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(Anesth Analg 2009;108:1788 –93)

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  1. Does Infusion of Colloid Influence the Occurrence of Postoperative Nausea and Vomiting After Elective Surgery in Women? (Anesth Analg 2009;108:1788 –93)

  2. BACKGROUND • The prevention of postoperative nausea and vomiting (PONV) has been the subject of several studies • In addition to the effects of various drugs, it has been shown that the administration of high volumes of intraoperative fluid replacement, commonly crystalloids, can decrease the incidence of PONV

  3. BACKGROUND • The impact of the type of fluid on postoperative nausea and vomiting (PONV) is not well defined. • In this study we investigated the effects of colloids or crystalloids on PONV when given in addition to a background minimal crystalloid infusion in a female population of surgical patients.

  4. METHODS • 115 female patients with ASA I or II • elective gynecological or breast surgery • randomly allocated to receive HES 130/0.4 or 0.9% NaCl • Exclusion criteria: • <18 yr • coagulopathy(凝血) • significant hepatic or renal dysfunction(肝肾功能) • congestive heart failure(充血性心衰) • hypersensitivity to HES(过敏)

  5. METHODS • background solution • starting at the induction of anesthesia • 5% dextrose in 0.45% NaCl • 0.5 mL /kg/h for 24 h • study solution • before the induction of anesthesia • 500 mL HES 130/0.4 or 0.9% NaCl • 1 mL /kg/ h for 24 h

  6. METHODS • No antiemetic prophylaxis • ECG, NBP, SPO2, and CO2 • induced : • 1–2.5 mg/kg propofol • 10–20 ug sufentanil • neuromuscular blocking drug • maintained : • sevoflurane (1–2 MAC) • sufentanil and/or neuromuscular blocking drugs

  7. Patients received IV analgesia for postoperative pain relief consisting of 1 g paracetamol 4 times per day , and 1 mg/kg diclofenac twice per day to a maximum of 75 mg twice per day

  8. Primary End Points • The occurrence of any postoperative nausea or vomiting during the 24 h after surgery • Nausea(恶心) • the urge to vomit without expulsion of gastric contents and without effort to empty the stomach • Vomiting(呕吐) • the forceful expulsion of liquid gastric contents • Retching(干呕) • vomiting efforts, but without gastric emptying, and was considered the same as vomiting for the purpose of this study

  9. The severity of nausea was rated on an 11-point number rating scale (NRS): any score on the 11-point NRS more than zero was considered to be a positive event • PONV was evaluated every hour for the first 4 h, and then every 3 h for 24 h.

  10. Secondary End Points • The frequency of antiemetic rescue therapy use • Treatment : • 5 mg dexamethasone • 1.25 mg droperidol • 100 mg alizapride • 4 mg IV ondansetron • if each of the previous treatments failed • The need for antiemetic therapy and the number of times antiemetic therapy was required were noted (mono, bi, tri, or quadritherapy )

  11. The incidence of hypotensive events (Hypotension defined as a 20% decrease in systolic blood pressure compared with the baseline) • Hypotension and nausea occurring at the time of the patient’s first mobilization after surgery • The severity of pain • In addition, pain severity was rated on an 11-point NRS and evaluated at the same intervals as PONV

  12. RESULTS

  13. RESULTS

  14. RESULTS

  15. RESULTS

  16. DISCUSSION • Previous studies investigating the effect of colloid versus crystalloid for surgeries in which large fluid shifts or blood loss was expected showed a 50% reduction in the incidence of PONV • The present study using female patients having surgery with limited fluid shifts or blood loss was unable to demonstrate that the infusion of HES 130/0.4, in addition to a fixed background infusion of 5% dextrose in 0.45% NaCl, could produce such a profound effect on the incidence of PONV or the need for antiemetic treatment compared with 0.9% normal saline

  17. DISCUSSION • limitations • First,there was no placebo arm, but this would have been difficult, as some fluids are required by all patients .We could perhaps have added a group with intraoperative lactated Ringer’s solution followed by 5% dextrose in 0.45% NaCl, which is our standard practice.

  18. Second, our choice of antiemetic drugs may not have been optimal; by choosing dexamethasone as the primary rescue antiemetic, this may have delayed the treatment of PONV and hence increased the incidence of PONV; nevertheless, this effect would have been the same for the two groups

  19. CONCLUSION • In conclusion, in women undergoing gynecological or breast surgery with no major blood loss, HES 130/0.4 and 0.9% NaCl, at the volumes used in this study, had similar effects on PONV when administered along with a low-volume baseline infusion of 5% dextrose in 0.45% NaCl • This is in contrast to when large fluid shifts or blood loss occur where colloid solutions seem to have a more profound effect on PONV

  20. THANK YOU!