• Carlos E Estrada Alamo, Suejean Hwangpo, Lisa Chamberlain, Connie Chon, Bala Nair, Vikas O'Reilly-Shah, Sarah E Bain, and Justin S Liberman.
• Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA. Electronic address: carlos_estrada@alumni.harvard.edu.
• J. Cardiothorac. Vasc. Anesth. 2024 May 1; 38 (5): 118111891181-1189.

ObjectiveThis study assessed the efficacy of palonosetron, alone or with dexamethasone, in reducing postoperative nausea and/or vomiting (PONV) and its impact on hospitalization duration in patients who undergo adult cardiothoracic surgery (CTS) under general anesthesia.DesignThis retrospective analysis involved 540 adult patients who underwent CTS from a single-center cohort, spanning surgeries between September 2021 and March 2023. Sensitivity, logistic, and Cox regression analyses evaluated antiemetic effects, PONV risk factors, and outcomes.SettingAt the Virginia Mason Medical Center (VMMC), Seattle, WA.ParticipantsAdults undergoing cardiothoracic surgery at VMMC during the specified period.InterventionsPatients were categorized into the following 4 groups based on antiemetic treatment: dexamethasone, palonosetron, dexamethasone with palonosetron, and no antiemetic.Measurements And Main ResultsPrimary outcomes encompassed PONV incidence within 96 hours postoperatively. Secondary outcomes included intensive care unit stay duration and postoperative opioid use. Palonosetron recipients showed a significantly lower PONV rate of 42% (v controls at 63%). The dexamethasone and palonosetron combined group also demonstrated a lower rate of 40%. Sensitivity analysis revealed a notably lower 0- to 12-hour PONV rate for palonosetron recipients (9% v control at 28%). Logistic regression found decreased PONV risk (palonosetron odds ratio [OR]: 0.24; dexamethasone and palonosetron OR: 0.26). Cox regression identified varying PONV hazard ratios related to female sex, PONV history, and lower body mass index.ConclusionsThis single-center retrospective study underscored palonosetron's efficacy, alone or combined with dexamethasone, in managing PONV among adult patients who undergo CTS. These findings contribute to evolving antiemetic strategies in cardiothoracic surgery, potentially impacting patient outcomes and satisfaction positively.Copyright © 2024 Elsevier Inc. All rights reserved.

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