Menstrual cycle irregularity and the incidence of nausea and vomiting after laparoscopy

Incidence and risk factors of postoperative nausea and vomiting following laparoscopic sleeve gastrectomy and its relationship with Helicobacter pylori: A propensity score matching analysis

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.

Effect of intraoperative intravenous crystalloid infusion on post-operative nausea and vomiting after diagnostic gynaecological laparoscopy: Comparison of 30 ml/kg and 10 ml/kg and to report the effect of the menstrual cycle on the incidence of post-operative nausea and vomiting

Aim:

Primary To compare effect of 30 ml/kg and 10 ml/kg crystalloid infusion on post-operative nausea and vomiting after diagnostic gynaecological laparoscopy. Secondary To correlate incidence of post-operative nausea and vomiting associated with different phases of menstrual cycle.

Study Design:

This prospective, randomized, double blinded study was conducted in 200 patients [Group I - 10 ml.kg^-1 crystalloid infusion (n = 100) and Group II - 30 ml.kg^-1 crystalloid infusion (n = 100)] of ASA grades I/II, of either sex in the age group 20-40 years undergoing ambulatory gynaecological laparoscopic surgery. Both groups were compared with respect to post-operative nausea vomiting, hemodynamic parameters and incidence of post-operative nausea and vomiting associated with different phases of menstrual cycle.

Statistical Analysis:

Data for categorical variables and continuous variables are presented as proportions and percentages and mean ± SD, respectively. For normally distributed continuous data, the Student t test was used to compare different groups. Categorical data were tested with the Fisher exact test. Pearson or Spearman correlation coefficients for data normally distributed and not normally distributed, respectively, were used to evaluate the relation between 2 variables. P values < 0.05 were considered statistically significant.

Results:

In the first 4 h after anaesthesia, the cumulative incidence of nausea and vomiting in Group I was 66% as compared to 40% in Group II (P value = 0.036, *S). Anti-emetic use was less in the group II as compared to Group I (13% vs. 20%, P = 0.04). Female patients in the menstrual phase experienced nausea and vomiting in 89.48% of cases as compared to 58.33% and 24.24% during proliferative and secretory phases of menstrual cycle, respectively.

Gender-specific differences in the central nervous system's response to anesthesia

Males and females are physiologically distinct in their responses to various anesthetic agents. The brain and central nervous system (CNS), the main target of anesthesia, are sexually dimorphic from birth and continue to differentiate throughout life. Accordingly, gender has a substantial impact on the influence of various anesthetic agents in the brain and CNS. Given the vast differences in the male and female CNS, it is surprising to find that females are often excluded from basic and clinical research studies of anesthesia. In animal research, males are typically studied to avoid the complication of breeding, pregnancy, and hormonal changes in females. In clinical studies, females are also excluded for the variations that occur in the reproductive cycle. Being that approximately half of the surgical population is female, the exclusion of females in anesthesia-related research studies leaves a huge knowledge gap in the literature. In this review, we examine the reported sex-specific differences in the central nervous system's response to anesthesia. Furthermore, we suggest that anesthesia researchers perform experiments on both sexes to further evaluate such differences. We believe a key goal of research studying the interaction of the brain and anesthesia should include the search for knowledge of sex-specific mechanisms that will improve anesthetic care and management in both sexes.

Influence of the menstrual cycle on the incidence of nausea and vomiting after laparoscopic gynecological surgery: a pilot study

STUDY OBJECTIVE

To investigate whether the phase of menstrual cycle influences the incidence of postoperative nausea and vomiting (PONV) in women undergoing general anesthesia for elective laparoscopic gynecological surgery.

DESIGN

Prospective, observational, blinded study.

SETTING

General hospital, Postanesthesia Care Unit, and gynecologic floor room.

PATIENTS

111 ASA physical status 1 and 2 women, aged 18 to 53 years.

INTERVENTIONS

Patients were classified into three groups according to the phase of menstrual cycle at the time of anesthesia: Group F1: follicular phase (menstrual days 1-8; n = 34); Group O2: ovulatory phase (days 9-15; n = 40); and Group L3: luteal phase (days 16 to end of cycle; n = 37). Anesthetic, postoperative pain management, and antiemetic regimens were standardized.

MEASUREMENTS

Frequency of nausea, vomiting, or both were assessed for early (0-2 hrs). Late PONV (2-24 hrs) along with the use of rescue antiemetic, severity of nausea, and pain.

MAIN RESULTS

In the follicular (n = 34), ovulatory (n = 40) and luteal phase (n = 37) groups, the frequencies of PONV over 24 hours were 35%, 38%, and 14% (P = 0.04), respectively. This was due to differences in the early postoperative period where the frequencies were 21%, 25%, and 3% (P = 0.02), respectively, as frequencies were similar in the late period (15%, 20% and 14%, P = 0.71), respectively. Nausea scores, rescue antiemetic usage, pain scores, and opioid consumption were similar in the groups.

CONCLUSION

Patients in the luteal phase of their menstrual cycle may have a decreased risk of PONV after laparoscopic gynecological surgery in the early postoperative period.

Patient Sex and its Influence on General Anaesthesia

Physiological and pharmacological differences exist between men and women. Women wake faster than men following general anaesthesia. Women also differ from men in their postoperative recovery as reflected by differences in postoperative pain, nausea and vomiting and overall quality of recovery. These gender differences seem to be more pronounced in premenopausal women, suggesting hormonal mechanisms are a major contributing factor.

Effect of intraoperative intravenous crystalloid infusion on postoperative nausea and vomiting after gynaecological laparoscopy: comparison of 30 and 10 ml kg(-1)

BACKGROUND

I.V. fluid administration has been shown to reduce postoperative nausea and vomiting (PONV). The optimum dose is unknown. We tested the hypothesis that administration of i.v. crystalloid of 30 ml kg(-1) would reduce the incidence of PONV compared with 10 ml kg(-1) of the same fluid.

METHODS

A total of 141 ASA I female patients undergoing elective gynaecological laparoscopy were randomized, in double-blind fashion, to receive either 10 ml kg(-1) (n=71; CSL-10 group) or 30 ml kg(-1) (n=70; CSL-30 group) of i.v. compound sodium lactate (CSL).

RESULTS

In the first 48 h after anaesthesia, the incidence of vomiting was lower in the CSL-30 group than in the CSL-10 group (8.6% vs 25.7%, P=0.01). Anti-emetic use was less in the CSL-30 group at 0.5 h (2.9% vs 14.3%, P=0.04). The incidence of severe nausea was significantly reduced in the treatment group at awakening (2.9% vs 15.7%, P=0.02), 2 h (0.0% vs 8.6%, P=0.04) and cumulatively (5.7% vs 27.1%, P=0.001). The numbers needed to treat to prevent vomiting, severe nausea and antiemetic use in the first 48 h were 6, 5 and 6, respectively.

CONCLUSION

I.V. administration of CSL 30 ml kg(-1) to healthy women undergoing day-case gynaecological laparoscopy reduced the incidence of vomiting, nausea and anti-emetic use when compared with CSL 10 ml kg(-1).