Abstract
ObjectiveLike other inhalational anesthetics xenon seems to be associated with post-operative nausea and vomiting (PONV). We assessed nausea incidence following balanced xenon anesthesia compared to sevoflurane, and dexamethasone for its prophylaxis in a randomized controlled trial with post-hoc explorative analysis.Methods220 subjects with elevated PONV risk (Apfel score ≥2) undergoing elective abdominal surgery were randomized to receive xenon or sevoflurane anesthesia and dexamethasone or placebo after written informed consent. 93 subjects in the xenon group and 94 subjects in the sevoflurane group completed the trial. General anesthesia was maintained with 60% xenon or 2.0% sevoflurane. Dexamethasone 4mg or placebo was administered in the first hour. Subjects were analyzed for nausea and vomiting in predefined intervals during a 24h post-anesthesia follow-up.ResultsLogistic regression, controlled for dexamethasone and anesthesia/dexamethasone interaction, showed a significant risk to develop nausea following xenon anesthesia (OR 2.30, 95% CI 1.02–5.19, p = 0.044). Early-onset nausea incidence was 46% after xenon and 35% after sevoflurane anesthesia (p = 0.138). After xenon, nausea occurred significantly earlier (p = 0.014), was more frequent and rated worse in the beginning. Dexamethasone did not markedly reduce nausea occurrence in both groups. Late-onset nausea showed no considerable difference between the groups.ConclusionIn our study setting, xenon anesthesia was associated with an elevated risk to develop nausea in sensitive subjects. Dexamethasone 4mg was not effective preventing nausea in our study. Group size or dosage might have been too small, and change of statistical analysis parameters in the post-hoc evaluation might have further contributed to a limitation of our results. Further trials will be needed to address prophylaxis of xenon-induced nausea.Trial RegistrationEU Clinical Trials EudraCT-2008-004132-20ClinicalTrials.gov NCT00793663
Highlights
post-operative nausea and vomiting (PONV) is regarded as any episode of nausea, vomiting, or retching, within 24h after general anesthesia [1]
Logistic regression, controlled for dexamethasone and anesthesia/dexamethasone interaction, showed a significant risk to develop nausea following xenon anesthesia
Xenon anesthesia was associated with an elevated risk to develop nausea in sensitive subjects
Summary
PONV is regarded as any episode of nausea, vomiting, or retching, within 24h after general anesthesia [1]. Higher PONV rates have been found in sensitive subjects [3]. PONV can be distinguished between an early phase in the first 2h after anesthesia, and a late phase between 2 and 24h following anesthesia [2]. PONV affects individual comfort [4] and might even influence the surgical outcome [5]. The use of volatile and gaseous anesthetics has been identified as one of the main causes for PONV in sensitive subjects [6,7,8]. Several strategies graded according to individual risk have been evaluated for PONV prevention and treatment [9,10,11,12]
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