Abstract
BackgroundIntravenous fluid is recommended in international guidelines to improve patient post-operative symptoms, particularly nausea and vomiting. The optimum fluid regimen has not been established. This prospective, randomized, blinded study was designed to determine if administration of equivolumes of a colloid (hydroxyethyl starch 130/0.4) reduced post operative nausea and vomiting in healthy volunteers undergoing ambulatory gynecologic laparoscopy surgery compared to a crystalloid solution (Hartmann’s Solution).Methods120 patients were randomized to receive intravenous colloid (N = 60) or crystalloid (N = 60) intra-operatively. The volume of fluid administered was calculated at 1.5 ml.kg-1 per hour of fasting. Patients were interviewed to assess nausea, vomiting, anti-emetic use, dizziness, sore throat, headache and subjective general well being at 30 minutes and 2, 24 and 48 hours post operatively. Pulmonary function testing was performed on a subgroup.ResultsAt 2 hours the proportion of patients experiencing nausea (38.2 % vs 17.9%, P = 0.03) and the mean nausea score were increased in the colloid compared to crystalloid group respectively (1.49 ± 0.3 vs 0.68 ± 0.2, P = 0.028). The incidence of vomiting and anti-emetic usage was low and did not differ between the groups. Sore throat, dizziness, headache and general well being were not different between the groups. A comparable reduction on post-operative FVC and FEV-1 and PEFR was observed in both groups.ConclusionsIntra-operative administration of colloid increased the incidence of early postoperative nausea and has no advantage over crystalloid for symptom control after gynaecological laparoscopic surgery.
Highlights
Intravenous fluid is recommended in international guidelines to improve patient post-operative symptoms, nausea and vomiting
The incidence of post operative nausea and vomiting (PONV) following ambulatory surgery is 40%–60% and ambulatory gynecological patients are at high risk
‘Rehydration’ is a recommended strategy to reduce PONV but have been subject to a relatively small number of studies in ambulatory anesthesia and there is no consensus as to which fluid or volume is optimal. [14,15,16,17,18] Studies suggest that intravenous crystalloid administration in healthy patients reduces the incidence of nausea, vomiting and antiemetic use after gynecological laparoscopy and other ambulatory procedures. [19,20,21,22] The antiemetic efficacy of intravenous crystalloid appears to be dose related
Summary
Intravenous fluid is recommended in international guidelines to improve patient post-operative symptoms, nausea and vomiting. The optimum fluid regimen has not been established This prospective, randomized, blinded study was designed to determine if administration of equivolumes of a colloid (hydroxyethyl starch 130/0.4) reduced post operative nausea and vomiting in healthy volunteers undergoing ambulatory gynecologic laparoscopy surgery compared to a crystalloid solution (Hartmann’s Solution). The incidence of post operative nausea and vomiting (PONV) following ambulatory surgery is 40%–60% and ambulatory gynecological patients are at high risk. [14,15,16,17,18] Studies suggest that intravenous crystalloid administration in healthy patients reduces the incidence of nausea, vomiting and antiemetic use after gynecological laparoscopy and other ambulatory procedures. Lower volumes do not have a significant effect and large volumes (30–40 ml/kg) are necessary to establish benefit. [19,23,24] Intravenous crystalloid has a short intravascular half life, its expected duration of action is short and solutions with longer durations of action e.g. colloid would be anticipated to have greater benefit. [25] We chose to study the effect of intravenous colloid solution in PONV and hypothesized that intravenous colloid would have a greater reduction on PONV than an equivalent volume of crystalloid solution
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