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Muscular Tissue Oxygen Saturation and Posthysterectomy Nausea and Vomiting.

Abstract：

BACKGROUND:Suboptimal tissue perfusion and oxygenation during surgery may be responsible for postoperative nausea and vomiting in some patients. This trial tested the hypothesis that muscular tissue oxygen saturation-guided intraoperative care reduces postoperative nausea and vomiting. METHODS:This multicenter, pragmatic, patient- and assessor-blinded randomized controlled (1:1 ratio) trial was conducted from September 2018 to June 2019 at six teaching hospitals in four different cities in China. Nonsmoking women, 18 to 65 yr old, and having elective laparoscopic surgery involving hysterectomy (n = 800) were randomly assigned to receive either intraoperative muscular tissue oxygen saturation-guided care or usual care. The goal was to maintain muscular tissue oxygen saturation, measured at flank and on forearm, greater than baseline or 70%, whichever was higher. The primary outcome was 24-h postoperative nausea and vomiting. Secondary outcomes included nausea severity, quality of recovery, and 30-day morbidity and mortality. RESULTS:Of the 800 randomized patients (median age, 50 yr [range, 27 to 65]), 799 were assessed for the primary outcome. The below-goal muscular tissue oxygen saturation area under the curve was significantly smaller in patients receiving muscular tissue oxygen saturation-guided care (n = 400) than in those receiving usual care (n = 399; flank, 50 vs. 140% · min, P < 0.001; forearm, 53 vs. 245% · min, P < 0.001). The incidences of 24-h postoperative nausea and vomiting were 32% (127 of 400) in the muscular tissue oxygen saturation-guided care group and 36% (142 of 399) in the usual care group, which were not significantly different (risk ratio, 0.89; 95% CI, 0.73 to 1.08; P = 0.251). There were no significant between-group differences for secondary outcomes. No harm was observed throughout the study. CONCLUSIONS:In a relatively young and healthy female patient population, personalized, goal-directed, muscular tissue oxygen saturation-guided intraoperative care is effective in treating decreased muscular tissue oxygen saturation but does not reduce the incidence of 24-h posthysterectomy nausea and vomiting. EDITOR’S PERSPECTIVE:

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Li G,Tian DD,Wang X,Feng X,Zhang W,Bao J,Wang DX,Ai YQ,Liu Y,Zhang M,Xu M,Mu DL,Zhao X,Dai F,Yang JJ,Che X,Yanez D,Guo X,Meng L,iMODIPONV Research Group.

doi

10.1097/ALN.0000000000003305

subject

Has Abstract

pub_date

2020-08-01 00:00:00

pages

318-331

issue

eissn

0003-3022

issn

1528-1175

pii

109182

journal_volume

133

pub_type

杂志文章,多中心研究

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Muscular Tissue Oxygen Saturation and Posthysterectomy Nausea and Vomiting.