Abstract：
Vitreoretinal surgeries require the administration of general anesthesia (GA) in selected groups of patients. The administration of intraoperative rescue narcotic analgesia (IRNA) during GA poses the risk of postoperative nausea and vomiting (PONV). The surgical pleth index (SPI), a crucial component of the adequacy of anesthesia (AoA) guidance of GA, optimizes the intraoperative titration of IRNA. The current analysis evaluated the risk factors for the occurrence of PONV and the oculo-cardiac reflex (OCR) in patients undergoing pars plana vitrectomy (PPV) under AoA guidance. In total, 175 patients undergoing PPV were randomly allocated to receive either GA with SPI-guided IRNA administration using fentanyl alone or in addition to different preoperative analgesia techniques. Any incidence of PONV or OCR was recorded. Obesity, overweight, smoking status, motion sickness, postoperative intolerable pain perception, female gender, fluid challenge and arterial hypertension did not correlate with an increased incidence of PONV or OCR under AoA guidance. Diabetes mellitus, regardless of insulin dependence, was found to correlate with the increased incidence of PONV. The AoA regimen including SPI guidance of IRNA presumably created similar conditions for individual subjects, so no risk factors of the occurrence of PONV or OCR were found, except for diabetes mellitus. We recommend using AoA guidance for GA administration to reduce OCR and PONV rates.
摘要：
玻璃体视网膜手术需要在选定的患者组中进行全身麻醉（GA）。GA期间术中抢救麻醉镇痛（IRNA）的给药存在术后恶心和呕吐（PONV）的风险。手术面积指数（SPI），GA麻醉（AoA）指导充分性的关键组成部分，优化IRNA的术中滴定。目前的分析评估了在AoA指导下接受平坦部玻璃体切除术（PPV）的患者发生PONV和眼心反射（OCR）的危险因素。总的来说,175名接受PPV的患者被随机分配接受GA和SPI指导的IRNA给药，使用芬太尼单独或除了不同的术前镇痛技术。记录PONV或OCR的任何发生率。肥胖,超重,吸烟状况,晕车,术后难以忍受的疼痛感知，女性性别,在AoA指导下,液体激发和动脉高血压与PONV或OCR的发生率增加无关.糖尿病,不管胰岛素依赖，被发现与PONV的发病率增加有关。包括IRNA的SPI指导的AoA方案可能为个体受试者创造了相似的条件，所以没有发现PONV或OCR发生的危险因素，除了糖尿病。我们建议使用AoA指导GA给药，以降低OCR和PONV率。
