Department of Anesthesiology and Pain Medicine and Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Medical School, Jeonju, South Korea.
Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, South Korea.
Surg Endosc. 2017 Nov;31(11):4576-4582. doi: 10.1007/s00464-017-5519-8. Epub 2017 Apr 7.
Laparoscopic surgery is associated with a high incidence of postoperative nausea and vomiting (PONV). The use of CO pneumoperitoneum has been proposed as a potential cause of high PONV incidence. However, intraoperative hypercarbia may be related to enhanced perfusion to the main effector sites for PONV, including the brain and gastrointestinal tract. In this study, we investigated whether an increase in intraoperative CO partial pressure in arterial blood (PaCO) reduces the incidence of PONV.
This study enrolled 400 female patients aged 20-60 years who were undergoing laparoscopic gynecologic surgery. The patients were allocated randomly to one of three groups with the following intraoperative PaCO levels: 36-40 mmHg (Group 1), 41-45 mmHg (Group 2), or 46-50 mmHg (Group 3). The anesthetic regimen used a standardized total intravenous anesthesia consisting of propofol and remifentanil for all patients. The arterial blood gas analysis was performed to identify the difference in CO partial pressure between arterial blood and end-tidal gas. The PONV incidence was evaluated for the periods of 0-2, 2-6, and 6-24 h after anesthesia. The incidence and severity of PONV and the administration of rescue antiemetics were recorded.
The three groups were comparable for the patient, anesthesia, and surgical characteristics. The average PaCO level during surgery was 38-39, 43-44, and 47-48 mmHg in Groups 1, 2, and 3, respectively. The incidence and severity of PONV and use of rescue antiemetics were not significantly different among the groups. The overall incidence of nausea during the first 24-h postoperative period was 54, 48, and 50% in Groups 1, 2, and 3, respectively (P = 0.593).
Our data suggest that mild to moderate intraoperative hypercapnia did not decrease the incidence and severity of PONV or the requirement for rescue antiemetics after gynecologic laparoscopic surgery.
腹腔镜手术与术后恶心和呕吐（PONV）的高发生率相关。使用 CO 气腹被认为是 PONV 发生率高的潜在原因。然而，术中高碳酸血症可能与增强 PONV 的主要效应部位（包括大脑和胃肠道）的灌注有关。在这项研究中，我们研究了术中动脉血 PaCO 分压（PaCO）升高是否会降低 PONV 的发生率。
这项研究纳入了 400 名年龄在 20-60 岁之间接受腹腔镜妇科手术的女性患者。患者被随机分配到三组，术中 PaCO 水平分别为 36-40mmHg（组 1）、41-45mmHg（组 2）或 46-50mmHg（组 3）。所有患者均采用标准化全静脉麻醉，包括异丙酚和瑞芬太尼。进行动脉血气分析以确定动脉血和呼气末气体之间 CO 分压的差异。评估麻醉后 0-2、2-6 和 6-24 小时期间的 PONV 发生率。记录 PONV 的发生率和严重程度以及止吐药的使用情况。
三组患者的患者、麻醉和手术特征具有可比性。手术期间平均 PaCO 水平分别为组 1 38-39mmHg、组 2 43-44mmHg 和组 3 47-48mmHg。三组间 PONV 的发生率和严重程度以及止吐药的使用无显著差异。术后 24 小时内恶心的总发生率分别为组 1 54%、组 2 48%和组 3 50%（P=0.593）。
我们的数据表明，妇科腹腔镜手术后，轻度至中度的术中高碳酸血症并未降低 PONV 的发生率和严重程度，也未降低止吐药的需求。
