Lam Priscilla, Druar Nicholas, Swaminathan Santosh, Ng Tian Sheng, Shetty Shohan
Stanley J. Dudrick Department of Surgery at Saint Mary's Hospital, 56 Franklin St., Waterbury, CT, 06706, USA.
Surg Endosc. 2024 Jan;38(1):407-413. doi: 10.1007/s00464-023-10430-1. Epub 2023 Oct 10.
While total intravenous anesthesia (TIVA) protocols include Dexamethasone and Ondansetron prophylaxis, bariatric patients continue to be considered at particularly high risk for postoperative nausea/vomiting (PONV). A multimodal approach for prophylaxis is recommended by the Bariatric Enhanced Recovery After Surgery (ERAS) Society however, there remains a lack of consensus on the optimal strategy to manage PONV in these patients. Haloperidol has been shown at low doses to have a therapeutic effect in treatment of refractory nausea and in PONV prophylaxis in other high risk surgical populations. We sought to investigate its efficacy as a prophylactic medication for PONV in the bariatric population and to identify which perioperative strategies were most effective at reducing episodes of PONV.
An institutional bariatric database was created by retrospectively reviewing patients undergoing elective minimally invasive bariatric procedures from 2018 to 2022. Demographic data reviewed included age, gender, preoperative body mass index (BMI), ethnicity, and primary language. Primary endpoints included patient reported episodes of PONV, total doses of Ondansetron administered, need for a second antiemetic (rescue medication), complication rate (most commonly readmission within 30 days), and length of stay. Fisher's exact test, Mann-Whitney test, and ANOVA were used to evaluate the effect of perioperative management on various endpoints.
A total of 475 patients were analyzed with Haloperidol being utilized in 15.8% of all patients. Patients receiving Haloperidol were less likely to require Ondansetron outside of the immediate perioperative period (34.7% vs. 49.8%, p = 0.02), experienced less PONV (41.3% vs. 64.3%, p = 0.01) and also had a decreased median length of stay (27.3 vs. 35.8 h, p < 0.0001).
Addition of low dose Haloperidol to Bariatric ERAS protocols decreases incidence of PONV and the need for additional antiemetic coverage resulting in a significantly shorter length of stay, increasing the likelihood of safe discharge on postoperative day 1.
虽然全静脉麻醉（TIVA）方案包括使用地塞米松和昂丹司琼进行预防，但肥胖症患者术后恶心/呕吐（PONV）的风险仍然特别高。减肥手术加速康复（ERAS）协会推荐采用多模式预防方法，然而，对于这些患者中管理PONV的最佳策略仍缺乏共识。已表明低剂量的氟哌啶醇在治疗难治性恶心和其他高风险手术人群的PONV预防中具有治疗作用。我们试图研究其作为肥胖症患者PONV预防药物的疗效，并确定哪些围手术期策略在减少PONV发作方面最有效。
通过回顾性分析2018年至2022年接受择期微创减肥手术的患者，建立了一个机构肥胖症数据库。审查的人口统计学数据包括年龄、性别、术前体重指数（BMI）、种族和主要语言。主要终点包括患者报告的PONV发作次数、昂丹司琼的总给药剂量、是否需要第二种止吐药（救援药物）、并发症发生率（最常见的是30天内再次入院）和住院时间。采用Fisher精确检验、Mann-Whitney检验和方差分析来评估围手术期管理对各种终点的影响。
共分析了475例患者，其中15.8%的患者使用了氟哌啶醇。接受氟哌啶醇治疗的患者在围手术期之外需要昂丹司琼的可能性较小（34.7%对49.8%，p = 0.02），经历的PONV较少（41.3%对64.3%，p = 0.01），并且中位住院时间也缩短了（27.3对35.8小时，p < 0.0001）。
在减肥手术ERAS方案中添加低剂量氟哌啶醇可降低PONV的发生率以及额外止吐覆盖的需求，从而显著缩短住院时间，增加术后第1天安全出院的可能性。
