Effect of modified rapid sequence induction on postoperative nausea and vomiting in patients undergoing gynecologic laparoscopic surgery - A randomized controlled trial

Background and Aims: 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. Material and Methods: 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. Results: 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. Conclusion: In patients with moderate to high risk, the incidence and severity of PONV were significantly reduced by the modified RSI technique.