68-6

19/104

control after LGS3).For improving patient satisfaction and enhancing patient recovery, antiemetic therapy to prevent PONV is essential1). Previously, we reported that the incidence of PONV after LGS was 70% without an effective antiemetic prophylaxis, but the inci-dence could be reduced to 43% with a prophylactic antiemetic, either droperidol or dexamethasone, and further, to 17% with a combination of both drugs4). After confirming these results, we incorpo-rated the routine use of both drugs into our anes-thesia practice for LGS. However, we have not investigated the usual anesthesia practice in LGS patients and the incidence of PONV before this change in the anesthesia protocol was made.In the present study, we retrospectively investi-gated anesthesia practice in LGS patients during the era earlier than the above-mentioned protocol change to learn a history of anesthesia practice for LGS at our institute, and hopefully, to identify factors affecting PONV in patients undergoing LGS.This retrospective, observational study was approved by the Ethics Committee of Juntendo University Hospital (approval number, 15-173), with a waiver of written informed consent.We investigated 1,236 consecutive patients who underwent LGS for benign diseases at Juntendo University Hospital between May, 2007 and January, 2009. We collected the following data from the anesthesia record: patients’ demographic charac-teristics, including age, body height, body weight, body mass index (BMI), and smoking habits; dura-tions of anesthesia and surgery; surgical proce-dures performed; methods of general anesthesia, including general anesthetics, opioid analgesics, muscle relaxants, reversal agents for muscle relax-ants, and prophylactic antiemetic agents given during anesthesia; the use or no use of intravenous fentanyl PCA for postoperative pain control, and contents of the PCA infusate, if used. Further, we collected the following data from the medical record: postoperative rescue analgesics, including opioid or non-opioid analgesics given in the post-anesthesia care unit (PACU) and/or ward, severity of PONV evaluated repeatedly on the four-category verbal rating scale (VRS; none, mild, moderate, and severe) in the PACU, severity of PONV evaluated on the 11-point numerical rating scale (NRS; 0 = none, 10 = worst imaginable) at 0, 3, 6, and 9 hours after the return to the gynecological ward, and rescue anti-emetics given in the PACU and/or ward.The use or no use of intravenous fentanyl PCA was left to the discretion of attending anesthesiolo-gists. If PCA was used, postoperative analgesia was managed basically with intravenous PCA using a disposable infusion pump (Baxter Infusor, BB30LV4, Baxter Limited, Tokyo, Japan), filled with fentanyl 1000 μg and normal saline in a total volume of 80 ml, allowing for a constant infusion rate, 4 ml/h (fentanyl, 50 μg/h) and a bolus dose on demand, 2 ml (fentanyl 25 μg), with a 30-minute lockout time. Droperidol 2.5 or 5 mg was added or not added to the PCA infusate at the discretion of attending anesthesiologists.Patients who continued to report ‘none’ on the nausea VRS in the PACU and ‘0’ on the nausea NRS in the ward, without developing vomiting nor receiving rescue antiemetics during the observa-tion period until nine hours after the return to the gynecological ward were deemed to have no PONV. Otherwise, patients were deemed to have PONV.Data are expressed as Mean ± standard deviation (SD), Median [Interquartile Range] or Number (%) according to data types. Data were compared between groups using the unpaired t test, Mann-Whitney U test, or chi-square test accordingly. Based on the recent guideline1), effects of nine factors likely to affect the development of PONV, including age, BMI, smoking habits, duration of anesthesia, the method of general anesthesia (inha-lation anesthesia versus propofol-based total intra-venous anesthesia [TIVA]), the use of prophy-lactic antiemetics during anesthesia, the use of the reversal agent for muscle relaxants, the use of intravenous fentanyl PCA, and the use of postoper-ative rescue opioids other than PCA fentanyl, were examined with univariate and multivariate logistic regression analyses. A p value < 0.05 was consid-ered statistically significant. Statistical analysis was performed with the EZR (Easy R), available from the Jichi Medical University Saitama Medical Center at https://www.jichi.ac.jp/saitama-sct/SaitamaHP.files/download.html.583MethodsStatistical analysis