Department of Anesthesiology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
Department of Obstetrics and Gynaecology, Phuntsholing General Hospital, Chukha, Bhutan.
BMC Anesthesiol. 2024 Jul 22;24(1):248. doi: 10.1186/s12871-024-02602-w.
Postoperative nausea and vomiting (PONV) are common distressing symptoms experienced after laparoscopic cholecystectomy. We report the rate, and the factors associated with postoperative nausea and vomiting, the patterns of prophylactic antiemetic prescription, and the anesthetic techniques used among patients who underwent laparoscopic cholecystectomy at the Jigme Dorji Wangchuck (JDW) National Referral Hospital, Bhutan.
A cross-sectional study was conducted at the JDW National Referral Hospital, from January to December 2018. All the patients who underwent laparoscopic cholecystectomy under general anesthesia were included in the study. The demographic variables, premedication, induction agents, muscle relaxants, inhalational agents for maintenance, opioid and adjuvant analgesics, the reversal agents used, and the occurrence of PONV within 24 h were recorded. Data were analyzed using SPSS (version 23). Continuous variables were compared using a t-test or Mann-Whitney test, categorical variables were tested using chi-square or Fisher's exact tests. Binary logistic regression analysis was performed to determine the factors associated with postoperative nausea and vomiting.
190 patients underwent laparoscopic cholecystectomy under general anesthesia. The rate of PONV after laparoscopic cholecystectomy was 31.1% (59/190). Over half (53.7%, 102/190) of the study population were within 21-40 years of age, over 80% (157/190) were female, and 2/3rd were overweight and obese. The most frequently used premedication was ranitidine (39%, 34/87) and metoclopramide (31%, 27/87). More than half (57.4%, 109/190) of the patients received morphine as an opioid analgesic before induction. Sodium thiopentone was a commonly used induction agent (65.8%, 125/190). Succinylcholine and atracurium were mostly preferred muscle relaxants. Isoflurane and air were the most used inhalational anesthetic agents for the maintenance of anesthesia. Ondansetron was the most preferred anti-emetics during the intraoperative period. Previous history of motion sickness (OR 5.8, 95%CI 2.9-11.2, p < 0.001), and use of sodium thiopental (OR 4.1, 95%CI 1.9-9.1, p < 0.001) were independent risk factors for PONV. The use of antiemetics (OR 0.1, 95%CI 0.0-0.4, p = 0.002), propofol (OR 0.2, 95%CI 0.1-0.5, p < 0.001), adjuvant analgesic paracetamol (OR 0.4, 95%CI 0.2-0.8, p = 0.026), and adequate hydration with IV fluids (OR 0.9, 95%CI 0.9-1.0, p = 0.042) were preventive factors for PONV.
The rate of PONV after laparoscopic cholecystectomy was high. History of motion sickness and use of sodium thiopental for induction were independent risk factors of PONV. The use of multimodal prophylactic antiemetics was robust and superior to monotherapy in preventing PONV. This finding re-emphasizes the need for risk stratification and appropriate use of antiemetics and anesthetic agents to prevent PONV.
腹腔镜胆囊切除术后常见的令人痛苦的恶心和呕吐（PONV）症状。我们报告了在不丹的 Jigme Dorji Wangchuck（JDW）国家转诊医院接受腹腔镜胆囊切除术的患者中，术后恶心和呕吐的发生率、与术后恶心和呕吐相关的因素、预防性止吐药的应用模式以及使用的麻醉技术。
这是一项 2018 年 1 月至 12 月在 JDW 国家转诊医院进行的横断面研究。所有接受全身麻醉下腹腔镜胆囊切除术的患者均纳入研究。记录人口统计学变量、术前用药、诱导剂、肌肉松弛剂、维持吸入麻醉剂、阿片类和辅助镇痛药、使用的逆转剂以及 24 小时内发生的 PONV。使用 SPSS（版本 23）进行数据分析。使用 t 检验或曼-惠特尼检验比较连续变量，使用卡方或 Fisher 确切检验比较分类变量。采用二项逻辑回归分析确定与术后恶心和呕吐相关的因素。
190 例患者接受全身麻醉下腹腔镜胆囊切除术。腹腔镜胆囊切除术后 PONV 的发生率为 31.1%（59/190）。超过一半（53.7%，102/190）的研究人群年龄在 21-40 岁之间，超过 80%（157/190）为女性，三分之二为超重和肥胖。最常用的术前用药是雷尼替丁（39%，34/87）和甲氧氯普胺（31%，27/87）。超过一半（57.4%，109/190）的患者在诱导前接受吗啡作为阿片类镇痛药。硫喷妥钠是最常用的诱导剂（65.8%，125/190）。顺式阿曲库铵和阿曲库铵是最常用的肌肉松弛剂。异氟烷和空气是维持麻醉最常用的吸入麻醉剂。在术中期间，昂丹司琼是最常用的止吐药。既往晕车史（OR 5.8，95%CI 2.9-11.2，p<0.001）和使用硫喷妥钠（OR 4.1，95%CI 1.9-9.1，p<0.001）是 PONV 的独立危险因素。使用止吐药（OR 0.1，95%CI 0.0-0.4，p=0.002）、异丙酚（OR 0.2，95%CI 0.1-0.5，p<0.001）、辅助镇痛药对乙酰氨基酚（OR 0.4，95%CI 0.2-0.8，p=0.026）和充分的静脉补液（OR 0.9，95%CI 0.9-1.0，p=0.042）是 PONV 的预防因素。
腹腔镜胆囊切除术后 PONV 的发生率较高。晕车史和使用硫喷妥钠诱导是 PONV 的独立危险因素。使用多模式预防性止吐药是有效的，并且优于单一疗法，可预防 PONV。这一发现再次强调了需要进行风险分层，并适当使用止吐药和麻醉剂来预防 PONV。
