PDF(Pubmed)
Abstract：
BACKGROUND: Intra-operative anaesthesia management should be optimised to reduce the occurrence of postoperative nausea and vomiting in high-risk patients; however, a single intervention may not effectively reduce postoperative nausea and vomiting in such patients. This study assessed the effect of an optimised anaesthetic protocol versus a conventional one on postoperative nausea and vomiting in patients who underwent laparoscopic sleeve gastrectomy.
METHODS: A single-centre randomised trial was conducted at Peking University Shenzhen Hospital from June 2021 to December 2022. Among 168 patients who underwent laparoscopic sleeve gastrectomy, 116 qualified, and 103 completed the study with available data. Patients were categorized into the conventional group (received sevoflurane and standard fluids) and the optimised group (underwent propofol-based anaesthesia and was administered goal-directed fluids). The primary endpoints were postoperative nausea and vomiting incidence and severity within 24 h.
RESULTS: Postoperative nausea and vomiting assessment at 0-3 h post-surgery revealed no significant differences between groups. However, at 3-24 h, the optimised anaesthetic protocol group showed lower postoperative nausea and vomiting incidence and severity than those of the conventional group (P = 0.005). In the conventional group, 20 (37.04%) patients experienced moderate-to-severe postoperative nausea and vomiting, compared to six (12.25%) patients in the optimised group (odds ratio = 0.237; 95% CI = 0.086, 0.656; P = 0.006). No significant differences were noted in antiemetic treatment, moderate-to-severe pain incidence, anaesthesia recovery, post-anaesthetic care unit stay, or postoperative duration between the groups. While the total intra-operative infusion volumes were comparable, the optimised group had a significantly higher colloidal infusion volume (500 mL vs. 0 mL, P = 0.014) than that of the conventional group.
CONCLUSIONS: The incidence and severity of postoperative nausea and vomiting 3-24 h postoperatively in patients who underwent laparoscopic sleeve gastrectomy were significantly lower with propofol-based total intravenous anaesthesia and goal-directed fluid therapy than with sevoflurane anaesthesia and traditional fluid management. Total intravenous anaesthesia is an effective multimodal antiemetic strategy for bariatric surgery.
BACKGROUND: This trial was registered with the Chinese Clinical Trial Registry (ChiCTR-TRC- 2,100,046,534, registration date: 21 May 2021).
METHODS: A single-centre randomised trial was conducted at Peking University Shenzhen Hospital from June 2021 to December 2022. Among 168 patients who underwent laparoscopic sleeve gastrectomy, 116 qualified, and 103 completed the study with available data. Patients were categorized into the conventional group (received sevoflurane and standard fluids) and the optimised group (underwent propofol-based anaesthesia and was administered goal-directed fluids). The primary endpoints were postoperative nausea and vomiting incidence and severity within 24 h.
RESULTS: Postoperative nausea and vomiting assessment at 0-3 h post-surgery revealed no significant differences between groups. However, at 3-24 h, the optimised anaesthetic protocol group showed lower postoperative nausea and vomiting incidence and severity than those of the conventional group (P = 0.005). In the conventional group, 20 (37.04%) patients experienced moderate-to-severe postoperative nausea and vomiting, compared to six (12.25%) patients in the optimised group (odds ratio = 0.237; 95% CI = 0.086, 0.656; P = 0.006). No significant differences were noted in antiemetic treatment, moderate-to-severe pain incidence, anaesthesia recovery, post-anaesthetic care unit stay, or postoperative duration between the groups. While the total intra-operative infusion volumes were comparable, the optimised group had a significantly higher colloidal infusion volume (500 mL vs. 0 mL, P = 0.014) than that of the conventional group.
CONCLUSIONS: The incidence and severity of postoperative nausea and vomiting 3-24 h postoperatively in patients who underwent laparoscopic sleeve gastrectomy were significantly lower with propofol-based total intravenous anaesthesia and goal-directed fluid therapy than with sevoflurane anaesthesia and traditional fluid management. Total intravenous anaesthesia is an effective multimodal antiemetic strategy for bariatric surgery.
BACKGROUND: This trial was registered with the Chinese Clinical Trial Registry (ChiCTR-TRC- 2,100,046,534, registration date: 21 May 2021).
摘要：
背景：应优化术中麻醉管理，以减少高危患者术后恶心和呕吐的发生；然而，单一干预可能无法有效减少此类患者的术后恶心和呕吐。这项研究评估了优化麻醉方案与常规麻醉方案对腹腔镜袖状胃切除术患者术后恶心和呕吐的影响。
方法：一项单中心随机试验于2021年6月至2022年12月在北京大学深圳医院进行。在接受腹腔镜袖状胃切除术的168例患者中，116合格，103人利用现有数据完成了研究。将患者分为常规组（接受七氟醚和标准液体）和优化组（接受基于异丙酚的麻醉并给予目标定向液体）。主要终点是术后24h内恶心和呕吐的发生率和严重程度。
结果：术后0-3小时的术后恶心和呕吐评估显示两组间无显著差异。然而,在3-24小时，优化麻醉方案组术后恶心和呕吐的发生率和严重程度低于常规组(P=0.005).在常规组中,20例（37.04%）患者出现中度至重度术后恶心和呕吐，与优化组的6例(12.25%)患者相比(比值比=0.237;95%CI=0.086,0.656;P=0.006).在止吐治疗中没有发现显著差异，中度至重度疼痛发生率，麻醉恢复,麻醉后护理单元留下来，或组间术后持续时间。虽然术中输注总量相当，优化组的胶体输注量明显更高（500mLvs.0mL,P=0.014）比常规组。
结论：腹腔镜袖状胃切除术患者术后3-24h恶心呕吐的发生率和严重程度，丙泊酚为基础的全静脉麻醉和目标导向液体治疗明显低于七氟醚麻醉和传统液体管理。全静脉麻醉是减肥手术的有效多模式止吐策略。
背景：该试验已在中国临床试验注册中心注册（ChiCTR-TRC-2,100,046,534，注册日期：2021年5月21日）。
方法：一项单中心随机试验于2021年6月至2022年12月在北京大学深圳医院进行。在接受腹腔镜袖状胃切除术的168例患者中，116合格，103人利用现有数据完成了研究。将患者分为常规组（接受七氟醚和标准液体）和优化组（接受基于异丙酚的麻醉并给予目标定向液体）。主要终点是术后24h内恶心和呕吐的发生率和严重程度。
结果：术后0-3小时的术后恶心和呕吐评估显示两组间无显著差异。然而,在3-24小时，优化麻醉方案组术后恶心和呕吐的发生率和严重程度低于常规组(P=0.005).在常规组中,20例（37.04%）患者出现中度至重度术后恶心和呕吐，与优化组的6例(12.25%)患者相比(比值比=0.237;95%CI=0.086,0.656;P=0.006).在止吐治疗中没有发现显著差异，中度至重度疼痛发生率，麻醉恢复,麻醉后护理单元留下来，或组间术后持续时间。虽然术中输注总量相当，优化组的胶体输注量明显更高（500mLvs.0mL,P=0.014）比常规组。
结论：腹腔镜袖状胃切除术患者术后3-24h恶心呕吐的发生率和严重程度，丙泊酚为基础的全静脉麻醉和目标导向液体治疗明显低于七氟醚麻醉和传统液体管理。全静脉麻醉是减肥手术的有效多模式止吐策略。
背景：该试验已在中国临床试验注册中心注册（ChiCTR-TRC-2,100,046,534，注册日期：2021年5月21日）。
