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Li ZP, Song YC, Li YL, Guo D, Chen D, Li Y. Association between operative position and postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy. World J Gastrointest Surg 2024; 16:2088-2095. [PMID: 39087131 PMCID: PMC11287665 DOI: 10.4240/wjgs.v16.i7.2088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/18/2024] [Accepted: 06/18/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity, and postoperative nausea and vomiting (PONV) is one of the common complications after bariatric surgery. At present, the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained, and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery. AIM To explore the effect of the operative position during bariatric surgery on PONV. METHODS Data from obese patients, who underwent laparoscopic sleeve gastrectomy (LSG) in the authors' hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed. Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV. RESULTS There were 15 cases of PONV in the supine split-leg group (incidence rate, 50%) and 11 in the supine group (incidence rate, 36.7%) (P = 0.297). The mean operative duration in the supine split-leg group was 168.23 ± 46.24 minutes and 140.60 ± 32.256 minutes in the supine group (P < 0.05). Multivariate analysis revealed that operative position was not an independent risk factor for PONV (odds ratio = 1.192, 95% confidence interval: 0.376-3.778, P = 0.766). CONCLUSION Operative position during LSG may affect PONV; however, the difference in the incidence of PONV was not statistically significant. Operative position should be carefully considered for obese patients before surgery.
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Affiliation(s)
- Zhao-Peng Li
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266033, Shandong Province, China
| | - Yan-Cheng Song
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266033, Shandong Province, China
| | - Ya-Li Li
- Department of Operation Room, The Affiliated Hospital of Qingdao University, Qingdao 266033, Shandong Province, China
| | - Dong Guo
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266033, Shandong Province, China
| | - Dong Chen
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266033, Shandong Province, China
| | - Yu Li
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266033, Shandong Province, China
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Katar MK, Turan UF. Efficacy and Safety of Paragastric Neural Blockade in Controlling Pain, Nausea, and Vomiting After Sleeve Gastrectomy: A Randomized Controlled Trial. Obes Surg 2024; 34:2383-2390. [PMID: 38713336 PMCID: PMC11217077 DOI: 10.1007/s11695-024-07255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/21/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND There are difficulties in controlling the symptoms of pain, nausea, and vomiting after laparoscopic sleeve gastrectomy (LSG). This study aimed to evaluate the efficacy and safety of PGNB on pain and nausea and vomiting in the early postoperative period in patients who underwent LSG. METHODS In this prospective, randomized, controlled, double-blind study, the patients were divided into two equally formed groups: patients who underwent PGNB after LSG and the control group. Postoperative pain symptoms were evaluated using the visual analog scale (VAS) scores, and nausea and vomiting symptoms were evaluated using the postoperative nausea and vomiting (PONV) scores. RESULTS The study was completed with 90 patients, 45 patients in each group. The VAS scores measured at postoperative hours 1, 6, and 12 were statistically significantly lower in the PGNB group. There was no significant difference between the two groups in terms of the 24th hour VAS scores. The mean PONV scores of the PGNB and control groups were 0.47 ± 0.89 and 1.67 ± 1.95, respectively, revealing a significantly higher value for the controls. The mean time to first mobilization in the postoperative period was significantly shorter in the PGNB group. Upon the evaluation of patient satisfaction, it was determined that the satisfaction score of the PGNB group was significantly higher. CONCLUSIONS PGNB is an effective and safe method for managing pain, nausea, and vomiting that occur in the early period after LSG.
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Affiliation(s)
- Mehmet Kağan Katar
- General Surgery Department, Faculty of Medicine, Atlas University, Istanbul, 34450, Turkey.
| | - Umut Fırat Turan
- General Surgery Department, Faculty of Medicine, Atlas University, Istanbul, 34450, Turkey
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Yang Y, Liao B, Deng R, Ren L, Sun Y, Xiong S, Wu X. Comparison of anaesthesia strategies on postoperative nausea and vomiting in laparoscopic sleeve gastrectomy: a randomised controlled trial. BMC Anesthesiol 2024; 24:207. [PMID: 38872117 PMCID: PMC11170773 DOI: 10.1186/s12871-024-02577-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024] Open
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. TRIAL REGISTRATION This trial was registered with the Chinese Clinical Trial Registry (ChiCTR-TRC- 2,100,046,534, registration date: 21 May 2021).
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Affiliation(s)
- Ying Yang
- Department of Anesthesiology, Peking University Shenzhen Hospital, No. 1200 Lianhua Street, Futian District, Shenzhen, Guangdong, 518036, China
| | - Bucheng Liao
- Department of Anesthesiology, Peking University Shenzhen Hospital, No. 1200 Lianhua Street, Futian District, Shenzhen, Guangdong, 518036, China
| | - Ruoxi Deng
- Department of Anesthesiology, Peking University Shenzhen Hospital, No. 1200 Lianhua Street, Futian District, Shenzhen, Guangdong, 518036, China
| | - Liwei Ren
- Hubei University of Medicine, Shiyan, Shenzhen, China
| | - Yongjie Sun
- Hubei University of Medicine, Shiyan, Shenzhen, China
| | - Shaowei Xiong
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xinhai Wu
- Department of Anesthesiology, Peking University Shenzhen Hospital, No. 1200 Lianhua Street, Futian District, Shenzhen, Guangdong, 518036, China.
