Meyer-Frießem Christine H, Hüsken Sabeth, Kaisler Miriam, Malewicz Nathalie M, Zahn Peter K, Baumann Andreas
Department of Anesthesiology, Intensive Care and Pain Medicine, Medical Faculty of Ruhr, University Bochum, BG-Universitätsklinikum Bergmannsheil gGmbH Bochum, Bochum, Germany.
Curr Med Res Opin. 2021 Dec;37(12):2035-2042. doi: 10.1080/03007995.2021.1980776. Epub 2021 Oct 1.
Inhalative anesthesia is of common use, but is generally known to potentiate postoperative nausea and vomiting (PONV). With an internal change of anesthesia regimen from total intravenous anesthesia (TIVA) to isoflurane (in terms of myocardial protection) in cardiac anesthesia a higher incidence of PONV was to be expected. Therefore, we evaluated the incidence of PONV after the simultaneous implementation of PONV prophylaxis.
The incidence of PONV, prospectively assessed in 197 cardiac surgery patients (68 ± 10.4, 66.5% male) having isoflurane plus dual PONV prophylaxis with dexamethasone and droperidol, was compared with previous data of 190 controls (67 ± 9.6, 71% male) having TIVA without and with single or dual PONV prophylaxis ( = 64 dexamethasone and droperidol, = 25 dexamethasone, = 101 only TIVA), and the Apfel-scoring (0-4 depending on PONV-risk). DRKS00014275. Statistics: Chi-test, < .05 (Bonferroni).
The incidence of PONV under isoflurane with antiemetic prophylaxis was 20.8% (95% confidence interval (CI) 15.4; 27.4) compared to 30.5% (95%CI 24; 37.6) under TIVA ( = .029; dexamethasone and droperidol 23.4% (95%CI 13.8; 35.7); dexamethasone 32% (95%CI 14.9; 53.5); only TIVA 34.7% (95%CI 25.5; 44.8)), but was not lower in high-risk patients than predicted according to Apfel-scoring 4 (71.4 vs. 78%).
In cardiac anesthesia, the use of isoflurane is not at the expense of PONV when using a risk-independent two-drug-prophylaxis. It is even beneficial resulting surprisingly in a lower incidence of PONV than under TIVA unless with and without prophylaxis. Patients with the highest risk for PONV and receiving isoflurane should receive a third antiemetic prophylactic drug.
吸入麻醉应用广泛，但普遍认为会加重术后恶心呕吐（PONV）。在心脏麻醉中，麻醉方案由全静脉麻醉（TIVA）改为异氟烷（从心肌保护角度）后，预计PONV发生率会更高。因此，我们评估了同时实施PONV预防措施后PONV的发生率。
前瞻性评估了197例接受异氟烷加地塞米松和氟哌利多双重PONV预防的心脏手术患者（68±10.4岁，66.5%为男性）的PONV发生率，并与190例对照组患者（67±9.6岁，71%为男性）之前的数据进行比较，对照组患者接受无PONV预防、单药或双药PONV预防的TIVA（=64例接受地塞米松和氟哌利多，=25例接受地塞米松，=101例仅接受TIVA），以及Apfel评分（0 - 4分，取决于PONV风险）。DRKS00014275。统计学方法：卡方检验，<0.05（Bonferroni法）。
异氟烷联合止吐预防措施时PONV发生率为20.8%（95%置信区间（CI）15.4；27.4），而TIVA时为30.5%（95%CI 24；37.6）（=0.029；地塞米松和氟哌利多为23.4%（95%CI 13.8；35.7）；地塞米松为32%（95%CI 14.9；53.5）；仅TIVA为34.7%（95%CI 25.5；44.8）），但高危患者的发生率并不低于根据Apfel评分4预测的发生率（71.4%对78%）。
在心脏麻醉中，使用异氟烷且采用与风险无关的双药预防措施时，不会以增加PONV为代价。甚至有益，令人惊讶的是，与TIVA相比，PONV发生率更低，无论有无预防措施。PONV风险最高且接受异氟烷麻醉的患者应接受第三种止吐预防药物。
