Bruderer U, Fisler A, Steurer M P, Steurer M, Dullenkopf A
Department of Anaesthesiology and Intensive Care Medicine, Kantonsspital Frauenfeld, Frauenfeld, Switzerland.
Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA.
Acta Anaesthesiol Scand. 2017 Aug;61(7):758-766. doi: 10.1111/aas.12921. Epub 2017 Jun 18.
The incidence of post-discharge nausea and vomiting (PDNV) after ambulatory anaesthesia using total intravenous anaesthesia with a risk-stratified anti-emetic approach is not well documented in the literature. In this study, we outline such an approach. The goal was to achieve an acceptably low rate of PDNV both immediately and the day after surgery.
With ethics committee approval, adult patients undergoing outpatient surgery received a Propofol-based general anaesthetic plus standardised PONV-prophylaxis corresponding to their Apfel risk-score (0-4); ondansetron (risk-score 2), additional dexamethasone (risk-score 3), and additional droperidol (risk-score 4). On post-operative days one and two, patients scored PDNV and pain (numeric rating scale (NRS); 0 = none at all; 10 = worst imaginable). On post-operative day two, patients indicated the level of interference of PDNV and/or pain with their quality of life. Data are descriptive (%) or mean.
There were 222 patients included (age 43 years, 44% female, anaesthesia time 95 min). On the day of surgery, 69.4% of patients did not experience any nausea, 10.4% complained about severe (NRS > 6) nausea, 6.3% experienced vomiting or retching. On the first and second postoperative day, nausea was absent in 88.7% of patients and 97.3%, respectively. Quality of life was impacted (NRS ≥ 4) more by pain (32.8% of cases), than by PDNV (13.6%).
Acceptably low rates of PDNV were achieved with the proposed standardised approach to PDNV prophylaxis. For almost 90% of patients, PDNV was not an issue the first day after surgery. Pain after discharge was a more common problem.
在文献中，关于采用风险分层抗呕吐方法的全静脉麻醉进行门诊麻醉后出院后恶心呕吐（PDNV）的发生率尚无充分记录。在本研究中，我们概述了这样一种方法。目标是在术后即刻及术后第一天实现可接受的低PDNV发生率。
经伦理委员会批准，接受门诊手术的成年患者接受基于丙泊酚的全身麻醉，并根据其Apfel风险评分（0 - 4）进行标准化的术后恶心呕吐（PONV）预防；昂丹司琼（风险评分2）、额外的地塞米松（风险评分3）和额外的氟哌利多（风险评分4）。在术后第1天和第2天，患者对PDNV和疼痛进行评分（数字评分量表（NRS）；0 = 完全没有；10 = 难以想象的严重）。在术后第2天，患者指出PDNV和/或疼痛对其生活质量的干扰程度。数据采用描述性（%）或均值表示。
纳入222例患者（年龄43岁，44%为女性，麻醉时间95分钟）。手术当天，69.4%的患者未出现任何恶心，10.4%抱怨有严重恶心（NRS > 6），6.3%出现呕吐或干呕。在术后第1天和第2天，分别有88.7%和97.3%的患者无恶心。生活质量受疼痛影响（NRS≥4）的情况（32.8%的病例）比受PDNV影响的情况（13.6%）更常见。
采用所提议的标准化PDNV预防方法可实现可接受的低PDNV发生率。对于近90%的患者，术后第一天PDNV不是问题。出院后疼痛是更常见的问题。
