engleski

Does Different Oxygen Fraction Influence the Incidence of PONV in Gynecologic Laparoscopy?

Introduction. Gynecologic laparoscopic surgery has high incidence of postoperative nausea/vomiting (PONV) up to 80% without prophylaxis (1). Whether high inspired oxygen fraction (FIO2) 0.8 reduces the incidence of PONV in gynecologic laparoscopy is controversial (2, 3). We investigated whether different intraoperative oxygen (O2) fractions reduce PONV in gynecologic laparoscopy. Methods. After obtaining IRB approval, 108 women ASA PS I-II, 21-75 years old, scheduled for gynecological laparoscopic surgery were randomized into three groups: G30 = 30% O2 in air (n=36), G50 = 50% O2 in air (n=36) and G80 = 80% O2 in air (n=36). Patients received 7.5 mg of midazolam PO 1h preop. No PONV prophylaxis was given. Anesthesia was induced with thiopental 5 mg/kg, vecuronium 0.1 mg/kg and fentanyl 1-2 g/kg, followed by 10 mL/kg/h saline and maintained with sevoflurane 1MAC. Patients were considered to have had PONV if at least one episode of nausea, vomiting or retching or any combination of these occurred during 24h postop. PONV and pain was assessed at 2h and 24h after surgery. Diclofenac IM and pethidine IV were used for postop pain and metoclopramide IV for PONV. Data were expressed as mean SD and analyzed using and Kruskal-Wallis test. P<0.05 was considered significant. Results. There were no significant differences among groups for age, weight, height, ASA PS, h/o smoking, h/o motion sickness/ previous PONV, type of surgery, duration of surgery and anesthesia, total amounts of thiopental and periop opioids, pain VAS (0-100 mm) scores. Incidence of PONV was not overall significantly different for 0-24h, early (0-2h) and late (2-24h) PONV but there was overall significant difference in early vomiting. The only difference was in early vomiting between G80 vs G30, p=0.028. Table 1.PONV data, pain VAS scores and use of metoclopramide in three groups (G30 = FIO2 0.3, G50 = FIO2 0.5, G80 = FIO2 0.8). G30 (n=36) G50 (n=36) G80 (n=36) PONV (24h) n (%)13 (36) 9 (25) 12 (33) p=0.57 PONV (0-2h) n (%)10 (28)7 (19) 6 (17) p=0.49 PONV (2-24h) n (%)7 (19)3 ( 8) 8 (22) p=0.25 Nausea (24h) n (%)12 (33)9 (25) 11 (31) p=0.73 Nausea (0-2h) n (%)9 (25)7 (19) 6 (17) p=0.67 Nausea (2-24h) n (%)6 (17)3 ( 8)7 (19) p=0.39 Vomiting (24h) n (%)11 (31)7 (19)7 (19) p=0.44 Vomiting (0-2h) n (%)8 (22)4 (11)1 ( 3)** p=0.039* Vomiting (2-24h) n (%) 6(17) 3 ( 8) 6 (17)p=0.50 Metoclopramide n (%)8 (22)5 (14)5 (14)p=0.55 Pain VAS score (mm) at 2h postop.=21.7(14.6) ; 23.6(10.7) ; 23.7(10.9)p=0.65 Pain VAS score (mm) at 24h postop.=14.9(7.7) ; 12.4 (10.3) ; 10.7 ( 11.2)p=0.15 * - statistically significant difference (p< 0.05), ** - statistically significant vs G30 (p< 0.05) Conclusion. We found that neither intraoperative FIO2 0.8 nor FIO2 0.5 reduced the incidence of PONV after gynecologic laparoscopy at 24h, but FIO2 0.8 reduced the incidence of early vomiting compared with FIO2 0.3 in patients with no PONV prophylaxis. References 1. Eriksson H, et al. Anesth Analg 1996 ; 82: 533-8. 2. Goll V, et al. Anesth Analg 2001 ; 92: 112-7. 3. Purhonen S, et al. Anesth Analg 2003 ; 96: 91-6. Summary: Neither intraoperative FIO2 0.8 nor FIO2 0.5 reduced the incidence of PONV after gynecologic laparoscopy at 24h, but FIO2 0.8 reduced the incidence of early vomiting compared with FIO2 0.3.

postoperative nausea and vomiting; different oxygen fractions

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