The Relationship Between Systemic Circulation Resistance And Postoperative Nausea And Vomiting During Laparoscopic Hysterectomy

ObjectivePostoperative nausea and vomiting(PONV)is one of the most common adverse reactions after general anesthesia and surgery.Patients usually develop PONV within 24 hours after surgery and have significant nausea before vomiting.However,the etiology and pathogenesis of PONV is currently unknown.The influencing factors include gender,smoking history,history of motion sickness or PONV,anesthesia method,type of surgery and postoperative opioid use.PONV is particularly common in female patients undergoing laparoscopic gynecological surgery.The incidence of PONV after laparoscopic hysterectomy could be 30%-80%.PONV not only reduces patient comfort and increases postoperative complications,but also may lengthen hospital stays,thereby increasing patient medical costs.Suboptimal gastrointestinal perfusion may be one of the important risk factors for PONV,and increased systemic vascular resistance(SVR)may lead to gastrointestinal ischemia.Therefore,we use SVR to reflect the perfusion of gastrointestinal tissue,and the relationship between the SVR index level and the occurrence of PONV was observed through this observation.MethodsThis is a prospective cohort study.304 patients aged 18 to 65 underwent elective laparoscopic hysterectomy(ASA ?-?)during the study period.Exclusion criteria included:history of smoking,prior history of PONV or history of motion sickness,patient refusal,emergent surgery,enter the intensive care unit(ICU)after surgery,simultaneous gastrointestinal surgery,vaginal or abdominal(open)hysterectomy,chemotherapy or radiotherapy before surgery,antiemetic medication in the ward within 24 h before surgery,significant cardiovascular disease,neuro,cognitive,or psychologic disease,pulmonary disease,hepatic disease.Among the eligible patients,228 gave written consent and were enrolled in the final analysis.SVR values were obtained through the LiDCOrapid monitor.The average values of the measurements within each minute were used for SVR indices derivation.At the same time,demographic and perioperative information such as age,height,weight,combined history of chronic medical conditions,history of anesthesia and surgery,preoperative laboratory test indicators,perioperative medications and postoperative complications were collected.Nausea and vomiting incidence and severity were evaluated while patients were awake and over the intervals from 0 through 2 h,2 through 6 h and 6 through 24 h starting upon arrival at the PACU.Initially,SVR indices and perioperative variables were evaluated for univariate association with PONV.Variables that were significant in univariate analyses(P<0.1)were included in a binary logistic regression model.ResultsThe incidence of PONV was 56.1%(128/228).SVR baseline(OR 2.153,95%CI 1.203-5.647,P=0.022)and SVR mean(OR 2.578,95%CI 1.363-6.041,P=0.043)were associated with PONV.Another independent risk factor of PONV was duration of surgery(OR 4.258,95%CI 1.471-12.329,P=0.008).No SVR indices showed significant difference between patients with mild and severe PONV.Patients who developed PONV had a higher incidence of taking more time to tolerate the diet and poorer sleep quality on the first night after surgery.Conclusions(1)The duration of surgery and two SVR indices(SVR baseline,SVR mean)are independent factors that affect PONV.(2)Intraoperative SVR levels are correlated with PONV after laparoscopic hysterectomy.Patients with a high SVR index are more likely to develop PONV.(3)There were no significant differences in SVR indexes among patients with different severity of PONV.(4)Patients with PONV take longer to tolerate the diet and have poorer sleep quality on the first night after surgery.