Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 13620, Gumi-ro 137-82, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Obes Surg. 2022 Oct;32(10):3368-3374. doi: 10.1007/s11695-022-05894-4. Epub 2022 Aug 17.
Postoperative nausea and vomiting (PONV) occurs frequently after bariatric surgery and is a major cause of adverse outcomes. This retrospective study investigated whether opioid-restricted total intravenous anesthesia using dexmedetomidine as a substitute for remifentanil can reduce PONV in bariatric surgery.
The electronic medical records of adult patients who underwent laparoscopic bariatric surgery between January and December 2019 were reviewed. The patients were divided into two groups according to the agents used for anesthesia: Group D, propofol and dexmedetomidine; Group R, propofol and remifentanil.
A total of 134 patients were included in the analyses. The frequency of postoperative nausea was significantly lower in Group D than that in Group R until 2 h after discharge from the postanesthesia care unit (PACU) (P = 0.005 in the PACU, P = 0.010 at 2 h after PACU discharge) but failed to significantly reduce the overall high incidence rates of 60.5% and 65.5%, respectively (P = 0.592). Postoperative pain score was significantly lower in Group D until 6 h after PACU discharge. The rates of rescue antiemetic and analgesic agent administration in the PACU were significantly lower in Group D than those in Group R.
Opioid-restricted total intravenous anesthesia using dexmedetomidine reduces postoperative nausea, pain score, antiemetic, and analgesic requirements in the immediate postoperative period after bariatric surgery.
减重手术后常发生术后恶心呕吐（PONV），是不良结局的主要原因。本回顾性研究旨在探讨使用右美托咪定替代瑞芬太尼的限制阿片类药物全静脉麻醉是否能减少减重手术中的 PONV。
回顾性分析 2019 年 1 月至 12 月期间行腹腔镜减重手术的成年患者的电子病历。根据麻醉药物将患者分为两组：D 组，丙泊酚和右美托咪定；R 组，丙泊酚和瑞芬太尼。
共纳入 134 例患者。与 R 组相比，D 组患者在 PACU 直至 PACU 出院后 2 小时（PACU 内 P=0.005，PACU 出院后 2 小时 P=0.010）时的术后恶心发生率显著降低，但未能显著降低 60.5%和 65.5%的总体高发生率（P=0.592）。D 组患者在 PACU 出院后 6 小时内的术后疼痛评分显著降低。D 组在 PACU 内给予止吐和镇痛药物的比例明显低于 R 组。
在减重手术后，使用右美托咪定的限制阿片类药物全静脉麻醉可减少术后恶心、疼痛评分、止吐和镇痛需求。
