Piper S N, Röhm K D, Boldt J, Faust K L, Maleck W H, Kranke P, Suttner S W
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen D-67063 Ludwigshafen, Germany.
Br J Anaesth. 2006 Nov;97(5):647-53. doi: 10.1093/bja/ael242. Epub 2006 Sep 8.
Postoperative nausea and vomiting (PONV) is one of the most frequent complications after general anaesthesia. Single-dose antiemetic prophylaxis has limited efficacy in high-risk patients. Adding a simple potential antiemetic approach, such as increasing the inspired oxygen fraction, to the antiemetic portfolio would preserve pharmacological interventions for treatment of symptoms in the postoperative period. However, the antiemetic effect of a high inspired oxygen fraction is still discussed controversially. The aim of the study was to evaluate whether an inspired oxygen fraction of 0.8 decreases PONV in patients receiving the 5-HT3-antagonist dolasetron.
In a randomized, placebo-controlled, double-blinded trial we studied 377 patients (ASA I-III) undergoing elective laparoscopic cholecystectomy. Induction of anaesthesia was standardized, including thiopental fentanyl and cis-atracurium. For all patients the individual risk for PONV was calculated using the Koivuranta score and all patients received 12.5 mg dolasetron i.v. before surgery. Patients were allocated randomly to one of three groups: Group A (n=125) received 80% oxygen in air, Group B (n=125) 40% oxygen in air and Group C (n=127) 40% oxygen in nitrous oxide. Postoperative nausea, postoperative vomiting (PV), or nausea, vomiting, or both (PONV) was assessed in the early (0-4 h) and overall postoperative period (0-24 h) by an anaesthesiologist unaware of patient allocation.
There was a significantly lower incidence of PONV and PV in Groups A (PONV: 11.2%; PV: 3.2%) and B (PONV: 10.4%; PV: 3.2%) compared with Group C (PONV: 26.7%; PV: 13.3%), but there were no significant differences between Groups A and B.
An inspired oxygen fraction of 0.8 does not further decrease PONV or vomiting in dolasetron-treated patients undergoing laparoscopic cholecystectomy. The lower incidence of PONV in Groups A and B compared with Group C is most likely caused by the omission of nitrous oxide.
术后恶心呕吐（PONV）是全身麻醉后最常见的并发症之一。单剂量预防性使用止吐药对高危患者的疗效有限。在止吐方案中增加一种简单的潜在止吐方法，如提高吸入氧分数，可保留用于治疗术后症状的药物干预措施。然而，高吸入氧分数的止吐作用仍存在争议。本研究的目的是评估吸入氧分数为0.8是否能降低接受5-羟色胺3（5-HT3）拮抗剂多拉司琼治疗患者的PONV发生率。
在一项随机、安慰剂对照、双盲试验中，我们研究了377例接受择期腹腔镜胆囊切除术的患者（美国麻醉医师协会分级I-III级）。麻醉诱导采用标准化方案，包括硫喷妥钠、芬太尼和顺式阿曲库铵。使用科伊武兰塔评分计算所有患者发生PONV的个体风险，所有患者在手术前静脉注射12.5mg多拉司琼。患者被随机分配到三组之一：A组（n=125）吸入80%氧气和空气的混合气体，B组（n=125）吸入40%氧气和空气的混合气体，C组（n=127）吸入40%氧气和氧化亚氮的混合气体。由不知道患者分组情况的麻醉医生在术后早期（0-4小时）和整个术后期间（0-24小时）评估术后恶心、术后呕吐（PV）或恶心、呕吐两者（PONV）情况。
与C组（PONV：26.7%；PV：13.3%）相比，A组（PONV：11.2%；PV：3.2%）和B组（PONV：10.4%；PV：3.2%）的PONV和PV发生率显著较低，但A组和B组之间无显著差异。
吸入氧分数为0.8并不能进一步降低接受多拉司琼治疗的腹腔镜胆囊切除术患者的PONV或呕吐发生率。与C组相比，A组和B组较低的PONV发生率很可能是由于未使用氧化亚氮所致。