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Han Z, Tang H, Hou M, Gao L, Dong Z, Wang C, Lin Q, Yang W. Auricular Acupressure in Relieving PONV and Promoting Gastrointestinal Function Recovery in Females After Laparoscopic Sleeve Gastrectomy: A Prospective Randomized Controlled Trial. Obes Surg 2024; 34:2007-2016. [PMID: 38652438 DOI: 10.1007/s11695-024-07243-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The role of current pharmacological treatment after laparoscopic sleeve gastrectomy (LSG) is limited. The incidence of postoperative nausea and vomiting (PONV) after LSG remains high. Auricular acupressure (AA) is believed to relieve PONV after laparoscopic surgeries, but its role in patients with obesity after LSG has yet to be confirmed. METHODS Ninety-five female patients who underwent LSG were randomized into two groups: AA combined with conventional anti-nausea medication (AA group, 47 patients) or conventional anti-nausea medication group (control group, 48 patients). Index of nausea and vomiting and retching (INVR) scores, postoperative anti-vomiting medication use, time of first anus exhausting, time of first fluid intake, and time of first to get out of bed were collected within 48 h after surgery. RESULTS Demographic data of patients in both groups were balanced and comparable. INVR score (F = 7.505, P = 0.007), vomiting score (F = 11.903, P = 0.001), and retching score (F = 12.098, P = 0.001) were significantly lower in the AA group than that in the control group within 48 h postoperatively. Use of metoclopramide was significantly less in the AA group than in the control group (4.7 [5.5]) vs. 8.8 [7.6], P = 0.004); time to first anus exhausting was significantly less in the AA group than in the control group (17.50 [6.00] vs. 20.42 [8.62], P = 0.020). CONCLUSIONS AA combined with conventional anti-vomiting agents can alleviate PONV in female patients after LSG, and AA can promote gastrointestinal exhaustion. TRIAL REGISTRATION The trial has been registered in the Chinese Clinical Trial Registry (ChiCTR) with the registration no. ChiCTR2100047381 on June 13, 2021.
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Affiliation(s)
- Zhonghui Han
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, Guangdong Province, China
- School of Nursing, Jinan University, No.601, Huangpu Avenue West, Guangzhou, Guangdong Province, China
| | - Hanlin Tang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, Guangdong Province, China
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Min Hou
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, Guangdong Province, China
- School of Nursing, Jinan University, No.601, Huangpu Avenue West, Guangzhou, Guangdong Province, China
| | - Lilian Gao
- School of Nursing, Jinan University, No.601, Huangpu Avenue West, Guangzhou, Guangdong Province, China
| | - Zhiyong Dong
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, Guangdong Province, China
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, Guangdong Province, China
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Qingran Lin
- School of Nursing, Jinan University, No.601, Huangpu Avenue West, Guangzhou, Guangdong Province, China.
- Department of Nursing, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, Guangzhou, Guangdong Province, China.
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.
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Ortiz E, González AI, Jaime V, Guzmán JA, Esparza I, Orozco JO, Guerrero MA, Ramos A, Zerrweck C. The impact of Aprepitant on Nausea and Vomiting following Laparoscopic Sleeve Gastrectomy: A Blinded Randomized Controlled Trial. Obes Surg 2024; 34:1316-1323. [PMID: 38429485 DOI: 10.1007/s11695-024-07129-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is associated with postoperative nausea and vomiting (PONV). We aimed to compare the effects of aprepitant on the incidence of PONV after LSG. METHODS In this double-blind, randomized controlled trial, the case group received the standard care regimen for PONV (dexamethasone 10 mg, ondansetron 4 mg, and metoclopramide 10 mg) plus prophylactic oral aprepitant 80 mg 1 h preoperatively. The control group received standard care plus a placebo. Comparative analyses using the Rhodes index were performed at 0, 6, 12, and 24 h postoperatively. RESULTS A total of 400 patients (201 in the aprepitant group and 199 in the placebo group) underwent LSG. The groups were homogeneous. The aprepitant group experienced less PONV: early, 69 (34.3%) vs. 103 (51.7%), p ≤ 0.001; 6 h, 67 (33.3%) vs. 131 (65.8%), p ≤ 0.001; 12 h, 41 (20.4%) vs. 115 (57.8%), p ≤ 0.001; and 24 h, 22 (10.9%) vs. 67 (33.7%), p ≤ 0.001. Fewer patients in the aprepitant group vomited: early, 3 (1.5%) vs. 5 (2.5%), p = 0.020; 6 h, 6 (3%) vs. 18 (9%), p = 0.020; 12 h, 2 (1%) vs. 17 (8.5%), p = 0.006; and 24 h, 1 (0.5%) vs. 6 (3%), p = 0.040. Patients in the aprepitant group required less additional PONV medication: early, 61 (30.3%) vs. 86 (43.2), p = 0.008; 6 h, 7 (3.5%) vs. 34 (17%), p = 0.001; 12 h, 6 (3%) vs. 31 (15.6%), p ≤ 0.001; and 24 h, 5 (2.5%) vs. 11 (5.5%), p ≤ 0.001. CONCLUSIONS Prophylactic aprepitant improved PONV between 0 h (early) and 24 h postoperatively in patients undergoing LSG.
