Prophylaxis of postoperative nausea and vomiting in elective breast surgery

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• 作者：Matthias  ; Voigt MD^a ;   ; ¹ ;   ; ^{voigt-m-fr@t-online.de} ; Privatdozent in Plastic Surgery ; Christian W.  ; Frö ; hlich MD^a ;   ; ^b ;   ; ¹ ; Chief Resident ; Klaus F.  ; Waschke MD^c ; Professor of Anesthesiology ; Christian  ; Lenz MD^c ; Professor of Anesthesiology ; Ulrich  ; Gö ; bel MD^d ; Chief Resident ; Heinz  ; Kerger MD^b ; Professor of Anesthesiology
• 关键词：Anesthetics ; volatile ; Antiemetic prophylaxis ; Breast surgery ; Dexamethasone ; Dimenhydrinate ; Haloperidol ; Postoperative nausea and vomiting ; Total intravenous anesthesia ; Tropisetron
• 刊名：Journal of Clinical Anesthesia
• 出版年：2011
• 出版时间：September 2011
• 年：2011
• 卷：23
• 期：6
• 页码：461-468
• 全文大小：231 K

文摘

Study Objective

To evaluate strategies to treat postoperative nausea and vomiting (PONV) in patients undergoing elective breast surgery.

Design

Prospective, randomized, double-blinded, placebo-controlled trial.

Setting

University-affiliated hospital.

Patients

480 patients with risk factors for PONV.

Interventions

Patients were randomized to three groups to receive an antiemetic prophylactic combination of haloperidol and tropisetron (Group HT), dimenhydrinate and dexamethasone (Group?DD), or no prophylaxis (Group P). Anesthesia was maintained with volatile anesthesia (desflurane or sevoflurane) and fentanyl or total intravenous anesthesia (TIVA).

Measurements

Incidence of nausea, emesis, or both in the early (0 - 2 hrs) and late (2 - 24 hrs) postoperative periods were recorded, as were the number of episodes and the time of each occurrence; and patient assessment of the PONV experience on a scale comparable to a numeric rating scale (NRS).

Main Results

Both antiemetic combinations significantly reduced PONV incidence. In patients who received no prophylaxis, PONV incidence was 48.2 % in patients given volatile anesthetics and 43.8 % in those who received TIVA. PONV incidence was 17.5 % in the Group HT patients who received volatile anesthetics, and 25 % in the Group HT patients who received TIVA. PONV incidence was 11.4 % in Group DD patients given volatile anesthetics, and 15 % in Group DD patients receiving TIVA. TIVA reduced the incidence of PONV in the early postoperative period (0-2 hrs), but increased PONV incidence in the late period (2-24 hrs). Patients given TIVA with propofol and remifentanil intraoperatively required more opioids postoperatively than patients given volatile anesthetics.

Conclusion

The frequency of PONV was reduced significantly with both antiemetic combinations.