From the Department of Anesthesiology, Yale School of Medicine, New Haven, CT; PACU Nursing and Acute Pain Service, Yale New Haven Hospital, New Haven, CT; Pharmacy Department, Yale New Haven Hospital, New Haven, CT; and Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, Veterans Administration Medical Health Systems/Yale School of Medicine.
Anesth Analg. 2013 Sep;117(3):591-596. doi: 10.1213/ANE.0b013e3182458f9e. Epub 2012 Jan 17.
Postoperative nausea and vomiting (PONV) remains the most common postoperative complication, and causes decreased patient satisfaction, prolonged postoperative hospital stays, and unanticipated admission. There are limited data that indicate that dextrose may reduce nausea and vomiting. In this trial, we attempted to determine whether the rate of PONV can be decreased by postoperative administration of IV dextrose bolus.
To test the effect of postoperative dextrose administration on PONV rates, we conducted a double-blind, randomized, placebo-controlled trial. We enrolled 62 nondiabetic, ASA class I or II nonsmoking outpatients scheduled for gynecologic laparoscopic and hysteroscopic procedures. Patients were randomized into 2 groups: the treatment group received dextrose 5% in Ringer lactate solution, and the control (placebo) group received Ringer lactate solution given immediately after surgery. All patients underwent a standardized general anesthesia and received 1 dose of antiemetic a half hour before emergence from anesthesia. PONV scores, antiemetic rescue medications, narcotic consumption, and discharge time were recorded in the postanesthesia care unit (PACU) in half-hour intervals.
The 2 groups were similar with regard to age, weight, anxiety scores, prior PONV, non per os status, presurgical glucose, anesthetic duration, intraoperative narcotic use, and total weight-based fluid volume received. Postoperative nausea scores were not significantly different in the dextrose group compared with the control group (P > 0.05) after Bonferroni correction for repeated measurements over time. However, patients who received dextrose 5% in Ringer lactate solution consumed less rescue antiemetic medications (ratio mean difference, 0.56; 95% confidence interval, 0.39-0.82; P = 0.02), and had a shorter length of stay in the PACU (ratio mean difference, 0.80; 95% confidence interval, 0.66-0.97; P = 0.03) compared with patients in the control group.
In this trial, postanesthesia IV dextrose administration resulted in improved PONV management as defined by reductions in antiemetic rescue medication requirements and PACU length of stay that are worthy of further study. In light of its ease, low risk, and benefit to patient care and satisfaction, this therapeutic modality could be considered.
术后恶心和呕吐（PONV）仍然是最常见的术后并发症，会导致患者满意度降低、术后住院时间延长和意外住院。有限的数据表明葡萄糖可能会减少恶心和呕吐。在这项试验中，我们试图确定术后静脉注射葡萄糖推注是否可以降低 PONV 的发生率。
为了测试术后给予葡萄糖对 PONV 发生率的影响，我们进行了一项双盲、随机、安慰剂对照试验。我们招募了 62 名非糖尿病、ASA 分级 I 或 II 级非吸烟的择期行妇科腹腔镜和宫腔镜手术的门诊患者。患者被随机分为两组：治疗组接受 5%葡萄糖生理盐水，对照组（安慰剂）组在手术后立即给予生理盐水。所有患者均接受标准化全身麻醉，并在麻醉苏醒前半小时给予 1 剂止吐药。PONV 评分、止吐解救药物、阿片类药物用量和出院时间在麻醉后恢复室（PACU）中以半小时为间隔记录。
两组患者的年龄、体重、焦虑评分、PONV 病史、非经口状态、术前血糖、麻醉时间、术中阿片类药物使用和总基于体重的液体量相似。在经过多次重复测量的 Bonferroni 校正后，与对照组相比，接受 Ringer 乳酸盐中葡萄糖的患者的术后恶心评分在统计学上无显著差异（P>0.05）。然而，与对照组相比，接受 Ringer 乳酸盐中葡萄糖的患者使用的解救性止吐药物较少（比值均数差，0.56；95%置信区间，0.39-0.82；P=0.02），并且在 PACU 中的停留时间更短（比值均数差，0.80；95%置信区间，0.66-0.97；P=0.03）。
在这项试验中，术后静脉注射葡萄糖可改善 PONV 的管理，表现为减少解救性止吐药物的需求和 PACU 停留时间的缩短，这值得进一步研究。鉴于其简便、低风险以及对患者护理和满意度的益处，这种治疗方法可以考虑。