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Affiliation(s)
- Elías Ortiz
- Bariatric Surgery Department, Baja Hospital, Ernesto Sarmiento 2308, Burócrata, Ruiz Cortines, 22046, Tijuana, BCN, Mexico
| | - Alberto I González
- Bariatric Surgery Department, Baja Hospital, Ernesto Sarmiento 2308, Burócrata, Ruiz Cortines, 22046, Tijuana, BCN, Mexico
| | - Valeria Jaime
- Bariatric Surgery Department, Baja Hospital, Ernesto Sarmiento 2308, Burócrata, Ruiz Cortines, 22046, Tijuana, BCN, Mexico
| | - José A Guzmán
- Bariatric Surgery Department, Baja Hospital, Ernesto Sarmiento 2308, Burócrata, Ruiz Cortines, 22046, Tijuana, BCN, Mexico
| | - Isaac Esparza
- Bariatric Surgery Department, Baja Hospital, Ernesto Sarmiento 2308, Burócrata, Ruiz Cortines, 22046, Tijuana, BCN, Mexico
| | - José O Orozco
- Bariatric Surgery Department, Baja Hospital, Ernesto Sarmiento 2308, Burócrata, Ruiz Cortines, 22046, Tijuana, BCN, Mexico
| | - Manuel A Guerrero
- Anesthesiology department, Baja Hospital, Ernesto Sarmiento 2308, Burócrata, Ruiz Cortines, 22046, Tijuana, BCN, Mexico
| | - Almino Ramos
- Bariatric Surgery Department, Baja Hospital, Ernesto Sarmiento 2308, Burócrata, Ruiz Cortines, 22046, Tijuana, BCN, Mexico
| | - Carlos Zerrweck
- Bariatric Surgery Department, Baja Hospital, Ernesto Sarmiento 2308, Burócrata, Ruiz Cortines, 22046, Tijuana, BCN, Mexico.
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Pratt S, Howard-Ruben J. Implementation of Electronic Postoperative Nausea and Vomiting Assessment and Best Practice Advisory Tools to Improve Patient Care. J Nurs Care Qual 2024; 39:136-143. [PMID: 38392948 DOI: 10.1097/ncq.0000000000000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) affects 30% of surgical patients undergoing anesthesia. PONV is a substantial cause of increased length of stay, cost of care, and unanticipated patient admission and readmission. LOCAL PROBLEM Seventy percent of patients received PONV prophylaxis; PONV assessment was performed in only 63% of patients in this hospital system. METHODS A standardized PONV preoperative assessment checklist and a best practice advisory (BPA) were implemented in our electronic medical record (EMR) and charting system. Anesthesia providers and postanesthesia care unit (PACU) nurses completed training on patient management for PONV, including preoperative assessment and BPA use. RESULTS The PONV preoperative assessment achieved high adoption, and providers followed its recommendations in more than 90% of cases. During the 6-month implementation phase, PONV rates decreased from 56% to 43.6%. CONCLUSIONS Implementing a standardized, electronic PONV preoperative risk assessment checklist and a BPA effectively reduced PONV rates in this hospital system.
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Affiliation(s)
- Samantha Pratt
- Author Affiliations: Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University, Chicago, Illinois
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Ding X, Che J, Xu S, Chen D, Zha T, Abudurousuli G, Liang H, Gui B. A nomogram to predict postoperative nausea and vomiting in the ward following laparoscopic bariatric surgery. Surg Endosc 2023; 37:9217-9227. [PMID: 37872426 DOI: 10.1007/s00464-023-10483-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/17/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a common and distressing complication of laparoscopic bariatric surgery (LBS). However, there is a lack of effective integrated prediction models for preventing and treating PONV in patients after LBS. METHODS Based on a randomized controlled trial conducted between November 1, 2021, and May 13, 2022, we included 334 participants who underwent LBS according to the inclusion criteria. The database was divided randomly into training and validation cohorts in a ratio of 7:3. Least absolute shrinkage and selection operator plus multivariable logistic regression were used to identify independent predictors and construct a nomogram. The performance of the nomogram was assessed and validated by the area under the receiver operating characteristic curve (AUC), the concordance index (C-index), calibration plots, and a decision curve analysis (DCA). We also explored specific risk factors for PONV in patients with diabetes. RESULTS The subjects were divided randomly into training (n = 234) and validation (n = 100) cohorts. Age, history of diabetes, type of surgery, and sugammadex use were incorporated to construct a nomogram prediction model. In the training cohort, the AUC and the optimism-corrected C-index were 0.850 [95% confidence interval (CI) 0.801-0.899] and 0.848, while in the validation cohort they were 0.847 (95% CI 0.768-0.925) and 0.844, respectively. The calibration plots showed good agreement between the predicted and actual observations. The DCA results demonstrated that the nomogram was clinically useful. The type of surgery, sugammadex use, and insulin level at 120 min were predictors of PONV in patients with diabetes with an AUC of 0.802 (95% CI 0.705-0.898). CONCLUSIONS We developed and validated a prediction model for PONV in patients after LBS. A risk factor analysis of PONV in patients with diabetes provides clinicians with a more precise prophylactic protocol.
