Simplified Algorithm for the Prevention of Postoperative Nausea and Vomiting in an Oncological Hospital
Simplified Algorithm for the Prevention of Postoperative Nausea and Vomiting in an Oncological Hospital
Previous history of nausea and vomiting induced by prior chemotherapy still not included as
 predictive factor of postoperative nausea and vomiting, although has been demonstrated that
 has influence in postoperative outcome.

 The project aims to evaluate the efficacy of a simplified algorithm in prevention
 postoperative nausea and vomiting , with pacients with previous history of nausea and
 vomiting induced by prior chemotherapy, submitted to medium or large surgery.
Quasi-experimental study, with evaluation before and after the application of a specific
 postoperative nausea and vomiting prevention algorithm for cancer patients.

 The study will be carried out in 3 phases:

 Phase 1: Database with 1829 patients evaluated and previously analyzed in the project
 "Evaluation of predictive factors and outcomes of the nausea, vomiting and acute pain
 phenomena in the postoperative period of cancer patients ", registered in number 319,985 of
 06/26/2013. This database contains the records of risk factors (Apfel scale, "chemotherapy
 "nausea and vomiting induced by chemotherapy prophylaxis for PONV used in the operating room,
 incidence of nausea and vomiting in the first 24 hours postoperative. This phase is already
 concluded

 Phase 2: Team training. In the second phase of the study, we established a protocol for PONV
 prophylaxis, using two questions:

 1. Patient undergoing chemotherapy before surgery;

 2. Patient presented nausea and vomiting induced by chemotherapy (CINV). If the answer is
 yes to both questions, the anesthetist administers 3 antiemetics (4mg dexametasone, 4mg
 ondansetron and 0,625mg droperidol). If the answer is no to one of the questions, the
 anesthetist administers 2 antiemetics (4mg dexametasone and 4mg ondansetron); In this
 phase, educational measures will be implemented by team meetings and individual approach
 of all anesthesiologists at ICESP to present the study project and the algorithm. A
 summary of the the study will be sent via a specific group of anesthesiologists at ICESP
 through the social network Whats App.

 The number of patients to be studied in the second phase of the project was calculated taking
 into account adherence to the new prophylaxis protocol for post-operative nausea and
 vomiting. If we consider an alpha error of 5% and test power of 80%, to have a NVPO reduction
 of 40% (current overall incidence) to 25% (incidence after protocol adherence) in high-risk
 patients, we need to study 330 patients (165 each group adherence and non-adherence to the
 protocol). The total number of patients in this study, therefore, it is 768.

 Phase 3: Post-training assessment. In the third phase of the study, after the end of the
 dissemination of the protocol among doctors, another group of patients will be evaluated on
 the first postoperative day, using the outcome parameters for PONV used in the first project
 . On the first postoperative day, prophylaxis for PONV used in the room will be recorded and
 the incidence of nausea and vomiting in the first 24 postoperative hours. The presence or
 absence of a previous NVIQ will also be recorded at this time.
Inclusion Criteria:

 -  All patients who underwent medium to large surgery

 Exclusion Criteria:

 -  Patients who are unable to communicate (orotracheal intubation after the surgery,
 confusion or agitation) or understand the Portuguese language;

 -  Insulin dependent patients

 -  Pacients who had an increased QT interval on the electrocardiogram

 -  History of allergy to dexametasone, ondansetron or droperidol