Effect of fluid preloading on postoperative nausea and vomiting following laparoscopic cholecystectomy

Abstract

Background:Postoperative nausea and vomiting (PONV) is a common complication following general anesthesia. Different regimens have been described for the treatment of PONV with few that mention the prevention of it. Therefore, we conducted this study to compare the effect of preloading with either crystalloids or colloids on the incidence of PONV following laparoscopic cholecystectomy (LC), under general anesthesia.Materials and Methods:This study was carried out on 80 patients who underwent LC. The patients were divided into four groups (each 20 patients), to receive preloading of intravenous fluid, as follows: Group 1 received, 10 ml/kg of low-MW tetrastarch in saline (Voluven™), group 2 received, 10 ml/kg medium-MW pentastarch in saline (Pentaspan™), group 3, received 10 ml/kg of high-MW heta-starch in saline (Hespan™), and group 4, received 10 ml/kg Lactated Ringer's, and this was considered as the control group. All patients received the standard anesthetic technique. The incidence of PONV was recorded, two and 24 hours following surgery. The need for antiemetics and/or analgesics was recorded postoperatively.Results:The highest incidence of PONV was in group 3 (75% of the patients) compared to the other three groups. Also the same trend was found with regard to the number of patients who needed antiemetic therapy. It was the highest incidence in group 3 (70%), followed by group 2 (60%), and then group 1(35%), and the least one was in the control group (25%).Conclusion:Intravascular volume deficits may be a factor in PONV and preloading with crystalloids showed a lower incidence of PONV.

Evaluation of antiemetic effect of intravenous palonosetron versus intravenous ondansetron in laparoscopic cholecystectomy: A randomized controlled trial

“…[1] The incidence of PONV remains unacceptably high (40-75% in the first 24hrs, without active intervention) following laparoscopic cholecystectomy. [23]…”

Is perioperative colloid infusion more effective than crystalloid in preventing postoperative nausea and vomiting?

“…Four studies [13,15–16,19] only included female patients, whereas another 4 studies [6,14,17–18] included both male and female patients. One study by Ghodraty et al [14] was performed under total intravenous anesthesia using propofol, whereas all other studies used inhalation anesthetics.…”

“…One study by Ghodraty et al [14] was performed under total intravenous anesthesia using propofol, whereas all other studies used inhalation anesthetics. Nitrous oxide and air were used in 3 [13,18–19] and 4 studies, [6,14–16] respectively. Patients in 2 studies [16,19] received postoperative opioids when needed, but patients in 4 studies [6,13–15] did not receive it.…”

“…However, universal pharmacological PONV prophylaxis is accompanied by side effects, such as oversedation, hypotension, dry mouth, and dysphoria, and is less cost-effective. [6,7]…”

“…[8] Especially most patients undergoing surgery are prone to gut ischemia because of overnight fasting prior to general anesthesia, and this could be associated with PONV. [6] High volume of perioperative fluid administration has been shown to reduce the incidence of PONV in previous studies. [9–12] Adequate intravenous fluid hydration has been recommended as an effective strategy for reducing the baseline risk for PONV in a previous consensus guideline.…”