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Affiliation(s)
- Xiahao Ding
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jinxing Che
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
- Department of Anesthesiology, Huai'an Maternity and Child Healthcare Hospital, Huai'an, China
| | - Siyang Xu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
- Department of Anesthesiology, Jiangsu Province Official Hospital, Nanjing, China
| | - Dapeng Chen
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tianming Zha
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Gulibositan Abudurousuli
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Hui Liang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bo Gui
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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Vitiello A, Iacovazzo C, Berardi G, Vargas M, Marra A, Buonanno P, Velotti N, Musella M. Propensity score matched analysis of postoperative nausea and pain after one anastomosis gastric bypass (MGB/OAGB) versus sleeve gastrectomy (SG). Updates Surg 2023; 75:1881-1886. [PMID: 37193850 PMCID: PMC10543143 DOI: 10.1007/s13304-023-01536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/10/2023] [Indexed: 05/18/2023]
Abstract
The aim of our study was to assess and compare postoperative nausea and pain after one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (LSG). Patients undergoing OAGB and LSG at our institution between November 2018 and November 2021 have been prospectively asked to report postoperative nausea and pain on a numeric analogic scale. Medical records were retrospectively reviewed to collect scores of these symptoms at the 6th and 12th postoperative hour. One-way analysis of variance (ANOVA) was used to evaluate effect of type of surgery on postoperative nausea and pain scores. To adjust for baseline differences between cohorts, a propensity score algorithm was used to match LSG patients to MGB/OAGB patients in a 1:1 ratio with a 0.1 tolerance. A total number of 228 (119 SGs and 109 OAGBs) subjects were included in our study. Nausea after OAGB was significantly less severe than after LSG both at the 6th and 12th hour assessment; pain was less strong after OAGB at the 6th hour but not after 12 h. Fifty-three individuals had a rescue administration of metoclopramide after LSG and 34 after OAGB (44.5% vs 31.2%, p = 0.04); additional painkillers were required by 41 patients after LSG and 23 after OAGB (34.5% vs 21.1%, p = 0.04). Early postoperative nausea was significantly less severe after OAGB, while pain was comparable especially at the 12th hour.
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Affiliation(s)
- Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Carmine Iacovazzo
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Maria Vargas
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Annachiara Marra
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Pasquale Buonanno
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
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Ding X, Zhu X, Zhao C, Chen D, Wang Y, Liang H, Gui B. Use of sugammadex is associated with reduced incidence and severity of postoperative nausea and vomiting in adult patients with obesity undergoing laparoscopic bariatric surgery: a post-hoc analysis. BMC Anesthesiol 2023; 23:163. [PMID: 37189069 DOI: 10.1186/s12871-023-02123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/04/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a common but troublesome complication in patients who undergo laparoscopic bariatric surgery (LBS). Whether sugammadex use is related to the persistent decrease in the occurrence of PONV during postoperative inpatient hospitalization, which is critical for the rehabilitation of patients after LBS, remains unknown. METHODS The study was based on a randomized controlled trial conducted in an accredited bariatric centre. A total of 205 patients who underwent LBS were included in the analysis. Univariate analysis and multivariable logistic regression model were used to identify the significant variables related to PONV. Then propensity score matching and inverse probability of treatment weighting (IPTW) were employed to compare outcomes between the sugammadex and neostigmine groups. The primary outcome was the incidence of PONV within 48 h after LBS. The secondary endpoints included the severity of PONV, time to first flatus, need for rescue antiemetic therapy, and water intake. RESULTS The incidence of PONV was 43.4% (89/205) within the first 48 h after LBS. In multivariable analysis, sugammadex use (OR 0.03, 95% CI 0.01-0.09, P < 0.001) was an independent protective factor of PONV. After IPTW adjustment, sugammadex use was associated with lower incidence of PONV (OR 0.54, 95% CI 0.48-0.61, P < 0.001), postoperative nausea (PON) (OR 0.77, 95% CI 0.67-0.88, P < 0.001), and postoperative vomiting (POV) (OR 0.60, 95% CI 0.53-0.68, P < 0.001) within postoperative 48 h. The severity of PON as well as the incidence and severity of POV within the first 24 h were also lower in the sugammadex group (all P < 0.05). Reduced need for rescue antiemetic therapy within the first 24 h, increased water intake for both periods, and earlier first passage of flatus were observed in the sugammadex group (all P < 0.05). CONCLUSIONS Compared with neostigmine, sugammadex can reduce the incidence and severity of PONV, increase postoperative water intake, and shorten the time to first flatus in bariatric patients during postoperative inpatient hospitalization, which may play a pivotal role in enhanced recovery. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2100052418, http://www.chictr.org.cn/showprojen.aspx?proj=134893 , date of registration: October 25, 2021).
