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在麻醉II期试验的气体混合物中评估氧化亚氮时的严重恶心和呕吐

Severe Nausea and Vomiting in the Evaluation of Nitrous Oxide in the Gas Mixture for Anesthesia II Trial.

作者信息

Myles Paul S, Chan Matthew T V, Kasza Jessica, Paech Michael J, Leslie Kate, Peyton Philip J, Sessler Daniel I, Haller Guy, Beattie W Scott, Osborne Cameron, Sneyd J Robert, Forbes Andrew

机构信息

From the Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Monash University, Melbourne, Victoria, Australia (P.S.M.); Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, People's Republic of China (M.T.V.C.); Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.K., A.F.); Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia (M.J.P.); School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia (M.J.P.); Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia (K.L.); Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Melbourne, Victoria, Australia (K.L.); Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia (K.L.); Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia (P.J.P.); Institute for Breathing and Sleep, Victoria, Australia (P.J.P.); Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (D.I.S.); Department of Anaesthesia, Intensive Care and Pharmacology, Geneva University Hospitals, University of Geneva, Switzerland (G.H.); Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada (W.S.B.); Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (W.S.B.); Department of Anesthesia, Perioperative and Acute Pain Management, Barwon Health, Geelong, Victoria, Australia (C.O.); and Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, United Kingdom (J.R.S.).

出版信息

Anesthesiology. 2016 May;124(5):1032-40. doi: 10.1097/ALN.0000000000001057.

DOI:10.1097/ALN.0000000000001057

PMID:26904965

Abstract

BACKGROUND

The Evaluation of Nitrous oxide in the Gas Mixture for Anesthesia II trial randomly assigned 7,112 noncardiac surgery patients to a nitrous oxide or nitrous oxide-free anesthetic; severe postoperative nausea and vomiting (PONV) was a prespecified secondary end point. Thus, the authors evaluated the association between nitrous oxide, severe PONV, and effectiveness of PONV prophylaxis in this setting.

METHODS

Univariate and multivariate analyses of patient, surgical, and other perioperative characteristics were used to identify the risk factors for severe PONV and to measure the impact of severe PONV on patient outcomes.

RESULTS

Avoiding nitrous oxide reduced the risk of severe PONV (11 vs. 15%; risk ratio [RR], 0.74 [95% CI, 0.63 to 0.84]; P < 0.001), with a stronger effect in Asian patients (RR, 0.55 [95% CI, 0.43 to 0.69]; interaction P = 0.004) but lower effect in those who received PONV prophylaxis (RR, 0.89 [95% CI, 0.76 to 1.05]; P = 0.18). Gastrointestinal surgery was associated with an increased risk of severe PONV when compared with most other types of surgery (P < 0.001). Patients with severe PONV had lower quality of recovery scores (10.4 [95% CI, 10.2 to 10.7] vs. 13.1 [95% CI, 13.0 to 13.2], P < 0.0005); severe PONV was associated with postoperative fever (15 vs. 20%, P = 0.001). Patients with severe PONV had a longer hospital stay (adjusted hazard ratio, 1.14 [95% CI, 1.05 to 1.23], P = 0.002).

CONCLUSIONS

The increased risk of PONV with nitrous oxide is near eliminated by antiemetic prophylaxis. Severe PONV, which is seen in more than 10% of patients, is associated with postoperative fever, poor quality of recovery, and prolonged hospitalization.

摘要

背景

“麻醉气体混合物中氧化亚氮的评估II”试验将7112例非心脏手术患者随机分为接受含氧化亚氮或不含氧化亚氮麻醉组；严重术后恶心呕吐（PONV）是一个预先设定的次要终点。因此，作者评估了在此种情况下氧化亚氮、严重PONV以及PONV预防有效性之间的关联。

方法

对患者、手术及其他围手术期特征进行单因素和多因素分析，以确定严重PONV的危险因素，并衡量严重PONV对患者预后的影响。

结果

避免使用氧化亚氮可降低严重PONV的风险（11%对15%；风险比[RR]，0.74[95%CI，0.63至0.84]；P<0.001），在亚洲患者中效果更强（RR，0.55[95%CI，0.43至0.69]；交互作用P = 0.004），但在接受PONV预防的患者中效果较弱（RR，0.89[95%CI，0.76至1.05]；P = 0.18）。与大多数其他类型的手术相比，胃肠道手术与严重PONV风险增加相关（P<0.001）。发生严重PONV的患者恢复质量评分较低（10.4[95%CI，10.2至10.7]对13.1[95%CI，13.0至13.2]，P<0.0005）；严重PONV与术后发热相关（15%对20%，P = 0.001）。发生严重PONV的患者住院时间更长（调整后的风险比，1.14[95%CI，1.05至1.23]，P = 0.002）。