The Effects of Systolic Arterial Blood Pressure Variations on Postoperative Nausea and Vomiting

In this clinical study, we tested the hypothesis that a marked systolic blood pressure decrease >35% (ΔSBP >35%) from preanesthetic baseline during the induction and maintenance of anesthesia is associated with more postoperative nausea and vomiting (PONV). In 300 ASA physical status I and II women undergoing elective gynecological surgery with general anesthesia, the maximum ΔSBP during the induction as well as maintenance of general anesthesia were calculated. Observers blinded to hemodynamic variables assessed the incidence of PONV. The overall incidence of nausea (visual analog scale >4) and vomiting within the immediate observation period (0–2 h) was 39% and 25%, respectively. Frequency of nausea and vomiting in the late observation period was 21% and 9%, respectively. Women with a ΔSBP >35% during the induction of anesthesia suffered from a more frequent incidence of PONV within the immediate (57% versus 35% and 41% versus 22%, respectively;P < 0.01) and within the late observation period (33% versus 18% and 19% versus 7%, respectively;P ≤ 0.01). In women with a ΔSBP >35% during maintenance of anesthesia, a more frequent incidence of nausea within the immediate observation period (53% versus 36%;P < 0.05) was found. We conclude that a maximum ΔSBP >35% during the anesthetic induction is associated with an increased incidence of PONV after gynecological surgery during general anesthesia.