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Affiliation(s)
- Xiahao Ding
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Xiaozhong Zhu
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
- Department of Anesthesiology, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210046, China
| | - Cuimei Zhao
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
- Department of Anesthesiology, Nanjing Qixia District Hospital, Nanjing, 210046, China
| | - Dapeng Chen
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Yuting Wang
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Hui Liang
- Department of General Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Bo Gui
- Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China.
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10
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Ding X, Chen D, Che J, Xu S, Liang H, Gui B. Penehyclidine hydrochloride for treating postoperative nausea and vomiting after laparoscopic bariatric surgery: a double-blinded randomized controlled trial. BMC Anesthesiol 2023; 23:135. [PMID: 37095439 PMCID: PMC10124062 DOI: 10.1186/s12871-023-02078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/04/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a common and distressing complication of laparoscopic bariatric surgery (LBS). Penehyclidine hydrochloride has been reported to be effective in preventing PONV. Considering the potential preventive effects of penehyclidine against PONV, we hypothesized that intravenous infusion of penehyclidine may alleviate PONV within the first 48 h in patients scheduled for LBS. METHODS Patients who underwent LBS were randomly assigned (1:2) to receive saline (Control group, n = 113) or a single intravenous dose of penehyclidine 0.5 mg (PHC group, n = 221). The primary outcome was incidence of PONV within the first 48 h postoperatively. Secondary endpoints included severity of PONV, need for rescue antiemetic therapy, volume of water intake, and time to first flatus. RESULTS PONV occurred in 159 (48%) patients within the first 48 h postoperatively, including 51% in the Control group and 46% in the PHC group. There was no significant difference in the incidence or severity of PONV between the two groups (P > 0.05). Within the first 24 h and 24-48 h, no significant difference was found in incidence or severity of PONV, postoperative nausea, postoperative vomiting, need for rescue antiemetic therapy, or volume of water intake (P > 0.05). Kaplan-Meier curves showed that penehyclidine was significantly associated with a prolonged time to first flatus (median onset time: 22 h vs. 21 h, P = 0.036). CONCLUSIONS Penehyclidine did not decrease incidence and severity of PONV in patients undergoing LBS. However, a single intravenous dose of penehyclidine (0.5 mg) was associated with a slightly prolonged time to first flatus. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2100052418, http://www.chictr.org.cn/showprojen.aspx?proj=134893 , date of registration: 25/10/2021).
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Affiliation(s)
- Xiahao Ding
- Department of Anesthesiology and Perioperative Medicine, 1st Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Dapeng Chen
- Department of Anesthesiology and Perioperative Medicine, 1st Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Jinxing Che
- Department of Anesthesiology and Perioperative Medicine, 1st Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
- Department of Anesthesiology, The Huai'an Maternity and Child Healthcare Hospital, Huai'an, 223002, China
| | - Siyang Xu
- Department of Anesthesiology and Perioperative Medicine, 1st Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
- Department of Anesthesiology, Jiangsu Province Official Hospital, Nanjing, 210009, China
| | - Hui Liang
- Department of General Surgery, 1st Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Bo Gui
- Department of Anesthesiology and Perioperative Medicine, 1st Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China.
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11
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Gao B, Chen J, Liu Y, Hu S, Wang R, Peng F, Fang C, Gan Y, Su S, Han Y, Yang X, Li B. Efficacy and safety of enhanced recovery after surgery protocol on minimally invasive bariatric surgery: a meta-analysis. Int J Surg 2023; 109:1015-1028. [PMID: 36999781 PMCID: PMC10389529 DOI: 10.1097/js9.0000000000000372] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/16/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS), a multidisciplinary and multimodal perioperative care protocol, has been widely used in several surgical fields. However, the effect of this care protocol on patients receiving minimally invasive bariatric surgery remains unclear. This meta-analysis compared the clinical outcomes of the ERAS protocol and standard care (SC) in patients who underwent minimally invasive bariatric surgery. MATERIAL AND METHODS PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched to identify literature reporting the effects of the ERAS protocol on clinical outcomes in patients undergoing minimally invasive bariatric surgery. All the articles published until 01 October 2022, were searched, followed by data extraction of the included literature and independent quality assessment. Then, pooled mean difference (MD) and odds ratio with a 95% CI were calculated by either a random-effects or fixed-effects model. RESULTS Overall, 21 studies involving 10 764 patients were included in the final analysis. With the ERAS protocol, the length of hospitalization (MD: -1.02, 95% CI: -1.41 to -0.64, P <0.00001), hospitalization costs (MD: -678.50, 95% CI: -1196.39 to -160.60, P =0.01), and the incidence of 30-day readmission (odds ratio =0.78, 95% CI: 0.63-0.97, P =0.02) were significantly reduced. The incidences of overall complications, major complications (Clavien-Dindo grade ≥3), postoperative nausea and vomiting, intra-abdominal bleeding, anastomotic leak, incisional infection, reoperation, and mortality did not differ significantly between the ERAS and SC groups. CONCLUSIONS The current meta-analysis indicated that the ERAS protocol could be safely and feasibly implemented in the perioperative management of patients receiving minimally invasive bariatric surgery. Compared with SC, this protocol leads to significantly shorter hospitalization lengths, lower 30-day readmission rate, and hospitalization costs. However, no differences were observed in postoperative complications and mortality.
