction (RSI) on the occurrence of PONV.

This randomized controlled study was conducted in 128 adult patients with a moderate to high risk of PONV (Apfel score ≥2), who were scheduled to undergo elective gynecologic laparoscopic surgeries under general anesthesia. Recruited patients were divided into two groups: Control group and RSI group. In the control group, anesthesia was induced by conventional induction with FMV, and in the RSI group, anesthesia was induced by a modified RSI technique avoiding FMV. The primary outcome was to compare the incidence of PONV. Secondary outcomes included comparing the severity of PONV (Bellville score), severity of nausea [visual analogue scale (VAS)], and requirement of antiemetics.

The 24-h incidence of postoperative nausea, retching, and vomiting was significantly less in the RSI group when compared to the control group [78.1% versus 17.2% (P < 0.001), 35.9% versus 9.4% (P < 0.001), and 42.2% versus 7.8% (P < 0.001), respectively]. The severity of PONV was significantly less in the RSI group, as evidenced by a reduced Bellville score [(0 (0-3) versus 2 (1-3), P < 0.001], reduced VAS score, and reduced number of episodes of retching and vomiting.

In patients with moderate to high risk, the incidence and severity of PONV were significantly reduced by the modified RSI technique.