Incidence of nausea/vomiting following propofol sedation with adaptive servo‐ventilation for atrial fibrillation ablation

• Published in: Journal of arrhythmia Vol. 40; no. 2; pp. 289 - 296
• Main Authors: Sakanoue, Haruna, Yamaji, Hirosuke, Okamoto, Sayaka, Okano, Kumi, Fujita, Yuka, Higashiya, Shunichi, Murakami, Takashi, Kusachi, Shozo
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01-04-2024; Wiley
• Subjects: Ablation; Analgesics; Anesthesia; anesthetic; Atrial fibrillation; Body mass index; Cardiac arrhythmia; Care and treatment; catheter; Catheters; Causes of; Ejection fraction; Embolisms; Females; gastrointestinal symptoms; Gender; Motion sickness; Nausea; Patient outcomes; Patients; Performance evaluation; postoperative complaint; Respiration; supraventricular arrhythmia; Vomiting; Japan; United States > US; supraventricular arrhythmia; anesthetic; catheter; postoperative complaint; gastrointestinal symptoms
• ISSN: 1880-4276; 1883-2148
• DOI: 10.1002/joa3.13012

Background
Postoperative nausea and vomiting (PONV) following atrial fibrillation (AF) ablation can cause considerable distress.
Aim
Continuous intravenous propofol sedation with adaptive servo‐ventilation (ASV) with or without an analgesic, pentazocine, during AF ablation was studied in 272 consecutive patients with paroxysmal, persistent, and long‐standing persistent AF. The study objectives were to determine the incidence of PONV after AF ablation and to assess the predictive value of factors for PONV using the area under the receiver operating characteristic curve (AUC).
Results
The present sedation maneuver was successfully accomplished with a low incidence of hypotension and without discontinuation of ablation or switching to general anesthesia, while maintaining an acceptable procedural time (102 ± 32 min). The incidence of PONV was 5.5% (15/272). Nausea occurred in nine patients after an average of 4.6 ± 3.5 h (range: 2–12 h) postablation, and vomiting with nausea occurred in six patients after an average of 4.5 ± 3.1 h (range: 1–9 h) postablation. The postablation interval did not differ significantly between the occurrence of nausea and nausea accompanied by vomiting. AUCs based on various factors, including the Apfel score, ranged from 0.55 to 0.67, indicating low accuracy in predicting PONV occurrence.
Conclusions
The incidence of PONV after propofol sedation with ASV was the lowest (5.5%) reported to date. Scoring systems, which included the Apfel score, were ineffective in predicting PONV. The low PONV incidence in addition to the efficacy of propofol sedation with ASV revealed the adequacy of this regimen for AF ablation.
The present study is the first to show that the incidence of nausea and/or vomiting was low (5.5%) after deep sedation with propofol combined with adaptive‐servo ventilation for atrial fibrillation ablation. The scoring system, which included the Apfel score, was not effective in predicting PONV.