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Affiliation(s)
- Benjian Gao
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Jianfei Chen
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Yongfa Liu
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Shuai Hu
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Rui Wang
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Fangyi Peng
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Chen Fang
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Yu Gan
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Song Su
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Yunwei Han
- Department of Oncology, The Affiliated Hospital of Southwest Medical University
| | - Xiaoli Yang
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Bo Li
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
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12
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Song Y, Zhu J, Dong Z, Wang C, Xiao J, Yang W. Incidence and risk factors of postoperative nausea and vomiting following laparoscopic sleeve gastrectomy and its relationship with Helicobacter pylori: A propensity score matching analysis. Front Endocrinol (Lausanne) 2023; 14:1102017. [PMID: 36909334 PMCID: PMC9992875 DOI: 10.3389/fendo.2023.1102017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) are common after laparoscopic sleeve gastrectomy (LSG), affecting patient satisfaction and postoperative recovery. The purpose of this study was to investigate the incidence and severity of PONV after LSG and the relationship between Helicobacter pylori (HP) and PONV. METHODS Patients undergoing LSG in our center from June 1, 2018, to May 31, 2022, were divided into HP-positive and HP-negative groups for retrospective analysis. The independent risk factors of PONV were determined by univariate and binary logistic regression analysis using a 1:1 propensity score matching (PSM) method. RESULTS A total of 656 patients was enrolled, and 193 pairs of HP-positive and negative groups were matched after PSM. Both groups of patients had similar clinical features and surgical procedures. PONV occurred in 232 patients (60.1%) after LSG, and the incidence of PONV in HP-positive patients was 61.10%. The incidence and severity of PONV were statistically similar in both groups (P=0.815). Multivariate analysis showed that the female sex (OR=1.644, P=0.042), postoperative pain (OR=2.203, P=0.001) and use of postoperative opioid (OR=2.229, P=0.000) were independent risk factors for PONV after LSG, whereas T2DM (OR=0.510, P=0.009) and OSAS (OR=0.545, P=0.008) independently reduced the incidence rate of PONV. There was no difference either in smoking (P=0.255) or alcohol drinking (P=0.801). HP infection did not affect PONV (P=0.678). CONCLUSIONS The incidence of PONV following LSG was relatively high. Female sex, postoperative pain and use of postoperative opioid predicted a higher incidence of PONV. Patients with T2DM and OSAS were less likely to have PONV. There was no clear association between HP infection and PONV after LSG.
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Affiliation(s)
- Yali Song
- Department of Metabolic and Bariatric Surgery, Clinical Research Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Institute of Obesity and Metabolic Disorders, Jinan University, Guangzhou, China
| | - Jie Zhu
- Department of Metabolic and Bariatric Surgery, Clinical Research Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Institute of Obesity and Metabolic Disorders, Jinan University, Guangzhou, China
| | - Zhiyong Dong
- Department of Metabolic and Bariatric Surgery, Clinical Research Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Institute of Obesity and Metabolic Disorders, Jinan University, Guangzhou, China
- Laboratory of Metabolic and Molecular Medicine, Guangdong-Hong Kong-Macao Joint University, Guangzhou, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, Clinical Research Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Institute of Obesity and Metabolic Disorders, Jinan University, Guangzhou, China
- Laboratory of Metabolic and Molecular Medicine, Guangdong-Hong Kong-Macao Joint University, Guangzhou, China
| | - Jia Xiao
- Department of Metabolic and Bariatric Surgery, Clinical Research Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Institute of Obesity and Metabolic Disorders, Jinan University, Guangzhou, China
- Laboratory of Metabolic and Molecular Medicine, Guangdong-Hong Kong-Macao Joint University, Guangzhou, China
- *Correspondence: Jia Xiao, ; Wah Yang,
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, Clinical Research Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Institute of Obesity and Metabolic Disorders, Jinan University, Guangzhou, China
- Laboratory of Metabolic and Molecular Medicine, Guangdong-Hong Kong-Macao Joint University, Guangzhou, China
- *Correspondence: Jia Xiao, ; Wah Yang,
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13
