p44

P44

AUDIT OF THE PONV RATES AND MANAGEMENT OF CHILDREN UNDERGOING SURGERY FOR COCHLEAR IMPLANTS AT ROYAL MANCHESTER CHILDREN'S HOSPITAL

M. R. Bowler1, L. Elliott2

1Royal Manchester Children’s Hospital, UK

2Stepping Hill Hospital, Stockport, UK

Introduction

Following an audit and quality improvement project to reduce PONV rates in children undergoing mastoid surgery, we assessed the PONV rates and anaesthetic techniques for cochlear implant surgery.  A previous audit for mastoid surgery demonstrated that PONV was associated with use of volatile anaesthesia as opposed to a propofol TIVA technique.  TIVA did not increase time to recover.  These results were distributed and encouragement of TIVA in emetogenic surgery was made.  We repeated the same approach for cochlear implant surgery using a similar methodology and audit standard.  The underlying guideline used was Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting, which supports that for high risk surgery 2 antiemetics should be used alongside a propofol TIVA technique (1).

Methods

We performed a 5 month retrospective review of all cochlear implants inserted within RMCH between September 2022 and March 2023.  We collected data on anaesthetic approach, intraoperative antiemetic use, postoperative rescue antiemetic, time in recovery and whether an overnight stay was required.  Patient details were gained utilising the reports function on Epic HIVE EPR system.  All data was extrapolated within the electronic system.

Results

30 patients underwent a cochlear implant within this period.  20 procedures were bilateral, with the rest unilateral.  Only one child suffered PONV and they received a volatile anaesthetic.  All children with the exception of one had intraoperative dexamethasone and ondansetron.  The one exception did not receive ondansetron because of long QT syndrome.  No children required postoperative antiemetic use.  22 of the 30 children had their anaesthetics performed using TIVA (Propofol/Remifentanil TCI).  The average recovery time for patients receiving TIVA was 37.5 minutes and without TIVA was 45.75, but this difference was not significant.  No children who received TIVA suffered N and V.  The majority of surgery was day-case (25/30).  Those admitted overnight were for comorbidities (3), bleeding (1) or vomiting (1).

Discussion

It is established that middle ear surgery is associated with increased rates of nausea and vomiting.  This review demonstrates that our rates of nausea and vomiting after unilateral or bilateral cochlear surgery are very low.  Unfortunately, significance was not reached to demonstrate that this was due to TIVA use.  This demonstrates that with appropriate anaesthetic techniques, day-case cochlear implant surgery is the normal.  Furthermore, quality improvement in other aspects of middle ear surgery with respect to propofol TIVA use has led to a similar increased rate of TIVA use within cochlear implant surgery, which has likely aided the rate of day-case surgery.

Reference:

1 Gan, Tong J et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anaesthesia and analgesia. 2020; 131,2: 411-448.

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