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Effect of Dexmedetomidine Compared to Remifentanil During Bariatric Surgery on Postoperative Nausea and Vomiting: a Retrospective Study. Obes Surg 2022; 32:3368-3374. [PMID: 35976557 DOI: 10.1007/s11695-022-05894-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Postoperative nausea and vomiting (PONV) occurs frequently after bariatric surgery and is a major cause of adverse outcomes. This retrospective study investigated whether opioid-restricted total intravenous anesthesia using dexmedetomidine as a substitute for remifentanil can reduce PONV in bariatric surgery. MATERIALS AND METHODS The electronic medical records of adult patients who underwent laparoscopic bariatric surgery between January and December 2019 were reviewed. The patients were divided into two groups according to the agents used for anesthesia: Group D, propofol and dexmedetomidine; Group R, propofol and remifentanil. RESULTS A total of 134 patients were included in the analyses. The frequency of postoperative nausea was significantly lower in Group D than that in Group R until 2 h after discharge from the postanesthesia care unit (PACU) (P = 0.005 in the PACU, P = 0.010 at 2 h after PACU discharge) but failed to significantly reduce the overall high incidence rates of 60.5% and 65.5%, respectively (P = 0.592). Postoperative pain score was significantly lower in Group D until 6 h after PACU discharge. The rates of rescue antiemetic and analgesic agent administration in the PACU were significantly lower in Group D than those in Group R. CONCLUSION Opioid-restricted total intravenous anesthesia using dexmedetomidine reduces postoperative nausea, pain score, antiemetic, and analgesic requirements in the immediate postoperative period after bariatric surgery.
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14
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Ashoor TM, Kassim DY, Esmat IM. A Randomized Controlled Trial for Prevention of Postoperative Nausea and Vomiting after Laparoscopic Sleeve Gastrectomy: Aprepitant/Dexamethasone vs. Mirtazapine/Dexamethasone. Anesthesiol Res Pract 2022; 2022:3541073. [PMID: 35535050 PMCID: PMC9078838 DOI: 10.1155/2022/3541073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022] Open
Abstract
Background Coadministration of different antiemetics proved to decrease postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG). This trial compared aprepitant/dexamethasone (A/D) combination vs mirtazapine/dexamethasone (M/D) combination vs dexamethasone (D) alone for prevention of PONV in morbidly obese patients undergoing LSG. Methods Ninety patients scheduled for LSG were randomly allocated to receive 8 mg dexamethasone intravenous infusion (IVI) only in the D group or in addition to 80 mg aprepitant capsule in the A/D group or in addition to 30 mg mirtazapine tablet in the M/D group. Assessment of PONV was carried out at 0-2 h (early) and 2-24 h (late). The primary outcome was the complete response 0-24 h after surgery. Collective PONV, postoperative pain, side effects and patient satisfaction score were considered as secondary outcomes. Results The A/D and M/D groups were superior to the D group for a complete response within 0-24 h after surgery (79.3% for the A/D group, 78.6% for the M/D group, and 20.7% for the D group). The D group was inferior to the A/D and M/D groups regarding collective PONV and use of rescue antiemetic 0-24 h after surgery (P < 0.001, P < 0.001, respectively). The peak nausea scores (2-24 h) were significantly reduced in the M/D group in comparison to the D group (P=0.005). Patients in the M/D group showed high sedation scores, while those in the A/D group showed low pain scores (2-24 h) and less analgesic requirements (P < 0.001, P < 0.001, P < 0.001, respectively). The A/D and M/D groups were superior to the D group with regard to the patient satisfaction score (P < 0.001). Conclusion Aprepitant/dexamethasone combination and mirtazapine/dexamethasone combination were superior to dexamethasone alone in alleviating postoperative nausea and vomiting in morbidly obese patients scheduled to undergo laparoscopic sleeve gastrectomy. Trial Registration: ClinicalTrials.gov identifier: NCT04013386.
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Affiliation(s)
- Tarek M. Ashoor
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Dina Y. Kassim
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ibrahim M. Esmat
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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15
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Schumann R, Ziemann-Gimmel P, Sultana A, Eldawlatly AA, Kothari SN, Shah S, Wadhwa A. Postoperative nausea and vomiting in bariatric surgery: a position statement endorsed by the ASMBS and the ISPCOP. Surg Obes Relat Dis 2021; 17:1829-1833. [PMID: 34462224 DOI: 10.1016/j.soard.2021.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Roman Schumann
- Department of Anesthesiology, Critical Care and Pain Medicine, VA Boston Medical Center, West Roxbury, Massachusetts.
| | | | - Adrian Sultana
- Department of Anesthesiology, Macquarie University Hospital, Sydney, Australia
| | - Abdelazeem A Eldawlatly
- Department of Anesthesiology, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Shanu N Kothari
- Department of Surgery, University of South Carolina School of Medicine-Prisma Health, Greenville, South Carolina
| | - Sajani Shah
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Anupama Wadhwa
- Department of Anesthesiology, University of Texas Southwestern, Dallas, Texas
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16
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The influence of preoperative carbohydrate loading on postoperative outcomes in bariatric surgery patients: a randomized, controlled trial. Surg Obes Relat Dis 2021; 17:1480-1488. [PMID: 34016554 DOI: 10.1016/j.soard.2021.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Preoperative carbohydrate loading is a component of Enhanced Recovery After Surgery (ERAS) protocols, but there is limited literature in bariatric surgery patients. OBJECTIVES The objective of this study was to characterize the impact of preoperative carbohydrate loading on postoperative bariatric surgery outcomes. SETTING University Hospital. METHODS Patients undergoing a primary minimally invasive Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2018 and 2020 were randomized to standard management or intervention. Standard management patients were nothing by mouth (NPO) after midnight prior to surgery. Intervention patients consumed 2 carbohydrate drinks: 1 the night before and another 3 hours prior to surgery. Primary outcomes analyzed included postoperative nausea and vomiting (PONV), length of stay, and overall complications. RESULTS In total, 134 patients were analyzed: 64 intervention (47.8%) and 70 (52.2%) standard. In the end, 7% and 15% of patients were lost to follow-up at 6-weeks and 3-months, respectively. There was no statistically significant difference in length of stay (2.0 ± 1.2 vs 2.1 ± .9 d; P = .65) or postoperative outcomes between the 2 groups. There were no episodes of aspiration among the intervention group. Among RYGB patients, intervention patients had a shorter duration of nausea compared with standard patients. There was no significant difference in glycemic control among patients with and without diabetes. CONCLUSIONS Preoperative carbohydrate drinks can be administered to bariatric surgery patients without significant risks. Carbohydrate loading preoperatively can decrease the duration of PONV in RYGB patients. Carbohydrate drinks can be safely included in bariatric ERAS protocols for patients with and without diabetes, although the benefits remain unknown.
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17
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Naeem Z, Chen IL, Pryor AD, Docimo S, Gan TJ, Spaniolas K. Antiemetic Prophylaxis and Anesthetic Approaches to Reduce Postoperative Nausea and Vomiting in Bariatric Surgery Patients: a Systematic Review. Obes Surg 2021; 30:3188-3200. [PMID: 32415635 DOI: 10.1007/s11695-020-04683-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
While guidelines exist for the management of postoperative nausea and vomiting (PONV) in the general surgical setting, there are no established guidelines for the prevention or treatment of PONV in bariatric patients, in whom PONV contributes significantly to perioperative morbidity and hospital resource utilization. This systematic review found that the multimodal pharmacological approach to PONV prevention recommended in current guidelines for high-risk surgical patients is appropriate for the bariatric subset. This includes multi-agent antiemetic prophylaxis with dexamethasone and one or more agents from other classes, and opioid-free total intravenous anesthesia, though the advantages of the latter need further evaluation. There remains a need for a standardized validated instrument to assess PONV in the bariatric setting.
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Affiliation(s)
- Zaina Naeem
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794-8191, USA
| | - Ingrid L Chen
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794-8191, USA
| | - Aurora D Pryor
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794-8191, USA
| | - Salvatore Docimo
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794-8191, USA
| | - Tong J Gan
- Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794-8191, USA.
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18
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Parisi A, Desiderio J, Cirocchi R, Trastulli S. Enhanced Recovery after Surgery (ERAS): a Systematic Review of Randomised Controlled Trials (RCTs) in Bariatric Surgery. Obes Surg 2020; 30:5071-5085. [PMID: 32981000 DOI: 10.1007/s11695-020-05000-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/06/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Our aim was to conduct an up-to-date systematic review of randomised controlled trials (RCTs) to determine the benefits and harms of enhanced recovery after surgery (ERAS) programme in bariatric surgery. METHODS MEDLINE, Embase, PubMed, CINAHL and the Cochrane Library were searched for RCTs on ERAS versus standard care (SC) until April 2020. The primary endpoint was the length of hospital stay (LOS). RESULTS Five RCTs included a total of 610 procedures. ERAS adoption is capable of significantly reducing LOS (MD of - 0.51; 95% CI - 0.92 to - 0.10; P = 0.01) and postoperative nausea and vomiting (PONV) (OR 0.42; 95% CI 0.19 to 0.95; P = 0.04). No significant differences in terms of adverse events and readmissions. CONCLUSIONS The implementation of ERAS in bariatric surgery produces a significant reduction in LOS and PONV.
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Affiliation(s)
- Amilcare Parisi
- Department of Emergency and Digestive Surgery, St. Mary's Hospital, 05100, Terni, Italy
| | - Jacopo Desiderio
- Department of Emergency and Digestive Surgery, St. Mary's Hospital, 05100, Terni, Italy
| | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, University of Perugia, St. Mary's Hospital, 05100, Terni, Italy
| | - Stefano Trastulli
- Department of Emergency and Digestive Surgery, St. Mary's Hospital, 05100, Terni, Italy.
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